3"^ UBRARIES Zk RXAUTIl MSRAXY I BOOKS BV ANNAM.GALBRAITH,M.D. Fout Epochs of Woman^s Life i2mo of 247 pages, illustrated. Cloth, ^1.50 net. 2d Edition Pefsonal Hygiene and Physical Training for Women i2mo of 371 pages, illustrated. Cloth, $2.00 net. PERSONAL HYGIENE AND PHYSICAL TRAINING FOR WOMEN BY ANNA M. GALBRAITH, M.D. Author of " Hygiene and Physical Culture for Women " and " The Four Epochs of Woman's Life ; " Member of the New York County and State and the American Medical- Associations ; Fellow of the New York Academy of Medicine ; Ex-President of the Alumnae Association, Woman's Medical College of Pennsylvania ; former Attending Physician, Neurological Department, of the New York Orthopoedic Hospital and Dispensary; late Attending Physician and Instructor in Diagnosis and Clinical Medicine at the Woman's Medical College, New York Infirmary ILLUSTRATED PHILADELPHIA AND LONDON W» B. SAUNDERS COMPANY 19 13 G-13 Copyright, 1911, by W. B. Saunders Company Reprinted April, 1913 PRINTED IN AMERICA PRESS OF W. B. SAUNDERS COMPANV PHILADELPHIA In Loving Memory of HELEN WORTHING WEBSTER, M.D. Professor of Physiology and Hygiene and Resident Physician at Vassar College from 1874 to 1881 An untiring worker of charming and inspiring personality the living embodiment of all that was womanly, great hearted, and noble This book is affectionately dedicated as a slight tribute of the esteem in which she was held, and in grateful acknowl- edgment of the value of her teachings By her former pupil THE AUTHOR Digitized by tine Internet Arciiive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/personalhygienepOOgalb PREFACE The aim of this work has been to present in a clear and concise manner the fundamental physiological laws on which aU personal hygiene is based ; together with the practical, detailed directions for the proper development of the body and the training of the physical powers to their highest degree of efficiency by means of fresh air, tonic baths, proper food and clothing, gymnastic and out- door exercise, so that the tissues will be placed in the best possible condition to resist disease. The spirit of the times demands nothing less than the most perfect development of body and mind of which youth is capable, and maintaining the highest degree of efficiency of the adult worker for the longest possible term of years. The fiat has gone forth from the American Medical Association for the scientific education of the pubhc in the laws of hygiene and sanitation. And the great civic movement inaugurated by that same Associa- tion and the Committee of One Hundred on National Health for the establishment of a National Department of Public Health, promises to be crowned with success in the near future. And so it has been deemed superfluous to expound at length what preventive medicine has al- ready accomplished in the short space of fifty years by the eradication of terrible epidemics and many diseases, 5 6 PREFACE and what a general knowledge of applied hygiene might reasonably be expected to accomplish in the near future. It gives the author great pleasure to have this oppor- tunity of expressing her deep indebtedness to Miss Ruth Blankenhorn, Vassar College, A. B., 1909, of Englewood, N. J., a most artistic and graceful dancer who posed for all the illustrations; and to Miss Harriet I. Ballintine, the able director of the Vassar College Gymnasium, who ar- ranged the poses for the very excellent plates illustrating the free exercises and classic dances. Also to the Vassar College Athletic Association for 1908-09 for the especially arranged dances and field sports which they were so ex- tremely kind as to demonstrate for her benefit. Anna M. Galbraith. New York City. CONTENTS CHAPTER I PAGE Hydrotherapy 11 Description of the Skin; Functions of the Skin, the Physio- logic Effects of Water, Hot and Cold; the Chief Varieties of Baths; Ablutions; the Tub Bath; the Alcohol Rub; the Cold Dip; AlkaUne and Saline Baths; the Rain Douche or Shower Bath; the Hot Foot-bath; the Sitz Bath; Technic of the Wet Sheet; Wet Hand Rub; the Salt Glow; Salt Ablu- tion; the Turkish Bath; the Electric-light Bath; Indica- tions for the Use of Turkish Bath, and Contraindications; the Douche; the Percussion Douche; Application of the Douche; Rationale of the Douche; Contraindications. The Internal Use of Water; Its Action on the Heart and Blood, on the Digestion; Therapeutic Indications for the Use of Water; Contraindications for Drinking Cold Water; The French Cures of the Vosges. Enemas; Vaginal Douche; Douching the Ear. CHAPTER II The Care of the Skin and its Appendages 53 The Complexion; the Action of the Bath in Health; the Proper Time to Bathe; the Care of Wash-cloths; Cleansing the Face; Protection of the Face; the Use of So-called Cos- metics for the Face; Facial Blemishes, Freckles, Liver Spots, Sallow Complexion, Pimples, Acne, Eczema, Wrinkles, and Superfluovis Hair and Their Treatment; the Relation of Dis- eases of the Skin to Internal Disorders. The Hair; Dandruff; Causes and Treatment of Premature Thinness of the Hair and Baldness; the Care of the Hair; Gray Hair. The Cosmetic Care and Treatment of the Hands; Cos- metic of the Nails; the Care of the Feet; Painful Affections of the Feet. CHAPTER III The Digestive System and the Maintenance of Good Diges- The Digestive Tract; the Care of the Mouth and Teeth; Digestion a Chemical Process; Digestion in the Small In- testine; the Microorganisms of the Alimentary Canal; the 7 80 8 CONTENTS PAGE The Digestive System and the Maintenance of Good Diges- tion (Continued) Importance of a Varied Diet; Classification of Food-stuffs; Tea, Coffee, and Cocoa; the Temperature of Foods and Drinks; Factors which. Favor Good Digestion. Overeating; Dietary in Sedentary Occupations; Heart Failure and Other Ills as the Result of Chronic Under- feeding; the Causes of Indigestion; the Symptoms of Indi- gestion; Intestinal Indigestion; Biliousness and Bilious Attacks; Ptomain Poisoning; Diet in Indigestion; Treat- ment of Acute Diarrhea; Chronic Intestinal Catarrh; Consti- pation and Mental Troubles; Treatment of Constipation. The Physiologic Action of Moderate Doses of Alcohol; the Effect"^of Alcohol on the Muscular System; the Effect of Alcohol on the Nervous System. CHAPTER IV The Respiratoet and Circulatory Systems: the Kidneys. . 125 The Mechanics of Circulation and Respiration; the Circulatory Apparatus; the Lungs; Hygiene of the Lungs and Its Relation to the General Health; Relation of Res- piration to Body Heat; the Respiratory Fimctions of the Abdominal Miiscles; the Importance of Good Chest Develop- ment, Proper Relation Between the Height, Weight, and Chest Measurements; Chemical Properties of Air; To\v-n and Coimtry Air; Dust and Its Relations to Disease; Role Played by Bacteria; Ventilation; the Injurious Effects of Overheated Air; the Proper Degree of Moisture for the Air of the House; Ventilation of Bed-rooms. Care of the Nose, Throat, and Ears; Impediments to Respiration; Ventilation of the Lungs and Breathing Ex- ercises; Cure of Chronic Bronchitis by Deep Breathing Ex- ercises; Relation of Colds to Pneumonia and Tuberculosis, and Their Prevention. The Kidneys and Their Functions; the Physiology of the Female Pelvic Organs. CHAPTER V The Nervous System as the Balance of Power in the Body 172 The Brain the Master Organ of the Body; the Functions of the Brain; Habit and Automatism; the Physiology of the Brain and Nervous System; the Hygiene of Work; the Tox- ins of Fatigue; Overwork; Signs of Ovem-ork; Nature's Res- toratives; Avocation; and Physiologic Necessity for Laugh- ter; Vacations and Health; Sleep; Insomnia. The Eyes; Eye-strain; Description of the Visual Appa- ratus; Optical Defects and Their Correction; the Mechan- ism of Eye-strain; Local Symptoms of Eye-strain; Arti- CONTENTS 9 PAGE ficial Lighting; Hygienic Precautions in Reading and Sew- ing; Injuries to the Eyes; Symptoms and Treatment of Conjunctivitis; Trachoma; Styes. Functional Nervous Disorders; Headache; Neurasthenia. CHAPTER VI The Hygiene of the Mind and its Relation to the Physical Health 212 Heredity; Temperament; Social Instincts; Fear. Mental Development; Self-control, the Moral Sense, the Rehgious Instincts; the Advantages of CoUege Life; Bal- ance of the Mental Faculties; the Effects of the Higher Ed- ucation of Women. The Environment; the Choice of Friends; Literature. The Power of the Will or Inhibition; the Effect of the Mental Attitude on the Physical Health; A Definite Occu- pation a Physical Necessity; the Psychology of Success. CHAPTER VII Dress the Fundamental Cause of Woman's Physical Deterioration 240 The History of Woman's Dress; the Corset in History; the Crusade Against the Corset; the Influence of the Corset on the Female Body; the Curved Front Corset; the Relation of Corsets to Abdominal and Pelvic Disorders; the Effects of Corsets on the Muscles; the Straight Front Corset; the Abdominal Corset; the Wearing of Corsets by Young Girls; What Style of Corset is the Least Injurious; the Shoe; the Stockings; the Essential Qualities for Winter Underclothing; the LeE^h of the Walking Skirt; the Winter Street Dress. CHAPTER VIII Physical Training the Key to Health and Beauty 271 The Ancient Greeks the Most Perfect Type of Beauty; the Cause of the Inferior Physique of American Women; the Physical Training of the Japanese Women; Improved Physique as the Result of Physical Training; Increasing Stature and Improved Physique of American Men; Report of the Royal Commission of Great Britain on Physical Training; Physical Training Among the Ancients; the Influence of Physical Training on the Health and Life of the Individual; the Effect of Exercise on Bram Develop- ment and Character; the Physiology and Pathology of Exercise; the Relative Proportions of a Perfect Female Form; Table of Standard Weights for Women; the Muscu- lar System; the Benefits of Exercise; Passive Exercise; Mas- sage; the Balance and Carriage of the Body; Co mm on 10 CONTENTS FAGB Physical Training the Key to Health and BEAtrrY (Con- tinued) Defects in the Carriage of the Body; the Heart's Need of Exercise; the Gymnasium in the Campaign Against Dis- ease; Gymnastic versus Athletic Training; Exercise After Eating; Effect of Brain Fatigue on Body Fatigue, and vice versa; Marks for Physical Efficiency; Advantages Derived from Athletic Sports; Ethical Value of Sports for Women; Forms of Athletic Games Best Suited to Women. CHAPTER IX Symmetric Development: Good Carriage and Grace of Motion Through GYansTASTics and Athletics 311 Gymnasiums, Baths, and Athletic Associations: a Fun- damental Part of a Woman's College and a Model Woman's Club; the Vassar College Gymnasium; the New York Colony Club; the Yoimg Women's Christian Association; Self-made Good Physique through Physical Training Rules for Taking Exercise; Gymnastic Dress; the Configuration of the Foot; Correct Attitude in Standing. Corrective Exercises: Exercises for Developing the Various Regions of the Body; Shoulder-blade Exercises; Respiratory Exercises; Exercise for Forward Projection of Chest and Retraction of Abdomen; Shoulder and Back Exercises; Leg Exercises; Squatting Exercises for Muscles of Spine and Abdomen; Alternate Ivneefing; Abdominal Exercises; Balancing Exercises for Poise and Carriage; Balancing Exercises for Extending Depth of Chest; Lateral Trunk and Waist Exercises; Exercises for Muscles of Back; Exercises for Muscles of Abdomen; Swimming Exer- cises, for Back, Thighs, and Abdomen; Rope-pulling Exer- cises for Back, Chest, Waist, Legs, and Arms; Exercises in Trunk Flexions for Back, Abdomen, and Legs; Exercises with Chest Weights for Chest, Shoulders, and Arms; Box- ing and Fencing; Classic and Jilsthetic Dancing an Essen- tial Feature in Physical Training. Outdoor Exercises: Effect of Walking on the Heart and Lungs; Rmming; Mountain Climbing; Swimming; Horse- back Riding as an Exercise; Rowing. Athletic Sports: Croquet; Lawn-tennis; Golf; Hockey; Basket-ball. Index 353 PERSONAL HYGIENE AND PHYSICAL TRAINING FOR WOMEN CHAPTER I HYDROTHERAPY Description of the Skin; Functions of the Skin; the Physiologic Effects of Water, Hot and Cold; the Chief Varieties of Baths; Ablu- tions; the Tub Bath; the Alcohol Rub; the Cold Dip; Alkaline and Saline Baths; the Raia Douche or Shower Bath; the Hot Foot-bath; the Sitz Bath; Technic of the Wet Sheet; Wet Hand Rub; the Salt Glow; Salt Ablution; the Turkish Bath; the Electric-light Bath; Indications for the Use of Turkish Bath, and Contraindications; the Douche; the Percussion Douche; Application of the Douche; Rationale of the Douche; Contraindications. The Internal Use of Water; Its Action on the Heart and Blood, on the Digestion; Therapeutic Indications for the Use of Water; Contraindications for Drinking Cold Water; the French Cures of the Vosges. Enemas; Vaginal Douche; Douching the Ear. The term hydrotherapy will be used here in its broadest sense, and may be defined as the hygienic and systematic use of water, both externally and internally, for the preser- vation and restoration of health and the prevention of disease. The hygienic and therapeutic value of the systematic use of water is just beginning to be appreciated by the medical profession. When this newly acquired knowledge is put to practical use by the great masses of the people, there will be a greatly diminished necessity for the use of drugs. Indeed, water has been pronounced by a high 11 12 PERSONAL HYGIENE FOR WOMEN medical authority to be, and probably is, more nearly a panacea for all human ills than any other known agent. The bath is generally considered merely as a cleansing procedure, whereas this is only one of its beneficial effects. There is, in addition, the stimulation of all the functions and organs of the body obtained through the temperature of the water, and the mechanical stimulation which is obtained by the mode of application. Fig. 1. — Vertical section of skin; sbg, Sebaceous glands; ep, epider- mis; h, hair; d, derma (Fox). Again, the skin is not a mere covering for the body, but one of its most important organs, with well-defined func- tions ; so that, in order to obtain a clear understanding of the subject, it is necessary first to consider briefly the functions of the skin; and, secondly, the physiologic action of water. Description of the Skin. — The skin is a very sensitive and complex organ, and upon the condition of the skin and the vicissitudes to which it is exposed the health of the individual is dependent to a very great degree. HYDROTHERAPY 13 The skin is composed of three distinct layers — the epidermis, the corium or true skin, and the subcutaneous connective tissue. The appendages of the skin are the hair, nails, the sebaceous and sweat-glands. This com- plicated structure is supplied with blood-vessels, lym- phatics, and nerves. The Epidermis. — The outer layer of this is the horny layer; when a blister is formed, its fluid raises the entire epidermis from the true skin. The flat scales forming the homy layer are continually being thrown off; this process of desquamation is increased by the friction of the clothes, of bathing, massage, and so forth, and is as constantly being replaced by new cells from underneath. The corium, or true skin, is the most important part of the integument. This is a thick, felt-like tissue which is pierced in all directions for the passage of the blood-ves- sels, lymphatics, sweat-ducts, and nerves, and affords lodgment for the hair follicles and sebaceous glands. The tension of the skin is produced by its muscular structure and elastic network, and is subject to temperature changes. This power of contractility is known as the tone of the skin. The skin has two kinds of glands, the sebaceous and sweat-glands. The sebaceous glands consist of a gland structure, with a short excretory duct, which opens upon the epidermis or into the hair follicles. These glands secrete an oily substance, which keeps the hair and skin soft and protects them from the sweat. There exists in "^he sebaceous glands of the skin an infinite number of vulnerable points for infection, and the greater part of the process of cleanliness is directed toward their protection. If in any part of the skin there is an accumulation of bac'lli, their toxins, or excretions, and, at the same point, a^ collection of sebum, the friction of the clothes, caused by 'he movements of the body, becomes an active agent in effecting their absorption by the skin. Hence, the scientific basis for the necessity of the daily bath. 14 PERSONAL HYGIENE FOR WOMEN In the subcutaneous tissue we find the fat ; it is this part of the skin that contributes to the roundness and beauty of the body. It is increased by abundant fatty food, sedentary habits, and freedom from care. Functions of the Skin. — The skin exercises three dis- tinct functions: first, as an organ of sense; second, as an organ of excretion ; and third, as an organ of heat regula- tion. Next to sight, the sense of touch is the most important of all the senses. Through this sense the human organism is made conscious of its contact with the outer world. The cutaneous nerve-endings stand guard, as it were, over most of the functions of the human body. The importance of the action of the skin as an organ of excretion will be better understood from the well-known fact that the skin is one of the most important aids to the kidneys. That the perspiration and the urine are to a certain extent vicarious excretions has been proved. The blood is the circulating medium which not only serves to convey nutritive materials from the stomach to the tissues, and the excrementitious materials from the tissues to the excretory glands, but also to equalize the body temperature. It conveys the surplus heat from the interior of the body to the surface, where it may be dis- sipated by conduction, radiation, and evaporation. Nearly nine-tenths of the daily heat-loss takes place through the skin; and of this, one-seventh is due to evaporation, which is enormously increased by perspira- tion. The amount of perspiration produced daily is about two pints, or in the neighborhood of ^ of the body weight. This is double the amount of wat3r thrown off by the lungs. The watery portions of the porspiration are readily evaporated, and the solid constituen ? are deposited upon the skin. Urea and uric acid, togetl er with more subtle poisons, are found in the sweat. Animal Heat. — The heat of the body is wholly derived from foods, which, when completely cxidized within the HYDROTHERAPY 15 body, produce practically the same amount of heat and energy that would be generated by their combustion out- side the body. But it is essential, in order to keep the body of warm- blooded animals at a constant or normal temperature, that an increase in the heat-production should be accom- panied by a corresponding increase in the heat dissipa- tion; the functions are reciprocal, and this equilibrium is regulated and maintained by a special nervous and functional mechanism. The automatic protective measures against the effects of heat are : First. — Dilatation of the cutaneous vessels and an acceleration of the circulation through the skin and the subcutaneous tissue. By this means the dissipation of heat is increased; the sweat at the temperature of the blood, deposited upon the surface of the body, evaporates under favorable circumstances, and in this way consider- able amounts of heat are abstracted from the body. In consequence of sweating and its evaporation, the blood circulating through the skin is cooled, and retumuig to the internal organs at a lowered temperature, prevents their overheating. Second. — Should the action of heat be continued for a greater length of time, a large amount of blood will be retained in the skin in consequence of the loss of tonicity of the cutaneous vessels ; the cutaneous circulation will be slowed, and thereby the blood, heated at the surface of the body, is prevented from returning to the internal organs and so overheating them. Third. — In consequence of the accumulated amount of blood in the skin, a diminished amount of blood will remain in the internal organs; thus their activity, and thereby also the production of heat, will be lessened. In these processes will be found a safeguard against the excessively rapid penetration of heat to the internal organs, and against the unduly rapid elevation of the body temperature through thermic influences. 16 PERSONAL HYGIENE FOR WOMEN As a result of the stimulating influence of cold, there first occurs contraction of the skin and its vessels. This, by restricting the dissipation of heat, brings about perfect compensation if the abstraction of heat be but slight; and but partial compensation, if the abstraction of heat is more marked. In the latter event the body tempera- ture will continue to decline, to a greater or less degree; in the former it will remain constant. The role played by the skin in maintenance of the nor- mal temperature of the body is indispensable. The normal temperature of the adult human body is 98.6° F. in the axilla; the temperature in the mouth is five-tenths of a degree higher than that of the axilla, and that of the rectum and vagina is one degree higher than that of the mouth. Fasting, sleep, and short applications of heat all decrease heat-production; during sleep the temperature of the body falls half a degree or more. Respiration by the skin varies from § to 1 per cent. of the total amount of oxygen taken into the body, and a somewhat lower percentage of carbonic acid is thrown off through this channel. The skin absorbs substances in watery solutions with difficulty, on account of the oil lying upon and in the epidermis; substances dissolved in oil and rubbed in are more rapidly absorbed; absorption takes place rapidly after the skin has been washed with ether, chloroform, or alcohol. The Physiologic Effects of Water. — These depend on whether the water is taken internally or applied ex- ternally. If applied externally, the effects will depend upon the temperature, whether hot, tepid, or cold; also on the manner of application, but, most of all, on the length of time which it is applied and the state of health of the individual. The temperature of water is classified as very cold, from 82° to 55° F.; as cold, from 55° to 65° F.; cool, from 65° to 80° F.; tepid, 80° to 92° F.; warm, 92° to 98° F.: hot, 98° to 104° F.; very hot, 104° F. and above. HYDROTHERAPY 17 Heat. — ^A general hot bath produces dilatation of the vessels of the skin and contraction of the vessels of the brain; a general activity of the glands of the skin, both perspiratory and sebaceous. Perspiration may be pro- duced, either to the degree of slight moisture or of profuse sweating, according to the length of time and the intensity of the application made. In a very hot bath the rate of perspiration may be increased from fifty to sixty times the ordinary amount. The most pronounced effect pos- sible may be secured by either the electric light or sun bath. Loss of fluids from the body has a depressing effect similar to, though somewhat less marked than, that produced by bleeding, so that there is a vital necessity for administering water internally before, during, and after the bath. Prolonged and repeated perspirations induced by artificial means weaken the skin, and thus lessen its power to resist cold impressions, unless counteracted by frequent cold applications. The general and usual reactions following the applica- tions of heat are atonic and depressing in character. For the most part, the reactions following cold applications are to be preferred to those following hot ones. The three great vascular areas of the body are the mus- cles, the portal system, and the skin. Each of these parts may be regarded as a great reservoir, capable of retaining a large part of the entire amount of blood of the body. When one of these areas is in a state of con- gestion, the others must be in a comparative state of anemia. The restorative effects due to the application of heat are due partly to the elimination of fatigue poisons which is thereby encouraged, as well as by the reflex stimulation of the nerve-centers. The good effects are much more decided and lasting, and the exhausting effects neutralized, if the hot application is followed by a short cold one. The effects of a neutral bath, 92° to 95° F., is sedative, diminishing nervous irritability. 18 PERSONAL HYGIENE FOR WOMEN A hot-water bottle or fomentations, placed over the stomach for an hour or two after eating, increase the gastric secretions, and, when placed over the liver, increase the flow of bile. The Physiologic Effects of Cold. — In suitable cases a short general apphcation of cold is a powerful heart tonic. Cold causes a contraction of the vessels of the skin and of those of the brain, with a dilatation of the internal vessels. There are pallor and coldness of the skin, and an almost instantaneous suspension of perspiration, which is dangerous only when the body is in a state of fatigue. If the application of cold is long continued, the surface becomes blue, the temperature of the muscles beneath the skin is lowered, thus checking heat-procluction in these muscles; the circulation is slowed, and the heart's action is diminished in frequency. There is a gooseflesh appear- ance of the skin; a sensation of chilliness, trembling, shivering, chattering of the teeth; at first a quickening and then slowing of the pulse, and deep gasping respira- tion. When the cold application is considerably prolonged, the tendency to reaction is suppressed. There is an ex- haustion of the nerve-centers as well as of the heat- producing powers of the body. Thus, the system grad- ually loses its power to resist the depressing effects of cold. The repeated chiUings of the body increase the length of time required to return to the normal tempera- ture. AppKcations of water below the temperature of the body always lower the temperature. Reaction. — If the application of cold is of very short duration, of very low temperature, and given imder high pressure, the phenomena of reaction begin immediately on its cessation. The reaction consists in a dilatation of the surface capillaries, with contraction of the internal vessels; red- ness of the skin; the skin is smooth, soft, and supple; there is a sensation of warmth, comfort, and well-being; HYDROTHERAPY 19 respiration is slower and deeper; there are a fall of the internal temperature and increase of perspiration. Certain measures to favor reaction should be taken before the bath, such as exposure to the air of a warm room, drinking hot water, and short exercise of a rather vigorous kind. During the bath the measures which favor reaction are short, sudden applications of cold, friction while in the bath with the hand, and pressure effects in the douche. After the bath reaction is favored by vigorous rubbing, a thorough drying of the body, warm clothing, warm air of the room, and as vigorous exercise as the strength of the individual will permit. Conditions which are unfavorable to healthy reaction are: old age, infancy, exhaustion, either temporary or from an excessive loss of sleep, or extreme nervous ex- haustion, obesity, rheumatic diathesis, unhealthy or inactive skin, profuse perspiration when accompanied by a state of fatigue, extreme nervous irritability, a very low temperature of the skin, an immediately preceding or impending chill, and extreme aversion to cold applications. The average temperature of the human nude skin is in the neighborhood of 90° F. The difference between the temperature of the skin and water is the chief element in determining the reaction of the individual. It is evident that water at a temperature of 90° F. would be neutral or indifferent; the difference of intensity of effect is in pro- portion to the difference of temperature of the water and skin. The duration of the cold procedure is an important element in the production of reaction. It may be laid down as a rule never to give any cold-water application without friction. The physical and psychic state of the individual exerts more or less influence upon his reactive capacity. An anemic, or otheiT\ase depressed individual must be managed with great circumspection, because she bears heat abstraction badly. The hydriatic procedure must always be adapted to the reactive capacity of the bather. 20 PERSONAL HYGIENE FOR WOMEN The woman must be thoroughly rubbed after the bath until a good reaction has occurred. Especial attention must be paid to the feet and legs. The bather should first be rubbed with a warm towel or sheet, and then with the bare hands of the attendant, as the warm hand greatly facihtates the reaction. The bather is by no means dry when the skin ceases to feel wet. So long as the skin is soft and spongy, it still contains moisture which has been absorbed by the superjficial layers of the epidermis. The absorbed moisture, being left to evaporate after the bath, the individual is liable to become chilly and contract a cold, which is erroneously attributed to the bath itself. Other injurious effects following imperfect reaction after the cold bath are secondary chills or a continuous chill lasting for several hours. The hands and feet are cold, there is headache, not infrequently diarrhea, and other evidences of internal congestion, such as abdominal or ovarian pain, vertigo, etc. Reaction may be favored by covering the patient with blankets, surrounding her with hot-water bottles, and giving her hot tea to drink. Exercise should follow the bath. Walking for from twenty minutes to an hour is the most usual form of exercise. Very vigorous exercise for a short time cannot be substituted for moderate exercise for a longer time. The Tonic Effect of Cold Upon the System. — The effect of cold upon the muscles, when given in the form of a cold bath, douche, or spray, is to augment muscular energy and tone to a very great extent; this increased muscular tonicity is the cause of the slight shivering. The cold douche, if short, — one or two seconds, — and given with a pressure of from 25 to 30 pounds, is a powerful restorative in fatigue resulting from severe muscular effort, but it must be immediately preceded by a short hot bath, and must be followed by vigorous rubbing and wrapping in a hot blanket. Short cold applications cause elevation of temperature and increased metabolism, while prolonged cold applica- HYDROTHERAPY 21 tions cause a fall of temperature and decrease of metabo- lism. The tonic effect of cold water is believed to be due to the stimulation of the sympathetic nerve-centers. The sympathetic nervous system controls the blood-vessels, heart, the functions of secretion and excretion; and, in- deed, all the vital functions of the body. The sensation of well-being which accompanies the reaction following a general cold application is largely due to an increased activity of the cerebral circulation. Cold water is a physiologic tonic, and the cold bath, prop- erly employed, increases the vital resistance to pathologic processes. All applications of water at a temperature low enough to provoke vital resistance are tonic; hence, tonic effects are produced by all temperatures below 90° F., but the most certain and pronounced results are obtained from the douche in every form, which adds mechanical impact to the thermic effects of cold. The most durable tonic effects are produced by the frequent use of very cold and very short baths. A tepid bath causes a lowering of the body temperature. The Chief Varieties of Baths. — These, in the order of frequency with which they are used, are: ablutions; tub; foot-tub; sitz; salt sponge; wet sheet; shower; Turkish; horizontal jet; needle; fan douche; Scotch douche; percussion douche; Roman and electric-light baths. Ablutions or Sponge Baths. — These baths are of universal use. The sponge is one of the dirtiest and most impossible articles of the toilet to clean and to keep clean. It is a collector of dirt and germs, and should be banished from every bath-room and from every house. It is not sufficient that each member of the family should have her own sponge; it is quite possible for the individual to become infected or reinfected from her own sponge. Incidentally, it does not afford sufficient friction, and thus does not favor reaction. In taking ablutions, the ap- plication of water may be made with the hand, though it 22 PERSONAL HYGIENE FOR WOMEN is best made by means of a wash towel. The good effects of the simple ablution will be greatly enhanced by the use of the hat tub, and this especially where there is no bath- tub in the house. When the bath is taken for the purpose of cleanliness, the water should be warm or hot, and pure Castile soap is one of the best that can be used. If the skin is rough, a good sand soap will be more beneficial. The bath should be completed by dashing cold water over the body with the wash-towel. The body must be quickly and thoroughly dried by means of a rough bath-towel. After this, the skin may be still further toned up by a good alcohol rub. If the ablution is taken simply for the tonic effect, it is generally taken on rising in the morning, and the water used is cold. The ablution may be confined to the upper part of the body, that is, the chest and back ; and consists in friction with a rough wash-towel, followed by dashing the water over the body ; followed by brisk friction with a rough bath-towel. This procedure causes a marked stimulation of the heart and lungs, and is followed by a rise of temperature. In winter all baths must be taken in a warm room. There is a decided increase of muscular and mental capacity after the cold ablution, demonstrating the tonic effect it has produced. The cold ablution may also serve as an introductory to other and more heroic hydriatic procedures. If the reaction is not good, water at a higher temperature should be used, and only small portions of the body should be attacked each day, followed always by brisk friction. As the reaction becomes better, the temperature of the water should be gradually lowered from day to day. There must be a decided sensation of warmth of the body before proceeding to take any form of cold bath. This may be induced by sipping a cupful of hot water before rising, and then being well covered with the bed- clothes until the body is in a glow. In conditions of HYDROTHERAPY 23 anemia or neurasthenia, where the circulation is markedly poor, in addition to drinking the hot water, the bather may stand on hot blankets while taking the cold ablu- *tion, and after it be rubbed briskly with hot towels. Nothing is gained, and a great deal of harm is done, by trying to persevere in the daily cold ablution when it is followed by a pallor of the skin, chilliness, etc. The Tub Bath. — This is much more refreshing, more salutary, and may be used to produce a much greater variety of effects than the simple ablution. Tub baths may be classified according to the amount of water in the tub as half or full tubs; and again, according to the tem- perature of the water, as warm, tepid, hot, and cold. The half tub contains about 30 gallons of water. In a general way it may be said that the half tub of warm water is used for the purpose of cleanliness; the hot baths for breaking up colds, for rheumatism, etc.; the tepid bath to allay nervousness; and the full cold tub, for the tonic morning dip. For cleansing purposes the so-called half tub, that is, the tub contains a sufficient amount of water to reach above the pelvis when one is seated in the tub, is used. The temperature ranges from 98° to 102° F. Five min- utes is as long as the bather should remain in the tub, as aU hot baths are more or less exhausting. After an initial immersion in the water, the scrub takes place by means of the Turkish bath-towel, or, better, by the use of the flesh brush. If there is a shower attached, the hot bath should always be followed by a brief cold shower; if not, the cold water should be turned on and dashed over the body by means of the wash-towel. This closes up the pores of the skin, prevents the profuse perspiration from taking place that so often follows a hot bath, and greatly diminishes the susceptibility to taking cold. An alcohol rub completes the procedure. This insures a further toning up of the cutaneous vessels. A smaU quantity of alcohol is poured into the hand and applied to a limited area of the body. It is well rubbed in with friction until 24 PERSONAL HYGIENE FOR WOMEN the alcoliol has wholly evaporated. Beginning with the arms, the legs, chest, and back are successively gone over. The hot bath is best taken immediately before retiring, and should not be repeated oftener than twice a week. Retiring to bed at once, the bed acts as the cooling cham- ber of the Turkish bath. The hot bath is most restful, and, except in rare cases, tends to the production of refreshing sleep. If the bather has a weak heart, suffers from shortness of breath, or is weak from any cause whatever, she should only take a half tub bath, since it has been learned from experience that when the water covers the entire body, there is increased difficulty in the respiration, and the heart's action often becomes embarrassed, palpitation of the heart is experienced, with a feeHng of impending suffocation. There is sometimes also a feeling of faint- ness. On getting into the tub, the temperature of the room should never be above 68° to 70° F. The Full Tub or Immersion Bath. — In this form of bath there is a complete submersion of the body in the water, so that the water reaches the under surface of the chin, the head of the bather resting on a cross strap, being the only portion of the body uncovered by the water. If the bath is tepid, that is, has a temperature of from 80° to 90° F., great care should be taken to have the chest covered, in order to prevent pulmonary congestion. This is best accomplished by placing a Turkish towel, wrung out of hot water, about the chest and shoulders of the bather just after she enters the tub. If the bath is hot, from 98° to 104° F., before entering the bath the face and neck are rubbed with cold water, in order to relax the vessels of the brain and so prevent cerebral anemia. Except when the hot bath is given for especial therapeutic purposes, as for rheumatism, cystitis, colic, etc., it should always be followed by a cold applica- tion. The Cold Dip. — For the dip, the tub is filled with water at a temperature of from 65° to 55° F. The dura- HYDROTHERAPY 25 tion of the dip varies from two or four seconds to one or two minutes. The bather should wet the face and chest before entering the water. It is best to enter the bath suddenly, as the sensation of cold is thus far less notice- able than when the bath is entered gradually. If the stay in the tub is more than momentary, vigorous rubbing must be kept up during the entire time spent in the tub. For persons in good health a cold dip on rising in the morning is excellent. It creates an appetite, accelerates the circulation, arouses the nervous system, and produces decided exhilarating effects in those who are strong enough to react after it. When employed for this pur- pose, the immersion should not be more than from three to fifteen seconds. The bather must rub herself vigor- ously while in the tub, and follow the bath with brisk toweling and plenty of friction. She should then take moderately active exercise for fifteen to twenty minutes. For any one just beginning to take the cold dips, the temperature of the water should be just 1 degree below that of the body, and gradually lowered by a drop of 1 degree every morning or two. Or, the dip may be pre- ceded by a preliminary warm bath or warm shower. The salient point in connection with bathing is not to allow the skin to lose heat too rapidly. To apply this as a warning in the case of cold baths: it has been estimated that the heat loss from the body immersed in cold water at the temperature of 86° F. is double the normal; at 77° F., three times, and at 68° F., five times, the normal. The daily use of the cold dip for those who are able to react after it is one of the best means of fortifying the system against both acute and chronic diseases. Contraindications. — The use of the cold dip is contra- indicated for young children, the aged, and in run-down conditions of the system; in all cases where the action of the heart is weak, in Bright's disease, or in any acute or chronic congestion of the kidneys; in all acute inflamma- tions, as inflammation of the bowels, peritonitis, or in- flammation of the uterus and ovaries. 26 PERSONAL HYGIENE FOR WOMEN Alkaline Baths. — For these baths from 4 to 12 ounces of the carbonate of soda should be used to 30 gallons of water. The water should have a temperature of from 92° to 96° F. This bath is useful in many forms of skin disease, and relieves the itching of jaundice and urticaria. Saline Baths. — The typical saline bath is the salt- water bath. Sea-water contains in solution from J to I pound of solids to the gallon of water. The principal ingredients are common salt, magnesium chlorid, and magnesium sulphate. These substances have a decidedly stimulating effect upon the skin and encourage reaction. For an artificial sea-water bath, 8 pounds of sea-salt should be used to 30 gallons of water. Ordinary coarse salt is purer, contains from 97 to 98 per cent, of the chlorid of sodium, is cleaner, and makes a clearer solution, and it dissolves in about one-third of the time required for sea salt, and can be obtained for about one-third of the cost. As a cleansing agent, a 5 per cent, brine is equal or superior to soap. Further, the axilla and hairy parts remain clean and sweet for a much longer time than after the use of soap. These brine baths, taken three times a week, are followed by a great improvement in the general health. The Rain Douche or Shower Bath. — The shower is the most tonic of all the baths that can be taken at home, and no bath-room should be considered complete without it. In this form of douche the water is projected through a perforated disc, falling upon the bather in a number of fine streams. It is necessary for the bather to wear a rubber cap in order to keep the hair dry. In taking the shower bath the bather stands up; the disc is generally placed about 3 feet above the head. The water should be allowed to fall first upon the feet, then the hands, arms, shoulders, back, and, lastly, upon the chest and abdomen. The bather should keep in active motion during the ap- plication, flexing the limbs, and rubbing the chest with the hands. At the beginning of the shower the hands HYDROTHERAPY 27 should be placed over the chest, in order to protect the precordial region from the impact of the water. The cold shower should be preceded by some kind of a heating process — either a hot plunge or a hot shower bath. A shower of from 100° to 104° F. may be applied for one to three minutes before the cold application. A cool shower of 75° to 65° F. is an excellent training for persons who are sensitive to cold. The neutral shower, 92° to 97° F., given for three to five minutes, is sedative in its effects. The cold shower, 60° to 70° F., duration from five to thirty seconds, is useful in phlegmatic neurasthenics and dyspeptics; sedentary people in whom the general meta- bolic activity is diminished ; also in obesity and in all cases after a sweating process. By standing in hot water the bather is much more tolerant of cold. The neutral shower is one of the most effective measures for the relief of insomnia; especial attention should be given to the back and legs. The action is quicker than that of the neutral immersion bath. As a hygienic measure, the shower bath offers a most agreeable and rapid means of cleansing the whole surface of the body. Since the effect of the douche depends on the pressure, it will be readily understood that the hose attached to the faucet of the domestic bath-tub is merely a sprinkler, and not a douche, in the proper sense of the word. Such a procedure can only be tolerated by the most robust. In the upper stories of most city houses the pressure is probably not more than from 3 to 10 pounds; the stream of water from the sprinkler is really only a drizzle; the mechanical effects being so slight, there is no reaction produced ; the result is that its use is followed by a feeling of chilliness and depression. The Hot Foot-bath. — The temperature of this bath should be at the beginning from 102° to 104° F,, and the duration from three minutes to half an hour. The pail is nearly filled with water, care being taken that it shall 28 PERSONAL HYGIENE FOR WOMEN not be so full as to overrun when the feet and legs of the bather are put in. A blanket, closely wrapped about the patient and the pail, should come up above the knees. As the water cools off, hot water should be added. This form of bath is most commonly used to relieve congestion and inflammation. The dilatation produced in the blood-vessels of the feet and legs relieves congestion of the brain and the organs of the upper half of the body, as well as of the pelvic viscera. It should be taken imme- diately before retiring. The Sitz Bath. — The sitz or hip bath requires a tub made for that particular purpose. The back of the tub, Fig. 2. — Sitz-bath tub made of tin (Ashton). which is most commonly made of tin, is cut high, while the front must be sufficiently low for the patient to sit com- fortably in it, without undue pressure being made on the under side of the knees. The tub is half filled with water of the prescribed tem- perature. It is well to begin with water at a temperature of 102° F., and increase the temperature while the patient is in the tub, making it as hot as is comfortable. In giving all hot baths a thermometer must be used, and a word of warning must be given about adding hot water HYDROTHERAPY 29 in case of sickness, as well-authenticated cases of paral- ysis are recorded in which the temperature sense of the patient was lost, and, in adding hot water, it was raised to such a temperature that the legs and feet of the patient were scalded. During the sitz bath the patijnt keeps on her stockings and bedroom slippers, and, unless friction is ordered, the entire body, as well as the feet and legs, are enveloped in blankets. The duration of this bath is from three to ten minutes. This bath is especially useful in restoring the menstrual function when it has been suspended as the result of chill or other causes; also, for relieving hemorrhoids, uterine colic, neuralgia of the ovaries, and inflammation of the bladder. To prolong the effect of the bath the patient may be put to bed wrapped up in her blankets. In cold weather it is a good precautionary measure to have the bed heated with hot-water bottles, in order to prevent chilling. Technic of the Wet Sheet. — The temperature of the room should be not less than 70° F.; having taken a glass of hot water as a preliminary procedure, the patient stands on a warm blanket. A linen sheet of coarse texture is very loosely wrung out of water at a tempera- ture of 80° F., reduced daily until it reaches 70° to 65° F. The sheet is applied under the right axilla of the patient; pressing the sheet firmly to her with her right arm, the patient turns around, and the attendant draws the sheet snugly around her. When the entire body is covered, the upper border of the sheet is tucked in around the neck and the lower border around the legs. The attendant now makes rapid passes over the sheet, up and down the back, sides, and lower extremities, with outstretched hands, occasionally slapping the surface to increase the mechanical irritation. The duration of the procedure varies with the object in view. After the rub, the sheet is dropped and the patient enveloped in a hot sheet, with which she is rapidly dried, and she herself is given hot 30 PEESONAL HYGIENE FOR WOMEN towels to aid in the process. If the reaction is not good, friction may be given with the bare hand or with a hair glove. This cold rub is generaUy given in the morning on rising, while the patient is still warm from the bed. It should be followed by a cup of hot milk. The patient makes her toilet, has breakfast, and should then go out- of-doors for a brisk walk. The indications for the use of this procedure are anemia of feeble persons, and neurasthenia and digestive distur- bances in the same class of patients. Wet Hand Rubbing. — If the patient is too feeble to be out of bed, very similar results can be obtained by this method. The bed must be protected by means of a rub- ber sheet, over which the muslin sheet is spread. A dry towel protects the hair and ears. The attendant stands facing the patient, dips both hands into the water, then applies them, one to each side of the patient's face, covering as large an area as possible. Friction is made from the median line outward, the tips of the fingers sweeping over the brow, and describing a sort of semicircle along the cheeks to the under side of the jaw. This movement is repeated from three to six times. Next, the application is made to the chest ; both hands are emploj^ed. First the upper part and then the sides are rubbed vigorously, then the abdominal surface. After the entire chest has been gone over three or four times, with quick short movements of considerable pressure, the towel is thrown over the chest and it is dried rapidly. The rubbing is continued imtil the surface is reddened. The face is not to be dried until the end, as it is desirable that these parts should be cooled by evaporation. The object of making the application to the chest before proceeding to the other parts of the body is to stimulate the action of the heart and lungs, thereby promoting reaction. The arms next receive attention — first one, and then the other. The attendant grasps the patient's hand with her HYDROTHERAPY 31 left, while with the other she vigorously rubs the arm with long strokes, from the wrist to the shoulder, her hand being kept wet and cold by dipping in the basin after every three to six strokes. On finishing the arm, the attendant rubs the hand between her own, and ends with one or two smart blows upon the palm with the flat of the hand. The arm is then enveloped and thoroughly rubbed wnth a rough towel until well reddened. It is then covered with the blanket, and the other arm is treated in the same way. Attention is next given to the abdomen. Friction is applied first transversely, the rubbing being done alter- nately with the two hands, then in a circular manner, following the course of the colon. The thighs, legs, and feet are then treated, one only being uncovered at a time. The patient then turns upon the face, with the arms folded beneath the forehead, so as to draw the shoulder- blades upward and outward and to flatten the surface of the back as much as possible. The attendant then applies the hands, first to the back and sides of the neck, extending the fingers so as to reach around to the front of the neck. The upper part of the back, the shoulders, the middle and lower parts, and the sides of the trunk, lastly, the whole length of the spine, are treated by a few vigorous strokes. As quickly as a part is dried it should be cov- ered. Not more than five to ten seconds should be given to the rubbing of any part with the wet hand before the application of the towel. If the rubbing is insuflacient to produce reddening of the part, light percussion should be made use of after drying. Good reaction should be procured in each area before proceeding to another part, and the skin must be warm at the time of the treatment. The temperature of the room should be not less than 70° F., and that of the water 85° F., gradually decreased by one degree each day until 70° F. is reached. The hand of the attendant is made wet without dripping. The feeble neurasthenic patient experiences after the 32 PERSONAL HYGIENE FOR WOMEN cold rub a delightful sensation of increased vigor and relief from malaise and nervousness. The warmth of the hand of the attendant, the rubbing, and the small amount of water used all tend to promote reaction, so that it may be said that there is no patient too feeble for this pro- cedure. The Salt Glow. — For this the ordinary cooking-salt is about the right degree of coarseness. The salt is slightly moistened, and is applied to the surface of the body with friction movements, the amount of reaction being ad- justed to the patient's sensation. With very thin-skinned patients abrasion and irritation of the skin may easily be produced. In that case it is necessary, instead of apply- ing the salt directly to the skin, to make a saturated solu- tion of salt in water, and apply it in the same way that the cold rub is given. After the application, the salt which adheres to the skin may be rerroved by the shower or spray. In feeble patients a dash of warm water should be given before a final dash of cold water. The salt glow is a tonic measure of high value, especially in feeble persons whose heat-producing capacity is small. Its use must be avoided in eczema and all other forms of skin disease. Salt Ablution. — As the name indicates, this is a salt- water bath, and the best results are obtained by using a saturated solution, which is in the proportion of 1 pint of salt to 1 gallon of water. Sea-salt is the best, but, if that cannot be obtained, ordinary salt may be used. If there is no bath-tub in the house an ordinary wash- bowl may be used, but the bath is most effective when taken in the tub. The salt and water are put in a papier- mache pail, which is placed at the foot of the tub. The chilliness which might be caused by sitting on the cold porcelain is avoided by placing a heavy folded bath-towel on the bottom of the tub. In cold weather the tub should be previously heated by allowing the hot water to run in. HYDROTHERAPY 33 The salt water feels very much colder than plain water at the same temperature. It is well to begin with a tem- perature of from 90° to 85° F., and gradually lower the temperature until 70° F. is reached. The water is applied by means of a Turkish wash- towel, accompanied by vigorous friction, beginning with the face and neck, arms, legs, back, and, lastly, the chest and abdomen are gone over. After that, the water is dashed over the entire body, and is followed by a brisk toweling and friction with the hands or hair glove. The salt water should not be washed off, except in those rare cases where it causes a disagreeable sensation; it is then removed by the use of the hot followed by the cold shower, as previously directed. Indications for Its Use. — It is an excellent nerve tonic in cases of depression with loss of appetite, insomnia, etc., also in anemia and neurasthenia. In this class of cases it is best taken in the afternoon, on rising from the siesta, and just before dressing for dinner. It is especially refreshing in the hot weather. Its use is contraindicated under the same conditions that other cold baths are, and must never be taken when the bather has a tendency to chilliness. The various kinds of baths previously described can aU be obtained in the home, but the Turkish bath, with its various accessories, can only be taken in a properly equipped bathing establishment. The Turkish Bath. — This form of bath dates back to the time of the Romans. The essential features of a modem establishment are: dressing-rooms; a warm room, with a temperature of from 110° to 130° F.; a hot room, temperature of 150° to 170° F.; a steam room; a shampoo room; a douche apparatus; a plunge bath, and a cooling room. In many establishments there is only one hot, dry-air room. The air of the room may be heated by steam-coils. The bather, having disrobed, is enveloped in a sheet, and enters the hot room, where she reclines on a steamer- 3 34 PERSONAL HYGIENE FOR WOMEN chair. A towel wrung out of cold water is placed on the forehead and changed as often as it becomes hot. The bather should drink a glass of cold water immediately before or on entering the hot room, and several glasses should be taken at intervals during her stay in this room. The skin is highly stimulated and profuse perspiration results. The profuse sweating promotes absorption from the alimentary canal, and so is a powerful stimulant to nutrition. It also emphasizes the necessity for copious water-drinking. Great harm often results from a too prolonged stay in this room. Ordinarily, the bather should leave the room as soon as free perspiration is established; that is, in from fifteen minutes to half an hour. From this room the bather next enters the Russian bath or steam room. It is very much more agreeable to have very little steam in the room on entering; when the steam is very dense, a feeling of suffocation may occur. Any one with a weak heart should avoid the steam room altogether, as it is apt to cause a sense of great oppression. For the complexion, bronchitis, or laryngitis, it is excellent. From the hot room the bather goes to the shampoo- room, where, lying upon a marble slab, she is first gone over from head to feet by the wet hands of the attendant. This manipulation removes the layer of cuticle which has been loosened by the free perspiration. These rubbings and strokings are continued until the skin feels smooth and polished. The bather is next shampooed with soap and water, applied with a bath-brush. This may in turn be followed by a salt rub. After this comes a douche, given with a horizontal jet, at a temperature of 104° to 106° F., fol- lowed by a cold douche. If the bather is a strong woman, she may now enter the cold plunge. The temperature of this should be from 70° to 60° F.; this must only be a quick dip. She is then vigorously rubbed and dried. After this she lies down in the cooling room and has an alcohol rub, which completes HYDROTHERAPY 35 the procedure. She should rest here for half an hour at least before dressing. The pulse should be normal and the skin perfectly dry before she dresses and goes out on the street. In winter, instead of the ordinar^^ alcohol rub which is given, it is much better to have a thorough massage with cocoa-butter or almond oil — the so-called Roman bath. Just following the Turkish bath much of this oil will be absorbed, which is beneficial for thin people, and, in any case, it will lessen the danger of getting chilled on going out into the cold air. The woman unaccustomed to these baths should under no circumstances go to a Turkish bath without consulting her physician, as great harm might result. The bath should not be taken oftener than twice a week, unless by special orders of the physician. Care must be taken not to overuse them, as frequent and prolonged exposures to the sedative influence of heat is very debilitating. The wise woman will provide her own bathing cap, bath- brush, and straw sandals. The use of the Turkish bath is indicated in rheumatism, toxemia, chronic dyspepsia, biliousness, obesity, sciatica, and lumbago. The contraindications to its use are, in Bright's disease of the kidneys, in most pulmonary affections, in the ad- vanced stages of arteriosclerosis, and in diabetes with emaciation. The Electric-light Bath. — This is now frequently used instead of the hot-air room of the Turkish bath, and possesses many advantages. A cabinet is lined on three sides with mirrors, on which are arranged 50 or 60 electric-light bulbs; the mirrors multiply the number of lights by reflection. A stool is placed in the cabinet for the patient to sit on, while the head protiiides above the top, which is closed. By means of switches and a proper grouping of the lamps in wiring, the number of lights, and so the temperature, can be instantly and perfectly con- trolled. The heat is derived by radiation, so that it is 36 PERSONAL HYGIENE FOR WOMEN not necessary to have the air confined. In this form of light bath the body is directly exposed to the effects of radiant light and heat. The incandescent electric-light bath is superior to every other form of heating procedure in which the only object is the preparation for the cold bath. The time required is not more than from three to five minutes. When it is desired to produce profuse perspiration, the patient may remain in from eight to fifteen minutes. A longer stay than this is apt to produce an overstimulation of the nervous system and an excessive elevation of tempera- ture. The electric-light bath possesses the distinct advantages that, while the body is exposed to a high degree of heat, the air of the room in which the head is, and which one is breathing, may be cool, and unique advantages in the exactness of the dosage as regards time and intensity. It can also be used in a much greater number of diseases than the hot-air room of the Turkish bath. The finishing treatment on leaving the cabinet is iden- tically the same as that for the ordinary Turkish bath. Indications for Its Use. — While the electric-light bath is not a complete substitute for sweating produced by exercise, it comes nearer to that than any other heating procedure, and, when followed by some vigorous cold application, it possesses a hygienic value which cannot be overestimated. It is especially valuable in cardiac disease and diabetes. It stimulates oxidation, and is thus valuable in obesity and the toxemia of chronic dyspepsia; also in malarial cachexia, syphilis, neuritis, neuralgia, sciatica, habit chorea, hysteria, rheumatism, and anemia. It is superior to all other treatment in chronic rheuma- tism and all diseases dependent on uric-acid diathesis or diminished metabolism, by the combined action of the elevation of temperature and the vigorous cutaneous activity. The elevated temperature stimulates the oxida- tion of the proteid wastes and augments vital combustion, HYDROTHERAPY 37 while the increased skin activity carries off all waste- products prepared for elimination. As a prophylactic, this form of bath is especially valu- able for all persons leading a sedentary life; it is the best substitute for exercise in the open air, and, where there are no contraindications to its use, should be taken once a week. In cases of obesity, sweating may be used to reduce the weight ; but, in order to obtain the best effects, it must be combined with exercise, and it must be borne in mind, that in obesity there is great danger of overheating the blood, in consequence of the obstacles to heat elimination presented by the thick layers of non-conducting fat. There- fore, these hot applications for the reduction of fat should never be too much prolonged, and the bath should always be finished by vigorous applications of cold. These cold applications have also a tonic effect upon the nervous system, and increase the muscular disposition for exercise, and this is the most rational treatment for obesity. Loss of Weight. — There are many cases in which metabo- lism has been so sluggish, allowing an accumulation of imperfectly oxidized matters in the body, that the first active stimulation of the nutritive processes is in dis- proportion to the increased destructive metabolism. Under these circumstances there is necessarily a decrease in weight. The rubbish must first be removed and old defective structures before new and highly organized tissues can be deposited. A slight loss of weight need, therefore, give rise to no apprehension, but if the loss is considerable, or continues for some time, especially if accompanied by loss of strength or appetite, it is a matter for investigation. Palpitation of the heart and fulness of the head are an indication that the applications have been too hot or too long continued. Vertigo and fainting are apt to occur when hot applications have been continued too long, but they are quickly relieved by cold applications, especially by cold affusions to the chest and shoulders. Headache 38 PERSONAL HYGIENE FOR WOMEN may result, either from excessively hot or cold procedures. Deficient reaction is generally the result of a too prolonged application of cold. On entering the electric-light cabinet, a wet towel wrung out of ice-water is placed around the neck and another around the forehead ; or an ice-bag may be placed on the top of the head. The Douche. — A douche consists of a single or multiple column of water directed against some portion of the body. The apparatus is complicated, and it is essential that an accurate pressure-gauge and thermometer should be intro- duced into the circuit of the douche. It can only be properly administered in a hydriatic establishment. In the employment of the douche three factors must be con- sidered — the temperature, pressure, and the mass. The range of temperature employed varies from 45° to 125° F. The pressure ordinarily employed varies from 10 to 60 pounds. The mass varies according to the effect desired, and may be regulated by means of the finger, placed in the water column near the nozzle. The douche is applied by means of the rubber hose, which is connected at its proximal end with the water- supply, and at its distal end is attached a nozzle, the average diameter of which varies from 2 inches to f inch. From these a fine or coarse jet or a fan douche may be produced. The latter is formed by placing the index- finger of the hand holding the nozzle upon the lower bor- der of the outlet, producing an expansion of the otherwise solid jet into a fan-shaped stream. The mechanical effects of the douche are derived from atmospheric pressure, and this is of more importance in the effects produced than the temperature. The Scotch douche consists of alternate streams of hot and cold water. The general cold douche is the most powerful of all the tonics; the warm or neutral douche is sedative; the very hot douche is frequently followed by atonic reactions. The Percussion Douche. — This is the form of douche HYDROTHERAPY 39 most frequently used in the hydriatic establishments of France, In this there is a combination of air and water, in such a manner that the column of water is broken up into a number of short columns, and projected upon the surface of the skin with any desired amount of force. The impression produced upon the skin may be compared to a stream of lead bullets from a Gatling gun, and is accom- panied by a strong tingling of the skin. Not only are the blood-vessels of the skin made to con- tract, but the force of the impact compresses the tissues and forces the blood out of the vessels, leaving them free to dilate again as soon as the pressure is removed. Thus the tissues are alternately compressed and released; in other words, a veritable massage is produced, whereby the circulation is excited and accelerated and the thermic effects of the douche materially aided by the purely mechanical or percussion effects of the moving water, as really as if friction or percussion had been effected by the hand. Under the influence of this douche, and the only other one comparable in its good effects, is the Scotch douche; the whole organism is aroused to the highest degree of activity, the vital resistance is increased, the digestive activity is augmented, oxidation and elimination are increased; all the wheels of hfe move with quickened vigor, and the individual lives on a higher plane, physically, mentally, and morally. Application of the Douche.- — Since in France the most careful scientific study has been made of all hydriatic procedures, and all the establishments there are under the direction of physicians, the douche will be described as given there. No patient at any of the cures there is allowed to drink the water or undertake any form of hydriatic procedure without first being carefully examined by one of the staff of physicians belonging to the "cure.'^ After this ex- amination a carefully written formula is given the patient for the instruction of the attendant, just as a prescription 40 PEESONAL HYGIENE FOR WOMEN would be written for the druggist. On this card is written the temperature of the douche, the duration, and the num- ber of pounds pressure to be given. The halls and dressing-rooms of these establishments are kept much cooler than in this country, so that a heavy dressing govm is needed to go from the dressing-room to the bath. Straw sandals are provided, which are re- moved on entering the douche room. The hair is kept dry by means of a iTibber cap, which should be pulled down well over the ears. The bather is first directed to wash her face, then the jet is applied first to the back for a few seconds, then the legs and arms, then the anterior part of the body and the liver, ending with a strong dash on the feet. The entire body is gone over in this way several times, the patient turning around as directed by the attendant. The patient stands while taking the douche; if she is feeble, rails are provided to lean against. In the application of the douche it must be remembered that the stream of water must not be allowed to fall stead- ily upon one spot, but, by constant movements of the nozzle and the body of the patient, the stream should be directed upon different portions of the body in a suc- cession of dashes. The hot douche is most frequently used as a preparation for the cold one. The cold douche is never given without some sort of heating process as a preparation. The dura- tion of the cold douche is from three to four seconds. The temperature of the cold douche is from 45° to 65° F.; the cool douche is from 65° to 80° F. ; the tepid douche, 80° to 92° F.; the neutral douche, 95° to 97° F.; and the hot douche, from 104° to 125° F. A good working douche is between 55° and 70° F. The higher the temperature, the longer must be the duration and the greater the pressure required to produce the tonic effects. The neutral douche should be given with a pressure of from 5 to 20 pounds, and a duration of from three to fifteen HYDROTHERAPY 41 minutes; but, if a sedative effect is desired, the pressure should not exceed 10 pounds. After the douche the patient is enveloped in a hot sheet, over which the bath-robe is thrown, the sandals are again put on, and the patient returns to her dressing-room, where she is vigorously rubbed down by the attendant through the sheet, the patient herself assisting in the drying process by the use of hot towels. After this, the attendant goes over the entire body with her hand cov- ered by a coarse hair glove, and very many pounds pres- sure, untU the whole body is in a glow. If the reaction is not as prompt as should be, the attendant uses her bare hand. This douche should not be taken sooner than two hours after meals. The best time of day is about 10 o'clock in the morning or 3 in the afternoon. Rationale of the Douche. — The douche is a thermic massage. Since the douche is a sorbefacient of pathologic products, the French have availed themselves of its use to aid the body to throw off an excess of uric acid, fatigue toxins, etc. It has been demonstrated that a rain douche of 50° F., under a pressure of two atmospheres, increases threefold the work that the muscles are capable of doing, while the Scotch douche, oscillating between 98° and 53° F., doubles the working capacity of the muscles. Even tepid douches increase the working capacity of the muscles, while a tub-bath of the same temperature is without decided effect. The pressure under which the douche is given adds a powerful element, which is absent in other hydriatic procedures. The percussion and vibration affect the vasomotor system much more powerfully than any form of stUl bathing. The power and action of the heart are greatly improved by the use of the douche, the capacity of the lungs is in- creased, and the digestion is improved. Brief douches of from ten to fifteen seconds generally act better than those of longer duration. The general 42 PERSONAL HYGIENE FOR WOMEN condition of the patient must always be carefully studied, and, like the Turkish bath, the douche should always be taken under the direction of a physician, as they are also capable of doing a great amount of harm as well as good. The best results from the douche are obtained when it is taken following the use of the electric-light bath. The neutral douche is particularly applicable in cardiac affections and in cases of high arterial tension. The sensation afforded should not be either that of hot or cold, and the duration from one to two minutes. The douche for this purpose should be given with only a slight degree of pressure, and to avoid irritation it should be directed to either side of the spinal column. This is a sedative application. Contraindications for the Use of the Douche. — In all acute inflammations and in eruptive disorders of the skin. The cold douche is contraindicated in inflammation of the uterus, ovaries, kidneys, stomach, liver, bowels, and bladder, in intestinal catarrh, chronic inflammation of the stomach, and general neuritis. It must also be avoided in rheumatism, arteriosclerosis, cardiac insufficiency, valvular diseases of the heart with deficient compensation, fatty degeneration of the heart, and in cases of extreme nervous irritability. The Internal Use of Water. — The internal use of water is essential to life. Water constitutes about two- thirds of the body weight ; it is found in every tissue and organ of the body; it acts to dilute the foods so that they can be absorbed from the digestive tract ; its presence in the blood is essential, both to carry foods to the tissues and to convey the waste matter away from the tissues. Its use in the form of a lavage is even more necessary, to keep clean and free from impurities the mucous membrane lining the 30 feet of the digestive canal and the tubules of the kidneys than is the external use of water to keep the skin in a healthy condition. Its use is also needed to keep the blood-pressure and the heart in a normal condition. HYDROTHERAPY 43 About 4§ pints of water are given off daily in tlie excreta and exhalations; but, since about one-half of the solid foods taken consist of water, 3 pints of water, taken daily as such, are sufficient to counterbalance the loss. All water for drinking purposes should be filtered. The best method is to have a filter attached to the pipes of the house-supply, so as to insure filtered water running from all the spigots. If the water is not filtered, it should be boiled for thirty minutes. The water should be run off in the morning, then poured into a well-kept tea-kettle and boiled. It is then allowed to stand and become partially cooled in covered vessels, when it is poured into large bottles — quarts are the most convenient size; these should be stop- pered with corks of absorbent cotton. When cool, the bottles are placed in the refrigerator beside the ice. Water should be boiled every morning for the twenty- four hours. Boiling for this length of time secures the destruction of all the germs of disease, and it is doubly essential on the return to town in the fall, when the house has been closed for some time ; also when typhoid fever in the neighborhood indicates the strong possibility of the impurity of the water-supply. The mistake should not be made of undoing the good that has been done by boiling the water by the addition of ice to the water when it is placed on the table. Further- more, ice-water is so cold that it retards and interferes with the digestive processes. In the internal use of water the same marked difference is caused by the different temperatures at which the water is taken, as was seen in the external applications of water; but, while the tem^perature of the skin is about 90° F., that of the mucous membrane lining the digestive tract is 98.6° F. and above. The Action of the Internal Use of Water on the Heart and Blood. — Water improves the quality of the blood, both by its direct action on the constituents and by the increased elimination of waste-products. By the increase of the 44 PERSONAL HYGIENE FOR WOMEN volume of blood, a more energetic contraction of the heart is caused, and the activity of all the glands of the body is increased. There is a greater amount of oxygen absorbed by the lungs; oxidation in the tissues is carried on more perfectly, the result of which is that there is a diminution or absence of the products of incomplete combustion in the body, such as uric acid, the oxalates, etc. By the increase of the blood-pressure, caused by drink- ing water in sufl&cient quantities, the activity of the kid- neys is increased, and this not only in the amount of urine passed, but also of the solid constituents, which are the waste-products, removed from the body through the agency of the kidneys. The Action of Water on the Digestion. — Very little water is absorbed from the stomach ; it passes from the stomach to the intestines, where it is absorbed. In order to ob- tain a thorough cleansing of the stomach, and at the same time not to cause its overdistention, not less than I pint of water and not more than IJ pints should be taken at one time. The water must be taken one hour before meals, in order to insure its removal from the stom- ach and the proper rest of that organ before food enters it, as it has been found by actual experiment that in a quarter of an hour after water had been taken one-half of the quantity remained in the stomach, but that none remained after the lapse of half an hour. Cold water is more quickly absorbed than warm, and the absorption is hastened by the presence of carbonic acid, while salt of any kind delays its absorption. The Therapeutic Indications for the Use of Water. — First, the temperature of the water taken must be regu- lated by the effect desired. Briefly stated, if the water is taken for dyspepsia in any form, whether acute or chronic catarrhal inflammation of the stomach or the intestinal canal, f pint of water, just as hot as it can be sipped with a spoon, should be taken three times a day, one hour before each meal. No water should be taken during the meal, and only HYDROTHERAPY 45 one glass, at a temperature of about 60° F., on its com- pletion. If the water is taken as a diuretic, or, in other words, to increase the activity of the kidneys, the most of the water should be taken in the morning on rising and the remainder about 4 o'clock in the afternoon. Probably the best natural waters for this purpose are the waters of the Vosges, France. The Vittel water, '^ Grande Source," acts on the kidneys alone; where the bowels are regular or inclined to be loose, this is the best water to use. If, on the contrary, there is constipation or biliousness, the "Source Salee" should be taken in connection with the first named or alone. The " Source Salee " has a decided action on the liver and is laxative. In order to obtain a pronounced effect, at least 3 pints of these waters should be taken daily; in some cases more is required. Two glasses may be taken on rising in the morning, with an interval of twenty minutes between; the last glass must be taken one hour before breakfast. The temperature of the water should be 50° F., which is the temperature of the water at the springs and that of the water when placed in bottles in the refrigerator against the ice. In the afternoon the other two glasses may be taken, with the same interval between. In gastric catarrh, where there is an accumulation of mucus or fermenting matter, with or without nausea and vomiting, hot water alone is useful. In addition to its action in diluting the contents of the stomach and the intestines, and its cleansing and antiseptic effect on their mucous membranes, the reflex effect of very hot water, slowly sipped, is a stimulation of their muscular coats, which furthers the passage of the digested food from the stomach into the intestines. The quantity taken must be from J to 1 pint, in order to obtain a thorough cleansing and yet not to cause an overdistention of the stomach. In acute nephritis, inflammation of the kidneys, small quantities of very cold water, repeated at half-hourly intervals, act as a diuretic. Care must be had, however, 46 PERSONAL HYGIENE FOR WOMEN not to overtax the stomach and heart by overfilling the system with fluids. In obesity, water-drinking is essential as a means of dis- solving and carrying out of the body the large amount of broken-down material which results from the increased tissue destruction caused by exercise, hot and cold baths, and other means employed to decrease the weight. For constipation and biliousness two glasses of cold vv^ater should be taken before breakfast, with an interval of twenty minutes between, the last glass being taken one hour before breakfast. Contraindications. — Cold water taken into the stomach produces more marked effects than water applied to an equal area of the skin. The quantity of water taken is a factor as well as the temperature. Cold-water drinking lowers the temperature and slows the pulse, so that drink- ing cold water must be strictly prohibited when one is in a state of fatigue, whether perspiring or not. Feeble persons should not drink cold water, except in very hot weather, or just before starting out for a brisk walk in the open air, or when about to engage in other exercise. With the air of the room at 70° F., a woman in fair condition, moving about making her toilet, may safely drink cold water slowly, except when there is a feeling of chilliness. In the latter case, the powers of reaction being diminished, chill and internal congestion, often resulting in great injury, may be produced. Cold-water drinking is always prohibited when in a state of fatigue. Ice-water should never be taken. When taken with meals, it greatly retards digestion and may do much harm. The French Cures of the Vosges. — Six hours east from Paris, situated in the foot-hills of the Vosges mountains, at an elevation of from 1 100 to 1200 feet, are three of the noted French cures — Vittel, Contrexeville, and Martigny- les-Bains. Their waters are very similar, those of Vittel being the mildest and those of Martigny-les-Bains the m-ost powerful, but at all of them the drinking of the waters is the main thing, supplemented by hydriatic HYDROTHERAPY 47 procedures. Contrexeville is the oldest and best known; Martigny-les-Bains has the best natural location and is the newest. Vittel has the advantage of having first- class hotels and an ideal hydrotherapeutic establish- ment, equipped with all the modem contrivances for mechanotherapy and every known form of douche. The manner of drinking the water is the same in all, the difference being in the quantity of water taken, which varies with its strength. At all there are only two meals a day, breakfast being omitted; the " dejeuner a lafourchette," at ten or half after, corresponds to our luncheon, except that it is much heav- ier. Dinner is served at half after six. On reaching the ''Cure" the patient at once selects her physician, and places herself under his care during her stay. She is subjected to a most careful examination, and closely watched to ascertain the effects of the waters and other procedures ordered. The drinking establishment is in the Park, and patients are expected to reach there at 7 o'clock in the morning. On the first morning of the cure only two glasses of water are taken; the size of the glass varies from J to 1 liter, according to the condition of the patient. The water is taken at the temperature at which it comes from the springs, namely, 50° F., as this is a much greater tonic to the digestive organs and the kidneys than warm water. The water is taken slowly, the patient moving about while drinking it. After this a brisk walk of twenty minutes through the park is ordered, when the patient returns to the pavillion for her next glass of water. The walk is then resumed, and great emphasis is laid on the rule not to eat anything for one hour after drinking the last glass of water. The reason for this is obvious. The water is given in such quantity as to cause a laxative action, the object being to secure a complete lavage of the gastro- intestinal tract when completely empty, so as not to inter- fere or carry off the products of digestion. Several watery stools are produced, the last one not being later than 10 48 PERSONAL HYGIENE FOR WOMEN o'clock in the morning; any stool after this hour is con- sidered in the light of a diarrhea and is so treated. At 4 o'clock in the afternoon another glass is taken. On the second day three glasses are taken in the morn- ing and two in the afternoon, always with an interval of twenty minutes between. On the third day four glasses are taken in the morning and two in the afternoon. This is the maximum quantity taken at Contrexeville; and this quantity of water is taken every day during the cure, except that at the last three days there is the same tapering off in the amount of water taken as was observed at the beginning. The time of the cure is three weeks. At first the lack of the accustomed breakfast feels like a great hardship, and if the patient is not very vigorous, she is apt to feel exhausted ; but, with the bracing morning air, the exhilaration of the brisk exercise, the lively music of a really excellent band, and the interest of the moving panorama, one soon becomes accustomed to the changed routine. The elevation, the great purity of the air of these pine forests, the entire change of scene, and the freedom from care doubtless all contribute to the benefits effected by these cures, but the substantial and very salutary after- effects can only be attributed to the ridding of the body of a large amount of toxins, and to the greater activity of all the digestive processes and of the general body metabo- lism. One's faith in the power of ozone and the benefits of early morning exercise in the open air becomes firmly fixed as she feels the cobwebs being swept out of her brain. The sensation produced is that of a current of fresh air passing through the brain itself. The accom- panying feeling of well-being, caused by the increased activity of the circulation of the brain, is indescribably delightful. On leaving the cure the patient is advised, on returning home, to drink the water one week out of every month — preferably the week following the menstrual period. HYDROTHERAPY 49 Enemas. — Coloclysters. — Another valuable internal use of water is for emptying the lower bowel, and washing out the large bowel in cases of catarrhal inflammation. For constipation, in which the object is to unload the bowel as quickly as possible, 1 or 2 pints of water, at a temperature of from 104° to 110° F., is made into a suds by means of Castile or other good soap, and poured into a fountain-syringe. If the enema is being given by an attendant, the patient lies on the right side in the Sims' position; the under leg is stretched out so that it forms a straight line with the trunk, while the upper leg is sharply flexed at the knee, so that the foot is opposite the knee of the under leg; the right arm is thrown back from under the body. If the patient is administering the enema to herself, the best position is the knee-chest. In this the patient kneels on the floor, the thighs are held rigid, and while the shoulders are brought to touch the floor, the face is turned to one side. The position can only be taken satisfactorily with the corsets and all tight bands around the waist removed. In this position gravity causes the intestines to fall upward toward the waist, and the water naturally follows this course. In this position the water goes up higher, and is retained longer, than when taken in the other positions. Two pints of the soap-suds are prepared at the proper temperature, and the patient uses as much of this as she feels that she can retain. The water should be retained from five to ten minutes, to get the best results. For the purpose of washing out the large intestine more water is used, but not more than 2 quarts should be used for this. The position of the patient and the temperature of the water are the same. But for this clyster, instead of adding soap to the water, cooking salt is used, in the proportion of 1 teaspoonful of salt to 1 pint of water. This lavage of the intestine removes rapidly large masses of decomposing material, swarming with microbes and ptomains and the toxins produced by them. It also increases the activity of the portal circulation. 4 50 PERSONAL HYGIENE FOR WOMEN In cases of chronic constipation there are atony and dilatation of the colon, and the patient always carries about with her an enormous accumulation of fecal matter, and lives in a state of chronic autointoxication. In this class of cases the coloclyster should be administered daily for from two to three weeks; if need be, so long as the patient complains of gaseous distention and fetid flatu- lence. After the discharge of the warm water, 1 pint of cool water should be introduced, beginning with a tem- perature of 85° F., and gradually decreasing this from day to day until 70° F. is reached. This water should be retained if possible; it acts as a tonic bath for the colon. Gare should be exercised to avoid the distention of the colon by an excessive amount of water, and, after the colon has been thoroughly cleansed, the amount of water used should be decreased from day to day, until finally only 1 pint is used. Warm water is always relaxing, whereas cold water stimulates and tones up the bowel. If the quantity of water used is smaU, the cold coloclyster may be used indefinitely without producing constipating effects. Great care must be used to avoid the introduction of air into the bowel with the water; to this end the water is allowed to run out of the nozzle before its introduction into the rectum. A small-sized nozzle should always be used, and this should be lubricated with vaselin or some other emollient, in order to prevent irritation of the mucous membrane. Vaginal Irrigations. — To be of any service the vaginal douche should be taken in the horizontal position. It may be taken on the bed, couch, or lying on the floor. When taken on the floor, a heavy rug or steamer blanket should be doubled four times, and two pillows are used: the under one goes up and down for the support of the back, while the second is used for the support of the head. A douche-pan is, of course, indispensable. The agate pans holding 4 quarts of water are the most serviceable. The douche-pan is placed against the lower edge of the under HYDROTHERAPY 51 pillow, which is protected by a bath-towel. The woman must throw a heavy shawl or blanket over herseM while taking the douche, otherwise there is great danger of becoming chilled, and thus doing actual harm instead of good. The most common and best form of syringe is the foun- tain-syringe. This is himg about 6 feet above the bed or floor. It should hold 4 quarts of water; this quantity of water is necessary when the douche is given, as it most commonly is, for pelvic inflammation. On beginning its use, the temperature of the water must be controlled by the sensitiveness of the patient; generally one can use a temperature of at least 112° F., but not always; some- times one must be content with a beginning temperature as low as 104° F., gradually increasing the temperature by two degrees every few da3^s, until from 114° to 120° F. is reached. The use of a bath thermometer is always essen- tial to test the temperature of the water. The tempera- ture of the douche should never go above 120° F., or actual harm will be done. On lying down, the lower part of the body rests on the broad strip of the douche-pan, the nates coming over the edge, and the clothing well pushed up, otherwise the water will seep up the back. The water acts as a hot poultice about the uterus and its adnexa; it is also astringent, and greatly reHeves ovarian irritation and congestion. It is highly sedative, and is best used at night just before retiring. In severe cases better results will be obtained by its use twice daily. In that case one douche must be taken in the morning, but in cold weather it must never be taken immediately before going out-of-doors; there must be at least one hour between the time of taking the douche and going out into the cold air. Patients taking hot douches must be warned that the pelvic viscera are much more susceptible of chiUing because of these heating procedures, and of the necessity to counteract this tendency by the wearing of woolen abdominal bands, both night and day. 52 PERSONAL HYGIENE FOR WOMEN Ordinarily, plain hot water is all that is necessary to use, but if the vaginal discharge is irritating, one tea- spoonful of borax may be added to the pint of water; or one teaspoonful of cooking salt; or one-half teaspoonful of the sulphate of zinc. Douching the Ear. — This procedure is made use of to remove impacted ear-wax or to relieve the pain of earache. A small fountain syringe should be used, hung not more than 3 feet above the head. The water should have a temperature of from 105° to 110° F. The nozzle must be small, and have a very fine opening, and great care must be used in its introduction not to allow the nozzle to enter beyond the external opening of the ear. A pus- basin or small dish may be used to protect the clothing from getting wet. After the procedure is finished, the ear is dried by means of a very fine handkerchief or a little absorbent cotton. CHAPTER II THE CARE OF THE SKIN AND ITS APPENDAGES The Complexion; the Action of the Bath in Health; the Proper Time to Bathe; the Care of Wash-cloths; Cleansing the Face; Pro- tection of the Face; the Use of So-called Cosmetics for the Face; Facial Blemishes, Freckles, Liver Spots, Sallow Complexion, Pim- ples, Acne, Eczema, Wrinkles, and Superfluous Hair and Their Treatment; the Relation of Diseases of the Skin to Internal Disor- ders. The Hair; Dandruff; Causes and Treatment of Premature Thin- ness of the Hair and Baldness; the Care of the Hair; Gray Hair._ The Cosmetic Care and Treatment of the Hands; Cosmetic of the Nails; the Care of the Feet; Painful Affections of the Feet. The face is a complete index of the life of the individual written large, so that he who runs may read. By looking at the condition of the skin and the whites of the eyes we can judge very fairly of the digestion. From the dulness or brilliancy of the eyes we can make a very good diagnosis of the mental condition. From the general expression of the face we can read the kind of life that has been led by the individual, whether of pleasure, dissipation, or sorrow. From greatest antiquity men and women have striven to beautify their bodies. To be indifferent to the personal appearance is an indication of some abnormal condition in the individual or her environment. The Complexion. — The skin of the face is known as the complexion, and this is the part of the skin that is most exposed to the vicissitudes of dust and grime of the streets or of the occupation, as well as to heat, cold, and winds. An ideal complexion combines the qualities of clearness, translucency, and fineness of the outer skin, with a proper disposition of the blood-supply. 53 54 PERSONAL HYGIENE FOR WOMEN The translucency of the skin may reach a point where it becomes an absolute defect, as is sometimes seen in wasting consumption. In sickness the skin becomes dull, opaque, and lusterless; with returning health, its proper translucency and bril- liancy return. The beauty of the skin is evidence of good respiration, good digestion, proper excretion by the bowels, skin, and kidneys, good condition of the blood, and plenty of out- door exercise. It is now well known that the skin, as well as other parts of the body, depends for its integrity upon the general nervous system. Disturbance anywhere in the body acts upon the central nervous system. A simple case of indi- gestion often manifests itself over considerable areas of the skin. It cannot be too earnestly impressed on the reader that beauty is entirely dependent on the health. It will readily be seen that no external applications can produce such qualities as fineness of texture, translucency, and delicate play of coloring produced by the contraction and dilatation of the blood-vessels. The natural order in which to consider the skin will be first as subservient to health, and then as it is conducive to beauty. The Action of the Bath in Health. — Not only in the art of pleasing, but in the maintenance of health, neatness of person must be carried to perfection. By the use of friction, soap and water, the scarf-skin becomes more and more constantly renewed by the layers underneath it. It becomes softer, more pliant, and finer than satin in appearance and texture. Besides this, as has already been shown, bathing has upon the corium or true skin, and thence upon the general system, a revitalizing in- fluence. Combined with the proper kinds of soap, avoiding the use of irritating ones, bathing removes from the skin all effete oily matters, scales of the scarf-skin, crusts, the saline matters excreted by the perspiration, PLATE I ^ THE CARE OF THE SKIN AND ITS APPENDAGES 55 dust of all kinds, soot, particularly that from the clothing, and so forth. Caustic soaps and borax in excess may remove the oil in so great quantities as to be detrimental to the skin. Within twenty-four hours the skin, especially those parts which are covered, becomes vested with a pellicle of impurities, which, when allowed to remain, become thicker every day, and may produce injurious effects by obstructing the excretory openings and affording lodge- ment for disease. The effects would be felt not only in the skin, but in the whole organism. The skin when not cleansed will be irritated chemically and mechanically. The Proper Time to Bathe. — This depends on the nature of the bath to be taken, the strength of the woman, the temperature of the room, and the season of the year. To repeat, a cold bath of any description must never be taken unless the body has a decided sensation of warmth. In winter, if she will drink a glass of hot water before rising and has a warm room, the woman in average health may take a cold sponge bath. But the body must be very gradually trained to the application of cold, just as it is to vigorous muscular exercise. For the woman who has never in her life taken a cold bath of any sort, except in midsummer, to begin a heroic treatment with cold baths in winter would be utter folly, which might easily be the cause of pneumonia and even of death. The time to begin a systematic use of cold water is in summer, con- tinued through the autumn, and by the time midwinter has arrived, the system has become so toned up that noth- ing but good can result. If the woman is not very strong, she had better begin with the cold ablutions, just to the waist, on rising in the morning. These must always be followed by a vigorous toweling and friction. In case of inflammation of the kidneys or pelvic viscera, cold applications to the abdomen should be avoided, as they are badly borne. If the woman is anemic, has a poor circulation, or is con- scious of her heart, she will feel at her best in the after- 56 PERSONAL HYGIENE FOR WOMEN noon. In that case, after a cup of hot bouillon, taken on rising from her siesta, she may take a quick hot scrub, followed by a cold shower. This is much more invigorat- ing than the cold ablution, and the reaction at that time of the day is more vigorous than in the early morning. From the simple ablution, the next step in training would be the cold wet sheet. It is impossible to take this without an attendant, but a good maid may readily be taught to give the necessary rubbing. Ordinarily, this will be enough to attempt in one winter. A strong woman, who has always been accustomed to taking cold baths, may all the year round, except just before, during, and immediately after the menstrual period, take a cold dip on rising in the morning. It must be literally a quick dip in a tubful of cold water, from 65° to 55 ° F., or, if she is sufficiently strong to stay in the tub longer, there must be a constant brisk friction kept up while in the water. It is permitted only a woman in good health, with a strong heart and normal kidneys, to get into a tub of cold water, take a cold plunge, or attempt sea-bathing. For the woman who is a semi-invalid, the only time allowable for a cold tonic bath is in the afternoon. In cold weather the shower, like all other forms of baths, must be taken in a warm room. The shower bath can be taken every day to the greatest possible advantage. An ideal way is to rest for half an hour on coming home in the afternoon; to sleep, if possible, then take a quick scrub, and follow it first by the hot shower of 100° to 104° F., and finish with the cold shower. A brisk rubbing should be kept up until the skin is in a good healthy glow. This bath is followed by a feeling of great exhilaration, and it gives a beautiful glow to the face and skin. It removes the tired feeling of the day's work, and leaves one feeling greatly refreshed for the evening. A daily ablution or a daily shower, with friction, will not cause an undue removal of the oil of the skin. All cold baths, when given in suitable cases, tone up the system to resist dis- THE CAEE OF THE SKIN AND ITS APPENDAGES 57 ease, and are the best preventives against ordinary colds and sore throat. A hot tub-bath is best taken at night just before retir- ing. In winter it must never be taken immediately before going out-of-doors, because the pores of the skin are more or less open and there is great danger of chilling. A hot tub-bath, remaining in the bath for some minutes, should not be taken more than twice a week, as it is too debilitat- ing, and a prolonged stay in the hot water causes an actual loss of flesh. A woman may take a warm sponge bath in a warm room at any time of the month, but during the menstrual period she must, under no consideration, take a cold tub-bath or even a cold sponge-bath, since this would be apt to cause a chill of the surface of the body and a congestion, if not an actual inflammation, of the pelvic organs. No bath should be taken within two hours after eating, as the bath draws the blood from the stomach toward the surface of the body and so interferes with digestion. The Care of Wash-cloths. — After using each time, the wash-cloth must be thoroughly washed, well rinsed, and hung up to dry. But this is not sufficient: once every week all wash-cloths must be sent to the laundry to be boiled, thus insuring the destroying of any germs that may lurk in the cloth. If a woman has any kind of skin disease, it is quite possible for her to reinfect herself after the dis- ease has apparently become cured. Further, each mem- ber of the family should have her own individual towels, soap, and wash-cloths. Aside from all sanitary questions, in a matter so intimate as the bath, there is something repulsive in the thought of having your toilet articles used by any one else. A pure Castile soap is one of the best that can be used. All cheap scented soaps should be avoided, as they are apt to contain impure materials that will actually injure the skin. If the skin is rough, rubbing it with a good sand-soap, and rubbing the same on the flesh-brush, will remove many of the scales and leave the skin much 68 PERSONAL HYGIENE FOR WOMEN smoother and softer. Medicated soaps should never be used except by the direction of a physician. Cleansing the Face. — The face should be well washed twice a day with cool or cold water, but the temperature of the water should not be below 60° F. The degree of coolness must be determined by the feelings and judg- ment of the individual. If the face were washed with very hot or very cold water, and then exposed to the cold air, the skin would become rough and chapped. The water should be soft. To soften hard water, put 1 pound of bran into a muslin bag, place in 4 quarts of water, and boil for fifteen minutes. Add enough of this bran water to the bath to make the water milky. A soft, woven face towel, kept for the face and neck only, should be used with a moderate degree of friction. Great care must be used to wipe the skin thoroughly dry. It is a question whether the daily use of soap on the face is advisable; for the healthy skin it is not essential and may prove very injurious. Soap should never be used on the face in winter just before going out-of-doors, as this would cause a roughening of the skin. When the hot tub-bath is taken, the face should be well washed with soap and hot water, plenty of friction being applied by means of the face towel, after which the face is thoroughly rinsed with pure water. This will open the pores of the skin, and should be followed by the use of cold water, which has a stimulant action on the blood-vessels and improves the circulation in the skin. It also improves the tone of the elastic fibers in the skin and tends to delay the appearance of wrinkles. If there is any tendency to dryness of the skin, a good cold cream should be well rubbed in just after bathing the face. The cream must be a good quality and perfectly fresh, as a rancid cream is irritating to the skin. Only so much of the cream should be applied as will be absorbed by the skin. When the skin is very thin, and there has been loss of subcutaneous fat due to ill health or other cause, the systematic application of cream in this manner THE CARE OF THE SKIN AND ITS APPENDAGES 59 aids in the nutrition of the skin; and, when apphed to the neck with good massage, is a great protection against sore throat due to exposure to drafts and cold. Protection of the Face. — The cold winds of winter cause a dryness of the uncovered skin of the face and lips, which often leads to a painful chapping, and, in the case of the lips, small fissures may be produced. In addition to the use of cold cream, a good rice powder may be applied, which serves as a further protection to the skin. In very cold weather a veil should be worn to protect the face from the cold and winds. In summer a parasol should always be carried, to protect the eyes and brain as weU as the face from the hot rays of the sun. The Use of So-called Cosmetics for the Face.— All skin speciaHsts, and these are in the very best position to judge of the great amount of harm that is done, say emphatically that the use of face lotions and "paints" can only work the lasting injury of the complexion. They may assist in hiding the defects of nature, but they frequently contribute to increase these defects. Many of them merely fill up the pores of the skin and give it a pasty look. Numerous cases of eczema and other dis- eases have followed the use of paints. Of the advertised cosmetics, many are not only worthless, but actually in- jurious. Certain applications to the skin of the face are permis- sible and beneficial. ''Virgin milk," which is a milky- looking mixture, composed of the tincture of benzoin and rose-water, renders the skin soft, and is said to prevent the formation of freckles. If the skin is dry, glycerin may be added to this. The formula for this mixture is as follows : Take of the tincture of benzoin and glycerin each 1 ounce, mix well, and then add 2 ounces of rose-water. This should be applied by the fingers, just after the face is washed. Pure glycerin is irritating, and should never be applied to the face without dilution. The various good preparations of rice and talcum pow- der on the market are perfectly harmless, and, if there is a 60 PERSONAL HYGIENE FOR WOMEN tendency to greasiness or shininess of the skin, the use of these is essential from an esthetic point of view. In case of greasiness a Uttle calcined magnesia may be used. In hot weather the use of face powder is very refreshing, and in the hot climates it is used for this purpose to a very striking extent. But the true cosmetics, and the only ones that can procure and keep a beautiful complexion, are plenty of exercise in the open air, attention to the diet, to the daily evacuation of the bowels, to the condition of the kidneys, to baths, and to proper dress. Facial Blemishes. — Among the most common facial blemishes are freckles, liver spots, a sallow complexion, pimples, acne, eczema, superfluous hairs, and wrinkles. Freckles. — ^These are brownish or yellowish pigmentary spots, varying from the size of a pin-head to that of a pea. They occur on the face and the backs of the hands. They consist of a circumscribed deposit of pigment; not much is known about their origin. The pigment is situated in the deep layers of the epidermis, and, in order to remove the freckles, it is necessary to use something capable of producing desquamation. As a rule, if left alone, they will gradually disappear. lAver Spots. — The so-called liver spots are irregular patches of a brownish color, which appear most frequently on the face, neck, chest, back, arms, and hands. If not caused by disorders of the liver and digestion, they are cer- tainly aggravated by them. They are not only unsightly blemishes on the skin, but sometimes cause great nervous- ness by the intense itching which accompanies them. Sallow Complexion. — This is generally caused by dis- orders of the liver, and is most frequently met with in hot countries. It is seen in chronic dyspeptics, and, indeed, in most forms of chronic disease, and is not only a symp- tom of the disordered bodily state, but a cause of its per- petuation. This appearance of the skin is due to the accumulation of effete matters in it and to its impaired nutrition, and this state exists not only in the skin, but in the whole body. THE CAEE OF THE SKIN AND ITS APPENDAGES 61 Pimples, or Blackheads, and Acne. — These are affections of youth, and are generally seen together, the last-named being simply a second stage of the first. Pimples, or blackheads, appear as small elevations in the skin, with a small black point in the center. The cause of the pimple is the alteration in the quality of the sebum, the oily secretion, which becomes and remains a hard mass in the excretory ducts of the sebaceous glands and plugs up its external opening. The dust of the air becomes mixed with the fat, and thus makes a black point. When the ducts cannot get rid of the sebum, they become stopped up, and in consequence become swollen. This irritation spreads to the adjacent tissues, and so inflammation arises. Finally, the contents of the duct undergo degeneration, suppuration occurs, and the contents become mixed with pus, small abscesses result at various depths in the skin, and so require more or less time to break out. This inflammatory condition of the sebaceous glands with their ducts is apt to become chronic and may prove an obstinate affection. It occurs most commonly about the face, on the back between the shoulders, or on the chest. The skin is rough to the touch, the ducts of the sebaceous glands are enlarged, and the skin is greasy. Eczema. — This is the most common of all skin affec- tions. It is a non-contagious, inflammatory disease of the skin, sometimes acute, but more often chronic, attended with itching and desquamation or loss of cuticle. With the itching may be a feeling of heat and tension in the part. Eczema is a local disease, brought about by a local irritation in the skin; but, in addition to this, there is generally a predisposing cause, as some disorders of the digestive tract, a bad condition of the blood, and so forth. The skin, like other organs of the body, depends on the whole system for its nutrition. When this nutrition is not sufficient, the skin appears pale, of a peculiar color, and is easily taken up in folds, an evidence of poor nutrition of the skin. When the skin is not properly nourished, every slight irritation is liable to produce eczema. 62 PERSONAL HYGIENE FOR WOMEN Treatment of Liver Spots, Sallow Complexion, Pimples, Acne, and Eczema. — First, the general treat- ment. While every case of skin disease must be treated according to the peculiarities of that patient's case, still, there are general rules which should be followed in the treatment of all cases, and first in importance comes at- tention to the bowels. There must be procured, by some means or other, a free daily evacuation. A hard, consti- pated movement is not sufficient. Fruits and vegetables are both laxatives and the very best. Water is also a laxative, and 3 pints a day should be taken, not only for the laxative effects, but also because this amount is needed to keep the kidneys properly flushed. Of the simple medicinal laxatives, one of the best is the effervescing granules of the phosphate of soda; the dose is from one teaspoonful to one tablespoonful, to be taken in a glass of cold water on rising in the morning. Sometimes pa- tients who are troubled with gas cannot take anything which effervesces; in that case, the plain phosphate of soda may be substituted. Next in importance to the attention to the bowels comes the diet. All articles of diet must be easily di- gested, while at the same time they are nourishing. Cereals, pies, pastry, fried foods, hot breads, rich gravies, rich salads, pork, and veal must be excluded from the bill of fare. Fresh meat must be eaten by a woman in health at least once a day, and young girls need it twice a day. This should be supplemented with eggs and milk, fresh vege- tables, and not an excess of stale bread or toast. The latter is constipating. Tea and coffee should both be avoided. A glass of hot water, taken one hour before meals, will do much to rid the stomach of mucus and put it in a good condition for the digestion of the food. For the congestion of the liver, which is so often at the bottom of these disorders, it is generally necessary to consult a physician. THE CARE OF THE SKIN AND ITS APPENDAGES 63 Pure air, associated with the proper kinds of exercise, promotes the functions of the skin, assists in keeping the blood in good condition, increases the vigor, keeps the complexion clear, and increases its beauty, while, on the other hand, a sedentary life in a confined air produces a pallid and frequently a blotched skin, with headache and dyspepsia. A thin condition of the blood, which is known as anemia, is another source of skin diseases. After the digestive system has been gotten in a good condition, some form of iron is generally necessary, which, if taken when the diges- tive tract were not in good condition, would do more harm than good, as it would only tend to still further clog up the system. Sweating baths are of the highest value as a means of ridding the skin of its accumulated impurities, and in unloading the obstructed sebaceous follicles of their hardened contents. In eczema tub-baths must be avoided, and soap and water be used sparingly. Bran may be added to the water, or baking soda, in the proportion of one teaspoonful to the basin of water. The water should always be soft. The use of water on the face should be at once followed by the use of cold cream. Local Treatment. — Without the correction of the im- paired functions of the general system, no local treatment can afford anjrthing more than mere temporary relief; but, as a rule, local treatment is necessary in addition to the general treatment. Steaming the Face. — It seems that the blood-vessels of the skin are much better able to absorb vapor than water. The vapor penetrates and softens the epidermis much better than the simple application of water would. The increased secretion from the skin which is thus caused is beneficial. After using the vapor bath, the outer layers of the epidermis peel off and the complexion is improved by the substitution of new pigment. The absorption of the moisture also causes a roundness of the skin and a 64 PERSONAL HYGIENE FOR WOMEN filling out of the wrinkles. Generally, vapor batha can be used in those cases of skin diseases where the skin is rough and dry. Next in importance to the vapor bath is steaming the face. Bathing the face with very hot water is also recommended. Massage of the Skin. — Where the complexion is sallow, or there is a tendency to pimples or blotches, massage of the skin of the face will do much to improve the circulation. The massage is most effective when it follows steaming or washing the face in hot water. The tips of the fingers should be dipped in cold cream, and then, pressure being exerted by them, the skin of the forehead should be deeply stroked from the middle line out over the temples. The nose should be stroked from the bridge outward and downward. The skin of the cheeks should be pinched up and rolled between the fingers and thumb. All these movements facilitate the emptying of the follicles. In case of black points, the too frequent squeezing out of the contents must be guarded against; also the too strong pressure of the fingers. These are often so deeply implanted in the skin that very strong pressure is neces- sary, but when the pressure is too strong, inflammation and suppuration may result. The extremity should first be opened by a very fine-pointed lance, which must be sterilized before using, and then a hollow key is placed over the pimple and gently pressed down over it. Through regular and even pressure over the sides the little worm- like mass is quickly pressed out. If these procedures are not sufficient, more heroic measures must be resorted to. Some of the skin specialists, believing that acne is of parasitic origin, use antiseptic remedies, and, instead of ordinary toilet soap, recommend the use of the officinal green soap or the tincture of green soap. After the use of this, the parts are to be thoroughly rinsed and sponged for five or ten minutes with water as hot as can be borne and wiped dry. When the skin is oily or sluggish, after washing, the face should be mas- saged by going over the parts with a small cupping glass. THE CARE OF THE SKIN AND ITS APPENDAGES 65 witli an opening of about 1 inch. This not only massages the face, but tends to empty the ducts. The face is again washed with soap and hot water, rinsed off with hot water, and is then dashed for a moment or two with cold water and wiped dry. After this the remedial application is made. These procedures are best carried out at night. In the morning tepid water is used to wash the face. The following preparations will be found to be effective in many cases. Take of the sulphate of zinc and the sulphuret of potassium, each, 1 dram; glycerin, 10 drops, and water, 4 ounces. If any irritation or scaliness results, the remedy should be intermitted for one or two nights and a good cold cream used instead. For freckles and liver spots the following prescriptions wiU be found useful: Take of powdered borax, 1 dram; of the hyposulphite of soda, 2 drams, and dissolve in 4 ounces of water. This should be applied after washing the face with hot water. The wash may be applied with the fingers or with absorbent cotton; it is to be immediately followed by this powder. Take of the oleate of zinc, 2 drams, and of the oxid of zinc, 1 ounce. This must be well mixed and powdered finely. It should be applied with absorbent cotton, while the skin is still moist from the use of the wash. This covers the face with a mask, and should be used at night only. As both of these appli- cations are astringent, their use must not be kept up for too long a time, or the skin will become dry and rough. They are very effective where the skin is greasy. For an obstinate case of freckles or liver spots the fol- lowing is recommended: Take of the corrosive chlorid of mercury, 6 grains; of the oil of lavender, 10 drops; of alcohol, 1 ounce; and of glycerin, 2 ounces. Mix well, and apply at night. For hyperidrosis, or profuse sweating in the axilla, of the feet or hands, take of salicylic acid, 15 grains; of starch, i dram; and of talcum powder, 1 ounce. Mix well, and dust over the parts night and morning. 5 66 PERSONAL HYGIENE FOR WOMEN Eczema is such an obstinate affection that the patient should at once seek the advice of a good physician; for the longer the disease lasts, the more difficult its cure becomes. Removal of Superfluoiis Hairs. — One of the best depila- tories consists of the sulphid of barium, 2 drams; the oxid of zinc and starch, each, 3 drams. Mix these well, and keep tightly corked. At the time of the application suffi- cient water is added to make a paste, which is thickly spread over the part and allowed to remain on for a min- ute or two. It is then washed off and a Httle soothing ointment applied. A variable amount of redness follows; the object is to allow the paste to remain on long enough to destroy the hair, and, at the same, to limit the resulting irritation. Ordinarily, a shght burning or sensation of warmth is an indication that the paste has been on long enough. The application is repeated as soon as the hair reappears — about every one or two weeks. Peroxid of hydrogen may be used instead for its bleach- ing properties, especially in patients with a dark growth. It should at first be diluted with equal parts of water and the strength gradually increased. A piece of cotton is wet with the solution, and applied to the region to be treated and left in place for several minutes. The pro- cedure is repeated daily until the desired result is obtained. The hair gets lighter and lighter in color and finally disap- pears. Of course, the hair follicles are not destroyed, so that the hair will grow again, necessitating another course of treatment. For the removal of large stiff hairs, electrolj^sis is the only safe and sure method, and no one but an experienced operator should be allowed to do this. Never use an ointment on the face that contains vaselin or lanolin, but particularly the former, as they are both apt to produce a growth of hair, but these preparations are excellent to increase the growth of the eyebrows. Wrinkles. — In very many cases wrinkles are the result of habit of expression, as in scowling; or an expression of THE CARE OF THE SKIN AND ITS APPENDAGES 67 dejection, when the angles of the mouth curve downward, and so forth. There are twenty-eight muscles about the mouth. Since all these muscles are developed by use, the mouth comes to assume the expression given to it by the thoughts of the individual. The figurative expression, " down at the mouth," comes to be literally true, and the angles of the mouth are seen to be habitually drooping, until at last this is the fixed expression of the face. A healthy frame of mind is the only means to keep the face from Fig. 3. — Muscles of the right side of the head and neck. being converted into a map of wrinkles and drooping angles at the mouth. The wrinkles are not, as a rule, caused by any trouble in the skin itself, but in the underlying muscles, the tissues of which have become relaxed or weakened. The circulation of the parts may be stimulated, and so in- creased nourishment be secured by deep massage of the muscles, and, at the same time, the use of a good cold cream will aid in the nourishment of the skin. The face should first be washed and steamed according to the directions already given. The massage of the face I 68 PERSONAL HYGIENE FOR WOMEN should always be carried out in a systematic manner. Begin with the forehead. Stroke with the two thumbs over the forehead, starting near the eyebrows, and work out toward the roots of the hair. In the second move- ment one hand is used to stretch the part worked upon, while deep friction is made with the tips of the fingers of the other hand. For wrinkles about the eyes, stroke with the tips of the fingers, over and below the eyes, from the nose toward the temples. Great care must be taken not to apply too much cold cream about the eyes, lest some of it should get into them. For the removal of the " crow's feet" at the outer angle of the eye stretch the part with the thumb and finger of one hand, and perform friction with the tips of the fingers of the other hand. To remove the lines that run from the corners of the nose to the angles of the mouth, stroke with both hands, one on each side of the face, beginning at the center and lower part, and stroke upward toward the temples. This up- ward motion counteracts the drawn and pulled-down condition of the face. For the cheeks, use both friction and deep kneading; pick up the muscles between the thumb and finger. To remove wrinkles under the chin and a double chin, begin at the middle line, and with both hands make deep pressure upward and outward. To remove superfluous fat, make deep friction with the tips of the fingers. In the latter case, only use enough cocoa-butter on the fingers to prevent the friction against the skin. The benzoin preparations, already given, will help to contract the tissues. A cold cream which is a good skin food is the follow- ing: Take of the oil of sweet almonds, 2 ounces; of sper- maceti, I ounce ; of white wax, J ounce ; and of rose-water, ^ ounce. Melt together at a moderate heat, the oil, spermaceti, and wax, then gradually add the rose-water; stir the mixture briskly and constantly until it is cool, and continue the stirring until it has become uniformly THE CARE OF THE SKIN AND ITS APPENDAGES 69 soft and creamy. The Dover egg-beater will give it the desired creamy appearance. The Hair. — From an esthetic point of view, a head of luxuriant hair is a matter of prime importance to the woman. The hairs are peculiar modifications of the epidermis. The hair follicle is a cylindric-shaped depression of the skin, whose fimnel-shaped mouth opens on the free sur- face. Immediately below this is a constriction^ called the neck, which is the narrowest part of the follicle; the duct of the sebaceous gland, which suppUes the hair with oil, opens at this point. The base of the follicle is bulb-shaped, to accommodate the hair-papilla and the hair-bulb. The hair-papilla contains the blood and nerve supply for the hair. When a hair is plucked or falls out, a new hair grows from the hair-papilla. According to Pincus, the life of a hair ranges from two to six years, after which it falls out, to be replaced by a new one. In this way about fifty or sixty hairs are nor- mally shed every day. In order to have thick, luxuriant, silky hair great atten- tion must be paid to the condition of the scalp, since it is the scalp which contains the blood-vessels that nourish the hair. The scalp should be thick and pliable and move freely over the bones of the skull. If the scalp is drawn tightly over the bones of the skull, it tends to constrict the blood-vessels, and so lessen the supply of blood to the scalp and cause atrophy of the roots of the hair from pres- sure. The hair has a great tendency to accumulate dirt. It catches the dust flying in the air, and also retains the secre- tion of fat and the desquamated epithelium of the scalp and the products of perspiration. The two chief causes of the premature thinness of the hair are a deficient circulation of blood in the scalp and dandruff, and it is said that dandruff causes the loss of hair in 70 per cent, of all cases. Dandruff. — The last few years has witnessed a revolu- 70 PERSONAL HYGIENE FOR WOMEN tion in the views of the skin speciaHsts in regard to the cause of dandruff. Previous to that time it was consid- ered as simply a collection of epithelial scales mixed with more or less oily matter. Now, following the investiga- tions that were first instituted by Unna, dandruff is con- sidered as a symptom of a parasitic disease of the scalp, called seborrheic eczema. Sabouraud believes that the same parasite that produces seborrhea causes the loss of hair. It is believed that the parasite grows down into the hair follicle, between its walls and the hair. Seborrheic eczema is a chronic desquamative inflam- mation of the scalp of bacterial origin. It is divided into two stages: the first may last from one to seven years; it is attended with more or less dandruff in the form of scales and dryness of the hair; or the dandruff may unite with the oil, producing fatty crusts which are removed with difficulty. This is followed by the second stage, in which the hair falls out. Symptoms of Seborrheic Eczema. — In the dry form of the disease, in which there is a scaling of the scalp, the hair is dry and unmanageable, the head itches, especially when the patient sits under a light or becomes overheated. There is a more or less constant falling of the scales upon the clothes. The scalp looks pale, and will be found covered with fine grayish or yellowish, readily detachable scales. Sometimes there is more or less redness of the scalp. This is the mildest grade of the disease. That dandruff is contagious has been proved by experi- ment, experience, and treatment. Lassar and Bishop made a pomade of the scales taken from the head of a student who was suffering from this disease, and rubbed it into the backs of guinea-pigs, which caused the same dis- ease in them, and falling out of the hair. Cases have been reported in which husband and wife have contracted dandruff after marriage, he or she having been free before. The drugs that are most efficacious in the cure of seborrhea are active antiparasitics. THE CARE OF THE SKIN AND ITS APPENDAGES 71 Causes of Seborrheic Eczema. — The general causes are debility, constipation, and anything which undermines the general health. The local causes are lack of cleanliness of the scalp, and using combs or hair-brushes which have been used on the scalps of persons who were suffering from this disease. In most families will be found one or more mem- bers who possess enough seborrheic infection to cause the spread of the disease throughout the rest of the household. Causes and Treatment of Premature Thinness of the Hair and Baldness. — It has already been stated that 70 per cent, of these cases were caused by seborrheic eczema. Among other causes may be mentioned a pro- gressive tightening of the scalp upon the skull, the scalp having lost the cushion of fat that is under it in early life ; insufficient or improper care of the scalp ; daily sousing of the head in cold water, combined with improper drying of the hair afterward; sweating of the head; constant mental strain, either on account of intellectual work or worry; wearing stiff, unyielding hats; gout, and aU diseases which lower the general nutrition. The chief treatment is by prophylaxis, or using pre- ventive measures to insure the healthy condition of the scalp. And first and most important of these is cleanli- ness. Because of the great length of time which it takes to dry long, thick hair, many women do not wash the scalp often enough. In the healthy state of the scalp it should be washed at least once a month. The Care of the Hair. — There is never any danger of shampooing the healthy scalp too frequently. The oil in the scalp is not removed by washing, but is, on the con- trary, always increased through the improvement in the circulation. Where there is much dandruff, or if the hair has begun to fall out prematurely, owing to long neglect or following an illness, it is well to begin by washing the hair two or three times a week, and then gradually in- crease the interval to every two or three weeks. 72 PERSONAL HYGIENE FOR WOMEN Borax in the water cleanses the scalp well, but its con- tinuous use is injurious; the same may be said of am- monia water. One of the best shampoos is the tincture of green soap. If this cannot be obtained, take of the official green soap 2 ounces, and of alcohol, 1 ounce; mix well, and make shampoo. One ounce of the tincture or its substitute should be diluted with twice as much water and applied to the scalp with the tips of the fingers. When enough of the shampoo has been used, add sufficient water to make a good lather. This must be thoroughly rubbed into the scalp, going over the whole systematically. After the scalp is cleansed, the soap must be well rinsed out of the hair. This may require many changes of the water, but it is most important. Dry the hair with hot towels, the process being completed by a radiator or stove oven. Fanning the hair will hasten the process very consider- ably. The hair should then be loosely braided and a hot towel wound around the head to insure perfect dryness of the hair and as a prevention against taking cold. One hour is sufficient for the entire procedure. In winter the hair should be washed just before retiring. Brushing the Hair. — Brushing increases the growth of the hair by stimulating the circulation in the scalp and by removing the dandruff. To be effective, the hair should be well brushed at least once a day, when there must be a deep brushing of the entire scalp. The bristles of the brush must be stiff enough to warm, but not to scratch, the scalp. Brushing and massage remove any loose hairs that are ready to fall, but they wiU soon be replaced by new vigorous ones. Combing simply disentangles the hair. The teeth of the comb must be far apart and have rounded ends. In no case should a fine-toothed comb be used. It tears out the hair, and often causes an irritation of the scalp which leads to disease. From what has been said, it will be seen that every member of the family should have a brush and comb for THE CARE OF THE SKIN AND ITS APPENDAGES 73 her own exclusive use, and that no one should allow a public brush or comb to be used on her head. The brush and comb must be washed once a week in water containing a little ammonia; they must be well rinsed out in pure water; the brush should be dried quickly, with the bristles down. If the brush and comb are not cleaned sufficiently often, the scales of dandruff would be sufficient to reinfect the scalp. Massage of the Scalp. — The scalp should be thoroughly massaged every night. Grasp the scalp with both hands laterally, as well as anteroposteriorly, and with some press- ure loosen the tissues from the underlying parts and try to raise it in folds, or it may be pinched with the forefingers, producing some vascular flux and a sense of warmth. Stelwagon recommends the use of electricity two or three times a week, by means of a metallic brush attached to a faradic battery. If the scalp is too dry, nothing is better than pure vaselin, though some persons prefer olive oil, applied by means of a dropper. The yolks of eggs beaten up with lime-water make an elegant shampoo. For the cure of dandruff, the following prescription will be found to be of great service. Take of resorcin, 2 drams; of grain alcohol, 3 drams; of glycerin, f ounce; and of rose-water, a sufficient quantity to make 4 ounces. This should be applied to the scalp with the fingers every night before the massage of the scalp. Since resorcin sometimes undergoes a change of color that gives to light, gray, or white hair a dingy, or dirty yellowish color, this may be obviated by the addition of 10 grains of salicylic acid to the oimce of the solution. For an oily condition of the scalp with thinness of the hair the following is an excellent formula: Take of the carbonate of ammonia, 20 grains; of the tincture of can- tharides, 1 dram; of alcohol, | ounce; and of bay-rum, a sufficient quantity to make 4 ounces. This should be well mixed, and applied at night with a good massage to the scalp. 74 PERSONAL HYGIENE FOR WOMEN For dryness with thinness of the hair, take of the tinc- ture of cantharides and of the tincture of capsicum, each, li drams; of castor oil, 2 drams; and of cologne water, 1 ounce. Mix well and apply at night. Or a prescription containing more oil is the following: Take of the tincture of cantharides and of the tincture oi- cap- sicum, each, 2 drams; of cologne water, 1 ounce; and of olive oil, a sufficient quantity to make 4 ounces. Dressing the Hair. — Dragging or twisting the hair from its natural direction, pulling it into constrained or arti- ficial positions, and even twisting the hair very tightly is injurious to it. The curling iron acts by abstracting more moisture on one side of the hair than on the other. The stronger the hair, the more easily it will curl, and the longer it will stay curled. The daily use of a hot iron, notwithstanding the greatest care, will in a short time prove injurious; the hair is apt to become thin and fall out. Its growth is interfered with. The use of kid curlers is much less injurious, but even here the tight twisting of the hair around the kids is said to be harmful. Shell hair-pins are the best for the hair. If steel ones are used, the points must be smooth and the pins kept in good condition. When the hair is dressed for the night, after the scalp has been brushed and massaged, it should be loosely braided and left hanging down. Gutting the hair 1 inch, every two or three months, is said to promote the growth of the hair and prevent its splitting. It does not increase the number of hairs. There is no truth in the assertion that the hair is a hol- low tube, which allows the escape of oil, and that if the ends are sealed by singeing much good will result. Gray Hair. — Grayness of the hair may be either premature or physiologic. When the grayness is due to some temporary cause, as anxiety or some diseased state, the process may cease completely on the removal of the cause. Usually the whitening is permanent. The gray- THE CARE OF THE SKIN AND ITS APPENDAGES 75 ness of the hair is caused by obscure changes in the nutrition of the hair-papilla, which interfere with the production of the pigment. As a rule, the hair whitens first on the temples, then on the top of the head. The hair first turns gray at its root. The grayness is due to the loss of pigment. Prolonged residence in either a very cold or a very hot climate will cause the hair to turn gray. A yellowish tinge of the hair is sometimes seen in pa- tients with jaundice, or gray hair may owe its dull yellow color to the tint of dry albumin of which it is composed. The glitter of steel-gray or silver-white hair is due to the high refractive power of the minute air-bubbles that lie in the substance of the hair. Treatment. — The color caimot be restored to gray hair. The roots of the hair are embedded in the hair follicles, and cannot be reached by any fluids applied to the scalp. Not only is the use of hair-dyes to be deprecated as an exhibition of poor taste, which happily is going out of fashion, but the use of hair-dyes is extremely dangerous. Cases are being constantly reported by physicians, where the use of these supposedly simple vegetable hair-dyes has been followed by very serious and extensive derma- titis of the face, neck, and shoulders. Gray hair is really very beautiful when it is of silvery whiteness, and very ugly when it is of a yellowish-white color. It must be treated with much greater care, in order to preserve its silvery whiteness, than was neces- sary to keep the hair in good condition before it lost its coloring pigment. It should never be wet, except when it is shampooed. For this reason, instead of using hair- curlers, crimping pins should be used. In this way the hair is waved quite as weU and the use of water is avoided. The Cosmetic Care and Treatment of the Hands. — Of all the members of the body, next to the face, the hands have the most expression, and serve as an index of character and refinement. Not only should the most scrupulous attention be given 76 PERSONAL HYGIENE FOR WOMEN to having clean hands and nails, but every precaution should be taken to keep the skin soft and the nails care- fully manicured. This is quite possible for the housewife, simply by wearing rubber gloves while she does her work. It preserves the fine sense of touch in the fingers, which aids in sewing and embroidery, at the same time that it adds much to the beauty of the hands. Chapped Hands. — ^To prevent chapping of the hands in cold weather heavy gloves must be worn or a muff carried. Another aid in the prevention of the skin of the hands from becoming rough and chapped, and the best means for curing them if this has occurred, is by the use of a good cold cream at night, just before retiring. The cold cream should be well rubbed in the skin, espe- cially about the finger-nails, and after this talcum powder be dusted over. This forms a thick covering for the hands, the talcum powder prevents the cream from being rubbed off on the bed-clothes, and, on getting up in the morning, the skin will be found to be soft. Only in case the hands are very badly chapped should old kid gloves be worn at night. Cosmetic of the Nails. — The physiologic function of the nails is to protect the tips of the fingers against pressure and to give them a firm support ; this increases the delicacy of the tactile sensations. The nails should be slightly curved from side to side, of a light rose color, and smooth surface. The lunula should be visible at the root of the nail. Brittleness of the nails is a defect, which causes them to tear easily; it is generally due to the condition of the general health. There is a natural tendency for the dirt to accumulate on the under surface of the nail, between it and the finger. This is not only unsightly, but it is often the cause of actual danger, as this forms a lodgment for the germs of disease. Not only is it necessary for doctors and nurses to give the most scrupulous attention to the care of the nails, but, when we learn that one cook has been the cause of spreading typhoid fever through a number of families, THE CARE OF THE SKIN AND ITS APPENDAGES 77 in her itinerary in going from place to place, we must be impressed with the necessity of more careful oversight being given to the hands of domestics and housewives who prepare the food. For the same reason, it is self-evident that the hands should always be washed immediately before going to the table, and cleaning the nails is always a finishing touch in the washing of the hands. For the purpose of cleansing the nails, an orange stick or nail-file should be used, and never the point of the scis- sors or the blade of a knife, for either of these causes a roughening of the under surface of the nails, whereby the lodgment of dirt becomes only the more securely fixed. After the use of the nail-file, the nail-brush should be used, followed again by the use of the file or stick. If there is a tendency to a roughening of the skin under the nail, it can be obviated by the use of cold cream at night. Just before retiring, the fingers should be dipped into cold cream, and let the tips take up just as much as they will retain, and after this dipped into talcum powder. The small rim of epidermis which laps over the nail should be gently shoved back with the orange stick every day. This skin, when torn, forms the so-called hang- nails, by which infection easily enters the system; it may give rise to felons or even to general blood-poison- ing. Warts. — These are unsightly blemishes on the hands. They may be removed by the systematic use of the follow- ing lotion: Take of salicylic acid, 1 dram; flexible collo- dion, 1 ounce. Mix well. This should be painted on the wart with a camel's-hair brush twice a day for two or three days, without removing the pellicle. At the end of that time the wart should be soaked in water and scrubbed with pumice stone. This usually brings away part of the homy covering. The treatment is continued until the wart has entirely disappeared. When the warts are small, they may often be removed by simply keeping them dry and applying boric acid. 78 PERSONAL HYGIENE FOR WOMEN The Care of the Feet. — In the care of the feet it must be remembered that the leather of the closely fitting boot allows very little ventilation, and so more attention must be paid to the airing of the feet as well as to their bathing. The feet should be bathed twice daily. On making the toilet for the evening dinner both shoes and stockings should be changed, the stockings hung up in the room, and the shoes left out to air and dry, instead of being stuffed into the shoe-bag, to remain there until the next morning. An alcohol rub will be found very refreshing to weary feet. For profuse perspiration of the feet, boric acid or talcum powder may be used, dusting the powder over the feet both night and morning. Ingrowing Toe-nails. — The common causes of ingrowing toe-nails are improper foot-wear and an improper method of cutting the nails. If the nail is cut too short, especially at the angles, while at the same time the shoe is too short or too narrow, the skin of the toe is forced over the nail, so that it necessarily happens that, by the further growth of the nail, the flesh of the toe is pushed still further over, until a point is reached where inflammation is set up. There is excruciating pain, which may be accompanied by the formation of a small tumor, which forms pus and may go on to granulation — the so-called "proud flesh." The preventive measures of the trouble are, first, in cutting of the nails. The toe-nail should be cut in a con- cave form, the outer angle projecting be^'^ond the toe. If there is a tendency for the flesh to grow over the nail, the flesh should be pushed back from the nail, and fast- ened in this position with a strip of oxid of zinc plaster, and a gauze packing should be inserted under the nail- edge. A saturated solution of boric acid serves as an antiseptic dressing. It is often possible to cut off the projecting nail, and, by the use of the boric acid dressing, the trouble disappears in a few days. Attention should always be given to the toe-nails when bathing. Corns. — There are two varieties of corns; both are very THE CARE OF THE SKIN AND ITS APPENDAGES 79 painful. Soft corns come between the toes, and unless absorbent cotton is inserted to prevent the rubbing of the toes together, a second com appears on the opposing sur- face of the adjoining toe. A very effective remedy for this is the application of blue-stone, or sulphate of copper, to the com. The stone is moistened in water and then applied thoroughly to the com; absorbent cotton should be placed between the toes. In very severe cases it may be necessary to stay off the feet for a few days and keep the foot upon a chair. Hard corns must be cut down with the greatest care. It should be done directly after the bath, so as to have the skin in as nearly an aseptic condition as possible. A small scalpel, composed entirely of steel, should be kept for this purpose. It must be thoroughly cleaned after it is used, and just before its use be sterilized by boiling for five minutes. The reasons for these precautions are the pos- sibility of cutting into the flesh and setting up blood- poisoning by the entrance of germs into the wound. After the com has been cut down, an application of the following prescription will hasten its disappearance. Take of the extract of cannabis indica, 15 grains; of salicylic acid, 1 dram; and of flexible collodion, 1 ounce. Mix well, and apply by painting over with a camel's-hair brush. The application should be repeated every night. CHAPTER III THE DIGESTIVE SYSTEM AND THE MAINTE- NANCE OF GOOD DIGESTION The Digestive Tract; the Care of the Mouth and Teeth; Diges- tion a Chemical Process; Digestion in the Small Intestines; the Microorganisms of the Alimentary Canal; the Importance of a Varied Diet; Classification of Food-stuffs; Tea, Coffee, and Cocoa; the Temperature of Foods and Drinks; Factors which Favor Good Digestion. Over-eating; Dietary in Sedentary Occupations; Heart Failure and Other Ills as the Result of Chronic Underfeeding; the Causes of Indigestion; the Symptoms of Indigestion; Intestinal Indigestion; Biliousness and Bilious Attacks; Ptomain Poisoning; Diet in Indigestion; Treatment of Acute Diarrhea; Chronic Intestinal Catarrh; Constipation and Mental Troubles; Treatment of Consti- pation. The Physiologic Action of Moderate Doses of Alcohol; the Effect of Alcohol on the Muscular System; the Effect of Alcohol on the Nervous System. The activities of animals are carried on by a certain expenditure of energy, which is set free as the result of a chemical breaking down of the living tissues of the body. In order to maintain the equilibrium of the body, this waste must be replaced by new material, which is taken into the body in the shape of food and drink. In the human body the digestive processes are brought about by mechanical disintegration; by the action on the food-stuffs of acid and alkaline fluids; by changes produced by active substances called ferments; and, lastly, decom- position is produced by the growth of microorganisms. The digestive tract, or alimentary canal, begins at the mouth and ends at the anus. It consists of the mouth, the esophagus or gullet, the stomach, the small and large intestines. Two large glands, the liver and pancreas, pour their secretions into the small intestine to aid in the di- 80 THE DIGESTIVE SYSTEM AND GOOD DIGESTION 81 gestion of foods. The alimentary canal, liver, and pan* creas together constitute the digestive system. Salivary, glands Duodenum- Large intes* tine Vermifonn appendix Salivary (parotid) gland Thoracic or chyle duct Esophagus Lacteals Small intes- tine Rectum Fig. 4. — General scheme of the digestive tract, with the chief glands opening into it (Stockton). The contraction of the muscular walls of the digestive tract is the propelling power that carries the food down- ward, while the contractions of its pouch-like dilatation^ the stomach, cause churning movements that bring the 6 82 PERSONAL HYGIENE FOR WOMEN food into contact with its secretions. These movements are known as the mechanics of digestion. The digestive tract is lined throughout its entire course by mucous membrane; that lining the mouth gives some idea of its character. It is from the mucous membrane lining the stomach and small intestines, as well as from the liver and pancreas, that the digestive juices are poured into its cavity. In passing downward the food meets with five different digestive fluids: the saliva in the mouth, the gastric juice in the stomach, and the bile, pancreatic, and intestinal juices in the small intestines. Each digestive fluid acts only on some particular kinds of food. This action of the digestive fluids on food is called the chemical part of diges- tion. To-day, when it is known that so many of the diseases of the body are caused by germs, it is evident that the greatest care must be exercised in the selection of foods, in their preparation, and in the care of the intestinal tract. The Care of the Mouth and Teeth. — The first stage of digestion takes place in the mouth. It is here that the food is ground into fine particles by the act of mastica- tion, so that it can be more easily and more quickly acted upon by the gastric juice. It is of the first importance that the mouth should be kept clean and as nearly aseptic as possible ; for, as the food is roUed about in the mouth in the process of mastication, it is obvious that it will carry all germs and mucus with it into the stomach. A nasal spray, containing some solution of an alkaline and antiseptic nature, should form an essential part of the toilet of the mouth. The Teeth. — From simply an esthetic point of view, well-kept teeth are beautiful, and greatly enhance the charm of the face. But the proper care of the teeth is also essential to good digestion and good health. In perhaps the majority of people the teeth are suffi- ciently far apart for small particles of food to become lodged between them. If not very promptly removed, THE DIGESTIVE SYSTEM AND GOOD DIGESTION 83 the heat and moisture of the mouth, actmg on these small particles, cause their decomposition and set up acid fer- mentation in the mouth, and it is this acid which causes the decay of the enamel and finally of the teeth. The decayed tooth gives still further lodgment to particles of food, and these, left to decompose, give rise to the most offensive gases, giving fetor to the breath, poisons the blood, and so injures the digestive and nervous systems. WTiere possible, a tooth-pick and dental floss should be used immediately after each meal, the waxed dental floss between the teeth, and the curved end of the tooth-pick being used to remove any particles that may have worked in about the roots of the teeth and gums. A tooth-brush with good tooth-powder should be used twice a day. The brush should not be too broad, and is better if slightly curved. The bristles should not be too hard. The use of tooth-powder, which must be very fine, or tooth-paste, is needed to produce sufficient fric- tion to clean the teeth well. Warm water is a better solvent than cold, and, therefore, it is well to use it for cleansing the teeth. T\Tiile it is generally known that decay if neglected will destroy a tooth, it is not so well known that many teeth are lost as the result of the accumulation of tartar at the gum margin. There is a tendency to this accumulation, especially about the necks of the lower incisors and upon the teeth that are not used in chewing. The deposit of tartar encroaches upon the neck of the tooth, presses upon the gum; the latter becomes irritated or inflamed, and recedes from the tooth ; malnutrition and loosening of the tooth follow. With very imperfect or decayed teeth proper mastica- tion is impossible. The teeth should be examined by a good dentist twice a year, so that small cavities shall be discovered in an early stage, the tartar removed, and the teeth kept in their best condition. This will prevent the early loss of the teeth. Lost teeth must be replaced so that the teeth shall be 84 PEKSONAL HYGIENE FOR WOMEN opposite each other, and another important factor in mastication is that the teeth shall strike properly. Digestion a Chemical Process. — Briefly stated, the process of digestion consists in the liquefaction of the Fig. 5. — Location of the viscera of the body and their relation to each other: D, D, Lungs with air expelled; E, E, diaphragm cut away to show, F, liver cut to show stomach; 2, gall-bladder; H, H, large iatestine; K, small intestine; L, vermiform appendix (after Heath). solid portions of the food and the conversion of the in- soluble parts into soluble. The last named is accom- plished through the action of the digestive ferments. THE DIGESTIVE SYSTEM AND GOOD DIGESTION 85 The work done in the alimentaiy canal is comparable to that done in a chemical laboratory. In order to effect the necessary changes in the foods, and render them of use in the body, there are secreted daily about three pints of saliva, twelve pints of gastric juice, two or three pints of bile, one pint of pancreatic juice, and a large amount of intestinal juice. Altogether the amount of fluids poured into the ali- mentary canal in the twenty-four hours is much more than the whole of the blood in the body; and, moreover, it is probable that every portion of the blood passes several times into the alimentary canal during this period. In other words, there is constantly going on in the body between the blood and the products of digestion a great ebb and flow; new substances are taken up by the blood for the repair of the tissues, and the worn-out substances are thrown off. The mouth is the only portion of the digestive canal which is under the control of the will. When the food is finely divided, it presents a much larger surface for the action of the gastric juice, and so the time that it remains in the stomach wiU be very much shorter than when it is swaUowed in large chunks, and the very act of chewing increases the secretion of saliva. The saliva not only protects the mucous membrane of the mouth, but it keeps it free from all food-particles, which, if allowed to remain, would decompose, and thus injure the teeth by the action upon them of the acids produced. It also moistens the dry food, aids in the process of swallowing, and has some action on the starchy substances of the food. By the process of mastication then the food is divided into small particles and thor- oughly admixed with the saliva, until the whole is con- verted into a fine pulp. The secretion of saliva is a reflex one, and is increased by the sight, smell, or thought of savory viands; and it may be almost wholly suppressed by a state of mental anxiety. Movements of the jaws without anything in the 86 PERSONAL HYGIENE FOR WOMEN mouth will also cause a flow of saliva. Besides favoring the mechanical part of digestion and its slight chemical action on starchy foods, saliva, being an alkaline fluid, is a distinct stimulation to the secretion of the gastric juice. Fletcher has greatly emphasized the necessity for thor- ough mastication. He holds that food should be masti- cated until reduced to a state of liquefaction ; by this means he declares that a smaller amount of food is necessary to maintain the health and efficiency of the body. After the food has been reduced into a pulp in the mouth, and the change of the starches into sugar has begun, it is swallowed, and passes into the next compartment of the digestive apparatus, namely, the stomach. The stomach may be felt at the lower extremity of the breast bone, in the triangular space caused by the di- vergence of the ribs. It is a large, hollow, compound gland, the walls of which contain muscle-fibers in addition to the tubules which elaborate the special secretion. Its cavity is lined with a thick mucous membrane, packed with tubular glands, and into which is being continually poured out a complex secretion, which is called the gastric juice. The purpose of this secretion is to act still further upon the food, and this is assisted by the churning move- ments of the stomach, designed to secure an intimate admixture of the food with the gastric juice. The first flow of the gastric juice is set up by the sight, taste, or smell of food, by a reflex mechanism similar to that of the saliva. The three principal active agents of the gastric juice are hydrochloric acid, pepsin, the proteo- lytic ferment, and rennin, the milk-curdling ferment. Gastric Digestion. — Gastric juice does not dissolve and chemically change all the food that enters the stomach, but acts only on that class of food called proteids. Pro- teids form the bulk of all meat, and are found in large quantity in eggs and milk. The new substance that is formed by the action of the gastric juice is highly diffus- ible, that is, possesses the power of passing through animal THE DIGESTIVE SYSTEM AND GOOD DIGESTION 87 membranes, and does at once pass into the veins and lymphatics of the stomach. While these changes are taking place the thick, turbid, grayish-looking liquid is from time to time ejected from the stomach, accompanied by even large morsels of solid, less digested matter. This may occur within a few min- utes of food having been taken, but the larger escape from the stomach does not begin till from one or two, and lasts from four to five hours after meals, such pieces as most resist the action of the gastric juice being the last to leave the stomach. The movements of even a full stomach are said to cease during sleep. During the intervals of digestion the stomach is quiescent and empty. An important role is played by the nervous system over the digestion of food, and a very practical point is that the secretion of gastric juice may be wholly arrested by any violent emotions. In the presence of healthy gastric juice and the absence of any nervous interference, the question of the digestibility of any food is determined chiefly by mechanical conditions. The more finely divided the material, and the less the proteid constituents are shelt- ered by not easily soluble envelopes, the more rapid the solution. Briefly, then, the work done in the stomach is that meats and allied substances are dissolved and transformed into a substance that is capable of passing through mem- branes, and does pass into the blood at once. If large quantities have been eaten, the surplus passes into the intestines, where its digestion is completed. Envelopes containing starches and fats are dissolved, setting these bodies free. The fats are melted by the heat of the stom- ach and tend to run together in large drops, forming an imperfect emulsion. As a general rule, one hour is the time required after an ordinary meal for the first portion of the gastric contents to pass into the small intestine. The process goes on for a considerable length of time, the pylorus opening in a rhythmic manner every five or ten minutes, until all the 88 PERSONAL HYGIENE FOR WOMEN stomach-contents have passed through. The larger the meal and the more solid the contents, the longer the process takes. Of aU the bodies which make up the food, fat is the last to leave the stomach. m-^ Fig. 6. — ^The ribs removed, showing relation of thoracic to ab- dominal viscera: A, Trachea; B, heart; C, C, lungs; D, liver; E, stomach; F, small intestine; G, large intestine; H, bladder (after Masse). Digestion in the Small Intestine. — Digestion is completed in the first portion of the small intestine, called the duodenum. This forms a kind of U-shaped tube; the degree of distention of this tube seems to have THE DIGESTIVE SYSTEM AND GOOD DIGESTION 89 some effect in the emptying of the stomach: so long as the duodenum is full, no further escape of food from the stomach takes place. When the partially digested food or chyme passes into the duodenum, it mixes with the bile, the pancreatic, and intestinal juices which it finds there. The bile arrests the action of pepsin ; it assists in emulsi- fying the fats and in their absorption; it exerts an anti- septic action on the contents of the intestinal canal; it moistens the coats of the intestines, and assists in giving the feces their normal amount of water, without which they cannot readily be evacuated. It thus acts as a natural laxative and increases the peristaltic action of the intestines. The second action upon the food in the intestine is that of the bicarbonate of soda contained in the pancreatic and intestinal juices, which neutralizes its acidity, and pancreatic digestion can only take place in an alkaline medium. Pancreatic juice is remarkable for the power it possesses of acting on all food-stuffs, starches, fats, and proteids. It contains four ferments — trypsin, which acts energeti- cally on the proteids which have passed from the stomach unchanged; a diastatic ferment, called amylopsin, which converts starch into sugar; a ferment which acts upon fats; and another ferment, which acts upon milk, curdling it. It is probable that when proteids are taken in excess they undergo pancreatic digestion, and it is quite possible that this pancreatic digestion of an excess of proteids is accompanied by a considerable development of bacteria and other organized bodies, which create trouble by in- ducing fermentative changes in the accompanying sac- charine contents of the small intestine. The digested substances pass directly from the small intestine into the lymphatics and blood-vessels. Since the amount of secretions from the small intestines is almost as great as the amount of absorption from it, the contents remain hquid throughout its course. The nutri- 90 PERSONAL HYGIENE FOR WOMEN tive elements are all absorbed before the large intestine is reached. Here, owing to the absorption of water, the contents become converted into solid feces, which shift in color from a bright orange to a dirty brown. When the bile is cut off from the intestines, the feces become clay-colored and constipation results. When digestion ceases, there is a cessation of contrac- tions, and the mucous membrane, which was deep red and congested, now becomes grayer, and the whole intestine is restored to a condition of repose. The Microorganisms of the Alimentary Canal. — Large numbers of bacteria flourish in the mouths of all animals, especially around the base of the teeth, and form a large part of the tartar. In the great majority of cases uncooked food contains a large number of microorganisms. Raw food, especially that which is green, carries with it into the alimentary canal a large number of bacteria. Also meats, which have been kept too long, and foods which have been in- sufficiently preserved, contain a large number of fungi, which are thus introduced into the body. Thoroughly cooked food, eaten hot, carries with it into the body very few bacteria. The normal mucous membrane of the intestines ap- pears to constitute one of the bulwarks which defends the animal organism from outside infective agents. The Importance of a Varied Diet. — It is known that for a healthy adult a mixed diet is essential, and a very important fact, which has only recently been discovered, is that habits of digestion may be formed; that is, each food only calls forth a supply of those ingredients of the digestive juices especially required for its own digestion. For instance, if the child is encouraged to avoid fats, he may ultimately lose the power of producing secretion especially suited for the digestion of fatty foods, and may thus, with the best intentions, be unable to eat fats all the rest of his life, and so suffer from impaired nutri- tion. This is the more to be regretted as there is reason THE DIGESTIVE SYSTEM AND GOOD DIGESTION 91 to believe that the inability to digest fats renders one peculiarly liable to become the victim of tuberculosis. Classification of Food-stuffs. — There are five classes of food-stuffs: the organic, comprising proteids or albu- minous food-stuffs, carbohydrates and fats, mineral salts, and water. All vegetable and animal food, whatever their nature, and whatever their origin, are composed simply of repre- sentatives of proteids, carbohydrates, and fats. Proteids are a source of energy, and contribute to form and to keep up the primary active protoplasm of cells and their accessory or inactive constituents. Fats are also sources of energy and may supply a portion of inactive material composing cells. Carbohydrates have a similar function to that of fats. The mineral salts are not pro- ducers of energy in the body, but are indispensable, both for the active or protoplasmic part and for the inactive framework of the cell. Water acts as a general solvent, and is a necessary agent for the various metabolic proc- esses. Proteids, water, and mineral salts are absolutely neces- sary for the preservation of the life of animals. Proteid substances can be so altered in the body as to supply both the fats and the carbohydrates when required. Fats and carbohydrates alone are not sufficient to support life, but, if these two classes of foods be given along with proteids, they diminish the amount of albuminous food necessary. Animal food is believed to make the blood richer in fibrin and corpuscles and to increase the mineral salts, especially the phosphates. It makes the muscles firmer than they were under a vegetable diet, and it favors the reduction of superfiuous fat. It increases the urates and urea, and tends to make the fluids of the body more acid. It increases the functional activity and the resist- ing power of the body. On the other hand, an increased animal diet necessitates an increased amount of oxygen for its proper burning up in the system. Meat is more 92 PERSONAL HYGIENE FOR WOMEN stimulating and strengthening than vegetable foods, and gives rise to a feeling of energy. When meat-eating is not counterbalanced by a proper amount of exercise in the open air, an excess of waste matter is produced, which accumulates in the system and causes biliousness and an excess of uric acid, which may lead to rheumatism, gout, etc. The generally accepted estimate is that meat should form one-fourth and vegetables three-fourths of the diet. A man cannot perform more muscular labor on an exclusively meat diet than on one of starches, but he does require animal food to replace the general wear and tear of the muscular tissues; energy for muscular contrac- tions is provided by the non-nitrogenous foods or carbo- hydrates. Meats give strength, but the carbohydrates furnish the endurance which is needed for prolonged strain. The amount of food for the twenty-four hours has been estimated as rather more than one pound of fresh meat, one pound each of bread and potatoes, or their equivalent in other starchy foods, with a quarter of a pound of butter, lard, and suet, and three pints of water. But were these same articles of diet placed on the table every day, cooked in precisely the same way, the appetite would soon cloy, and the individual would be incapable of eating enough food to properly do the normal amount of work. So it becomes necessary that certain articles belonging to the same class should be varied from day to day, with the greatest possible variety in the preparation of the same dishes. Preparation of Food. — Fresh meats are highly nutri- tious, but, in order that the nutritive properties should not be lost in the cooking, they must be eaten " rare," that is, beef and mutton should be at least pink. A roast should be done in a quick oven, so that the albumin will rapidly coagulate on the surface and prevent the escape of the nutritive juices. Or, if the meat is THE DIGESTIVE SYSTEM AND GOOD DIGESTION 93 boiled, it should, for the same reason, be plunged into boiling water. On the other hand, in treating meats in order to obtain "stock" for soup, cold water should be used, and the tem- perature slowly raised, but not quite to the boiling-point, in order that as much as possible of the soluble ingre- dients may be extracted. Eggs are almost as nutritious as meat. They are most easily digested when soft-boiled or poached. Dry toast, finely broken up and mixed with a soft-boiled egg, aids in its digestion. Soft-boiled eggs are more easily digested than raw eggs, but raw eggs are less irritating to the stomach, probably because they are digested in the in- testine. Fresh Meats. — The breast of chicken, fresh beef, and mutton are among the most easily digested of the solid foods. Raw and rare meats are more easily digested than well-done meats; in other words, cooking lessens the digestibility of meats. Veal and pork are both very dijB&cult of digestion. Steak should be broUed and never fried; all fried foods are very difficult to digest. Milk is the most digestible of aU foods if consumed in a reasonable way. The addition of Vichy or lime-water renders the milk less liable to form tough clots, hence renders it more digestible. Boiled milk is more digestible than raw milk ; boiling increases the toughness of the curd, but it destroys all bacteria. Milk is a fluid only outside of the body; when it enters the stomach, it is converted by the rennin into a solid clot; the clot formed in the stomach of infants is much less firm and more easily digested. Anything which will prevent the formation of this clot will hasten its digestion. The milk should be sipped slowly, and not a tumblerful gulped down at a swallow. Bread or cracker, broken up in the milk, aids in its digestion; also the addition of equal parts of barley or aerated waters. Buttermilk and kumiss are more easily digested than cow's milk. A glass of milk is digested in about two hours. 94 PERSONAL HYGIENE FOR WOMEN Vegetables differ from aniraal food in containing a much greater proportion of material which, for man, is indi- gestible and much less nutritive material. Vegetables and fruits are both rendered more digestible by cooking. Cane-sugar, especially in strong solution, is an irritant to the stomach. The liver makes all the sugar that is needed in the system when none is taken in the food. In addition to this, all the starch that is taken as food is converted into sugar in the body. Many foods contain sugar, as honey, molasses, milk, raisins, dates, figs, and, indeed, all kinds of fruit. When sugar is taken in excess, it undergoes fermenta- tion in the alimentary canal, being converted into alcohol, carbonic and acetic acids. This fermentation and its products impede the work of the liver, make the system run with friction, prevent the elimination of effete products, and, after long-continued use, cripple all the processes of life. Butter suppUes to most people the largest amount of fat they take, but its use should be supplemented with the fats of fresh meat and of bacon. It is easily digested by most persons, except when it is rancid; it then causes dyspepsia and diarrhea. As a rule, it may be said that decomposing fats of all kinds disagree with the system. Common salt in moderate quantity is essential to the economy, but its excessive use is harmful. All highly spiced or seasoned foods should be avoided. Condiments improve the appetite, but they are irritating to the stomach, and should be eaten sparingly. Vinegar. — The acid of vinegar, being a fermentation acid, renders the digestion of many foods with which it is taken more difficult, while vegetable acids, such as lemon- juice and citric or tartaric acid, do not cause that ob- jectionable effect. Thus, cucumber salad, made with the vegetable freshly cut, w^hen dressed with vinegar, is so difficult of digestion as to be for many persons almost poisonous; whereas if lemon-juice is used instead of vine- gar in the dressing, it can be easily and comfortably THE DIGESTIVE SYSTEM AND GOOD DIGESTION 95 digested by the same persons. Vinegar retards salivary- digestion and the digestion of those carbohydrates with which it is combined. Tea, coffee, and cocoa all retard gastric digestion. Cocoa is the most nutritious. Both tea and coffee are pure stimulants. Coffee should never be taken more than twice a day, and the amount should be limited to one cupful of coffee at breakfast and a demi-tasse after dinner. Its well-known power as a brain stimulant leads to drinking it in excess; it then seriously interferes with digestion, and its continuous excessive use may lead to chronic dyspepsia and insomnia. The amount of harm done by tea depends to a great extent on the way in which it is made and the quantity which is taken. Tea improperly made is capable of doing so great an amount of harm to the digestive and nervous systems that emphasis must be laid on the necessity of making it properly. The Prcper Method of Making Tea. — The water should be freshly boiled ; the tea-pot heated, so that the water will be maintained at the boiling-point ; one teaspoonful of tea is allowed to the cup. The tea is measured out, put in the tea-pot, and the requisite amount of boiling water poured over it. It is then allowed to stand on the kitchen table, not the range, from two to three minutes, and should then be strained into the tea-pot for the table and served. Unless the tea-leaves are strained off, the infusion contin- ues for some time; this extracts the tannic acid and the bitter principles. In addition, the prolonged infusion dissipates the volatile oil, to which much of the fragrance of a good cup of tea is due. As it is almost impossible to have the requisite amount of care exercised in the making of tea in the kitchen, it is much better that it should be made on the table. Sugar detracts from the healthfulness of the beverage. Water constitutes about two-thirds of the weight of the body, so that water is both a tissue-builder and a food. 96 PERSONAL HYGIENE FOR WOMEN About 4| pints of water are given off daily in the form of the various excreta and exhalations, but, since about one- half of the solid foods taken consist of water, 3 pints of water taken as such is sufficient to counterbalance the loss. The Temperature of Foods and Drinks. — The ideal temperature of food and drinks is about that of the body itself. Gold food is difficult to digest, for it does not excite the stomach sufficiently, nor does it possess the stimulating properties of a hot meal. Extremes of temperature in foods should be avoided, as tending to produce local injury to the stomach; from 45° to 130° F. are probably the limits of safety. Drinks at a temperature of 122° F. are sufficient to wann the body, and a temperature of 45° F. is sufficient to cool it. In both extremes there is danger of exciting gastric catarrh. The temperature best suited to quench the thirst is from 50° to 70° F. Ices should be avoided, as they may cause dyspepsia, neuralgia about the heart, and even acute dilatation of the stomach. Factors which Favor Good Digestion. — The stomach acts as a reservoir, and renders the taking of meals pos- sible. The capacity of the stomach varies in different individuals; it contains from 2 to 4 pints of liquids, or about 2 pounds of solids. The process of digestion con- tinues from about four to five hours; by the end of that time the stomach is empty. This gives us a very useful hint as to the length of time that must elapse between meals. If a fresh meal is intro- duced into the stomach before it has had time to empty itself, the process of digestion is started afresh, and the stomach is robbed of the necessary rest between • two periods of activity. As a rule, three meals a day has been found to be the best arrangement, and there should be an interval of five hours between meals. If possible, dinner, which is the principal meal of the day, should be taken at the end of the day, after its work is over, so that comparative repose may be enjoyed after it. The meals must be served at THE DIGESTIVE SYSTEM AND GOOD DIGESTION 97 the same hour every day. The perfectly healthy woman should never take anything to eat between meals. Gentle exercise may aid digestion, while severe exercise, by diverting much blood and nervous energy to the mus- cles, would have an adverse effect. Sleep directly after a hearty meal is injurious and sometimes proves fatal, because there is a depression of the circulation, and the digestive processes may stop absolutely during sleep. The best employment after a hearty meal is frivolous conversation, which keeps the heart alive, without making too great demands on the brain. A hearty meal should never be eaten when one is ex- hausted or greatly fatigued. Half an hour's rest before dinner is a great aid to digestion. Certain conditions are imperative in order to maintain a healthy state of the digestive organs and of the body. These are both physical and psychic. A good caterer, a good cook, a cheerful frame of mind, and the proper leisure to eat the meal are all essential factors. The influence of the psychic on the process of digestion has not been sufficiently well understood. It is intimately bound up with the sensations of appetite and hunger. Appetite is the most powerful excitant of the gastric juice. Hence the importance for digestion of such im- portant aids to appetite as agreeable surroundings, a well- appointed table, and good cooking. A very practical point is that gastric secretions may be whoUy arrested by violent emotions. On the completion of a hearty meal, which has been eaten with the greatest relish, the arrival of a telegram containing the intelligence of the death of a friend or of a heavy financial loss causes the dinner to lay like lead on the stomach. This shows the important role played by the nervous system over the secretion of the digestive juices. Water. — With the proper mastication of the food there will be less desire to drink water during the meal; a glass of water should be slowly taken at the end of the meal. Water is not absorbed by the stomach, but passes 7 98 PERSONAL HYGIENE FOR WOMEN directly into the small intestine. A pint of hot water escapes into the intestiae in about three-quarters of an hour after it is taken. Hot water has a powerful stimulat- ing effect on the peristalsis of the stomach, and so is a very material aid to sluggish digestion. It should be taken one hour before meals, so as to wash out the stomach, and not to fill it up at the time the meal is taken. Water is a very dangerous vehicle for infection. The only sure method of rendering water harmless is by boiling. The addition of a little wine or even spirits does not destroy the germs. The mineral waters promote digestion, by causing an earlier and more abundant secretion of the gastric juice. Defecation. — The waste matter which collects in the lower bowel must be evacuated every day. Allowed to remain longer than this, the digestive system is clogged by the non-removal of worn-out material, and the blood is constantly absorbing matter which is poisonous to the body. Decomposition goes on without being suspected by the sufferer. Overeating. — It is generally recognized that mental efficiency is very dependent on bodily conditions. The question how best to maintain the body in its highest degree of efficiency becomes a vital one to every person. Professor Chittenden, of Yale University, one of the foremost physiologists of the day, as the result of scientific experimentation carried on, on himself, on professional men, on a group of university athletes, and on a squad of United States soldiers, reached the following conclusions: that men eat far too much, that incalculable energy is wasted by our bodies in getting rid of the surplus food, that overeating causes a host of needless ailments, and that better health, increased efficiency, and enhanced probabilities of longevity would certainly follow the general adoption of a dietary standard, calling for not more than one-half the proteid food which common custom has established as the general standard. He is convinced that we eat too much and that we eat too rapidly. THE DIGESTIVE SYSTEM AND GOOD DIGESTION 99 Obese patients grow fat because they overeat, but with a thorough mastication of the food their appetites would be satisfied with far less food than they have been ac- customed to eat and the superfluous fat would drop off. Thorough mastication is also useful to thin persons, who have been in the habit of bolting their food, and have gotten indigestion as the result. They eat less food under this system, but they get fat under it. When such an excess of proteids is taken into the body that it cannot be disposed of in the ordinary process of oxidation or burning up, there are solid chunks of unburned material that must be gotten rid of by the liver and kidneys, which is injurious to them. As a result, the liver and kidneys are overworked in their efforts to rake down the ash produced by the combustion of proteids within the body, and eventually are not able to dispose of the surplus; gastro-intestinal disturbances, bilious attacks, gout, rheumatism, and other diseases follow. The chief factors leading to overeating are the uses of wines and condiments at dinner and elaborate course dinners. The first two overstimulate the appetite, and the great variety offered by the latter tempt the appetite, and make it possible to eat more than one could if the bill of fare were more limited and simple. Dietary in Sedentary Occupations. — The important considerations in the question of a diet are what to eat, how to eat, and how much to eat. The appetite is not a safe guide in very many cases, because persons engaged in sedentary occupations, who take next to no outdoor exercise, are frequently in a run-down condition and have very poor appetites. It is not that the average woman eats too much, but that she does not eat the right kind of things. She eats too little fresh meat and eggs, and drinks too little milk. She eats very much too much sweets, in the form of pastry, cake, or candy, and the lunch is not sufficiently nourish- ing. The age and occupation of the individual are important 100 PEESONAL HYGIENE FOR WOMEN factors to be taken into consideration in making out the dietary. The following dietary has proved to be the most satis- factory for women having no occupation or a sedentary one. On it women have maintained good health, and many other women have recovered their health. Breakfast. — Fruit, bacon and eggs, breakfast hominy, rolls or toast and butter, a glass of milk, and one cup of coffee. The fruit may be any raw fruit in season, except apples or bananas; apples should always be cooked for breakfast, because they are more easily digested; bananas are too heavy and indigestible to be served for breakfast. Stewed prunes are good and especially laxative. Bacon is not a necessity, though it is an appetizer. Eggs may be served in any way, but they are most diges- tible if soft-boiled or poached. The hominy is boiled in water and served as a vege- table, with a little salt and butter, but no sugar. It will be noted that the cereal so generally served for breakfast is omitted. The only excuse for eating a cereal is plenty of sugar and good cream. The cream can be taken in the milk, and the amount of sugar used is apt to cause fermentation. The whole forms a coating over the walls of the stomach, which prevents the action of the gastric juice on the rest of the food. In addition to this, after the cereal is eaten the appetite is generally gone. It is difficult of digestion, and should only be eaten by those who take a great deal of outdoor exercise. Luncheon. — Hamburg steak, or a made dish from the meat left over from the previous day's dinner, creamed potatoes, stewed fruit, bread and butter, a glass of milk, and one cup of tea. Oysters served up in a variety of ways make an appetizing dish for luncheon. Dinner. — Soup should always be served except in very hot weather. A roast or other substantial fresh meat, two vegetables, a salad, fruit, or a made dessert with cake, a demi-tasse of coffee after dinner. A glass of water is THE DIGESTIVE SYSTEM AND GOOD DIGESTION 101 served with each meal; it should be taken after the meal is finished, and one glass is as much as should be taken. Vinegar should never be placed on the table, nor be used in salad dressings, for reasons which have already been given. For a French dressing, lemon-juice should be substi- tuted for vinegar. The following are the correct pro- portions: take one tablespoonful of lemon-juice, one tablespoonful of water, and two tablespoonfuls of oHve oil. Mix well, and pour over the salad just before serving. The greatest variety possible in the menu from day to day is advised, but not any greater variety for the daily meals than that given above. Heart Failure and Other Ills as the Result of Chronic Underfeeding. — A long-continued deficiency of food or improper kinds of food leads eventually to general malnutrition, anemia, and finally to failure of the heart itself. At first the muscles of the heart and cells of the brain are nourished at the expense of other struc- tures, from which a definite daily quantity is taken to provide their supplies of albumin, but there comes a time when these organs also suffer. DebiHty from underfeeding comes on so insidiously that it is often far advanced before being recognized by the sufferer. Frequently it is only by comparing the present condition with that of six months ago, and noting the greatly decreased power of endurance, that the woman realizes that something must be wrong. Further, this condition constitutes part of a vicious circle ; with the decline of strength, there is often a decline of appetite, which leads to a further loss of both, and a more or less decided collapse eventually occurs. This underfeeding may have occurred as a result of ignorance, or from an ill-advised dieting for disease, as, for instance, rheumatism or gout, or from poverty. An expression often employed by this class of sufferers is that they have "lost heart." It is believed by some authorities that this depressed feeling is caused by the 102 PERSONAL HYGIENE FOR WOMEN fact that the heart muscle is at last sharing with the other muscles in the general malnutrition. As a result of this, the heart probably fails and dilates, and is perhaps never again able to keep up the same blood-pressure, to produce the same muscular nutrition, and the former strength of muscle, nerve, and will-power. A nutritious diet and rest with massage are the best means to restore as far as pos- sible the ill effects of such a condition. Two points stand out boldly in this connection. In the first place, there must be sufiicient proteid food ingested to protect the organism from body loss; and, secondly, there must be a sufiicient heat value in the fats or carbo- hydrates to protect the body fat of the person and so prevent emaciation. In regard to the proteid require- ment, it has been found, by investigation, that about 300 gm. of meat per day is necessary. In this state of the system there is a weakening of the digestive organs; the more their nutrition fails through not eating, the less they are able to digest. This is often seen in dyspepsia, and the first step in the cure is to com- pel them to eat more. The tubercle bacillus seems to find a particularly favorable soil in ill-nourished persons. The association between bad feeding and scrofula is weU established, and an improvement in nutrition is often followed by their cure. Another danger of underfeeding is the effect on the mind. There is not only a lowering of the mental power, but a feeling of dissatisfaction, discomfort, depression, culminating sometimes in hallucinations and insanity, which imperfect nutrition of the mind is apt to produce. A hungry man is an angry man. Deficient diet, like all morbid conditions, both corporeal and mental causes a vitiating and degenerating infiuence. Famine is naturally the mother of crimes and vices, not onty of such sort as will satiate the gnawing desire for food, but of general violence and lawlessness, ill temper, avarice, lust, and cruelty. THE DIGESTIVE SYSTEM AND GOOD DIGESTION 103 The love of purposeless destruction, exhibited by the Parisian communists in our own day, may be fairly credited to deficient food. No well-fed people could have wrecked the Vendome Column, or burnt the Town Hall and the Tuileries, of which they were so proud. "They were like hungry children smashing their dolls." The Causes of Indigestion. — Normally, the process of digestion is effected unconsciously; the individual is not aware that she has a stomach. It may be accepted as an axiom, that when any organ or any part of the body persistently obtrudes itself on the attention of the owner, there is some abnormal or pathologic condition present. Some of the more prominent causes of indigestion are: imperfect mastication, septic stumps of teeth, an excessive quantity of food, improper kinds of food, food taken at too frequent intervals, alcohol, tea, and coffee, and ex- haustion of the nervous system. Imperfect Mastication. — Defective teeth are responsible for much imperfect mastication of food. The opposing teeth may have been lost, or soreness of the gums or sensitive teeth may prevent the act of mastication from being properly performed. When the food is not sufficiently well subdivided, the saliva and gastric juice cannot mix properly with it, gastric digestion will be retarded on account of the small area of food presented, and the prolonged stay of food in the stomach increases the opportunities for fermentation. Since chewing is one of the chief excitants of the flow of saliva, it is much better that the work should be done in the mouth than in the kitchen. Septic Teeth. — As a result of these, microorganisms may be swallowed with the food and act injuriously on the stomach. They may irritate the mucous membrane and set up a chronic gastritis, or these bacteria may cause a fermentative process in the stomach. An excessive quantity of food may produce symptoms by its bulk in several ways : it may so distend the stomach as to give rise to sensations of weight, fullness, and pain; 104 PERSONAL HYGIENE FOR WOMEN or the amount of food taken may be in excess of the powers of the gastric juice to digest, and digestion in the stomach may be so prolonged that the stomach cannot empty itself before the next meal; or the bulk of food may be so excessive as to mechanically impede the movements of the stomach; or excessive bulk of a vegetable nature will interfere with its own digestion, by increasing the peristal- sis in the small intestine to such a degree that it will be moved along before it has had time to digest. Improper or Indigestible Foods. — For practical purposes, the digestibility of any food may be gauged by the length of time which it remains in the stomach, since the stomach expels the food as soon as it has been reduced to a semi- fluid consistence. Certain articles of diet so react on each other as to produce an insoluble substance. For example, strong tea, taken with any meat meal, converts the albumin of the meat into a dense precipitate that is absolutely indigestible. Glaret and coffee both delay digestion. Again, the combination, already mentioned, of vinegar with the carbohydrates, as in salads. Cheese is one of the most indigestible of substances. All fried foods are highly indigestible, because the fat envelops the food, and has to be melted off before the gastric juice can act on the substance of the food itself. Pastry is very indigestible. Of the vegetables, beans, while highly nutritious, are exceedingly difficult of digestion; also boiled cabbage, cauliflower, hot breads, iced drinks, ice-cream, and water-ices. Food May be taken at Too Frequent Intervals. — Digestion is not completed until the last particle of food has passed out of the stomach into the duodenum. If a fresh meal is introduced into the stomach before this has occurred, the process of digestion is started afresh before the stomach has had time for the rest it must have between two periods of activity. This is a physiologic law which is habitually violated in the prevailing custom of afternoon teas. Alcohol is a direct irritant to the coats of the stomach, and its use forms one of the most frequent causes of gastric THE DIGESTIVE SYSTEM AND GOOD DIGESTION 105 diseases of the present day. The injurious effects of alco- hol upon the stomach are that it acts as a local irritant, producing dilatation of the vessels of the stomach and subsequent gastritis; by overstimulating the secretion of hydrochloric acid, it leads to hyperacidity of the stomach; the tartrates and malates contained in wine are decom- posed in the stomach, setting free organic acids, while the acetic acid and yeast in beer set up an acetic acid fer- mentation in the stomach-contents. Alcoholic drinks, when taken in large quantity, eventually produce dilata- tion of the stomach. Alcohol taken into the stomach along with the food has two periods of action: during the first of these the diges- tion of albumin is impeded; after the absorption of the alcohol the secretion of hydrochloric acid is increased to two or three times the normal amount; even after stomach digestion is completed, the secretion of hydrochloric acid continues longer than it normally would. Tea. — In addition to the injurious action of the tannin of the tea on the albuminous constituents of food, exces- sive tea-drinking causes digestive disturbances by its action on the nervous system, which is similar to that of tobacco; it dilutes the contents of the stomach below the point of concentration at which digestion can efficiently take place, by the undoubted tendency that constant dis- tention of the stomach with hot liquids has to produce atony of the stomach-walls. Tea is most injurious to neurasthenic persons. Both tea and coffee act powerfully to retard digestion. Coffee acts more energetically, as it is generally taken much stronger. It is certain that the ordinary use of coffee as a beverage must interfere greatly with gastric digestion. Eating when in a state of nervous exhaustion or great physical fatigue, prolonged mental strain, or excessive grief may be sufficient to cause severe dyspepsia. The Nature of Indigestion. — From the excessive mucus in the stomach, as in chronic gastritis, the food will be 106 PERSONAL HYGIENE FOR WOMEN coated by mucus which will prevent the ready access of gastric juice, or there may be an excess of hydrochloric acid in the gastric juice, as the result of the irritation of the secreting glands from the use of alcohol, tobacco, condiments, or the lack of mastication. Motor insufficiency of the stomach or atony of the stom- ach-walls may result from general weakness, or have been caused by local irritation in some of the ways above men- tioned. From a prolonged stay of food in the stomach there results a decomposing mass, teeming with microorgan- isms; from the acrid and irritating nature of this results a catarrh of the intestines and a practical arrest of the digestive processes. From a chronic catarrh of the intestine or colitis, as it is called, there may result diminished peristalsis, which leads to constipation. On the other hand, when the peristalsis is increased, the food is hurried along the intestines, with the inevitable result that the absorption of water is interfered with and the stools become loose. With defective peristalsis and constipation there is fecal retention, abnormal fermentation, an accumulation of gas, with certain nervous phenomena, such as headache, irritability of temper, melancholia, a feeHng of pins and needles in the hands and feet, numbness and tingling in the extremities. It is a question as to whether these symp- toms are reflex in origin or are due to the absorption of toxins. The s3miptoms of indigestion are sensations of full- ness or pressure referred to the region of the stomach. Pain may come on entirely independently of taking food ; it may come on when the stomach is empty, or it may come on at the height of digestion or following it. Pain coming on independently of the taking of food is neuralgic in character. In neurasthenia pain may come on when the stomach is empty and be relieved by the taking of food — this is evidently the cry of the system for food ; or the pain THE DIGESTIVE SYSTEM AND GOOD DIGESTION 107 may be due to the hypersecretion of hydrochloric acid. Pain coming on when the food has reached the stomach shows some abnormally sensitive condition of the mucous membrane. Pain at the height of digestion, or about three hours afterward, is almost invariably due to an excess of hydrochloric acid. Pain coming on four hours after meals is due to the fact that the stomach has not emptied itself; abnormal fermentation takes place, with the formation of acrid organic acids, which irritate the mucous membrane or cause an evolution of gas which dis- tends the stomach. Eructations of gas may be due to an atonic condition of the walls of the stomach, and the gas which would nor- mally pass into the duodenum accumulates and distends the stomach, or the gas may be due to the fermentation of food, due to its prolonged stay in the stomach. There may be an eructation of a small quantity of acrid fluid, which may or may not be brought up into the mouth. This liquid may give rise to a sensation of heat and con- striction of the throat, called pyrosis or heart-bum; or the eructation may be neutral or alkaline — the so-called waterbrash; this most usually occurs in the morning on an empty stomach. There may be a furred tongue, with loss of appetite. This may be caused by a poisoned condition of the blood circulating through the stomach, where the blood is loaded with the effete products of metabolism. The term metahoUsm includes all the chemical processes taking place in the body, by which the available elements of food are prepared for nutrition, changed for incorpora- tion into the tissues and fluids, used up for the purposes of movement or vitality, and, finally, altered into forms capable of excretion. Intestinal Indigestion. — This is a much more common form of functional disturbance than gastric indigestion. It is a well-established fact that the greater part of the digestive work is done in the duodenum, by the hepatic and pancreatic fluids. The duodenum, also called the second stomach, has none of the peculiar characteristics 108 PERSONAL HYGIENE FOR WOMEN of a receptacle which receives crude substances that the stomach has. There is a much greater sensitiveness of the intestinal canal than of the stomach, which is accounted for by the fact that the sympathetic nervous svstem sur- rounds the intestines. Symptoms of Intestinal Indigestion. — The tongue is pale and flabby and indented at the edges by the teeth; it may be heavily coated white, or yellow in case of bilious- ness. There is a bitter, coppery taste in the mouth, due to taurochohc acid, a common symptom of Hthemia, or to imperfection oxidation of albumin, fatigue, headache, buzzing in the ears, disturbances of sight, loss of memory, faintness and vertigo, and emaciation. The lack of appetite leads to habitual underfeeding, the digestive organs themselves become weakened, and they in turn are not able to properly digest the food. Severe and protracted indigestion may lead to as profound emaciation as tuberculosis itself. Biliousness and Bilious Attacks. — During the period of digestion there is a physiologic congestion of the liver; this is increased by the ingestion of food of an irritating nature, which is apt to cause fermentation in the intes- tines. Biliousness and bilious attacks are generally evidences of indiscretion in diet, some blockade in the intestinal canal, or constipation. But there may also be acute attacks of congestion of the liver, caused by a severe chill- ing of the body. In cases of chronic congestion of the Hver there is usually intestinal uncleanUness, constipa- tion, and a greater or less degree of auto-infection. Symptoms. — There may be a slight chill or chilliness, or a dryness of the skin, with a feeling of feverishness; pain in the region of the liver, radiating to the right shoulder, nausea, vomiting of mucus and bile, bilious diarrhea, jaundice; the whites of the eyes are yellowish, the tongue is heavily coated yellow, and the urine is slight in quantity and yellowish. There is a marked degree of vertigo and a floating of black spots before the eyes. THE DIGESTIVE SYSTEM AND GOOD DIGESTION 109 The nights are restless, filled with dreams or night- mares; there is often a tendency to wake up at the same early hour every morning. On rising, there is a thick, metallic taste in the mouth, frontal headache, an inapti- tude for mental work, and a feeHng of despondency and depression. There may be a cumulative auto-infection which has been going on for years. The eyes and skin are jaun- diced with black rings under the eyes; the skin is dry, pale, and muddy, with more or less eruptions. There may be a scarlet redness of the nose and cheeks and eczema. The hands and feet are cold. The pulse is fee- ble, and the patient is anemic from the impoverishment of the blood. The individual is depressed, irritable, and languid. Treatment. — The best treatment is to take 2 grains of calomel just before retiring. If this causes a free evacua- tion of the bowels'within ten hours, nothing more is neces- sary. If not, some saline laxative must be taken. After this, the first thing on rising in the morning, one teaspoon- ful to one tablespoonful of the effervescing granules of the phosphate of soda should be taken in a glass of cold water. This acts very pleasantly on the liver, and is, at the same time, a mild laxative. The dose of calomel must never be repeated under one month's time. The alkaline mineral waters are good, especially those of Contrexeville and Vittel. Most important in the treatment of aU these cases is the daily exercise in the open air, and at least one hour's brisk exercise is essential. Cold sponge or other cold baths, given according to the condition of the patient, as directed in the chapter on Hydrotherapy, and a proper ventilation of the house day and night. Ptomain Poisoning. — This usually causes an acute attack of indigestion, coming on within a few hours after the ingestion of the poisoned food, as canned lobster, chicken, and fish. The symptoms are usually nausea and vomiting; severe pain in the stomach and intestines; there 110 PERSONAL HYGIENE FOR WOMEN may be a rise of temperature, and either constipation or diarrhea. Treatment. — It is essential to empty the stomach as quickly as possible, so that the poison may not be absorbed by the entire system, and for this purpose free vomiting must be produced. This may be accomplished by the tickhng of the back of the throat by the finger, or by taking from 4 to 1 pint of lukewarm water with a little table salt in it. After the stomach has been emptied, one glass of veiy hot water, containing one teaspoonful of the bicar- bonate of soda — baking soda — should be taken to dis- solve the mucus and to wash out the stomach. In a couple of hours 2 grains of calomel should be given. If this does not act freely within ten hours, it must be followed by a seidlitz powder or some other saline laxa- tive. In case there has been no nausea or vomiting, and the first indication that the wom_an has ptomain poisoning is the occurrence of rigors, castor oil should be given, as it acts more quickly than calomel, and, in addition to clear- ing out the bowel, it exerts a sedative influence upon the irritated intestine. The Administration of Castor Oil. — Take an ordinary medicine bottle, holding from 6 to 8 ounces, fill it half full of hot milk, add one tablespoonful of castor oil, insert the cork, and shake briskly for a few minutes. At the end of this time the oil will have disappeared, having formed a perfect emulsion with the hot milk. Given in this way, castor oil is practically tasteless. Diet in Indigestion. — When there is an acute attack of indigestion, whether it is gastric or intestinal, there should be complete abstinence from food for from twelve to eighteen hours. During this time the patient should onlj^ take occasional sips of very hot water. After the symptoms have subsided, liquids may be given in four-ounce quantities every two hours. Hot milk may be given, to which may be added 15 grains of baking soda, or one tablespoonful of lime-water, or one- THE DIGESTIVE SYSTEM AXD GOOD DIGESTION 111 third part Vichy, or, any of the following may be giA'en: chicken broth, barley water, the white of egg beaten up with plain water, beef-juice, or beef-tea. In all these cases the first thing to do is to get the mucous membrane of the stomach and intestine in a healthy condition. This is best accomphshed by drinking a glass of very hot water three times a day. Next in importance comes attention to the diet. Since the digestive organs are weakened, only such foods must be taken as are most easily digested. The following is a very good diet in this class of cases : Breakfast. — A soft-boiled egg, or an egg poached on toast, dry toast, and a glass of hot milk. If the milk disagrees with the stomach, it may be diluted with one- third part Vichy. If there is a tendency to constipation, a baked apple, without sugar, may be added to this. Luncheon. — Raw oysters in season, cold roast lamb, beef or chicken, bread, and a very little butter, apple- sauce, stewed peare or peaches, and a glass of hot milk. In changing from a liquid to a solid diet it is weU, before giving solids en masse, to give beef sandwiches for several days. The sandwiches are made as foUows : A piece of tender, juicy steak is scraped with a blunt knife in a direction parallel with its fibers. In this way the pulp is freed from the fibers; it is then seasoned with a little salt and spread thinly on a dry piece of stale bread. This makes a very delicate and palatable sandwich. Dinner. — A thin soup, beef, lamb, chicken, or broiled steak; one of the following vegetables: celerv% raw or stewed with white sauce, potatoes baked in the skin; asparagus with white sauce ; lettuce with a French dress- ing, made with lemon-juice; cranberry jelly. There must be no desert. A glass of water may be sipped slowlj^ after the meal is over. When the digestion improves, a cupful of weak tea may be taken for breakfast and lunch. If the digestion is so weak that very little can be 112 PERSONAL HYGIENE FOR WOMEN taken at one time, a cup of beef-tea, chicken, or mutton broth, with a plain cracker, should be taken between meals. A glass of hot milk may also be taken before retiring. It is very important to remove all fat from meat broths. The broth is allowed to become cold, and the fat is first skimmed off with a spoon; after this, a torn piece of white blotting-paper removes all the small particles of fat which may have been left. The following articles of diet must not be taken : Rich soups or chowder, veal, pork, hashes, stews, turkey, gravies, fried foods, liver, kidney, pickled, potted, or smoked meats, or fish; goose, duck, sausage, crabs, lob- ster, salmon, hot breads, pastries, candies, cheese, ice- cream, nuts, bananas, ice-water, malt, or spirituous liquors. Treatment of Acute Diarrhea. — In case of acute diarrhea the patient should remain in bed. If there is severe pain, a hot-water bag often gives relief. The diet should consist of scalded, not boiled, milk and dry toast. A glassful of hot water should be taken three or four times a day. The most effective procedure in these cases is to wash out the bowel itself with hot water, which contains one teaspoonful of table-salt to the pint of water; this removes the mucus and is an astringent to the inflamed mucous membrane. For the medicinal treatment a good physician should be summoned at once, as the cases are frequently very serious, and, at best, may nm into a chronic form of a catarrhal inflammation of the bowels. The longer the duration of the disease, the longer does it take to accomplish a cure. Chronic Intestinal Catarrh. — There may be consti- pation or diarrhea, or the two may alternate, but in the chronic forms there is more apt to be constipation. Fecal accumulations may sometimes be felt by placing the hand over the abdomen, which may be so hard that they can be removed neither by purgation or clysters. THE DIGESTIVE SYSTEM AND GOOD DIGESTION 113 If the catarrh is situated in the lower part of the intestine or in the rectum, the scybala are enveloped in mucus or blood, and sometimes, after much tenesmus and bearing down, only large quantities of mucus will be voided. A frequent result of this condition is piles, associated with an intense itching or burning, which extends up into the rectum. Constipation and Mental Troubles. — A noted French writer states that there is no person afflicted with mental troubles who is not a sufferer from constipation, at least in the early and curable stage of this malady, as weU as from stomach, liver, and intestinal disturbances. Even in the normal individual constipation brings about torpor of ideas, inaptitude for work, and a bad temper, while the autointoxication, which is caused by constipation, is a prolific source of neurasthenia. It must be remembered that the intestine is a permanent source of poisons, which, under certain conditions, cause grave alterations in the principal organs, notably in the hver, kidneys, and skin, and serious functional dis- turbances of the nervous system. Normally, the organism manages to protect itself against the microorganisms which are found in the intestines; given, however, certain conditions, the toxic products can be generated in excess of the powers of the organism to dispose of them, such as errors of diet, quantitative or qualitative, atony of the muscular walls of the intestine, and, above all, constipation. The higher up in the in- testine the stasis occurs, the more serious is the result. Constipation is considered by many surgeons as the most important factor in the production of appendicitis. There is frequently a condition present which is known as semiconstipation, and which is most deceptive to the patient. There may be a bowel movement every day, but the bowel is never emptied ; only the lower portion of the hardened fecal matter is broken off. This is repeat- edly found to be the case in examining women for some form of pelvic trouble, and in a woman who says that she 8 114 PERSONAL HYGIENE FOR WOMEN has a daily evacuation of the bowels, and has had one that very morning, the sigmoid flexure will be found to be packed with hardened feces. Beside the clogging up of the digestive system by the non-removal of the waste-products of digestion, the formation of hemorrhoids, which is caused by the mechani- cal pressure on the veins, and so interferes with their emptying out in the normal way, and the general auto- intoxication of the entire system, there are also caused in women serious displacements of the pelvic organs, to- gether with their congestion and inflammation. The general symptoms of autointoxication are: head- ache, vertigo, palpitation of the heart, a feeble and irreg- ular pulse, irritabihty of temper, melancholia, numbness and tingling in the hands and feet, and the emaciation and loss of weight are sometimes so marked as to lead to the suspicion of malignant disease. Treatment of Constipation. — This should always be preventive, and the diet is a most important factor. The food should be of a coarse quality, that is, such as directly stimulates the walls of the intestine to contraction by their constituents, or by the large amount of the indigestible bulk. Com and Graham bread should be substituted for white bread. Toast is always constipating. Plenty of fresh fruit and vegetables should be eaten. For those who can digest them, raw apples, eaten just before retiring, are a great aid. The drinking of a sufficient quantity of water daily is also essential, and this quantity must be 3 pints. A glassful of cold water, taken the first thing in the morning on rising, is often very effective. If this is insufficient, the phosphate of soda, as already directed, may be added. Habit. — Nowhere is the effect of habit more conspicuous than in the matter of a daily evacuation of the bowels. There should be a fixed time every day for this, and the very best time is in the morning, directly after breakfast. Such a habit, once established, will enforce itself upon the attention and make regularity a necessity. It not infre- THE DIGESTIVE SYSTEM AND GOOD DIGESTION 115 quently happens that constipation is the result of irregu- larity in going to the toilet. The school-girl or woman gets up a little late, and, although she may feel the inclina- tion to empty the bowels, she is able to defer it. If the movement is sufficiently large, one stool daily is sufficient, but where the stool is sHght in quantity, there may be two or three during the day, entirely consistent with health, and in a run down state of the system there are apt to be several small movements rather than one full stool. So long as the stools are not watery, the individual may rest assured that there is no looseness of the bowels. Constipation should never be allowed to become chronic. It is, as has already been shown, the progenitor of myriads of the most serious diseases; and, after the bad habits of years have been established, it is one of the most obstinate of diseases to cure. In every case a good physician should be consulted at once, and the treatment should be persevered in until the cure is complete. It is a weU-known fact that all medicines for this trouble lose their effect, the dose has to be increased, and a frequent change made from one laxative to another. When every- thing else fails, electricity may be resorted to. It is one of our most valuable remedies, since it brings about a cure through the toning up of the muscular walls of the in- testine. The constant use of hot clysters to empty the rectum is one of the most pernicious habits; in this manner the bowel becomes overdistended and loses its tone, and the fecal mass is not sufficiently large to cause the distention of the rectum, which is the normal stimulus leading to the desire to defecate. The Physiologic Action of Moderate Doses of Alcohol. — The result of a series of experiments by Dr. Parke were as follows : " By quickening the action of the heart, it shortens the interval of rest, and, therefore, in- terferes with the nutrition of the heart. It also produces palpitation and breathlessness. Even small doses of alcohol, by increasing unnecessarily the action of the heart, 116 PERSONAL HYGIENE FOR WOMEN are injurious. It acts on the nervous system by lessening the rapidity and the deUcacy of the impressions, as well as by lessening the power of control of a train of thought. Further, by this same blunting of the nervous system, voluntary muscular power is impaired, and the finer combined movements are less perfectly made. It causes a lowering of the temperature of the body, and, although it is taken to overcome the effects of exposure to cold, it has been learned that persons who take it are less able to resist the exposure to cold." As the result of modern scientific investigation and ex- perimentation, alcohol with its compounds has been taken out of the list of beverages, where it has heretofore been classified with tea and coffee, and out of the list of foods, to which class it had been admitted because of the known oxidation of alcohol in the body, and has been placed in that list of drugs known as narcotics, alongside of ether, chloroform, opium, and cocain — all of them, the most deadly drugs in the Pharmacopeia, yet, when used by skilled hands, the most beneficent. The first effect of this class of drugs is a short temporary stage of exhilaration, more or less rapidly followed, ac- cording to the amount taken, by a stage of sleepiness or actual insensibility, which lasts longer than the stage of excitement, and this in turn is followed by a long period of depression. Like other members of its class, alcohol has a cumula- tive action, the residual quantities habitually taken ac- cumulate and gradually affect the efficiency and well- being of the individual. A point that must always be borne in mind in giving any medicine is that not a few drugs have a curious ten- dency to induce a craving for their repetition. The amount of alcohol contained in some of the most commonly used of the alcoholic beverages is as follows: beer, 4 to 5 per cent. ; hard cider, from 5 to 10 per cent. ; claret, 8 to 11 per cent. ; port, 9 to 22 per cent. ; champagne, 10 to 15 per cent. ; rum, gin, and strong liquors, 40 to 50 THE DIGESTIVE SYSTEM AND GOOD DIGESTION 117 per cent.; whisky, 44 to 50 per cent.; brandy, 48 to 56 per cent. These alcoholic beverages are often made still more harmful by adulterations by ingredients in themselves harmful. A large percentage of alcohol is also found in bitters and patent medicines. We will consider the subject of alcohol under the fol- lowing aspects: First, the question of alcohol as a food; second, the effects of alcohol on the digestive system and the metabolism; third, the effects of alcohol on the heart and the muscular system; and fourth, the effects of alcohol on the nervous system. First, Is Alcohol a Food? — ^The substances used as foods act in providing energy for muscular work, in maintaining the heat of the body, in building up of the tissues, and in saving the waste of the tissues. Moreover, a food which does harm to any organ, or to the system as a whole, when taken in moderate repeated quantities, becomes a poison for that individual. A food may be defined as any substance which, when absorbed into the blood, will nourish, repair waste, and furnish force and heat to the body, without causing injury to any of its parts or loss of functional activity. From any one of these four standpoints alcohol cannot be regarded as a food. The physiologic effects of alcohol and real food-stuffs are totally different. Fats, carbohydrates, and nitroge- nous foods after mastication at once begin to be digested and assimilated, and to fulfil the true functions of a food by maintaining a natural temperature, pulse-rate, and tissue repair of the body, without any disturbance of its mental and physical functions and activities. Alcohol, on the contrary, is absorbed from the stomach unaltered by the digestive processes; circulated in the blood in its original form, it at once interferes with the ordinary activity of the brain and other organs, and, by its anesthetic action, hampers the mental and phys- 118 PERSONAL HYGIENE FOR WOMEN ical activities and interferes with the processes of meta- bohsm. The Effects of Alcohol on the Digestive System and Metabolism. — The local action of alcoholic liquids is particularly destructive on an empty stomach; and when taken in strong solution, but it is also known that smaller doses, taken continuously, are liable to effect the digestive organs in a slower though similar way. The injurious effects of alcohol are that it acts as a local irritant, producing dilatation of the blood-vessels of the stomach and subsequent gastritis; it leads to hyperacidity, by stimulating the secretion of hydrochloric acid; the tartrates and malates contained in wine are decom- posed in the stomach, setting free organic acids, and thus producing acidity; the acetic acid and yeast in beer set up an acetic acid fermentation in the stomach- contents. Whether taken alone or with food, the tendency of alco- hol throughout is to lessen the churning movements of the stomach, and leads to atony of that organ, which in turn leads to dilatation of the stomach. Alcohol appears to have a particularly deleterious effect on the digestion of women. This is explained by the fact that men lead a more active outdoor life, and consequently retain their appetite for food longer than women. For the same reason, they are able to work off the effects of drinking more easily and start afresh the assimilation of food. The indoor life led by women, their clothing, worn tight around the stomach, are added causes for lack of appetite. Catarrh of the stomach results; this is followed by insufficient food and an increased amount of stimulants. There follow nausea, irregular and insuf- ficient nutrition, indigestion, and a faulty elaboration of the food. By its action on the liver alcohol interferes with the amount and quantity of bile, and so inevitably leads to indigestion and constipation, and a similar interference with the action of the liver-cells and their chemical THE DIGESTIVE SYSTEM AND GOOD DIGESTION 119 changes set up in many cases gouty conditions, accom- panied by mental depression and irritability. Diseases of the liver occur more frequently as the result of taking frequent small doses of alcohol, though never reaching the stage of intoxication, than as the result of indulging more freely, but at longer intervals. The Effect of Alcohol on the Blood.- — The blood is a mix- ture of corpuscles and a fluid known as the blood plasma. The corpuscles are of two kinds — red and white. The red blood-corpuscles are the oxygen carriers; they carry the oxygen to the tissues, where they readily give it up. They are constantly being destroyed by the liver and spleen, and are replaced by new ones, which come from the red marrow of bones. The white corpuscles are much fewer in number, but they play a most important part in pro- tecting the body against disease. It is now about twenty years since Professor Metchnikoff, of the Pasteur Institute of Paris, announced to the world his discovery that the white corpuscles have the power of destroying the mi- crobes to which so many diseases are due. These white blood-cells form the standing army or policemen of the body, and their duty is to attack, and, if possible, to destroy, any foreign matter, such as dust or disease germs. The plasma of the blood contains various kinds of salts, and include sodium chlorid or common salt, the phos- phates, and chlorids of calcium and potassium. The way which the body fights disease is partly by means of the white blood-corpuscles, which totally destroy the germs, and partly by the increase in the blood of those chemical substances which are antidotes for the poisons given out by the germs. Alcohol taken into the stomach is quickly absorbed and reaches the blood in two minutes. The maximum of alcohol is found in the blood in fifteen minutes after it is swallowed. The blood is the medium by which food and oxygen are conveyed to the tissues, and by which the refuse material 120 PERSONAL HYGIENE FOR WOMEN from the tissues is carried away; alcohol interferes with both these processes. The red cells are liable to become damaged and anemia results. It has now been proved that even tiny doses of alcohol paralyze more or less the white cells, and thus in- terfere with their power of destrojdng microbes. Chemi- cal substances tend to exert a delaying or inhibitory in- fluence over the chemical processes of the body. These chemical processes are oxidation, the storing up of nutri- ment, the manufacture of secretion, the production of energy and muscular movement, and the excretion of waste materials. The greatest possible difference exists as to the rate at which oxidation goes on. ^Mien there is nothing to hinder its occurrence, the poisonous toxins and waste matters are rapidly burned up and ehminated and health prevails. Alcohol, by its affinity for oxygen, robs the tissues of oxygen which they would otherwise use for combustion. Hence the tissues are kept starving for oxygen, metabo- lism is interfered with, and they cannot get rid of their waste material. This delayed oxidation tends to increase the body weight. The cells in an intermediate stage of fatty degen- eration clog the body, and, of course, add to its weight. The natural effect of taking alcohol is to make the body obese. On abstaining from alcohol, the superfluous tissue is often burned away, and the weight of the body reduced, and a look and feeHng of youth is recovered. The Effect of Alcohol on the Heart and Circulation. — By the circulation we understand the driving of the fluid blood around the body, through the blood-vessels, such driving being maintained by the pumping power of the heart, which is practically a hollow muscle. In consequence of this pumping power of the heart, the blood in the vessels is under considerable pressure, which is naturally increased if the blood-vessels are narrowed or contracted, and diminished if the blood-vessels are expanded or dilated. THE DIGESTIVE SYSTEM AND GOOD DIGESTION 121 Gradual deterioration in the heart power is a cause of premature death. One of the early indications that the foregoing changes may be occurring in a heart is a sense of fatigue and breathlessness on slight exertion, or a feeling of disinclination for normal effort. The result of such depression of the ef&ciency of the heart is often seen when the individual is attacked by some disease; she succumbs to heart failure, instead of being able to resist the disease. This probably accounts for a great many deaths between forty and sixty years of age. Further, it must be remembered that all the nutritive action of the blood depends on its power of rapidly filtering through the walls of the blood-vessels to the tissues, and, conversely, its power of drawing off the waste-products of the tissues depends on the facility with which such products can penetrate its walls. As soon as degeneracy sets in, the walls of all vessels tend to become thickened, and the active transference through them, more and more prevented; the nutrition of the body is thus gravely hampered, and, with the advance of this thickening of the walls, the vessels are less able to adjust themselves to the variations in pressure from within; and, finally, when xmable to withstand the pressure, they rupture, causing hemorrhage and apoplex;^', which, when occurring in the brain, cause paralysis and mental decay. A similar degeneration takes place in old age, but the point is, that many persons, instead of waiting until old age comes to them, dehberately precipitate these senile changes. The Effect of Alcohol on the Kidneys. — The elaborate mechanism of the kidneys consist of a filtering system of thousands of tubules, arranged closely side by side, whose function it is to carry away from the body the waste material, which otherwise would interfere with the vitaHty of the different organs. The part played by the kidneys in rapidly eliminating effete material cannot be too carefully safeguarded. 122 PERSONAL HYGIENE FOR WOMEN Anything which interferes with its work will sooner or later cause a retention of waste-products in the system, and will also permit of the escape of valuable albuminous materials of the substance of the blood through the filter- ing apparatus. The effect of alcohol upon the kidneys can only be described as disastrous. In proportion as the kidney shrinks, there is a diminution of the excre- tion of urine, and, finally, the condition known as Bright's disease is established. The Effect of Alcohol on the Muscular System. — The muscular tissue forms 43 per cent, of the body weight. It has been proved that under the moderate use of alcohol the muscles become flabby and less vigorous and effective ; that troops cannot work or march on alcohol; that in training for athletics, for races, or for other sports, total abstinence is always practised; the true sportsman de- pends quite as much on his brain as on his muscles for success. In England it is recognized that total abstinence is a necessity where great exertions are concerned, and it is now beyond all question that alcohol, in even so-called dietetic quantities, diminishes the output of muscular work, both in quantity and quality, and that the best physical results are obtained under total abstinence from its use. Alcohol actually lowers the temperature of the body from three-fourths of one degree to three degrees. This depression of temperature is not transient, but lasts for several days, so that its use, when the person is exposed to intense cold, is extremely hazardous to Hfe. The Effects of Alcohol on the Nervous System. — Kraepelin has carried out a series of experiments to prove the effects of small doses of alcohol on the output of work. In all mental work there are two elements to be considered, namely, quality and speed. Now, all observers are agreed that the quality of mental work is affected even before speed, more mistakes being made. Tests were made in reading aloud; in adding figures in various com- binations; in type-setting; and in memorizing; in aU THE DIGESTIVE SYSTEM AND GOOD DIGESTION 123 these instances it was found that, after taking moderate doses of alcohol for a number of consecutive days, the work done was less, was less accurate, and that there was a decrease in the power of memorizing. Another series of investigations, made by Rudin to determine how long the intellectual abilities continue to be depressed after the effects of alcohol pass off, showed that the effects of a single dose of alcohol persisted until noon or evening of the next day. Von Helmholtz, one of the greatest observers and thinkers of the nineteenth century, noted on himself the effect of alcohol in interfering with the highest powers of thought and conception. Describing the conditions under which his highest scientific thoughts had matured and come to fruition, he said: "As far as my experience is concerned, they never come to a wearied brain or at the writing-desk; they were especially inclined to appear to me while indulging in a quiet walk in the sunshine or over the forest-clad mountains, hut the smallest quantity of alcohol seemed to drive them away." Professor Sikovsky's testimony is that "alcohol dimin- ishes the rapidity of thought, makes the imagination and the power of reflection commonplace and deprived of originality, acts upon fine and complex sensations by transforming them into coarse and elementary ones, provokes outbursts of evil passions and dispositions, and in this predisposes men to strife and crime, and upsets habits of work and perseverance." Gelf-control is one of the highest functions of the brain, and the racial power which results to a people as a conse- quence of the individual practice of self-control cannot be too highly estimated. Therefore, children are trained as far as possible to control their emotions and actions. Alcohol diminishes and breaks down this power of ac- quired self-control, undoing the work of parents and educationalists. Quite small doses are often responsible for reckless and self-pleasing actions, which are far reaching in their results in loss of moral tone and self- 124 PERSONAL HYGIENE FOR WOMEN respect. The ideals of duty are lost sight of, and, at best, leave the individual in a laissez-faire attitude. Among the depressant effects of alcohol are intellectual lethargy and a sense of fatigue, which, combined with the other factors, lessen the capacity for genuine enjoyment and pleasure. CHAPTER IV THE RESPIRATORY AND CIRCULATORY SYS- TEMS: THE KIDNEYS The Mechanics of Circulation and Respiration; the Circulatory Apparatus; the Lungs; Hygiene of the Lungs and Its Relation to the General Health; Relation of Respiration to Body Heat; the Res- piratory Functions of the Abdominal Muscles; tne Importance of Good Chest Development; Proper Relation Between the Height, Weight, and Chest Measurements; Chemical Properties of Air; Town and Country Air; Dust and Its Relations to Disease; Role Played by Bacteria; Ventilation; the Injurious Effects of Overheated Air; the Proper Degree of Moisture for the Air of the House; Ventila- tion of Bed-rooms. Care of the Nose, Throat, and Ears; Impediments to Respiration; Ventilation of the Limgs and Breathing Exercises; Cure of Chronic Bronchitis by Deep Breathing Exercises; Relation of Colds to Pneiunonia and Tuberculosis, and Their Prevention. The Kidneys and Their Fvmction; the Physiology of the Female Pelvic Organs. It is said that diseases of the lungs are the cause of four-fifths of all indispositions, ill health, and actual disease among civilized people, and that, between the age of fifteen and twenty-five, almost one-half of the mortality is due to pulmonary tuberculosis. This almost universal weakness of the lungs, as it may be styled, is a product of modern civiHzation, and is caused by our unhygienic mode of life. Too little im- portance is attached to physical development, and well- developed lungs can only be found in a well-developed chest; too little time is spent in outdoor exercise; and private houses, public conveyances, and public assembly rooms are not properly ventilated. Good development of the chest and lungs, and thorough and systematic ventilation of the lungs, are essential to a strong heart, a vigorous circulation, and power of the tissues to resist disease. 125 126 PERSONAL HYGIENE FOR WOMEN The Mechanics of Circulation and Respiration. — In order to understand the mechanics of circulation and respiration, it is necessarj^ to appreciate four funda- mental facts — that the thorax is a distensible, air-tight cage; that it contains and is filled by the heart, limgs, and great blood-vessels ; that the exchange of gases in the blood takes place in the lungs; and that, on the develop- ment of the chest and respiratory muscles, depend the development of the lungs and the force of the circulation. F hating ribs Fig. 7. — The bony thorax, anterior \aew (Ingals). The Thorax. — The chest or thorax is a cone-shaped, distensible cage, formed of bones, elastic cartilage, and muscles. The spinal column forms the fixed part of this Hving cage, and the ribs are attached to this in such a way as to allow of their being raised in inspiration, thus increasing the anteroposterior and the lateral diameters of the chest. The thorax is converted into an air-tight cavity by THE RESPIRATORY AND CIRCULATORY SYSTEMS 127 means of muscles. The base is made up of one huge muscle, the diaphragm. This is attached at its border to the ribs and posteriorly to the backbone. It is the dia- phragm which separates the cavity of the thorax from that of the abdomen. When the diaphragm is relaxed, it has a concavoconvex form, the convexity being directed toward the chest, and the heart and lungs rest directly on it, while the concave surface covers or rests on the liver. The Circulatory Apparatus. — This consists of a central force and suction-pump, the heart, and a series of elastic tubes that grow smaller the further from the heart they are situated; they divide and subdivide, like the branches of a tree. The smallest arteries, called capillaries, from their hair-like size, are so minute that they only allow the passage of a single corpuscle at a time and their walls are transparent. The heart is a somewhat cone-shaped organ, placed between the two lungs ; it is situated more or less obliquely in the chest, immediately back of the breast-bone. Roughly speaking, the base of the heart corresponds to the right edge of the sternum, while the apex lies a little below and to the right of the left nipple. The heart is divided into a right and left side. The left side forms the force pump, whose motive power is supplied by the contraction of its own muscle-fibers. The bright red blood, with its fresh supply of oxygen — hence its color — flows from the lungs into the left heart, which then contracts automatically and forces the blood into the arteries of the body. The arteries consist of a series of elastic tubings ; hence, the smaller the tubing, the greater the resistance which has to be overcome by the force of the heart's beat, so that during violent exercise, when the contraction of the muscles causes a pressure on the minute arteries and capillaries situated in them, the more forcible must be the beat of the heart to overcome this additional resistance. Likewise, when the surface of the body is suddenly 128 PERSONAL HYGIENE FOR WOMEN chilled, as by a plunge into cold water, all the vessels situated here contract, and, again, more work is thrown on the heart. The three chief factors in the mechanics of the circula- tion are the force and frequency of the heart's beat, the peripheral resistance, and the elasticity of the arterial walls. Any disturbance between these relations brings about abnormal conditions. Right common carotid artery' Subclavian arteries Innominate artery Arch of aorta Right lung Superior vena cava Right auricle Coronary artery Fig. 8. — Front view of heart and lungs, showing relations to other thoracic organs (Ingals). The average frequency of the heart's beat, or the pulse, is 72 times a minute. It is increased by exercise; it is quicker in the standing than in the sitting posture. It is quickened by meals, and, on the whole, it is quicker in the evening than in the early morning hours. Inde- pendent of muscular exertion, it is quickened by great altitudes. It is said to be quicker in summer than in winter. Its rate is profoundly influenced by mental con- ditions. THE RESPIRATORY AND CIRCULATORY SYSTEMS 129 The whole of the blood of the body passes through the heart in 32 beats — that is, in less than half a minute. The greatest part of this time is spent in the capillaries, There the tissues are obtaining their fresh supplies of food and discharging their waste matter into it. The heart, great blood-vessels, and the lungs are placed in the air-tight cavity of the thorax, and are subjected to the pumping action of the respiratory movements. The inspiratory muscles elevate the ribs, at the same time that Fig. 9. — Relation of heart and great vessels to the wall of the thorax. The collapsed lungs are drawn slightly aside (after Heath). the diaphragm, by its contraction, pushes the contents of the abdomen downward. The cavity of the chest, so enlarged, causes the pressure around the heart and the great blood-vessels within the chest to be less than that on the blood-vessels outside the chest; hence, during each inspiration the venous blood is sucked back into the right side of the heart. The tissues deprive the blood of its oxygen, so that which flows back to the heart in the veins is blue. The right 9 130 PERSONAL HYGIENE FOR WOMEN heart then sends this blue blood to the lungs, that it may- get rid of its carbonic acid, which is not only not needed, but is actually injurious to the body, and to receive a fresh supply of oxygen, which has been carried into the lungs in breathing. The blood is the great medium of exchange between all parts of the body. It is, at the same time, the nourisher and the scavenger of all the tissues. After the food has been liquefied and converted into new substances in the digestive system it is poured into the blood. From the blood all the tissues draw material to renew their own worn-out parts and other material which they store up Fig. 10. — The diaphragm (after IGtchen). as latent force, which, when it unites with the oxygen of the blood, becomes active force, such as heat and motion. The blood holds in suspension a vast number of minute cells or corpuscles ; the red corpuscles give its color to the blood, and are the oxygen carriers, while the white are the phagocytes or the protective agents of the body against disease. The blood constitutes about one-thirteenth of the body weight. Of this, one-fourth is distributed to the heart, lungs, and great blood-vessels, one-fourth to the liver, one- fourth to the skeletal muscles^ and the remainder to other organs. THE RESPIRATORY AND CIRCULATORY SYSTEMS 131 In order that the blood may be a satisfactory medium of exchange between all the tissues of the body two things are necessary — first, there must be through all parts of the body a flow of blood of a certain rapidity and general constancy; and, second, this flow must be susceptible of general and local modifications. The lungs are the essential organs of respiration or ventilators of the body. They are two in number, separ- ated from each other by the heart, are placed in a semi- distended state in the air-tight thorax, which we have seen they, together with the heart and great blood- vessels, completely fill. The lungs ultimately consist of air-cells, surrounded by dense plexuses of capillaries and nerves. The air-cells communicate with the exterior through the bronchial tubes, trachea, larynx, throat, and nose. The larynx is the organ of voice. It is situated be- tween the trachea and the base of the tongue, at the upper and back part of the neck, where it forms a considerable projection in the middle fine, called Adam's apple. The trachea is a cyhndric tube, which extends from the larjmx downward about 4^ inches, when it divides into the right and left bronchial tubes. The bronchial tubes, on entering the lungs, divide and subdivide, until finally they terminate in a lobule which is composed of air-cells and intercellular passages. In inspiration the cavity of the thorax is enlarged by an active contraction of the muscles, in consequence of which the pressure of air within the lungs becomes less than that of the air outside of the body, and this differ- ence of pressure causes a rush of air through the trachea into the lungs, until an equilibrium of pressure is estab- lished between the outside air and that within the lungs. This constitutes mspiration. Upon the relaxation of the respiratory muscles, the elasticity of the chest-walls and lungs, aided perhaps, to some extent, by the contraction of certain muscles, causes the chest to return to its original size. In consequence of this, the pressure within the 132 PERSONAL HYGIENE FOR WOMEN lungs now becomes greater than that outside, and the air rushes out of the trachea, until the equilibrium is once more established — expiration. During quiet respiration all parts of the lungs are not equally expanded; it is chiefly the apices of the lungs, reaching up into the region of the neck, and the central parts of the lungs, which undergo the least change of volume. This lack of a thorough distention and aeration of every part of the lungs is a cause of weakness of the lungs as well as of the entire body, for it is precisely those parts of the lungs which are the least active that are most prone to become the seat of tuberculosis. In forced inspiration the cavity of the thorax is in- creased from 2 to 3 inches, partly by the elevation of the ribs and partly bj^ the descent of the diaphragm, due to the contraction of its muscular fibers. In contracting, the diaphragm presses upon the abdominal viscera, push- ing them downward about 3 inches, so that a projection of the flaccid abdominal walls occurs. The movements of the diaphragm are less extensive in women than in men, which is believed to be due to the corsets and general manner of dress. A perfectly free mobility is necessary for change in the size of the chest and lungs, in which the respiratory movements take place from sixteen to twenty times a minute. The amount of air entering and leaving the lungs varies greatly in ordinaiy and forced respiration, being often three times as much in the latter. The volume of air is detennined by the spirometer. Mr. Hutchinson, who invented the spirometer, has defined the vital ca- pacity of the lungs as that amount of air which can be expelled by the most forcible expiration, and so the meas- ure of the individual's respiratory^ power. The vital capacity varies according to a number of conditions, as age, sex, weight, but, most important of all, is the height. It has been found that between five and six feet the vital capacity increases eight cubic inches for each inch in height. THE RESPIRATORY AND CIRCULATORY SYSTEMS 133 The vital importance of the role which oxygen plays in the health and life of the individual may be better understood from the facts that about 10,000 liters of air are breathed daily, which makes the amount of food and drink consumed daily seem almost infinitesimal, and, important as the quality of the food is, the quality of the air is much more so, and, finally, that one can live for some days without either food or drink, but dies in a few min- utes if the supply of air is cut off. Secretion of the Lungs. — Like the lips and mouth, the lungs are invested on their free inner surface by a delicate mucous membrane, which constantly secretes a clear viscous fluid, the mucus. The lungs, therefore, like the nose, are always moist, and just as the nose is cleared by blowing it, so the lungs are cleared by hawking or cough- ing, A sense of discomfort or a feeling of irritation of the windpipe induces a deep inspiration, followed by an explosive expiration, which quickly brings up the mucus, so that it can be expectorated. The only difference be- tween the mucus of the lungs and that of other organs is that the former is mixed with air and has, therefore, a frothy appearance. The secretion of the lungs naturally flows down and accumulates, until it is voluntarily brought up and ex- pelled. Any one with a cold on the chest, or who is sub- ject to catarrh, will notice that, on moving about in the morning in making the toilet, especially on raising the arms to dress the hair, expectoration is greatly facili- tated, and that this is followed by a feeling of clearing out of the throat and lungs. Because of the great aid given to the lungs in clearing them of mucus, moderate exercise in the open air is a much better treatment of an ordinary cold than a pro- longed stay in bed. And for the same reason, in the treat- ment of lung troubles, so soon as the temperature of the patient is down to normal, and her strength makes it safe to allow her to move about, the recovery of the patient is hastened by getting up and moving about the house. 134 PEESONAL HYGIENE FOR WOMEN Hygiene of the Lungs and Its Relation to the General Health. — Two conditions are essential for the preservation of the health and prevention of diseases of the lungs — good chest and lung development, and a con- tinuous supply of fresh air for the proper ventilation of the lungs. Fully one-third of the whole volume of blood is always circulating in the lungs, and each corpuscle passes through them 8000 times in the twenty-four hours. In other words, the lungs are the vitualizing stations of the corpuscles which unceasingly go hurrying by. If these carbonic-acid-laden corpuscles arrive in the lungs, and do not find the requisite amount of oxygen awaiting them, they return to the tissues, carrying part of their carbonic acid back to them instead of a fresh supply of oxygen, and so the tissues are weakened instead of being nourished, while the corpuscles themselves suffer from lack of proper nourishment and deteriorate in form and color. Imper- fect ventilation of the lungs is the most frequent cause of anemia or thinness of the blood. It must not be overlooked that the air may be fresh and pure, and yet not able to penetrate aU parts of the lungs because of superficial and improper breathing. Relation of Respiration to Body Heat. — The heat of the body is generated by the oxidation of the tissues. The chilliness experienced by persons engaged in seden- tary occupations is by no means always caused by the low temperature of the room, as will be proved by the thermometer, but by the close air of the room and super- ficial respiration, which causes internal overheating with imperfect combustion. The correctness of this state- ment may be proved if the woman wiU throw the win- dows wide open and take deep breathing exercises for five minutes. She will then go back to her work thoroughly comfortable. In other words, she has breathed herself warm. The Respiratory Function of the Abdominal Mus- cles. — Well-developed abdominal muscles play an im- THE RESPIRATORY AND CIRCULATORY SYSTEMS 135 portant part in expiration, hence, in emptying the lungs of their impurities. Under normal conditions the pres- sure in the abdominal cavity is greater than that of the atmosphere; hence in the elastic recoil following inspira- tion, the abdominal viscera constitute a buffer, so to speak, and drive the diaphragm upward. The chief causes of flabby abdominal muscles, with its consequent low intra-abdominal pressure, are a sedentary- life, the wearing of corsets which prevent the free play of the abdominal muscles, and the overdistention of the abdominal walls by repeated pregnancies and by the accumulations of fat. As a result of lax abdominal walls, there is very fre- quently an enteroptosis or a falhng of the abdominal con- tents far below their normal position; this includes the liver, spleen, pancreas, the intestines and stomach, and is the most frequent cause of floating kidney. Further, the accelerating influence of the diaphrag- matic movements on the circulation is seriously interfered with. The Importance of Good Chest Development. — The least chest development of the adult woman— that is, the underarm girth around the chest — consistent with good health is 28 inches, and this girth must be enlarged 3 inches on forced inspiration. In ordinary respiration the waist expansion should be from ^ to 1 inch, while dur- ing muscular activity it should be from 1 J to 3 or 4 inches. In women the movements of the upper part of the chest are very conspicuous, the breast rising and falling with every respiration; whereas, in children and in men the movements are almost wholly confined to the lower part of the chest, and are called diaphragmatic, in contradis- tinction to those seen in women, which are called thoracic. It is now the opinion of many observers in this country and in Europe that the habit of thoracic breathing in women has been brought about by constricting the waist and the lower ribs. Observations made among the In- dians and Chinese women show that the abdominal is 136 PERSONAL HYGIENE FOR WOMEN there the type of breathing, and civilized ■women who wore no corset had relatively good abdominal breathing. Further, that a thoracic type of breathing can be pro- duced in man by putting him in a corset. Vital capacity is, as we have seen, the term employed to denote the amount of air that can be expired after the fullest possible inspiration. The amount for persons 5 feet in height has been estimated as 174 cubic inches, with an increase of 8 cubic inches for every inch in height above this. The relation between height and vital capac- ity is rather remarkable, since height is chiefly determined by the length of the legs, and not by the size of the trunk and thorax. This is due to the fact that mobility of the chest increases with stature. The capacity of the chest is determined by the spirom- eter. A person who can only blow, say from 180 to 250 cubic inches, has a good pair of lungs, while, on the other hand, an ability to blow only 100, even where per- cussion and auscultation had revealed nothing, is sus- picious. One test by the spirometer is not sufficient to judge of the condition of the lungs, since the woman may be ner- vous or may not understand how to breathe into it, so that a number of tests should be made on different days, which may give a much better result, though no change has occurred in the lungs. Proper relation between the height, weight, and chest measurement : Height. Average weight. Average chest Feet. Inches. Pounds. Inches. 5 120 29.80 5 1 122 30.60 5 2 125 35.00 5 3 128 35.75 5 4 131 36.25 5 5 135 37.00 5 6 139 37.50 5 7 143 38.00 5 8 147 38.50 5 9 151 39.00 THE RESPIRATORY AND CIRCULATORY SYSTEMS 137 The Chemical Properties of Air. — It is of more vital importance that the air which we breathe should be pure than the food which we eat should be, although the latter is universally conceded to be a matter of prime importance. The reason is that the poisons in the air, inspired by the lungs, pass directly into the blood, whereas, taken into the stomach, the action is much slower, and there is at least the possibility of their passing through the digestive tract unassimilated. The olfactory nerves are the normal guides as to the purity of the air, and, if they have not been dulled by long usage in breathing impure air, they are extremely sensitive to impurities in the atmosphere. Country Air. — In the open air there is a con^ant, even though insensible, movement of the currents of air; the result is a constant renewal or ventilation of the air. There is, in addition, the evaporation from brooks, rivers, lakes, the dew and rain, which aid in cleansing the air from dust ; the peculiar freshness of the air in the country after a heavy fall of rain is familiar to all. The " bouquet " of the air, most noticeable and delightful in the early morning, especially in the spring of the year, is due to the fragrance given off from the flowers, plants, and trees, and imparts a feeling of exhilaration and a sense of the joy of living. Sunshine increases the respiratory movements. Wind clears the air of impurities, and is only harmful when it carries dust with it, or when it is so strong that it impedes the respiration or bodily movements. Very weak persons get out of breath easily when battling against the wind. Town Air.— Even the outdoor air of towns has its full quota of oxygen,— 21 per cent.,— and so is healthier than indoor air. The carbonic acid in the air varies from 0.2 to 0.6 per cent. Among the impurities of the air are smoke, fog, and dust. Dust and Its Relation to Disease. — Dust, consisting of particles of all kinds of organic and inorganic matter, 138 PERSONAL HYGIENE FOR WOMEN is a nuisance of indoor as well as outdoor life. That the dust in cities is the intolerable nuisance and menace to public health that it is, is due to the filthy condition of the streets. The specific cause of tuberculosis is the tubercle bacil- lus. Considering the prevalence of the custom of spitting on the pavements, streets, floors of public conveyances, and public haUs, that the dust from the streets is carried into the houses on the shoes and the trailing skirts of women, it is seK-evident that anything which stirs up the dust, as sweeping, stamping on the floor with the feet, dancing, and on the streets strong currents of air and high winds are a most serious menace to the health and lives of the communitj' . In addition to the fact that dust is the great carrier of the tubercle bacillus, the particles of dust cause a direct irritation of the mucous membranes lining the nose, throat, larynx, and bronchial tubes. That dust is an important factor in the causation of colds may be inferred from the facts that they are more common in the city than in the country, and that in the city they are more frequent in the spring and fall, when the streets are not watered. The R61e Played by Bacteria. — Bacteria are distrib- uted nearly evei-j^where and in larger quantities than is generally believed. The air in open spaces in cities con- tains from 100 to 1000 bacteria per cubic meter, while the air of an inhabited room contains from 6000 to 10,000. It can now be definitely stated that microorganisms are the immediate or exciting cause of bronchitis observed in diphtheria, in influenza, measles, whooping-cough, pneumonia, etc. These microorganisms are conveyed both directly from the sick to the well, and from the inhala- tions of the germs floating in the atmosphere. \Mienever dust is raised, we breathe in a great number of micro- organisms. In influenza the bacilli are found in the secretions of the nose, throat, and in the expectorations from the lungs. THE RESPIEATORT AND CIRCULATORY SYSTEMS 139 The bacilli are not only the cause of the acute infections, but also of chronic bronchitis. The bacterial flora usuaUy present in the throat and the respiratory passages is rich and varied. So long as the mucous membrane lining these passages remains in a healthy condition, an unfavorable condition is offered for their growth and development and these microorganisms are harmless. But just so soon as the general vitality is lowered, or there is an impairment of the normal condi- tion of the epithelium lining the respiratory tract, a cul- ture-medium is provided in which these germs flourish and grow. Anything which will cause an irritation or congestion of the mucous membrane of the throat and bronchial tubes furnishes the necessary conditions for the infection to take place. The germs themselves excite an acute inflammation, and the inflammation extends from the head or throat to the bronchial tubes, through the spread of the infective agent along the respiratory tract. Ventilation. — Very few people in cities spend more than one hour a day in the open air, which means that they are housed up for the other twenty-three hours, so that no pains should be spared to bring up the quality of the indoor air to approximate as nearly as possible that of the outdoor air. The air of houses contains many more microbes than that of the street. For dwelling-houses 3000 cubic feet of fresh air is needed every hour. It is said that in the country the only bad air is in farmers' houses, whence it has no chance to escape. Direct sunlight kills the tubercle bacillus in thin layers of sputum in five or six hours, and diffused sunlight in several days, and proper ventilation greatly facilitates this bactericidal action. A large cubic space is of little avail if the ventilation is inadequate. The windows should be at least one-seventh of the floor space. The air of the house must be fresh, pure, and cool, to allow proper ventilation of the lungs and skin. Colds are prevalent in winter, because that is the season when people are housed up and breathe impure air. 140 PERSONAL HYGIENE FOR WOMEN The commonest causes of impurities of the air in houses are the expired air and the transudation of the skin; the production of the combustion of lights or unconsumed gas may come from the burner when lit, if the pressure is very strong, or the rubber fittings may retain the gas; tobacco smoke; the effluvia of simple uncleanliness of rooms and persons; and the products of the fluid or solid excreta retained in the room. In addition, there may be special conditions which allow the impure air to flow into the room, as from the basement or cellar of a house, from imperfectly trapped soil and waste-pipes, or from other impurities outside of the house. In respiration the air is vitiated by a decrease in the amount of oxygen and an increase in the amount of car- bonic acid ; the expired air contains about 4 or 5 per cent, less oxygen and about that amount more of carbonic acid than the inspired air. It has been estimated that an individual takes into her lungs about 500 cubic inches of air per minute and exhales the same amount of vitiated air. The expired air is of a higher temperature, and is loaded with aqueous vapor. The organic substances present in expired air are in part the causes of the odor of the breath; it is probable that many of them are of a poi- sonous nature. The air is still further vitiated by the products of decomposition of persons having decayed teeth, nasal catarrh, and disorders of the digestive systems, as well as by personal emanations. When the sensibilities of the sense of smeU become dulled, they give no warning of the sense of danger, and the individual may not feel conscious of the harm, al- though the nervous centers may be greatly depressed, and, because discomfort has not been experienced in a vitiated atmosphere, it does not follow that harm has not been done. The effects are slowly and imperceptibly cumulative, but are on this account none the less injur- ious, and are now recognized as being among the most potent and wide-spread of all the predisposing causes of disease. THE RESPIRATORY AND CIRCULATORY SYSTEMS 141 The physiologic effects of breathing vitiated air are that, owing to the impurities of the air, the respirations become quicker and shallower, the heart's action more rapid and feeble; there is a more or less irritation of the mucous membranes lining the nose, throat, and larynx. In extreme cases, where many people are crowded together and the ventilation is totally inadequate, the air often becomes so impure as to cause headache, lassitude, nausea, and fainting. The long-continued action of such impurities on the olfactory nerves may ultimately induce, through the cen- tral nervous system, alterations in the respiration, circula- tion, and nutrition. When moderately vitiated air is breathed more or less continuously, the individual becomes pale and loses her appetite; after a time there is a decline in the muscular strength and animal spirits. The aera- tion and nutrition of the blood is interfered with, and the general tone of the system falls below par. It has further been maintained that metabolism is hindered by much-breathed atmosphere. In addition to the ordinary symptoms of discomfort, the long occupancy of so-called stuffy rooms so lowers the resistance as to be conducive to the contraction of colds and even to more serious infections. People in this lowered condition of health, which is very common among those who spend the greater part of the day indoors, in offices, houses, schools, factories, and workrooms, offer much less resistance to attacks of acute diseases than do people who lead an outdoor life. In considering the ventilation of a house, the purity of the air, the temperature, and the dryness of the air must all be considered. The test now generally accepted as the standard of purity of the air is not the chemical one of the estimation of the amount of carbonic acid contained in the air of a closed space, but that, on entering a room or closed space from the outside fresh air, no sense of impurity or close- ness should be noticable. 142 PERSONAL HYGIENE FOR WOMEN The so-calljd natural ventilation of houses, which takes place through the porosity of the walls, the cracks around the doors and windows, is generally too inconsider- able to be taken into account. Where houses are heated by furnaces, a certain amount of ventilation is furnished by this means, but the air is by no means so pure as the air of a house heated by hot air or steam pipes. In the latter case, the greatest drawback is the drjmess of the air. As the air contained in an inhabited room cannot be kept as pure as the outside air, the object of ventilation is, by the admission of the pure external air, so to minimize the impurities that the air respired may not be detrimental to health. The most effective means for the ventilation of houses and apartments is the throwing wide open all doors and windows; the windows must be opened at both top and bottom, as the hot impure air rises and the cold air falls to the floor. The length of time which the house should be left open will depend on the outside temperature and the velocity of the winds. This ventilation of the entire house should be carried out three times a day — in the early morning, at noon, and again in the evening. In addition to this, provision should be made for a con- stant access of fresh air to the room. A simple and rather primitive method is by raising the lower sash by a strip of wood several inches in height and the exact width of the window. The air will then enter the space between the upper and lower sashes. Some such or any better method of ventilation should be in continuous use, day and night, when the room is occupied. So soon as the weather is sufficiently mild, some of the windows should be left open aU the time. When the air of a room is fresh and pure, the human system is furnished with all the oxygen it can consume, and heat is thus introduced into the body, so that a lower external temperature is necessary for comfort. Hence, supplying a sufficient quantity of fresh air mini- THE RESPIRATORY AND CIRCULATORY SYSTEMS 143 mizes the amount of coal consumed, besides increasing the vigor of the body. The temperature of the house will depend on the occupa- tion, age, and health of the inhabitants. With a sedentary occupation, a temperature of from 64° to 70° F. is the most suitable. The temperature of the bedroom at night should not be allowed to fall below 50° F. Every room in the house should be furnished with a thermometer. The Injurious Effects of Overheated Air. — A rise of temperature in the surrounding air diminishes the amount of oxygen consumed and the amount of carbon dioxid discharged ; a fall of temperature has the opposite effect. In addition, this overheated air forms a hot jacket about the body, which prevents the radiation of heat necessary to keep the body in a healthy condition. For the same reason, when out-of-doors, furs should not be worn close up around the neck, and fur coats should only be worn in the extremely cold weather. Paper and rubber worn about the body act in the same way, by preventing the radiation of heat and moisture — practically steam jackets are formed; the skin is rendered very sensitive and susceptible of chilling on the shghtest fall of temperature. The Proper Degree of Moisture of the Air of the House. — The air below the freezing-point is deprived of much of its moisture; brought into the house, and raised from 70° to 80° F., or drawn into the nostrils and raised to 98° F., it must take up its quota of moisture. This moisture must, therefore, be provided in the air of the house. In the case of houses heated by furnaces, some moisture is furnished by the water-pans of the furnace; but in the case of heating by hot air and steam pipes, there is less circulation of air, the air is very much drier, and generally of a very much higher temperature. A satisfactory method of furnishing these houses with the proper degree of moisture has not yet been invented. One is only comfortable in a dry air when it is of a low temperature. When the dry air becomes heated, there ia 144 PERSONAL HYGIENE FOR WOMEN more moisture given off by the mucous membranes, whicli causes a feeling of dryness and irritation in the nose, throat, and larynx; there may also be a sensation of uneasiness of the chest, and, at the same time, the individual feels chilly. Persons constantly breathing abnormally dry air lower the resisting power of the respiratory mucous membranes and become very" susceptible of taking cold. Since the degree of moisture of the air of a house is equally important as its temperature, every' room should be furnished with a hygrometer, which should register from 65 to 70 per cent, of moisture. The Ventilation of Bed-rooms. — The importance of the proper ventilation of the sleeping-room will be seen from the fact that two-thirds of the oxygen absorbed in the twenty-four hours is absorbed between 6 o'clock in the evening and 6 o'clock in the morning; and on the state of the air of the bed-room will depend greatly the vitality of the individual. During sleep inspiration occupies ten-twelfths of the respiratory period, while at other times it occupies only five-twelfths of that period. In a closed room the oxygen would eventually be con- sumed, the air become filled with impurities, and the body languish for want of oxygen and incapacity to throw off its impurities. The air of the room should be perfectly fresh on retiring; where it has been used as a sitting-room, it should be throT^Ti wide open and thoroughly ventilated just before going to bed. The temperature of the room should not be above 65° F. In the bed-room at night all the air coming into the room should come from the same side of the room, and the doors opposite should be closed. If the room is small, and the window is at the head or foot of the bed, some provision must be made to screen the bed, and to allow the air to enter the room without falling directly on the sleeper. In the intense heat of summer, especially if the air is saturated with moisture, one sleeps much more com- THE RESPIRATORY AND CIRCULATORY SYSTEMS 145 fortably on the side, with the face almost at the edge of the bed; in this way the formation of a stagnant pool of exhaled air about the face is prevented, which would otherwise be rebreathed, and greatly increase the feeling of discomfort and malaise. On retiring at night the clothes worn during the day should be spread out over chairs to become thoroughly ventilated, instead of being hung up in a closed press or closet. From a sanitary point of view, it is essential that every article of clothing worn during the day should be removed at night. Both clothes and body need venti- lation. In the morning the clothes should all be taken off the bed, and they, as well as the night-clothes, should be spread out to be aired during the ventilation of the room. The windows are thrown wide open when one goes to breakfast. The Care of the Nose, Throat, and Ears. — It will be most profitable to consider the care of the nose, throat, and ears together, since the mucous membrane lining these cavities is continuous, and so there is always great danger of an inflammation of one extending to the others. It has been calculated that about one-third of our adult population are notably deaf in one or both ears. In the majority of cases deafness is the result of colds and throat troubles, and much can be done to prevent its occurrence. The nose communicates through the nasal fossae with the nasopharynx, and the mucous membrane hning the nose is continuous with that Hning the throat. The nose performs four important functions — it serves as a passageway for the air in breathing, and it warms, moistens, and filters the inspired air; it is the organ of smell; it aids in phonation; and it affords ventilation to the ears and accessory sinuses. But by far its most important function is the role which the nose plays in respiration. To supply the large amount of water neces- sary to moisten the inspired air, it has been calculated 10 146 PERSONAL HYGIENE FOR WOMEN that about one pint of water must be secreted by the nose daily; part of this amount of moisture is furnished by the tears. Mouth-breathing always causes dryness of the throat. The filtration of the air is accomplished first through the action of the hairs at the external margin of the nose, which hinder the entrance of large particles, and, second, by the adherence of small particles to the moist surface of the intricate passages of the nose and nasophar3Tix. The microbes are expelled with the dust; in addition to this, the nose probably has the power of destroying any bacteria through the action of its germicidal mucus. Obstruction of the Nasal Passages. — In adults the com- monest modes of obstruction are the bending of the nasal septum to one side, or by a thickening of the septum by which one nostril may be completely closed up. The occlusion may also be due to the swelling of the mucous membrane or the presence of polypi. In children the most common form of obstruction of the nose is by the adenoids and the enlargement of the tonsils; this enlargement may be so great as to prevent nasal breathing and interfere with the normal ventilation of the ears. The Throat or Pharynx. — The throat or pharynx is the upper and funnel-like portion of the alimentary canal, which is seen at the back part of the mouth. It extends up back of the nose. The cavity of the throat is some- what separated from that of the mouth by the soft palate. This is a membranous curtain, which is attached to the posterior part of the hard palate. The pendulous part of the soft palate is known as the uvula. The uvula sometimes becomes so greatly relaxed that it rests on the base of the tongue, which causes a constant irritation and slight cough, a condition which is easily relieved by a few astringent applications. On looking into a mirror there will be seen, on either side of the throat, two arches, formed by folds of mucous membrane; these are known as the pillars of the throat. THE RESPIRATORY AND CIRCULATORY SYSTEMS 147 Between these pillars, on either side, is an almond-shaped body called the tonsil. In health the tonsil should not protrude beyond the anterior pillar. Causes of Diseases of the Nose and Throat. — Exposure to wet and cold, when insufficiently clad, or, even worse, sitting still with damp skirts or shoes on. A still more potent factor than exposure to cold is the relative degree of humidity of the atmosphere; great humidity is fre- quently accompanied by epidemics of influenza. Ex- posure to very high winds; sudden changes of tempera- ture; the very dry air and the overheating of houses; insufficient covering at night; the inhalation of irritating vapors and finely divided mechanical irritants. Also, gastro-intestinal affections and uric acid. Chronic enlargement of the tonsils predisposes to tonsillitis and to aU the infective and contagious throat diseases. In addition, the breath is apt to be fetid, and swallowing the mucus, germs, and toxins has a deleterious effect on the stomach and general health. Mouth-breath- ing and anemia often follow, and there is an increased liability to inflammation of the eyes. The Importance of a Healthy Condition of the Throat and Nose. — The nose and throat are the portals of entrance to the bronchial tubes and lungs, and it depends on the condition of their mucous membranes whether the germs of disease wiU find lodgment here and be carried down into the bronchial tubes and lungs, or whether they will be expelled with the mucus. Any irritant which destroys the vitality of the epi- thelium covering the mucosa, or a local congestion which interferes with the nutrition, circulation, and secretions of the part, offers favorable conditions for the culture of bacteria normally present. Also, anything which will cause a lowering of the general health, and thereby lessen tissue resistance, acts as a predisposing cause to local inflammation, while the germs themselves excite inflammation by their active growth in loco. From these facts will also be seen the importance of 148 PERSONAL HYGIENE FOR WOMEN having cut short, as rapidly as possible, any congestion or inflammatory troubles of the nose and throat. Prevention of Nasal Catarrh and Sore Throat. — First in importance comes attention to the general health. Under this must be considered the clothing, food, ventilation, and exercise. The clothing should be Hght, yet sufficiently warm to be a protection against the cold and winds. Heavy shoes with thick soles are necessary to protect the feet, and it is not so much the matter of getting wet as it is of sitting down with damp clothing on. An atmosphere filled with dust in sweeping should not be tolerated in any well-kept house. Local Treatment for the Prevention and Cure of Mild Cases of Nasal Catarrh and Sore Throat. — The treatment is practically the same. The toilet of the nose and throat should be made at least as often, and at the same time, as that of the teeth; certainly, the first thing on getting up in the morning and again before dressing for dinner. In our seaboard cities and towns, at least, there is a very general predisposition to some degree of congestion of the mucous membrane of the nose and throat. This means an abnormal amount of mucus which collects in the parts during sleep. Again, on coming in from out-of-doors on a windy day a large amount of dust, which means microbes as well, has become lodged in the mucous mem- branes of the nose and throat. This toilet of the nose and throat is best carried out by means of a nasal spray. The spray apparatus consists of a bottle holding some two ounces, a hard-rubber spray piece, and a bulb with tubing to force the fiquid through the spray piece. The tip of the spray should have the form of a cone; this should be introduced into each nostril, the bulb squeezed several times, until the amount of fluid is sufficient to be hawked out, and this process is facilitated by holding the mouth open during the sprajang of the nostrils. After the nostrils have been thoroughly cleansed, the throat should be sprayed directly. THE RESPIRATORY AND CIRCULATORY SYSTEMS 149 The liquids used must be bland and unirritating, and only enough should be used at one time to cleanse the parts. There are on the market excellent alkahne and antiseptic tablets; one tablet should be dissolved in a spray-bottle not quite full of water. This solution keeps in perfect condition, and is always ready for use. A solution of boric acid, in the proportion of two tea- spoonfuls of boric acid to one pint of water, may also be used. If the nose and throat are inflamed, this so-called water spray should be followed by an oil spray, which will be found to be most soothing and heahng. A separate apparatus for this wiU be necessary, as an oily solution would clog an ordinary water-spray, but the principle of the spray is the same, and it is used in the same way. The following is an excellent formula: Take of menthol and carbolic acid each two grains; of eucalyptol, six drops; and of albolene, two ounces. Mix well, and fill the spray- bottle one-third fuU; it is to be used in the full strength. Use only enough of this spray to moisten the nose and throat; by inhaling simultaneously with squeezing the bulb, the very fine spray is carried into the larynx, and so is very useful when there is an irritation of that organ, as shown by hoarseness. If there is only a slight irrita- tion of the parts, the use of the spray twice daily will be sufficient; the last time should be just before retiring. On windy days it will be a great protection to the mucous membrane of the throat to use it just before going out- of-doors, on the throat only. If the inflammation is severe, the spray may be used as often as every two hours. This prescription should be put up by a good druggist. Ear specialists condemn all nasal douches as dangerous, on account of the possibiHty of the water being forced into the Eustachian tubes. General Treatment. — First of aU, the system must be toned up by the systematic use of cold baths, adapted to each particular case, tonics, iron, and cod-hver oil. It is a grave mistake to allow these cases to become 150 PERSONAL HYGIENE FOR WOMEN chronic, as they may be the forerunners of influenza and even general tuberculosis. They need prompt and scientific treatment, which the physician alone is capable of giving. The Ear. — The ear is divided into three parts — the external ear, the middle ear or tympanum, and the internal ear or labyrinth. The internal ear is the essential part of the organ of hearing in which the auditory nerve ends. Its structure is very complicated. The external ear is separated from the middle ear by the tympanic mem- brane or drumhead. This is a thin, small, membranous sheet, which is stretched tautly across the junction of these two cavities, and vibrates inward and outward between them. The external ear collects and conducts the waves of sound to the tympanum. The middle ear, or tympanum, is an irregular cavity, situated within the bone. It is traversed by a chain of movable bones, which connect the drumhead with the internal ear, and serves to convey vibrations of sound to it. The middle ear, or drum cavity, is filled with air, and communicates with the pharynx by means of the Eustachian tube. The middle ear is lined throughout with mucous membrane, which is continuous with that of the throat and nose. The Eustachian tube is continuous with the middle ear, and extends downward and forward about an inch to connect it with the pharynx, where it opens by a trumpet-like expansion, just above the soft palate, at the junction of the throat and nose. It serves to carry off the excess of fluid from the middle ear and to preserve the equilibrium of the pressure between the gaseous contents of this cavity and the atmosphere. The walls of the Eustachian tube are in close contact, but they are normally opened during every act of swallowing, yawning, etc., when the air finds its way into the middle ear. A stoppage of the nose reverses the process, and when the tubes are not likewise stopped up, every swallowing motion draws air out of the tubes. If the openings of the THE RESPIRATORY AND CIRCULATORY SYSTEMS 151 tubes become closed, deafness, dizziness, and subjective noises will result. The middle ear is the seat of about two-thirds of aU aural troubles, and, since much of this could be prevented, this becomes a matter of great practical importance. Causes of Impairment of Hearing. — The majority of the affections of the middle ear originate from extensions of catarrhal inflammations, from the nose and throat, through the Eustachian tubes. In children adenoids are the most frequent cause of deafness. The so-called hereditary- deafness is probably due to an inherited configuration of the septum of the nose, a bending of the septum to one side, or a tendency to catarrhal affections of its mucous membranes. Every cold in the head tends to mechanically involve the ears, and, while recovery may seem complete, there is likely to be some unrelieved trouble which insidiously but steadily increases — first one ear, and then the other, shows signs of defective hearing. If only one ear is in- volved, the condition may progress seriously before the patient is aware of the trouble. Preventive Measures Against Deafness. — From what has been said, it naturally f oUows that the preventive measures must be chiefly those already given against taking cold. If one does take cold, instead of leaving it to run its course, as is too often done, proper therapeutic measures should be at once adopted to bring as speedy a cure as possible. Impacted Ear-wax and its Removal. — A healthy ear should never show more than enough wax to render the hairs within soft, and the individual should be uncon- scious of the wax coming away. Wax does not collect in a healthy ear. When it does occur, there is a stopped- up feehng in the ears, due to the occlusion of the meatus by wax. The only procedure that is safe to follow in order to remove the wax from the ear is to gently douche the ear with warm water, at a temperature from 105° to 110° F. 152 PERSONAL HYGIENE FOR WOMEN If this does not suffice, a physician must be consulted, as all efforts to remove the wax after it has become impacted are dangerous and futile except in skilled hands. Earache. — The best thing for the relief of earache is the external application of heat by means of a hot-water bag. If this does not give relief, the ear may be douched with warm water. Earache can often be prevented, by those subject to it, by placing a veiy small piece of absorbent cotton in the ear before going out in very high winds or in automobiling. Impediments to Normal Respiration. — These are, for the most part, acquired through improper habits of posture, dress, lack of muscular and chest development. Other impediments to respiration are a deviation of the septum of the nose to one side, marked curvature of the spine, and deformities of the chest which may be the results of rickets. Curvature of the spine is frequently the result of mus- cular weakness, combined with faulty position at the desk. The clothing must be sufficiently loose to admit of the fullest possible chest expansion; the measurements for the clothing, and most especially for corsets, must be taken during full chest expansion. Heavy clothing suspended from the shoulders is also hurtful, because it renders impossible the expansion of the apices of the lungs. Obviously, all tight bands around the neck interfere with the respiratory movements. Bodily position plays a very important part in main- taining the symmetric development of the chest and in the proper ventilation of the lungs; and this is a matter of the greatest importance to students, clerks, and writers who spend a great part of every day at the desk. The faulty attitude, together with the weak muscles and the poor muscular development, are fruitful sources of spinal curvatures and flat chests; and free respiration is interfered with. Writing with a pen is most apt to be accompanied by a peculiarly cramped position of the body, rendering normal respiration impossible. THE EESPIRATORY AND CIRCULATORY SYSTEMS 153 The Correct Attitude at the Desk. — ^The chair should be of such a height that the woman may rest her feet firmly and easily on the floor or upon a foot-rest, the seat being deep enough from before backward to accommodate about three-fourths of the length of the thighs, while the back of the chair should be so curved as to support the spine easily in its natural curves, both at the waist and at the level of the shoulder-blades. The chair and desk should be sufficiently close together so that the student may sit erect to read from books, since leaning forward at the desk causes round shoulders, flat chest, and short-sightedness. When the desk and chair are properly arranged, tw^o-thirds of the forearm can be rested upon the desk without raising the shoulders. In reading, the distance of the book from the eyes should be twelve inches, and the book-rest should be inchned, sloping downward toward the reader, at about an angle of 85 degrees. If the woman has any great amount of writing to do, she should learn to use a typewriter. In using this machine she not only writes very much more rapidly and easily, but the position of the body is much more erect than that assumed when using the pen, and it is not nearly so fatiguing to the muscles of the hands and arms. All closely confining sedentary occupations, as writing, sewing, etc., should be frequently interrupted to move about for a few minutes, rest the eyes, and take a few deep breathing exercises before an open window; this is necessary for the eyes as well as for the ventilation of the lungs. Ventilation of the Lungs and Breathing Exercises. — Forced respiration is essential to completely change the air in the lungs, to maintain the elasticity of the lung tissue, and to expand the chest in every direction. Only in this way can a thorough ventilation of the lungs take place; a full supply of oxygen is taken in, which stirs up, disinfects, and cools the stagnant residual air, and 154 PERSONAL HYGIENE FOR WOMEN forced expiration expels the respiratory excretions. One of the frequent causes of foul breath is lack of ventila- tion of the lungs, so that the expired air becomes laden with impurities. In normal breatliing the current of air which passes in and out of the lungs travels through the nose, not the mouth. The ingoing air, by exposure to the vascular mucous membrane of the narrow and winding nasal passages, is warmed and moistened, and at the same time the mouth is protected from the desiccating effects of the continual inroad of comparatively dry air. By means of respiratory exercises the mobility of the chest may be greatly augmented; there is a.n increased flexibility of the ribs and sternum, as well as loosening of the thoracic joints, which may have become stiff, and these exercises also lead to a development of the respiratory- muscles. In this manner only can the frame work of the chest become thoroughly inflated from within, and thus all parts of the lungs, which run the risk of becoming in- capacitated from lack of use, be brought into play. It is highly important that this thorough ventila- tion of the lungs should take place at least three times a day — the first thing in the morning, while making the toilet, again about the middle of the day, and at night just before retiring. To obtain the greatest benefit from these exercises they must be taken without corsets, the clothing must be light and loose, and the body lightly clad. The air in the room must be fresh, and after they have been learned, they can, as a rule, be taken before an open window. In the morning they are best taken just after the cold bath, when, by removing the impurities and fiUing the lungs with fresh air, and at the same time starting up a good vigorous circulation, they cause one to begin the day with energy and zest. The respiratory movements are diminished during sleep, and at the same time there is a large accumulation THE RESPIRATORY AND CIRCULATORY SYSTEMS 155 of blood in the splanchnic veins, so that, particularly when there is any tendency to difficulty with the breathing at night, the trouble is greatly lessened by filling the lungs with pure air just before retiring. It is necessary, first of all, to learn the art of breathing, to be able to dissociate the clavicular, the costal, and the diaphragmatic. By clavicular breathing is meant the raising of the coUar-bone and shoulders as high as possible by means of a slow but deep inspiration — this expands the apices of the lungs; costal breathing is the throwing out and expanding the chest to its utmost capacity, and so enlarging the chest in its transverse and anteroposterior diameters; diaphragmatic breatliing is the depression of the diaphragm and the protrusion of the abdomen with- out raising the lower ribs. The last is the most readily learned in the supine position ; the bed supports the weight of the body, so that the individual is able to concentrate her entire attention on fix:ing the bony thorax, depressing the diaphragm, and protruding the abdomen at every in- spiration and retracting it to the utmost with every ex- piration. This, of course, develops and gives tone to the abdominal muscles. When the woman has conquered these first principles of respiration, she is ready to put them into practice in the standing posture. They should be learned before a mirror, and after that taken before an open window. The hands should be placed on the hips; first elevating the collar-bones and the shoulders to the utmost, while still holding the breath, she expands the chest, always breathing in from above downward, and, lastly, the diaphragm is depressed. With the lungs thus expanded to their utmost capacity, the breath is held as long as possible, then the lungs are emptied by an abrupt and forced expiration. These exercises should be repeated at first ten times, gradually increasing to thirty times. It is well to take one or two ordinary respirations between the forced ones. 156 PEESONAL HYGIENE FOR WOMEN It will be found that, as these exercises proceed and the lungs are filled with purer air, the breath can be held for a longer period of time, and that with practice the length of time that the breath can be held is greatly increased; it should be held for half a minute. Public speakers, singers, and divers are all skilful in this respect. When these simple breathing exercises have been mastered, breathing exercises can be combined with other exercises, which have as their aim the development of the muscles of the chest. Reading aloud, singing, talking, laughing, are all good exercises for developing the capacity of the lungs. The Cure of Chronic Bronchitis by Deep-breathing Exercises. — The upper part of the body must be nude and the exercises taken before a mirror, so that the woman can watch the movements of the chest and abdomen, see that all the hollows of the chest are filled out during forced inspiration, and that the muscles of the abdomen are properly retracted. For the average woman this last will be the most difiicult; in beginning these exercises she will find that it will require all her concentrated energy and will power to cause a retraction of these disused muscles. Patients with chronic bronchitis do not have the ability to perform forced respiration properly. The respirations are too superficial, and the respiratory move- ments are not properly performed. As respiration is ordinarily performed, the partial expansion of the upper part of the chest is accompanied by a contraction of the abdominal muscles, whereby the diaphragm is forced upward, with the result that the lower part of the lungs remains very slightly expanded, whereby the circulation as well as the removal of mucus is imperfectly performed. This lack of forced respiration IS a frequent cause of acute bronchitis running into a chronic form. In chronic bronchitis it is especially in the lower part of the lungs that stagnation of the secretions takes place, THE RESPIRATOEY AND CIRCULATORY SYSTEMS 157 and they can only be dislodged from the mucous mem- brane by forced abdominal expiration and the ascent of the diaphragm. This causes a cough which expels the mucus, and forcible abdominal expiration and cough are the only means of drainage of the lower and deep- seated parts of the lungs. Further, in forced respiration the muscle tissue of the bronchial tubes contracts, which certainly does not take place in ordinary respiration, but, on the contrary, this tissue atrophies. Other beneficial results from forced respiration are increased oxygenation, improved nutrition, changes of a mechanical nature, ventilation, and disinfection of the lungs, massage of the lungs and pleura, and drainage. No other method of treatment is so successful in the cure of chronic bronchitis not dependent on disease of the nose and throat. In from two to six weeks of treat- ment, in which there is a profuse discharge of mucus, it will be found that the bronchial tubes have cleared up, provided that the patient is supplied with an abundant supply of fresh air day and night. Methodically practised, deep breathing is not only the surest cure, but also the safest stimulating expectorant. Relation of Colds and Influenza to Pneumonia and Tuberculosis and their Prevention. — We have already seen that bacilli are not only the cause of acute infec- tions, but also of chronic bronchitis, and that this was especially true of the bacillus of influenza and the pneu- mococcus of pneumonia. It is weU known that influenza is an infectious disease, which rapidly spreads through the family and the com- munity, but it is not so well known that the so-called "common colds," ordinary sore throat, and tonsilhtis are also highly contagious. The infection is carried from one person to another by direct contagion; the air is being constantly sprayed with the germs of disease in talking, laughing, sneezing, and coughing. In coughing and sneezing it is not sufficient to hold the hand before the mouth — a handkerchief must be used for this purpose. 158 PERSONAL HYGIENE FOR WOMEN Colds are among the most frequent of the so-called minor ailments in this countiy. The causes are the over- heating of the houses, the great drATiess of the air, badly ventilated houses and public assembly rooms, which render people very susceptible to the great variations in temperature. Prophylaxis, or the prevention of colds, combine aU those measures which promote the general tone of the system, and may be said to embrace all the elements of personal hygiene. Good digestion and proper nourishment of the body with suitable food; the proper ventilation of houses, all public buildings and conveyances, for in these latter the public are brought into very close contact with their feUow-men. Local prophylaxis would consist in the toilet of the nose and throat — the removing of adenoids and enlarged tonsils. The individual must remember that she can reinfect herself; for this reason, an abundant supply of hand- kerchiefs must be used; they should be placed in a handkerchief bag and washed separately. Packs of cards should be thrown away before they become soiled. Sprays and atomizers must be individual property, and be kept thoroughly cleansed. With the exception of deep-seated chest colds, in the early stages a cold may often be nipped in the bud by a few hours of hard sudorific work in the open air. In half a day the nasal ducts and respiratory system will throw off irritating matter that would take much longer time if the patient remained indoors and relied on the action of drugs alone. Treatment. — Other methods of treatment are a hot tub-bath on retiring, an active but not too severe cathartic, as two grains of calomel, taken just before going to bed, and, if the individual is chiUy, a hot lemonade should be taken at the same time. Both the cathartic and the free perspiration wiU aid in relieving the internal con- gestion and thus aid in its abortion. A cold sponge THE RESPIRATORY AND CIRCULATORY SYSTEMS 159 should be taken the following morning to tone up the system. Turkish baths are also useful in breaking up colds; again, the precaution must be taken to avoid chill- ing on leaving the bath. The following tablet is a very simple and very efficacious remedy for breaking up a cold in the early stages: Take of powdered camphor | gr.; of the sulphate of quinin i gr. ; and of the fluidextract of belladonna root | minim. This should be well mixed, and made up into one tablet or a capsule. One tablet is taken every half-hour, until four doses have been taken; after that one tablet every three hours, until the running of the nose has ceased, which generally occurs within twenty-four hours. If there is not marked improvement at the end of this time, or if there is any fever, a physician should be consulted at once. Quinin, when given alone to abort colds, must be given in sufficiently large doses to produce cinchonism, the subjective symptom of which is a slight deafness or ringing of the ears. The natural tendency of cold is to cause inflammation of the middle ear, and since the use of quinin in large doses causes a congestion, and so pre- disposes to inflammation of the middle ear, its use should be avoided. The great amount of illness and mortality from pneu- monia during and following epidemics of influenza is too familiar to the public to need more than mentioning. The patient is so rapidly and extremely prostrated by the attack of influenza as to be susceptible to the ready action of the pneumococcus, which, as we have seen, is ever present, and the extension of the inflammation from the fine bronchial tubes to the air-cells of the lungs rapidly takes place. In the exhausted condition of the patient she is not able to resist this invasion, the heart is already weakened, and death frequently rapidly ensues as the immediate result of heart failure. The Prevention of Tuberculosis. — The tubercle bacillus is practically ubiquitous, and the prevalence of 160 PERSONAL HYGIENE FOR WOMEN tuberculosis is universal. Hence it is imperative to raise the resistance of the individual in every way pos- sible, as well as to Hmit the spread of the infection. This means the employment of all the resources of pubhc and personal hygiene, pubHc and private sanitation, and the education of the public in how the disease is disseminated, and how its spread may be prevented; also the teaching of the individual, her duty to the family and society, as well as to herself, in order not to spread the contagion. Tuberculosis attacks the crippled and poorly developed lung just as surely as it shuns the one which is fully ex- panded and in constant and active service. Numerous observations have established the existence of a constant ratio between tuberculosis of the lungs and deficient chest expansion. Diet. — The doctrine has been growing among the laity that the child's hkes and disKkes should determine what food it should eat. Thus a finical taste is cultivated and a lack of proper nourishment follows, and it is this finical diet class of people which forms a large percentage of tuberculous invahds. It has long been recognized that a proper diet and the tolerance of it is of the utmost importance in the treatment of tuberculous patients, but from the foregoing it would appear that a proper diet throughout fife is also of the utmost importance in the prevention of disease; a sufficiency, not only as to quantity, but also as regards variety. It is the patient who can eat everything who stands a good chance of getting well. So, too, it is the individual whose diet for years has been perverse, who could not eat meat, to whom eggs were distasteful, who could not stand milk, who was infected with the vegetarian fad, or the two-meal-a-day fad, who stands a fair chance of falling a victim to tuberculosis, through a lowered tone of the system, because it offers but a feeble resistance to a powerful and insidious enemy. And the mode of the preparation of the food is an equally important factor. It has been shown that the poor cooking among the lower THE RESPIRATORY AND CIRCULATORY SYSTEMS 161 classes is a powerful predisposing cause to intemperance and tuberculosis. Influenza is a frequent and important agent in bringing to light latent tuberculosis, and must be classed as an important exciting if not predisposing cause. Low, damp climates predispose to the infection by lowering the vitality. Tuberculosis is more prevalent in cities than in rural communities, due to the manner of housing and the character of the occupation. Sumimary of the Present Views of Infection. — The doctrine of inherited and acquired susceptibiUty still holds sway; next, that all infants are susceptible, and that suscepti- bihty lessens with increase in age; that adults are com- paratively insusceptible when free from general and local lowered resistance and repeated and prolonged exposure. As to the source of infection, the consensus of opinion and ascertained facts point to the sputum as of over- whelming importance; cow's milk is an important factor; the food may be infected directly by coughing, or the dirt and dust from the floor and hands; the fingers and many other objects that find their way into the child's mouth are sources of danger. To adults, both dust and moist droplets are more often the source of infection than infected food. Expectoration. — Careless expectoration is the chief source of infection. Laws should be passed and enforced prohibiting the expectoration on pavements, stairways, in all public conveyances, and all pubHc places. The danger of infection from tuberculous house servants has not been sufficiently appreciated. A chronic cough in the case of a servant should be at once investigated by the family physician. Servants should be taught the necessity for washing the hands before touching the food or cooking utensils. The condition of their rooms, clothing, bathing, and other personal habits should be closely investigated, and personal cleanHness should be demanded as a sine qua non for obtaining or keeping a situation. 11 162 PERSONAL HYGIENE FOR WOMEN Since it is a well-known fact that tuberculosis can be acquired from the occupation of houses and rooms formerly occupied by tuberculosis patients, it has been suggested that a clean bill of health should be demanded of the owner of the house before renting it; that is, a certificate from the Board of Health, that no case of infection has existed in the house, or that it has been properly disinfected since that time. If such a move- ment became popular, landlords would be obliged to furnish these bills of health in self-defense. Since the Boards of Health demand the reporting of all cases of tuberculosis, this scheme is by no means impracticable or Utopian. The tubercle bacillus is not destroyed by any degree of cold, but both hght and sunlight are distinctly injurious to these bacteria. The lowest fatal temperature to the tubercle bacillus is 131° F. of moist heat, acting for a period of six hours. The thermal death-point of tubercle baciUi in milk is of great practical importance, and many experiments have been made which have determined that a temperature of from 140° to 167° F., was sufficient if continued for one hour. If it is desired to pasteurize the milk, it should be placed in a closed bottle or stirred and heated for at least twenty minutes at a temperature of 149° F. Disinfection. — The use of formaldehyd gas has practi- cally displaced the use of sulphur for the fumigation of rooms, as well as for the disinfection of furniture and clothing. For this purpose a moist vapor used in a sealed room is essential. At least 8 ounces of the commercial 40 per cent, formalin should be used for each 1000 cubic feet of air content. The most efficient method is that used by Biggs, of New York, which is as follows: For an ordinary room, 1000 cubic feet, 1 pound of lime, 8 fluidounces of formalin, and from 2J to 3 fluidounces of commercial sulphuric acid are required. All openings but the door are sealed. The formalin is poured into an empty water-pitcher, 4 ounces THE RESPIRATORY AND CIRCULATORY SYSTEMS 163 of water are added, and then the sulphuric acid is poured slowly in. The lime is placed in a china or earthenware wash-basin on the floor upon newspapers; all water is removed from the room. All drawers and cupboards opened; the mattresses stood on end; and the mixture poured quickly upon the lime, when the door is sealed. The sulphuric acid may be packed in a tin bucket contain- ing the lime, and, with the formalin in a separate bottle, may be used by any person of ordinary intelligence. The room should remain closed from twelve to eighteen hours. It must not be lost sight of that after disinfection by means of formaHn a thorough cleansing is imperative. A room which has been thoroughly cleaned and carbolized is safer than a room which has been disinfected with formalin and not properly cleaned. After death or removal the entire place should be renovated. Besides disinfection and scrubbing the painted woodwork with a solution of hot soda water, the walls should be repainted or repapered, and the wood- word repainted. Rugs, bedding, pillows, and clothing should be disin- fected by hanging up in the room while it is undergoing disinfection. Books and all articles of small value should be burned. All soiled linen should be boiled. The Kidneys and their Function. — The kidneys are the secretory organs of the uiine; they are two in number, and are the largest tubular glands in the body. They are deeply seated in the lumbar region, lying one on each side of the vertebral column; the kidneys extend from the eleventh rib nearly to the crest of the pelvis. They are usually embedded in a considerable quantity of fat, which is the chief factor in holding them in position, aided to some extent by the large blood-vessels with which they are connected. The kidneys are oblong bodies and measure about 4 inches in length, 2J inches in breadth, and over 1 inch in thickness. Their weight is about 4J ounces. As an excretory organ the kidney probably stands 164 PERSONAL HYGIENE FOR WOMEN second to the alimentary canal; it surpasses in importance the skin, whose total excretion of water it equals. The abnormal substances appearing in the urine are often not the products of disease of the kidneys, but of some other organ or system. The kidneys excrete and put the finishing touches upon the urinary fluid; they act at the end of the meta- bolic course, both as active and as passive agents. While to some extent the kidneys are mechanical contrivances, mere filters, so to speak, they are to a far greater degree active, specific glands. The renal epitheHum has the power of synthesis, and builds up complex substances that are not apparent as such in the blood or lymph, as well as the power of analysis or breaking down of sub- stances. These changes are due to the formation in the tubular cell of an enzyme, which we call histozyme. The kidney is the end link in the vascular chain, and the daily performance of healthy kidneys is no doubt a combination of the mechanical and the vital processes. The Secretion of the Urine. — In a perfectly normal being the problems of waste and repair are balanced to a nicety. As we know, the tissues of the body are bathed in lymph containing in solution the compounds that are necessary for their nourishment — proteids, carbohydrates, fats, salts, and gases. Waste follows in direct proportion to the activity of the tissues. The worn-out, effete material first finds its way into the lymph, and from it into the blood-stream, to be later ehminated from the economy, else deleterious results will follow their retention in the body. It is by the selective action of the cells of the various glands of the body that these useless substances are removed from the blood, and converted into such forms as can be readily excreted. In the main, the products to be removed are urea and the allied nitrogenous bodies — carbon dioxid, salts, and water. These organs are of \'ital importance, since nearly all of the waste- products containing nitrogen are eliminated in the urine. The most easily understood function of the kidneys THE RESPIRATORY AND CIRCULATORY SYSTEMS 165 is the excretion of the urinary water; this varies in amount with the rapidity of flow through the renal vessels and to some extent on the blood-pressure. The separation of the solid substances of the urine form the next function of the kidneys, and these substances Fig. 11. — Relation of kidneys to heart and great blood-vessels: A, Heart; B, B, kidneys; C, bladder (after Quain). fall into two groups — inherently useful materials, which are in excess or which have served their purpose, and substances which are inherently harmful. The latter class embrace many end-products of metabolism, which we are accustomed to consider as normal constituents of the urine. 166 PERSONAL HYGIENE FOR WOMEN The analytic study of the urine is of great value to the physician and surgeon, because of the knowledge which it gives concerning the processes of metabolism occurring within the body. The nature and amounts of the various end-products of metabolism are carefully investigated as they occur in the urine, whether they be normal or patho- logic. The Urine. — The normal human urine recently passed is a clear liquid, of a straw color, with an average specific gravity of 1020, the specific gravity indicating the amount of solids contained in the urine. It is acid in reaction. The quantity for twenty-four hours is 50 ounces, or about 3 pints, depending on the amount of water ingested. During sleep the amount secreted is less than at other times. The amount of urine is decreased after profuse sweating, diarrhea, thirst, diminution in the blood-pressure, and after severe hemorrhage. When the body temper- ature is considerably higher than normal, the amount of urine is again diminished in quantity. Urea forms nearly one-half of the solids in normal urine and nearly one-half of the urea is nitrogen. It is the principal representative of the waste of the nitrogenous tissues. The chief source of urea is from the metabolism of the muscles; the ingestion of a large amount of proteid food stimulates metabolism. The quantity of urea passed in the twenty-four hours is about 500 grains. The uric-acid constituent is very small, and in the human urine scarcely reaches 0.03 per cent, of the solids. Lack of exercise leads to an increased formation of uric acid by a lessening of the oxidation of the tissues. In gout the amount of uric acid excreted is abnormally small, because it accumulates in the blood and tissues. The brick-dust deposit sometimes seen in the urine is composed chiefly of the urate of sodium. The average daily amount of uric acid passed in the human urine is about 7 grains. The excretion of uric acid may be increased by drinking copious drafts of water. Toxicity of the Urine. — After the removal of both kid- THE RESPIRATORY AND CIRCULATORY SYSTEMS 167 neys the animal dies of uremia; that is, there is an accu- mulation of urinary products in the blood. The removal of one kidney is not necessarily fatal, and women have so lived very comfortably for many years. A human being excretes enough poisonous material by the kidneys in two days to cause death. The Urinary Excretory Apparatus. — After the urine has been secreted by the kidneys it must be carried away from the body, so that the economy may not suffer from the resorption of the contained toxic principles. The excretory apparatus comprises the ureters, the bladder, and the urethra. The ureters are two cylindric tubes of the diameter of a goose-quill and about 15 inches long. They make their exit from the inner border of the kidney, and pass downward and inward toward the median line, to empty into the base of the bladder by a slit-like orifice. The bladder is the reservoir for the urine. It is a musculomembranous sac, situated in the pelvis, and in the female it is in front of the uterus and above the vagina. It normally contains one pint. It should be emptied four times a day. If it is allowed to go longer than this, it becomes overdistended, and is apt to displace the uterus backward, and the bladder-walls themselves become weakened. The Physiology of the Female Generative Organs. — The internal and essential organs of generation are the uterus, ovaries, and the Fallopian tubes. These organs have to do with the process of ovulation, menstruation, and reproduction. The Ovaries. — These are two small bodies of an almond shape, and lie one on either side of the uterus. The bulk of the organ consists of connective tissue, in which lie embedded the Graafian follicles, or ovisacs, in which the ova are contained. During the child-bearing period, or from about the age of fifteen to forty-five years, the development of the Graafian follicles and the discharge of the ova are con- 168 PERSONAL HYGIENE FOR WOMEN tinually taking place. The liberation of the ova usually takes place at definite times, which, in general, coincide with the menstrual epochs, one or more ova being set free at each period, but this is by no means invariable. The Uterus. — The virgin uterus is a small, hollow, muscular organ, somewhat pear shaped, whose cavity is about li inches deep. The uterus is situated in the middle of the pelvic cavity, between the bladder and the lower bowel. It is held in position by broad elastic bands, which go to different sides of the pelvis; it is also in part supported by the structures below and above it; but so loosely is the utenis held that it is easily pushed about, as, for instance, by a full bladder or a packed bowel, and persistently allowing the bladder to become overful, and failure to have a daily evacuation of the bowels, are prolific sources of displacements of the womb. Respiratory Movements of the Uterus. — When no constric- tions are placed about the waist, the uterus moves freely up and down with every respiration. So distinctly, and with such regularity, do these movements occur that an operator, by watching the movements of the uterus, can tell the effect that the anesthetic is having on the patient's breathing. These so-called respiratory move- ments play a very important role in the circulation of the uterus, and in the return of the venous blood to the heart. Anything which interferes with these movements, as the wearing of corsets or of tight bands about the waist, prevents the free return of the venous blood. The utems becomes congested, and through the constant abnormal weight of the organ itself, as well as by the pressing down upon it from above of the superincumbent organs, the uterus is pushed down below its normal position, the hgaments whose duty it is to hold it up become relaxed, and the unhappy woman suffers all the agonies that are attendant on the "falling of the womb." For this reason the disorder is frequently met with in women who have never borne children as well as in those who have. The Functions of the Uterus. — The function of the THE RESPIRATORY AND CIRCULATORy SYSTEMS 169 uterus is to provide a favorable place for tlie reception of the product of conception, where it may be protected and nourished during the period of its development. The purpose of menstruation is to keep the uterus in suitable condition for the reception of this product of conception at any time. It is now known that the menstrual flow is not the whole of menstruation, and that the changes going on in the uterus are almost as continuous as the process of digestion. Average Duration of the Menstrual Flow. — The average duration of the menstrual flow is five days, although the variations are considerable in healthy women. A flow lasting any place from two to six days is perfectly consistent with health, but a flow continuing less than two days or more than six days generally indicates a local or general disease. Character of the Menstrual Flow. — For the first few hours, or perhaps for the first day, the flow is usually slight in quantity and hght in color; on the second and third day the flow reaches its height, and is profuse and dark in color, but it should never be clotted; after this it generally ceases. The amount of the flow varies from 5 to 10 ounces. If less than 5 or 6, or more than 18 napkins, are pretty well saturated through, the amount may be considered abnormal. Premonitory Symptoms of the Flow. — The premonitory symptoms of the monthly flow should not be so marked as to cause the individual any discomfort. The first indication of the return of the period should be the flow. There is generally a feeling of abdominal fulness, with some lassitude and sometimes shght headache. The temperature is lower and the pulse is slower than at other times. This lowered tone of the system is an additional reason for increased care against exposure in wet or cold weather. Hygiene of Menstruation. — During the menstrual period all cold baths must be strictly prohibited, whether tub-baths or cold sponges. The reason for this is that the 170 PERSONAL HYGIENE FOR WOMEN application of cold to the surface causes a driving in of the blood from the exterior of the body to the internal organs, and, at the time of the menstinal periods, there is already a congested condition of the pelvic organs, and it must be remembered that congestion is the first stage of inflammation. Hot or warm sponge baths may be taken throughout the period, and the vulva should be bathed with warm water twice a day throughout the entire period of the flow, as this not only removes the clotted blood before it decomposes and becomes the source of irritation, but also removes other irritating matters, and prevents the nervousness that is caused by local irritation. Another question which is still sub judice is the necessity for and the frequency with which vaginal douches should be taken; all physicians are agreed that a vaginal douche, taken immediately after the menstrual period, is beneficial, as it removes all of the debris of the flow, which is some- times very irritating. Exercise. — A moderate amount of exercise should be taken eveiy day; this is needed now quite as much as at any other time, and only good can result from it, and no harm comes of a woman going out in the rain or the cold weather. As has been sho"v\m, the menstrual process is going on for a large part of the time, and the flow is only the external appearance, but during the time of the flow the woman must be unusually careful not to get her feet wet or sit down with damp clothing on. Violent exercise of all kinds is to be prohibited at this time, as dancing, bicycling, gymnastics, and walks of over three miles. The reason for this is very obvious: the uterus has now reached the height of its turgescence, and is heavier than at any other time, hence the danger that displacements or a veiy profuse flow would be caused by any kind of violent exercise. Treatment. — If the woman has been so unfortunate as to have been caught out in a heavy rain, so that her clothes have been wet through, or if in the cold weather THE RESPIRATOEY AND CIRCULATORY SYSTEMS 171 she should come into the house thoroughly chilled, the best thing to do is to take off her wet things as quickly as possible; be well rubbed down with hot rough towels; drink a cup of hot tea, and go to bed at once, with a hot- water bag placed over the abdomen or under the small of the back. She should remain in bed until the next morning, to the end that the circulation may regain its equilibrium as quickly as possible by the immediate relief of the pelvic congestion. If this exposure should have caused the sudden cessa- tion of the flow, a hot mustard foot-bath should be taken. One tablespoonful of ground mustard is used to the gallon of water, as hot as it can be borne; the pail should be made as nearly full as possible, without nmning over, and a blanket wrapped about the pail and woman, so as to cause a profuse perspiration; this should be kept up for ten minutes; as the water cools off, hot water may be added. Profuse menstruation, painful menstruation, and scanty, very slight, or irregular flow are aU abnormal conditions that are due to some abnoraial or pathologic causes, and a good gynecologist should be at once consulted, so that not only suffering may be prevented, but that serious consequences to the general health may be averted. CHAPTER V THE NERVOUS SYSTEM AS THE BALANCE OF POWER IN THE BODY The Brain the Master Organ of the Body; the Functions of the Brain; Habit and Automatism; the Physiology of the Brain and Nervous System; the Hygiene of Work; the Toxins of Fatigue; Overwork; Signs of Overwork; Nature's Restoratives; Avocation; the Physiologic Necessity for Laughter; Vacations and Health; Sleep; Insomnia. The Eyes; Eye-strain; Description of the Visual Apparatus; Optical Defects and Their Correction; the Mechanism of Eye-strain; Local Symptoms of Eye-strain; Artificial Lighting; Hygienic Precautions in Reading and Sewing; Injuries to the Eyes; Symp- toms and Treatment of Conjvmctivitis; Trachoma; Styes. Fvmctional Nervous Disorders, Headache; Neurasthenia. The Brain the Master Organ of the Body. — The brain is not only the most important organ in the body, but its essential organ, for the sake of which all the other organs and tissues exist, and it is the master of the whole. It not only receives help from every other organ, but it also largely controls the working of each. By its mental action alone it can hurry the heart's beat or slow its pace; it can make the skin shrivel or flush; it can quicken or stop digestion; it can stop or change the character of all secretions; it can arrest or improve the general nutrition. Every organ and every vital process is represented in the structure of the brain, by special centers and groups of cells that have a direct relation with such organs and processes, and through which they are controlled. The Functions of the Brain. — The brain may be said to have four chief functions; the first is that of motion; it presides over and stimulates all the voluntary muscular movements of the body, regulating their force, and co- ordinating in their working the different groups of muscles 172 NERVOUS SYSTEM BALANCE OF POWER IN BODY 173 needed to perform them. Mind and muscular movement have the closest possible connection with each other. The second function of the brain is that of feeling and sensation; the third is that of nutrition; through this its own nourishment and that of the rest of the body is regulated. While mind is the fourth and highest form of nerve force, it is not created in the brain, but is abso- lutely conditioned by that organ. Different groups of brain-cells have different work as- signed them; some have motion, some have sensation, some have nutrition, and some have mind. For example, special tracts of brain govern inhibition. While every group does its own work, it is related to and combined with others, influencing them, and being influenced by them. Every kind of mental activity uses up the brain energy of the cells. To think clearly, plenty of healthy blood must be supplied to the cells. In order to make healthy blood, there must be an abundance of fresh air supphed to the lungs, and a vigorous heart to pump it up to the brain. It has been demonstrated that, during intellectual work or emotional feeling, there is an increased supply of blood to the brain, which may become more or less con- gested, and that there is an actual rise of temperature; whereas during periods of relaxation, rest, or fatigue, the brain is pale and anemic. The brain-cells generally, but particularly those cells involved in mental activity, are of such a nature and con- stitution that they cannot rest absolutely during the waking hours. They may act slowly or with great rapidity; different brains have different capacities for energizing, both in regard to speed and force; and, further, the brain may be pushed to work greatly in excess of its normal activity, just as an engine may be allowed to go at the rate of 50 or 60 miles an hour, or may be pushed to go at the rate of 100 miles an hour. In both cases the danger resulting from speeding are greatly in excess of going at the normal rate of speed. 174 PERSONAL HYGIENE FOR WOMEN In any case, the continuous brain action implies the necessity for continuous repair. The only complete physiologic rest which the brain enjoys is during sleep, when the process of repair goes on most rapidly; during this period the brain-cells absorb their nourishment from the blood in excess of their needs, and so lay up a store of energy for the waking hours. Habit and Automatism. — It is one of the innate quahties of every tissue and of eveiy organ in the body, that when any vital action is performed, any vital proc- ess gone through with, it is easier to do it the second time, and the continuous exercise of the action makes the per- formances more and more easy, until they become auto- matic. The physiologic basis of habits consists of the plasticity of the nerve substance, and in the capacity of nerve sub- stance to receive and retain impressions. There results the certainty that the nervous system wUl act again more easily in those ways in which it has already acted. On the one hand, the automatic performance of work saves an enormous amount of brain energy; on the other hand, bad habits may be formed whose effects may be most pernicious, and which are gotten rid of only with the greatest difficulty. An example of the first is the young child learning to walk; at first he accomplishes the feat only by the fixed concentration of every power of the brain on the act; whereas the healthy adult walks automatically, without paying the least regard to the movements or the manner in which they are accomplished. Hysteria and ungovernable outbursts of passion furnish good examples of the bad habits that may be fonned, owing to the lack of discipHne and the powers of inhibi- tion ; every time that a woman gives way to one of these outbursts, so much the harder will it be for her to prevent or control another outbreak. Inhibition is the highest and most important function of the brain. Habits woman must have, but it is for her to choose what they shall be, provided she chooses quickly; the NERVOUS SYSTEM BALANCE OF POWER IN BODY 175 time limit in habits is one of the strong evidences of the close connection of body and mind. It is a startHng fact to face, that a woman's habits are largely fixed before she is twenty; that the chief lines of her future growth and acquaintance before she is twenty-five; and her profes- sional habits before she is thirty; yet to something Hke this James believes that physiologic psychology points. The woman becomes a bundle of habits, and her habits settle about her Hke a plaster cast. The Physiology of the Brain and Nervous System. — The brain, spinal cord, and spinal nerves constitute the so-called cerebrospinal nervous system. The brain is that portion of the nervous system which is contained within the cranial cavity and which it completely fills. The spinal cord is the continuation downward, from the brain through the spinal canal, of nerve substances, and from which the spinal nerves are given off. The nerves may be described as cords and threads of varying degrees of fineness, distributed to every tissue and organ in the body. The nervous system has been likened to the electric telegraph, the brain being the central station, while, in addition to the special senses, the body is provided with numerous terminal substations in the skin and internal organs of the body, which keep the brain informed of what is going on in the world around it, as well as in the various parts of the body. The nerves simply act as conductors to transmit the messages. The body is supplied with two distinct sets of nerves or wires, one of which carries messages from the outside world and various organs to the brain, while the other set transmits orders from the brain. The spinal cord is the center of reflex acts; that is, if the leg of a brainless frog is touched with acid, he wiU take the other leg to wipe it off with. There are, as we have seen, substations in the skin, hence the acid causes the sensation of a foreign body, word is telegraphed the spinal cord, where there is a large central station; 176 PERSONAL HYGIENE FOR WOMEN from here word is sent out by another set of nerves, to move the leg away from the acid, but this being insufficient, word is telegraphed to the other leg to wipe off the offend- ing substance. Did the same thing happen in the body, at the same time that the cord telegraphed word to the affected member to withdraw it, it would telegraph the brain, and the sensation of pain would be felt. A message travels along a nerve at the rate of about thirty-six yards a second, or a mile a minute. This is about the time made by a lightning express train. The distance in the body being so short, the time taken is imperceptible, and we say that movement is instantaneous. The paths traveled by nerve impulses are made passa- ble by use; the oftener an impulse traverses a given route, the more adapted such a route becomes for future trafl&c. But all of this has to do with the nerves which are under the control of the will. There is another set of telegraph wires in the body, called the sympathetic or vegetative system, so-called because it presides over the processes of nutrition and is beyond the control of the will. The Hygiene of Work. — Since the motor centers are located in the brain, it is natural to expect that all de- finitely directed movements will directly affect the brain and the mental development, and so it is. Du Bois Reymond says that it is easy to demonstrate that such bodily exercises as gymnastics, fencing, swimming, riding, dancing, and skating are much more exercises of the central nervous system, of the brain, and spinal cord than of the muscles. It is further urged that healthful energy of will is impossible without strong muscles, which are its organs, and that endurance, self-control, and great achievement all depend on muscle habits. The philosophy of work consists in its necessity. The brain-cell in health cannot cease to be active, except to a. partial extent during sleep. There must be some output NERVOUS SYSTEM BALANCE OF POWER IN BODY 177 of mind from the mind cell and of motor stimulus from the motor cell. The proper selection of work for that particular brain to do, and the physiologic regulations of the work done, is the basis of the hygiene of work. For health, for happiness, and for efficiency, right work rightly done is the most important matter in any man's or any woman's hfe. The physiologic, as well as the moral necessity, has always been conceded for every man to have a life-work — a vocation; a work for which he should be fitted, and for which he was capable, sufficiently congenial not to sink into mere drudgery, and which would, at the same time, afford ample financial compensation to be remunera- tive and a stimulus to his power of endurance. Important, from a physiologic point of view, as a vocation is for men, it is equally or even more important for women. It is highly probable that the unstable nervous system of women and their emotional extrava- gance and dissipations, whether of frivohty, wickedness, or grief, is largely due to lack of mental disciphne and muscular development. It is a psychologic proposition that any woman who has a toothache suffers less if she keeps busy, and any one will testify that she suffers much less from the intense heat of summer if she is busily employed. One of the great objects of a definite and fixed occupa- tion is to turn the thoughts out from the ego. Work of some kind is indispensable to the health and happiness of every one, since it necessitates an objective instead of a subjective attitude of mind. Experience teaches that the brain, like the muscles, is subject to training; occasional excessive efforts, with long intervals of repose, are rather injurious, while a many- sided activity, constantly repeated, interrupted by suffici- ent shorter rests and supported by sufficient nutrition, is strengthening. A healthy training of the brain should be as many sided as possible. Symmetric development and training of every func- 12 178 PERSONAL HYGIENE FOR WOMEN tion of the brain is as essential for mental efficiency and sanity as the development of all the muscles of the body is for bodily vigor, and a one-sided training of the mental powers is as certain to produce eccentricities of habits of thought and actions as those occupations which call into play only the action of certain groups of muscles is to cause bodily deformities. An3^thing which will prove injurious to the dehcate nerve substance must be avoided, as laziness, idleness, and, worst of all, any form of nar- cotics. Many-sided life work, consistently carried through, not only strengthens the brain, but also its continued power of adaptation, and one's whole life is a continuous struggle for adaptation. The more the brain works, the more capable it is of receiving new impressions and elaborating old ones, and it retains its elasticity longer. Hurry generally implies lack of system in carrying out the routine of work, or the undertaking of more work than the individual can accompHsh without injury to herself. Few things can more certainly muddle the brain and produce a sense of physical exhaustion than a sense of hurry. Without the sense of this insane driver with a lash in his hands standing over one, she can work more rapidly, with complete self-possession, and do more accurate and better work. The peculiar sense of being hurried has a direct benumbing physical effect, that can often be felt in the brain as distinctly confusing. The Toxins of Fatigue. — By speeding the machinery to the utmost, a strain is placed on nerves and muscles, and they are kept keyed up to the greatest possible ten- sion. There is a natural pace that one can keep up; force the pace, and weariness results. A man can go for hours at the rate of five miles an hour; he can run at the rate of six miles an hour for quite a long while; but if he tries to run eight miles an hour, he will drop out very soon. The powers of endurance must be gradually developed, but no machine should ever be run at its utmost speed. NERVOUS SYSTEM BALANCE OF POWER IN BODY 179 By undue pressure, at any period of life, it is possible to use up energy that ought to have been spread out over long periods; and this is emphatically the case during adolescence; too heavy a drain is made on futurity, which means a serious breakdown, or, at least, premature old age. It has long been assumed that during the activity of muscles substances were produced which exerted a poisonous influence upon the muscle tissues. Exactly what these substances were was not known, but it was supposed that they were definite products of metabolism or tissue waste. It is a well-known phenomenon, observed during the training of athletes and soldiers, that pro- longed and disciplined exercise makes it possible for individuals to support easily an amount of work which would prove exhausting or even fatal to the untraned. Increased work, under any circumstances, means increased metabolism, and consequently a more rapid accumulation of its products. A German investigator, Dr. Weichardt, has shown that if guinea-pigs were put upon a miniature treadmill and forced to run it until they dropped dead from exhaustioti, a highly poisonous Hquid could be pressed from their muscles, and that the injection of this liquid or extract into the veins of healthy guinea-pigs produced, when administered in small doses, rapid fatigue; whereas, larger doses caused death, accompanied by all the symp- toms observed in the original animal during the process of mechanical tiring. On the other hand, Uquid taken from unworked guinea- pigs had no such effect. Further, that if these Uttle animals were put upon a treadmill and worked to just short of exhaustion, and then were given time to re- cuperate, as we say, the liquid or extract from their muscles had no such effect: it was quite harmless. From the results of these carefully carried out scientific investigations, Weichardt has come to the conclusion that fatigue is due to a definite toxin, analogous to that 180 PERSONAL HYGIENE FOR WOMEN of diphtheria and tetanus, and he beheves that the ex- planation of the phenomena of training hes in the fact that in the body of the athlete there must be a specific "antibody," which neutralizes the "fatigue toxin" as soon as it is formed. In the animals undergoing these experiments of extreme fatigue there was a fall of temperature. A practical use of this fact could be made for the individual, by noting the fact that a subnormal temperature was a grave danger-signal. Other observers concede that fatigue is due to chemical substances, produced in the body as the result of brain and muscle activity, and find that these toxins produce a depressing effect, especially on the muscular system, and that the sensation of fatigue is in large part the manifestation of this depression. The action of toxins is not confined to the tissues in which they arise; exces- sive activity of one tissue can cause fatigue of others. The facts of acid intoxication are noticed as analogous to fatigue phenomena, so far as the latter are due to toxic substances. As antidotes, only rest and sleep can be relied upon. Observations in the electric experiments on nerve-cells have shown a remarkable shrinking of the nerve-cells, and especially of their nuclei. After five hours' con- tinuous work, the cell nucleus was only half its normal size, and twenty-four hours of rest was necessary in order to restore it to its normal size, but half that amount of work does not require half that amount of time for its recovery. The mental symptoms of normal fatigue are loss of memory; the sense of perception is less acute; the associa- tion centers act less spontaneously and therefore slower; the vocabulary diminishes; the emotional tone is lowered; the attention is unstable and flickering. All these are marked symptoms that the individual is far below her best. All kinds of perceptions are more acute in the morning. NERVOUS SYSTEM BALANCE OF POWER IN BODY 181 Fatigue is not, therefore, merely physically uncom- fortable; it is intellectually, physically, and morally dangerous. Overwork. — A surplus nervous energy must be per- sistently aimed at — what Emerson calls "plus health." It must be indelibly impressed on the intelhgence of every one that no fatigued individual can be at her best; she is doomed to do inferior work, to be mentally de- pressed, and to be morally weakened. Hope and courage ooze away, and aU sense of proportions and perspective are lost. The amount of work that can be performed without fatigue is a matter of individuahty, and the only safe gauge of overwork are the danger-signals sent out by nature — loss of appetite, insomnia, increasing exhaustion from day to day without increase in the amount of work done, mental depression, lack of interest and initiative. No one can afford to disregard these danger-signals. Habitual overwork produces fag and a desire for stimulants to act as a spur to the overworked muscles during the day, and recourse to increased stimulants or sedatives to act as hypnotics at night. The inert nerve- centers have no reserve energy to give out, so it is worse than useless to stimulate them. On the other hand, the nerve-centers are at too low an ebb to react from the depressing effects of sedatives, which, to the indi- vidual, must be positively injurious. The aim must be to promote nutrition, and to give complete rest to the exhausted nerve-centers. Brain work, to be beneficial, must be regulated with the greatest care. During the exercise of the brain there is always an increased blood-supply to it. If the exercise is continued too long, there is a tendency for the blood to remain in too great quantity, due to the exhaustion of the nerve-cells, which are no longer able to control the vessels. During sleep the blood-supply to the brain is diminished and the cells recover themselves, but if this hyperemia 182 PERSONAL HYGIENE FOR WOMEN be persistently kept up, sleep soon becomes impossible, the brain-cells have no opportunity to become repaired, and their activity is diminished. Richardson says: " Making all allowances for differences, even in the prime of their mental and physical vigor, few individuals can exceed six, and for most persons prudence would direct not more than four or five hours of close mental application, without seriously endanger- ing their health." No real advantage is gained by eight or ten hours of daily study, since the memoiy and reasoning powers become so exhausted that the assimilation of ideas becomes slower and more difficult. When in his prime, Walter Scott declared that six hours a day was all that he could profitably spend upon his Kterary compositions. In later years, because of his pecuniary embarrassment, he worked beyond this Hmit, and, as the result of exces- sive labor, his last years were spent in hopeless imbecility. Signs of Overwork. — These show themselves in irritability, with a sense of exhaustion, the irritability being due to an exhaustion of the nerve-centers. Work becomes irksome. There are periods of depression and melanchoHa, which recur at shorter and shorter intervals and continue for a longer period of time. There is a shght loss of memory, together with inability to concentrate the mind upon any given subject for any considerable length of time, and the power of thought and judgment are impaired. There are sleepless nights, ringing in the ears, fatigue from the slightest exertion, an irregular action of the heart, with palpitation and a frequent desire to urinate. Various forms of pain and neuralgia occur. There may be as yet no loss of flesh or impairment of the appetite, but this condition of cerebral anemia furnishes the possessor with a pair of blue spectacles through which the intelligence must look, and which throw their own color over everything. Distressing dreams and unrefreshing sleep allow the brain httle opportunity for either rest or repair. The mind becomes as sensitive NERVOUS SYSTEM BALANCE OF POWER IN BODY 183 as the skin after a blister, and the calm, vigorous mental labor is superseded by feverish anxiety, wearing responsi- bility, and vexing chagrin. When the brain is well supplied with a powerful circula- tion, and a rich blood-supply from a good digestion furnishes it with an abundance of pabulum, the cares of life are borne with equanimity and cheerfulness. One of the most unerring signs of faihng health is the inabihty to withstand the pressure of these same daily cares. When the cares that formerly sat lightly on the shoulders become well-nigh an insupportable burden, a state has been reached where the mind reacts on the body. Worry. — It is readily evident that worry is bred of exhaustion, and is one of the signs of overwork; but, if too often indulged in, it becomes a fixed habit, and the mind rapidly becomes settled in a state of gloom. It is most important for overwrought business and professional women, but most especially for those women whose vocations in life combine three distinct occupa- tions or callings — namely, wives who act in the capacity of housekeepers, ministers of finance to the household, and the bringing up of children — to reahze the importance of not undertaking more than they can accompHsh with- out fret and worry. The overconscientious woman may object that it is selfish to consider her own comfort when she has work to do for others, but to expend too freely of the nervous energy, even in a good cause, is like giving so much of our substance to charity that we our- selves are in turn obhged to lean on others for support. In properly conserving our own energies, we may ulti- mately be lightening the burden of others. There is a proper balance between the duty one owes to one's self and to others. Once bred, worry is an endless chain. Tell such a woman not to worry, and she worries for fear she may worry. She is afraid that she has decided wrongly, and regards decisions in regard to the most trivial affairs of life as though they were matters of vital importance. 184 PERSONAL HYGIENE FOR WOMEN The obsession "to arrive" is a fertile source of fret and worry. This habit of mind leads to frantic and incessant labor and blocks all pleasure at every point. The person who plays a game only to see who wins, loses half of the benefit of the recreation. "The legs of the stork are long, the legs of the duck are short; you cannot make the legs of the stork short, neither can you make the legs of the duck long. Why worry?" (Chinese proverb.) Insomnia. — This is another symptom of overwork. The mind, worried and harassed all day, retires at night to struggle in the darkness and solitude with worries, forebodings, doubts, and regrets, which now assume gigantic and fantastic shapes. In this case the insomnia is due to faulty habits of mind. Another form of insomnia is caused by intellectual work being carried on at night until time for retiring; the mind is then so fully saturated with the subject that it is unable to throw it off on going to bed. Whatever be the cause of the insomnia, it soon becomes a fixed habit, and, whether it is a case of laying awake a long time before sleep comes, or waking up at a regular hour toward morning, — and it is a curious fact that the habit of waking up recurs at almost precisely the same hour in the morning, — the longer this habit of insomnia is indulged in, the more difficult it is to break it up. Nervousness, — This is a well-known sign of overwork, which shows itself in intense nervousness and irritability. Everything jars on the nerves. The woman gives way to her emotions, over which she loses control. To keep placid when overworked to the limit of physical endurance requires a stolidity of soul and lack of nerves only known to the North American Indians, and perhaps the Japanese, and it matters not what the kind of over- work is, whether business, pleasure, or charity. Nature's Restoratives. — The proper division of the day is eight hours to be alloted to work, eight to sleep, and the remaining period of eight hours is to be divided NERVOUS SYSTEM BALANCE OF POWER IN BODY 185 among tlie various methods of refreshing body and mind — the toilet, eating, rest, and recreations. Not only are rest, recreation, and sleep in proper proportions essential to the health of the body, but they are equally essential to the quantity and the quality of the output of work. From them result a feeling of physical well-being, an exuberance of animal spirits which go into the work. The perspective is more ac- curate, the judgment is clearer, and the creative power is greater. Work goes of itself with a swing. Happiness is an expansive quality, that makes itself felt throughout the entire body, but its effects are most manifest in the mental power. The mother who so honestly works and plans for the good of her family as to give herself no time to rest after her physical efforts is in such an exhausted condition as only to be able to give them the tired and critical side of herself for daily association. There are few human achievements much finer than to make human beings happy, and this power woman is endowed with to a very- large extent. Rest, to be of value, must be systematically taken. Bearing in mind the shrinking in size of the nerve-cells after stimulation caused by work, and that they recovered their normal size in relatively less time if the shrinkage were less, it becomes obvious that, in order to accomplish the best work, whether purely mental, or of the more complex mental and physical work demanded of the mother who is at the same time the housewife, that a break in the day's work will aid in securing the best results. The exact time of the daily siesta must be adapted to the family regime, but a fixed hour should be set aside for this purpose, and this should be known as the mother's hour, and nothing short of a catastrophe should be allowed to infringe on it. The woman should retire to her bed-room, undress, and go to bed. The room should be darkened, and at 186 PERSONAL HYGIENE FOR WOMEN the same time there must be an abundant supply of fresh air. One soon forms the habit of taking a short nap, of perhaps haK an hour; one hour should be spent in bed. After this, she gets up, takes a shower or other bath, dresses, and is then ready to enjoy hfe and be a comfort to her family. In this way alone can absolute relaxation, rest of mind, and body be secured. Avocation. — Second only to the physiologic necessity for a vocation in life, is the necessity for an avocation, and this must be in the nature of a recreation. It is a weU-known fact in farming that any one kind of crop will exhaust the very best soil, but few people recognize the necessity for a change of occupation and recreation in order to produce the best mental and physical results. Joyless drudgery drains the springs of health. There is a mental starvation, due to the lack of recreation, as well as the physical, due to the lack of bread. The French aris- tocrats, noted for the gaiety of their pastimes, in spite of their dietetic and other sins, furnish a remarkable list of longevity. Persons of a cheerful disposition are generally long-lived, and anything tending to counter- act the influence of worry and discontent directly con- tributes to the preservation of the health. Despair, which frequently results from years of overwork, can paralyze the energies of vital functions like a sudden poison, while hope fulfilled has cured many a disease. The nature of the avocation chosen will necessarily depend upon the character of the vocation. For women whose vocations are intellectual and sedentary, as writers, teachers, stenographers, etc., some outdoor employment, which calls into activity the muscles of the body, rests the eyes and brain, and, at the same time, pleasantly occupies the mind, is the best, as walking, gardening, lawn-tennis, goK, rowing, etc. For all women engaged in sedentary occupations, daily exercise in the open air is the first essential, and let them be assured that their feelings of fatigue and disinclination NERVOUS SYSTEM BALANCE OF POWER IN BODY 187 to exercise are no safe guide as to their ability to take exercise. The first cause of the feeling of fatigue is due to the lack of oxygen in the lungs and the impure air of the room. On going out-of-doors, the woman will be surprised at how much stronger and better she feels after an hour's brisk walk than she did on starting out. ''Fancy work" and lace-making, instead of being classed with recreations, must be classed with fine hand- sewing of the most taxing kind. It calls the same groups of muscles into play, and is productive of the same evils, with a greater tendency to produce eye-strain and a paralysis similar to writer's cramp. The proper avocation of the tired housewife, who has been on her feet all the time and whose vocation is manual labor, will be the diversion of the mind by reading a good book, while comfortably pillowed on a veranda chair, a drive, a visit to some congenial friend, a game of cards, or music. Literary clubs for women should be more largely organ- ized through the country and in country towns. In the cities women have found these clubs a great boon, not only to the health and happiness, but they are in the highest degree educational. Further, women have found that these Hterary clubs were profitable, as a means of bringing their minds in contact with other educated minds, and thus they had not only the additional stimulus to study, but a broaden- ing of their horizon, which the woman's heretofore shut- in household Hfe had precluded. Courses in domestic science would be a boon to the home. The greater the number of interests which education and culture have created, the greater wiU be the diversity of the recreations open for the woman's enjoyment. Care must be taken that the avocation, which is at first an enjoyment and relaxation, is not turned into hard labor. The moment that any one strains every nerve, 188 PERSONAL HYGIENE FOR WOMEN even to excel in a game, that moment it ceases to be a relaxation. History shows that the laws of all nations have always provided a certain number of days of rest, or at least a change of occupation, and that these days were fixed at more or less regular intervals. This was partly from a religious and partly from a hygienic standpoint. The necessity for the interruption of the regular routine work has always been recognized, and one day out of every seven has been set aside for this purpose. The custom that is so frequently adopted by city folk of going out of town over Sunday might very well be imitated by country folk by going into the town or city over Sunday. For not only is the too continuous apphca- tion to one's employment fraught with danger, but it has been conclusively shown that a monotonous routine of occupation, such as lived by the average farmer's wife, is a severe tax on the sanity of the mind. Statistics show that the heaviest percentage of insanity faUs on farmer's wives, and the supposed cause of this is the monotony of their Hves. A horse cannot gaUop as many hours as it can walk, and the daily task should be the sum-total of what man or beast can do compatibly with health. To combine a day of toil with a second of amusement in one twenty- four hours does not give the proper allowance for sleep, and cannot be done without injury to the individual. Fun and laughter are the most efficacious remedies in the pharmacopeia, and tired humanity owes a debt of gratitude to the guild of humorists, be they writers, comedians, or musical composers. The Physiologic Necessity for Laughter. — The at- titude of the individual varies with age, temperament, and the perspective of Hfe. Grave adults are apt to think of laughter and smiling as something occasional, a momen- tary lapse once in a while from the persistent attitude of seriousness. Healthy children, on the contrary, consider that a state of laughter is the normal condition of human- NERVOUS SYSTEM BALANCE OF POWER IN BODY 189 ity, and that seriousness is a tiresome necessity, which must be tolerated from time to time. But very few people have any idea that there exists a well-defined physiologic necessity for laughter, and the greater the intellectual labor and the mental strain, the greater is this necessity. The deep forcible chest movements increase the rapidity of the circulation, the force of the heart's beat, and secures a more complete oxygenation of the blood. It is not improbable that this accelerated circulation produces remote effects on the organism. One of the im- mediate effects of a good laugh is that it relieves the brain by the rapidity of the movements of the blood through the capillary circulation. In addition to the immediate physiologic effects which result from laughter it is highly beneficial, by relieving the brain and nervous system from the intense strain and tension of the daily affairs and occupations of life, and gives relief to the severely congested capillaries, which otherwise involve considerable risk to the individual. Physiologists hold that pleasurable feelings tend to further the whole group of organic functions, and that laughter produces a considerable increase of vital activity by the heightened nervous stimulation. There is a sense of increased energy, of a high tide of the fulness of the life current. Vacations and Health. — The secret of success of the old Romans in conquering the world lay as much in their ability to maintain the health of their troops in their va- rious campaigns as by the courage and organization of those troops; or, rather it may be said that courage is but the coefficient of a good physique and a general men- tal vigor. A rest one day out of seven, with an occasional outing for the week-end, is good but not sufficient. If one would keep up to her highest standard of physical and mental efficiency, she must have at least one month of absolute change of environment and outdoor life in the year. The kind of place one choses for her vacation will 190 PERSONAL HYGIENE FOR WOMEN depend on where her home is. To dwellers in cities, the mountains and seaside resorts are the most beneficial, August is our most trying month, and every one who can would do well to take her vacation at that time, always selecting some resort north of her own home, so that she may have the additional advantage of a more bracing climate. Maine furnishes many of the most beneficial of our health resorts, combining as it does so many attractions — its bracing atmosphere of pine forests, its beautiful scenery with vast expanses of water, and the great variety of diversions which it affords. It is always wise to send an advance scout to investigate the place in which you contemplate spending your vaca- tion. Avoid low and swampy land; investigate the character of the water-supply and the nature of the plumbing, together with the sewerage system, for it is all too frequent that an attack of typhoid fever follows an outing in the country. Every good summer resort should furnish facifities for a variety of outdoor sports — golf, tennis, boating, swimming, etc. During the vacation needless exposure to the direct rays of the sun must be avoided. There is probably nothing which lowers the vital resistance, and so prepares the way for disease as much as exhausting exposure to the hot rays of the sun. Long hours of sleep should be indulged in. The morn- ing air is the most beneficial; it is, therefore, a good habit to retire early and to rise early. If the vacation is not properly spent, it may be the means of doing more harm than good. On the other hand, if properly spent, vacations prepare one as nothing else can to meet and resist the vicissitudes of the follow- ing winter. It is the people who go off on long vacations who have the least need of the doctor's care. Sleep. — During sleep all the bodily functions are in abeyance and the secretions are diminished; respiration is slow and confined to the chest, so that the amount of NERVOUS SYSTEM BALANCE OF POWER IN BODY 191 inspired air is only one-seventh of that during the waking hours; the temperature of the body falls; less blood circulates through the brain; and the sensibility of the nerves to external stimuli is diminished. Sleep is not only 'par excellence the time of repose and recuperation of the brain and nerve substance, but it is the only time when, by the diminution of waste caused by the incessant activity of the brain, that the organ can be properly nourished, the deficit in nerve force canceled, and the surplus of energy stored up. Without this absolute remission of brain activity every twenty-four hours an actual destruction of substance would occur, which, if persisted in, would be so depressing to the nervous functions as to be inconsistent with Hfe, and this is the case in the concluding stages of fatal diseases. The sleepy feeHng caused by fatigue is due to the circulation in the blood of toxins resulting from tissue waste, which benumb the brain-cells; while the feehng of freshness and bien-etre with which one awakens in the morning is due to the eHmination of the fatigue products from the blood during sleep. If the blood of a tired dog be transfused into the veins of a perfectly fresh animal, the latter will immediately show symptoms of somnolence and seek a dark comer for sleep. The medical authorities of to-day are pretty well agreed that eight hours of sleep is the minimum required for the maintenance of health, and all concede that the brain- worker requires more sleep than the manual laborer. Every moment after the feehng of languor presents itself is a strain upon the nerves and muscles which will sooner or later invalidate for life, and finally bring the victim to a premature grave. Habitual deficiency of sleep will undermine the strongest constitution. It is a matter of great importance to train one's self in the habits of sleep, regularity in the hour of retiring, abstinence from active brain work for the hour immediately preceding going to bed, since, if active brain work is con- 192 PERSONAL HYGIENE FOR WOMEN tinued until one goes to her room for the night, the chances are that the brain will continue its activities after getting into bed, and sleep may be banished from the pillow for several hours. A few minutes spent in breathing exercises, the vigorous use of the flesh brush or hair glove, a hot plunge or foot- bath are no mean hypnotics. A sound sleep is dreamless. Dreams require a certain expenditure of nerve force and mental energy, so that dreamless sleep is the most restful. Disagreeable dreams and ''night-mares" are generally associated with indiges- tion and biliousness, which also occasion a general rest- lessness. All this can be overcome by taking some med- icine for the liver. Two grains of calomel taken just before retiring often works like a charm. The dose must not be repeated under a month. In case of tendency to insomnia, no coffee should be taken after breakfast. Treatment of Insomnia. — The mechanical measures for the relief of insomnia have for their purpose the with- drawing of the blood from the brain to the surface of the skin. Hot foot-baths; general warm baths ; cold douches to the spine, brisk exercise; Hght massage, and cold rooms. Mental work should be laid aside several hours before retiring; late suppers avoided; coffee, if taken at all, should only be taken for breakfast, and then only one cup. Reading or amusement should be selected that does not excite the nerves. To woo sleep the woman should put herself in a position of rest, which of itself physiologically induces sleep. Avoid irritations, noises, bad air, cold feet, overloaded bowels, all of which tend to wakefulness and to prevent the proper physical rest. Then sleep usually comes of itself. The Eyes : Eye-strain. — Of all the misfortunes that could befall a human being, the loss of sight is probably the greatest, and yet no organ of the body is so constantly abused as the eye. The trouble is that the possessor of the normal eye NERVOUS SYSTEM BALANCE OF POWER IN BODY 193 does not take into consideration that in all near work, as in reading, writing, sewing, etc., the eye is actively- engaged as well as the hands and brain, and that the eye only is at rest when looking into space or when closed. Description of the Visual Apparatus. — The eyeball is contained and protected in a bony cavity, formed by the bones of the face and skull, and is supported by a cushion of fat and other tissues. It is held in place by its membranes and muscles, by which it is also moved. It is further protected by the eyehds, the eyebrows, and the eyelashes. The eyebrows protect the eyes from dust and perspiration and shade the eyes. The eyelids are lined by a very delicate mucous mem- brane, called the conjunctiva. They are maintained in close apposition to the eyeball by atmospheric pressure. The tears are secreted by the lacrimal gland, which is at the upper and outer angle of the orbit. The lubrica- tion by the tears and the mucus secreted by the con- junctiva cause them to move smoothly and without fric- tion. An important function of the hds is to distribute the tears over the front of the eyeball, and by incessant winking to free the front of the eye from dust and to keep it moist. The conjunctiva is continuous with the mucous mem- brane of the nose and mouth. Hence, in inflammation of the nasal mucous membrane, as in an ordinary cold in the head or influenza, the conjunctiva is liable to become very much congested or inflamed. The eyeball is spherical in form, having the segment of a smaller and much more prominent sphere ingrafted on its anterior part. The segment of the larger sphere, which forms about five-sixths of the globe, is opaque, and forms the sclerotic coat, the so-called "white" of the eye. The smaller sphere, which forms the remaining sixth, is trans- parent, and is formed by the cornea. The iris is a circular contracting membrane, suspended from the edges of the cornea, in front of the eye like a curtain. The iris gives color to the eye, and when we 13," 194 PERSONAL HYGIENE FOR WOMEN say that an eye is blue or brown, we mean that is the color of the iris. The iris is freely movable, and, according as to whether it dilates or contracts, there is an alteration in the size of the central aperture, called the pupil. The chief function of the iris is to regulate the quantity of light admitted to the interior of the eye. In a very strong light the pupil quickly contracts, shutting out the exces- sive light, while in a subdued Hght the pupil dilates, thus allowing more light to enter. When looking at a distance or when looking languidly into space, the pupil dilates. The Formation of the Image. — The eye is a camera, con- sisting of a series of lenses and media arranged in a dark chamber, the iris serving as a curtain. The object of the apparatus is to form on the retina a distinct image of external objects. The Mechanism of AccomTmdation. — In the passive condition of the eye, when it is adjusted for far objects, the anterior surface of the lens is somewhat flattened. Accommodation for near objects consists in a contraction of the circular ciliary muscle and an increase in the con- vexity of the anterior surface of the crystalline lens. The light enters the eyeball through the pupil, falls upon the retina, which has often been compared to the sensitive plate of a camera, is received and transmitted by the optic nerve to the visual centers of the brain. The eyeball does not see. It is only a sensitive end-organ, which receives and transmits the impressions to the higher centers of sight. The act of vision is performed in the brain. The focusing power of the eye is the property of bend- ing nearly parallel rays of light from distant and divergent rays or from close range so that they meet exactly on the sensitive retina; this is called refraction. In the normal eye these rays are focused exactly on the retina. Optical Defects and their Correction. — In the normal eye the near limit of accommodation is from 4 to 5 inches, and the far limit may be put at an infinite distance. Myopia or Near-sightedness. — This is one of the most NERVOUS SYSTEM BALANCE OP POWER IN BODY 195 common refractive defects of the eye. In this condition, because of the greater length of the eyeball or increased refractive changes of the media, rays of light from a distance are focused in front of the retina, producing an indistinct image. The near-point is brought much nearer — from 2 to 2^ inches — and the far limit is at a very short distance. In reading, the myope is obliged to hold her book very- close to the eyes in order to see. In doing so, she strains her muscles of convergence, producing ocular congestion and compression of the eyeball. The predisposing causes of myopia are heredity; it is said that half of myopics are descended from near- sighted parents; uncorrected astigmatism, and the effort to read very fine print or figures, entails severe strain on the eyes, which may result in myopia. Myopia is corrected by a concave lens, which diverges the rays of Hght, prolonging the focal distance, so that the rays of light are focused exactly on the retina. Not only are myopic eyes not injured by wearing suit- able glasses, but, on the contrary, are often preserved from injurious pressure on the globe, due to the indul- gence of the habit to nearly close the Hds in order to see better, as is commonly done when glasses are not worn. Hyperopia or Far-sightedness. — In this condition the eye- ball is too short, and the rays of hght from a distance are focused behind the retina. Instead of being distinct, the image is blurred. Hyperopia is corrected by a convex lens, which converges the rays of light, bringing them sooner to a focus. In the hyperopic eye the near-point of accommodation is at some distance, and a far limit of accommodation practically does not exist. Presbyopia. — This is a loss of the power of accom- modation, by which reading, writing, sewing, and other near work is accomplished. This power of accommoda- tion is greatest in early life, and gradually diminishes until about the age of forty years, when reading at the ordinary distance becomes uncomfortable. At about 196 PERSONAL HYGIENE FOR WOMEN seventy-five years of age the power of accommodation is practically lost. Every person over forty-five years, with normal or far- sighted eyes, should wear glasses to perform near work. Astigmatism. — Astigmatism does not depend on the length of the eyeball, but on the curvature of the cornea, and rarely on that of the lens. Uncorrected astigmatism necessitates the expenditure of more muscular effort in the attempt to see distinctly than is necessary when Fig. 12. — Astigmatic chart. refraction is normal. This is accompanied by early fatigue and more or less congestion of the vascular tunics of the eye. Astigmatism is corrected by a cylindric lens, which has a plane surface in one axis and a concave surface in the axis at right angles to it. In simple astigmatism, on looking at the accompany- ing astigmatic chart with each eye separately, certain lines in the defective meridian seem very much blurred, while those at exact right angles appear clear and black. This NERVOUS SYSTEM BALANCE OF POWER IN BODY 197 furnishes a test for astigmatism, since to the normal eye the lines appear of equal distinctness and clearness. Astigmatism is a very common ocular defect. The Mechanism of Eye-strain. — Comparatively few eyes are perfect. Far-sighted or astigmatic eyes can secure perfect vision by means of accommodation. By constant strain on the ciliary muscle, the crystalline lens is so increased in curvature as to exactly counterbalance the optical defect of the eyes. Healthy eyes should do their work without the con- sciousness of the owner, and this is a safe test as to the kind and amount of work demanded of them. Perfect rest for the eyes is impossible in the waking state — distant vision represents rest for the eyes and near vision exertion. Near work is the chief cause of near-sightedness. Distant vision should alternate with near work, and in near work the object should not be brought nearer to the eyes than 12 inches. The Local Symptoms of Eye-strain. — There may be a sense of fatigue in the eyes after reading for a short time, and this may be followed by a constant sense of discomfort in the eyes, which is increased on using them, and which may be accompanied by severe pain in the back of the head. There is a sensitiveness to light, and inflammation of the eyelids and conjunctiva. There may be twitching of the eyelids, and in extreme cases difficulty in keeping the eyes open on account of drowsiness. The eyes may smart, itch, or burn, and continually "water." As the trouble becomes more pronounced, reading for a short time may be followed by a blurring of the type, and finally the fines may run together. There is a constant sense of the eyes feeling for the lines, and, perhaps one of the first things to call attention to the condition of the eyes may be the losing of the fines in reading. The general or reflex symptom of eye-strain is head- ache, which frequently takes the form of migraine. This 198 PERSONAL HYGIENE FOR WOMEN is increased on reading, sewing, riding in the cars, etc. The headache is usually over the region of the temples or just above the eyes, but it may be on the top of the head or at the base of the skull. Vision is so fundamentally related to all the brain func- tions that eye-strain, or anything which interferes with normal sight, may cause the most varied disturbances of bodily functions. The Prevention of Eye-strain. — Persons whose work necessitates much ocular labor should vary their duties with intervals of rest. In continued reading or sewing it is well to desist at short intervals and fix the gaze on some distant object, and to frequently close the lids. Lace work, very fine needle work, working on black goods, reading very fine print, or print on an inferior quality of paper, or attempting to read in a dim light, are all a severe tax on the eyes, and should be avoided, as they are certain to cause them permanent injury. Defective vision is so common in school-children, it is so often present without being suspected, and so much harm is done to the eyes and the general health of the individual before it is discovered, that there should be a compulsory law requiring the examination of all school- children; and, again, before boys and girls enter the normal schools and colleges. Clear vision gives clear judgment; defective vision in its various manifestations gives different warps and bents to the mind of their unfortunate possessors. Veils. — The wearing of veils is responsible for not a little deterioration of vision, particularly when they are thick or dotted. Unless the meshes of the veil are very large, it holds a layer of impure air close to the face, so that the wearer is breathing vitiated air. It hinders clearness of vision, because the external world is viewed through a narrow lattice. The best veil for the eyes is one with a single mesh, either without dots, or the dots so far apart that none shall come over the eyes. NERVOUS SYSTEM BALANCE OP POWER IN BODY 199 Protection of the Eyes from the Glare of the Sun. — In very hot weather the eyes should always be so protected that the rays of the sun do not shine directly into them. This protection may be afforded by the brim of the hat or by a parasol. At the sea-shore, or on an ocean voyage, where the glare of the sun is constant and particularly trying, the eyes should be protected by wearing slightly tinted smoked glasses. Artificial Lighting. — The main sources of artificial lighting are kerosene, gas, and electricity. The principal questions of importance are the quantity and quality of the hght, its steadiness, the vitiation of the atmosphere by the products of combustion, and the expense; also the proper arrangement of the fight. Kerosene is the most extensively used means for arti- ficial fighting. The principal objections are — the heat, the trouble of filfing and keeping the lamps in order, and the danger of explosion and fire if upset; the odor and the great vitiation of the atmosphere. The modem lamp gives a brilliant Hght, and if prop- erly shaded by a sfightly bluish chimney, so as to absorb the excess of yellow rays, it is very satisfactory. IHuminating gas, as furnished in cities, has a great excess of yefiow rays, which are very injurious to the eyes, and the vitiation of the atmosphere is very considerable. Gas-fight is modified by the Argand and Bimsen burners. Of these, the Bunsen burner, a patented composition burner, heated to incandescence, is the best. It gives a white fight, resembfing dayfight, and, under proper adjust- ment, a far greater volume than any other burner. It is not so hot, does not consume as much gas, and so there is less vitiation of the atmosphere. It is intensely briUiant, and must be shaded by ground glass or a proper shade. Electricity gives the very best fight, with a minimum amount of heat and vitiation of the atmosphere. For individual use 16-candle power is sufficient. The lamp-shade should be opaque, of a dark-green color, and lined with a white, reflecting surface. Transparent 200 PEKSONAL HYGIENE FOE WOMEN lamp-shades, especially when patterned, are always bad, whatever their color; because of the different degree of illumination thrown upon the work, the Hght is irritating to the eyes. Hygienic Precautions in Reading and Sewing. — There should be free access of open dayhght. Near the window is obviously the best place for working, and the seat should be so selected that the window is to the left of the worker. This prevents the work from being shaded by the hand, and protects the eyes from being fatigued by the light falling directly into them. Any room will have too much Hght into which the sun shines directly. Even if the worker's face is not turned directly toward the sun, yet the Hght reflected from the book or other work wiU be so intense as to be dazzHng. The softest and most pleasant Hght to work by is the diffused light from the northern sky. An excess of Hght may be easily regulated by a shade. Reading. — 'Very fine type should always be avoided, it is a very unnecessary strain on the eyes, as are also books printed on a poor quality of paper with improper spacing. The paper should be unglazed. Length of Line. — The length of the printed Hne should not be more than 4 inches, nor less than 2f inches; that is, not more than 10 or less than 7 centimeters. If the line is too long, the effort to find the succeeding Hne is too great. If, on the other hand, the line is too short, the lateral movements of the eye are so frequent that the muscles concerned in these movements soon become fatigued. The position of the reader should be sitting upright, with the back toward the Hght, which should fafl over the left shoulder, and the book held nearly on a level with the eyes. The book should be held at a distance of about 12 inches from the eyes. The Hght should be on a level with the head or slightly above it. In desk work, a shade should always be worn to protect the eyes. Reading in the recumbent position is a pernicious habit, NERVOUS SYSTEM BALANCE OF POWER IN BODY 201 and is particularly bad when convalescing from an illness or when very tired. Reading in carriages or cars is injurious to all eyes, but especially so to myopic eyes; because of the constant jolting, the distance between the type and the eyes is continually changing, necessitating the frequent and abrupt adjustments of accommodation; besides, the illumination is apt to be very poor. Reading in a dim light or the twilight is also very bad for the eyes. Sewing and embroidery require the most trying ocular labor and the best conditions for illumination. Working on black goods by artificial fight should be absolutely forbidden. Injuries to the Eyes. — The most common injuries to the eyes are the entrance of smaU particles of dust, cinders, steel fifings, etc., into the conjunctival sac, or into the substance of the cornea. Frequently, with the aid of a little winking, the tears wash away these foreign sub- stances, but if the susbtance lodges in the fining mem- brane of the upper or lower fid, or is imbedded in the cornea, it may be necessary to resort to other means in order to remove them. The fining membrane of the lower fid is brought into view by simple tension of the lower fid downward by one finger. If the offending particle is not seen, the upper fid should be everted. This may be easily effected by the fingers alone. The patient is told to look down, the edge of the upper lid and the lashes are seized by the thumb and forefinger of the right hand, and the fid is drawn at first forward and then downward away from the eye, then upward over the point of the thumb or fore- finger of the left hand, which is held stationary on the fid and acts as a fulcrum. The foreign body should be removed with the handkerchief, but, if it is imbedded, it may be necessary for a competent physician to remove it. The habit of opening the eyes when dipping the face into a basin of water, or when diving, produces congestion and inflammation of the conjunctiva. 202 PERSONAL HYGIENE FOR WOMEN Symptoms and Treatment of Conjunctivitis. — The eyes may be blood-shot and the hning membranes of the lids intensely red. There is a sense of irritation about the eyes and an intolerance of light, with a constant sense of discomfort. The sensation produced is that of having sand in the eyes. The eyes are heavy, and tire after using them for a short time. The best treatment for acute conjunctivitis, which is so often caused by the penetration of dust or other foreign bodies into the conjunctival sac, is the application of cold water. A folded handkerchief is wrung out of ice- water and laid on the closed Hds. It must be changed every few minutes, so that it shall not become warm; two cloths are necessary. When the acute symptoms have begun to abate, the patient will no longer find these applications grateful, and they must be discontinued. For chronic conjunctivitis hot applications are the best. For these, one teaspoonful of fine table salt may be dis- solved in a pint of hot water, or two teaspoonfuls of boric acid may be used instead ; the last named is a mild anti- septic. The boric acid dissolves very slowly, so that it is well to prepare enough in the morning for the entire day. One tablespoonful of boric acid may be put into a quart bottle of hot water, and be well shaken from time to time, until there is a perfect solution. When ready for use, half a pint may be heated, poured into a tumbler, which is then placed in a basin of hot water; this latter serves as a water-bath to keep the solution in the glass hot. The application should be made with a rather thick wad of absorbent cotton or a piece of fine cheese-cloth. The absorbent cotton should be picked up with all the water it will hold, and be placed over the closed eyes just as hot as can comfortably be borne, and held there until it begins to cool, when the procedure should be repeated. The two eyes can be treated simul- taneously. These hot fomentations should be kept up for ten minutes, and be repeated four times a day. Trachoma. — This malady, of which so much is heard NERVOUS SYSTEM BALANCE OF POWER IN BODY 203 now, is another name for granular conjunctivitis or granular lids. The affection is very contagious. It comes on slowly, and is frequently accompanied by redness and an appreciable degree of secretion in the early stages. Presence of secretion or of interference of the vision should always attract attention. Strict precautions must be taken that the patient's handkerchief, towel, and wash-basin are not used by other members of the family. Further, the other members of the family should bathe their eyes several times a day with a solution of boric acid. Styes. — Styes are a very painful species of small boils that generally form on the edges of the eyeUds, They are apt to appear in succession. Certain persons are Hable to them if the system is run down from general causes. Like boils in other parts of the body, they give evidence of impaired nutrition. Hot fomentations of boric acid solution will some- times abort them if used early. If pus has formed, the stye must be opened by an incision parallel to the edge of the hd. This should not be attempted by any one except a physician. Color-blindness. — As a rule, about 4 per cent, of males and about one-half of 1 per cent, of females are color-bhnd. The part of the color sense that is most often deficient is that for green and red. Cataract. — This is a disease in which the crystalline lens or its capsule, or both, lose their transparency and become opaque. Eventually total bhndness is the result. Senile cataracts appear after the forty-eighth year. The only remedy for the disease is the surgeon's knife. Functional Nervous Disorders. — Evidences of sound health are: first, individual adaptabihty or capacity of the individual to easily adapt herself to extremely oppo- site conditions of existence; second, endurance, or the capacity to do a considerable amount of mental work for a short time without suffering fatigue, or to be able to quickly recover from the fatigue; third, to be able to 204 PERSONAL HYGIENE FOR WOMEN control the emotions; fourth, to be able to resist morbific influence; that is, the capacity on the part of sound organs of excretion to quickly eHminate all poisons from the system. The signs of debihty are just the reverse: first, de- formity, obesity, or leanness; second, personal inadapta- bility, that is, when physical or mental discomfort is caused by such slight provocations as change of food, clothing, or cHmate; third, lack of endurance, so that a long rest is required to repair the fatigue incident to slight exertion; fourth, lack of control of the emotions; fifth, a proclivity to morbific influences, so that the individual succumbs to every contagion or miasm that she encounters. Nervousness is a disease of civilization, coupled with overwork and indoor life. The more complex the environ- ment in which the individual finds herself, and to which she must adjust herself, the greater the demands made on the nervous system. The extreme dryness of our climate, together with the great variations of temperature between winter and sum- mer and the rapid fluctuations of temperature, predisposes to nervous disorders. Headache. — Headache is a symptom rather than a disease, but there is no symptom which requires more careful investigation of its cause than that of headache. It occurs at all ages, but is most common from ten to twenty-five years and from thirty-five to forty-five years. Women suffer from headache more than men, in the proportion of about three to one. Headaches are most common in the spring and fall of the year and in the temperate cHmates. Causes of Headache. — These may be classified into those in w^hich the blood is at fault; reflex causes; various nervous disorders; and organic diseases. The blood may be impoverished, as in the case of anemia, where there is a deficiency in hemoglobin; but by far the most frequent cause of headache is where the blood is NERVOUS SYSTEM BALANCE OF POWER IN BODY 205 disordered, as in gout, rheuraatism, kidney diseases, diabetes, and the infectious fevers and malaria. Among the more common reflex causes are eye-strain, especially errors of refraction; disorders of digestion, particularly constipation; and pelvic disorders, as in inflammation of the pelvic viscera. Functional diseases of the nervous system causing head- ache are overwork, neurasthenia, hysteria, epilepsy, and neuritis. Among the most common of the organic diseases is arteriosclerosis; other diseases are meningitis and brain tumors. Symptoms. — The pain is often dull in character and rendered worse by stooping; the location of the pain depends on the cause of the headache. The most common variety is over the forehead or eyes. In eye-strain the pain may either be in the front or back of the head. In indigestion, the pain is most frequently over the eyes, but it may also be on the top of the head. In anemia the pain may be either frontal or diffuse. In pelvic dis- orders the pain is generally at the base of the brain, though it is sometimes in the top of the head. Neuralgic headaches are generally characterized by sharp paroxysmal attacks, located in the temporal regions, and associated with pain in other parts of the body. It is perhaps most frequently caused by anemia. In hysteria the headaches are characterized by a circumscribed pain — it has been likened to the driving of a nail into the head. In migraine the pain is paroxysmal and intensely severe; it is frequently caused by some poison in the blood, as in autointoxication, due to failure of proper regulation of the bowels, also by pelvic disorders. Treatment. — The treatment is constitutional, and ia based on the removal of the cause. First, there should be a regulation of the diet, a free evacuation of the bowels, and their proper regulation. In every case of headache there should be an examination of the urine. Often there 206 PERSONAL HYGIENE FOR WOMEN is some congestion of the kidneys where it is least sus- pected. If the headache is persistently made worse by reading or sewing, the patient should be referred to a competent oculist. An inquiry should always be made into the condition of the menstrual function, backache, and leukorrhea. Any marked disorders here will neces- sitate a gynecologic examination. For the immediate relief of migraine, the patient should go at once to bed and drink a glass of hot water; some- times a cup of hot tea gives great relief. No food should be taken for from six to twelve hours, according to the severity of the case. The room must be kept dark and quiet and the head high. A strip of prepared mustard leaf, 5 inches wide by 8 inches long, should be cut, and a piece of cheese-cloth, 6 or 8 layers thick, should be folded the same size. The cheese-cloth is then wrung out of hot water, and the mustard leaf is quickly dipped into the same. The cheese- cloth is placed on the back of the neck, between it and the mustard leaf. The clothes should be kept dry by a folded napkin. In this way the mustard may be kept on from six to eight minutes, until it begins to burn and the skin get red. If left on too long, the mustard may produce the most painful kind of a blister. When taken off the neck, the mustard may be put on over the stomach. The medicinal treatment must be directed by the physi- cian, but a perfectly safe prescription, and one which may be kept on hand, is the following: Take of sodium bromid, 15 grains; of essence of peppermint, 10 drops; and of water a suflScient quantity to make 1 dram. Mix well. The dose may be repeated in three hours if necessary. This prescription should be put up by a good druggist, in a three-ounce quantity. Sometimes relief is afforded by 1 teaspoonful of the aromatic spirits of ammonia, taken in four tablespoonfuls of water, and this is about the right quantity of water to take any liquid medicine in. At night 2 grains of calomel should be taken, so that the NERVOUS SYSTEM BALANCE OF POWER IN BODY 207 patient shall not be disturbed through the night, and it is not so apt to cause nausea as when taken through the day. Neurasthenia or Nervous Prostration. — This disease first saw hght in the United States, and was christened by Beard as an American disease that was absent from no household in which the inhabitants used their brains. It is certainly much more prevalent in this than in any other coimtry. Americans scarcely treat their bodies with more consideration than their automobiles; they put on high pressure and speed them to the utmost. Add to the high pressure under which we live that other fact of heredity, that many persons are born with unstable nerve- cells, and may be nervously bankrupt, and it is not difficult to understand that 50 per cent, of Americans are suffering in some degree from lowered nerve tone. Causes of Neurasthenia. — All classes of men and women who use their brains severely, and who have seasons of excessive anxiety and responsibility, are subject to neurasthenia. We have seen that fatigue was caused by the accumulations of toxins in the body, due to muscular activity, but these toxins miay also be caused by intel- lectual overwork or anxiety over domestic or business affairs. Other causes are the intemperate amount of intellectual work which is forced on the brain, and the excessive indulgence of the emotions and the passions. Combined with the strenuousness of life is the large element of uncertainty, the intense anxiety, and the restless en- ergy which is the price of success. Added to these may bo lack of suitable and sufficient recreation and short hours of restless sleep; the restrictions of a narrow lot, lonehness, and isolation, the frequent repetitions of un- interesting tasks, added to the burdens of maternity, domestic cares, and worries. In cities the ear-strain caused by the incessant noises of the street, the amount of work done by insufficient and improper lighting, the unsanitary mode of life, the 208 PERSONAL HYGIENE FOR WOMEN improper diet, the monotonous and infertile work, the unhappiness and discontent bred of a life of idleness, or one given to society and gambling, whether bridge whist or poker, the senseless bolstering of shattered nerves with alcoholic stimulants and beverages, patent medicines, and hypnotics, all add their quota to the breaking down of the nervous system. A man can do a prodigious amount of work if he only varies it with play which really amuses him, or if he sub- stitutes for mental occupation those which involve bodily exercises. In so-called latent gout insomnia is a frequent symp- tom, or insomnia may develop as the result of bad nervous habits, Insortmia from whatever cause is followed by the impairment of nerve substance and an overloading of the body with toxins. This continued nerve exhaus- tion leads to oxaluria, uric acid, gout, anemia, gastric and intestinal dyspepsia, muscular insufficiency, and precordial distress. Whatever enfeebles the body by overtaxing the nervous system the waste is in excess of the repair, in all over- work the destructive metamorphosis is greater than the reparative processes, and so there is an accumulation of toxic products and a more or less severe and permanent injury is done the nervous system. Other causes of neurasthenia, not so generally recog- nized as overwork, are to be found in the pathologic con- ditions of the intestinal canal, which becomes a veritable culture tube, and absorption from this into the blood con- stantly takes place. And this condition of putrefaction has to be overcome before relief can be afforded, and in many cases this condition is associated with an insuffi- ciency of the elimination of urine. The large intestine is the seat of an enormous bacterio- logic flora ; they are not there by millions, but by billions. Some of them are harmless, but not all of them, and if these pathogenic bacteria are present in sufficient quan- tity, they, too, may produce symptoms of mild poisoning. NERVOUS SYSTEM BALANCE OF POWER IN BODY 209 So, too, may mere indigestion, or the malfunction of any other organ, torpidity of the liver, a deficiency of the ex- cretion of bile, which is generally accompanied by con- stipation. The Symptoms of Neurasthenia. — ^The symptoms are essentially those of chronic fatigue, which has become ex- aggerated and pathologic. They may be classified as sensory, motor, psychic, and somatic. The sensory symptoms first noticed are those of generaHzed fatigue, with such localized sensations as headache, backache, and Umbache. The motor symptoms are muscular fa- tigue, muscular weakness, and muscular exhaustion on slight exertion. The psychic symptoms are manifested by a diminution in the capacity for sustained mental effort and the spontaneity of thought and exhaustion after slight mental effort. The somatic symptoms show them- selves in atony of the digestive tract and the circulatory apparatus, with disturbances of the secretions. Headache is one of the most common symptoms of locahzed fatigue, and, associated with this, may be a sense of constriction about the head, and there may be either a sense of lightness or fulness of the head. A woman who is chronically tired loses all her personal vigor, force, aggressiveness, and, above all, will power. Associated with this lack of will power are hesitation, in- decision, a marked irritability, and timidity. Neuras- thenic patients are subject to spontaneous attacks of fear, causeless In origin, and generaHzed in character. These attacks may be accompanied by paUor of the face and palpitation of the heart, just as in normal fear. The tired woman is a cross woman. The irritability shows marked impairment of the power of inhibition. The Rational Treatment of Neurasthenia. — First of all, there must be a removal of the cause which has produced it. There are two distinct classes of cases — the over- worked and the idle. The first class, and the most im- portant to the world, are the overworked. We may have to deal with the intellectually overworked, in which the 14 210 PERSONAL HYGIENE FOR WOMEN mental overwork was combined with financial anxieties, domestic difi5culties, or lack of success in their work, or the cause may have been the tremendous responsibilities of their positions, which involved the Hves or fortunes of many people. Added to this great strain and overwork, has been a lack of proper intervals for rest, recreation, and sleep, and the body has become a storehouse for vari- ous toxins, and so is suffering from both acute and chronic poisoning. This class of patients must have the most rigid rest treatment, such as was prescribed by Weir Mitchell years ago. It is most important that the patient should be removed from her old surroundings; if this is not possible, she should be isolated on the top floor of the house with a good nurse. The room selected must be bright and cheer- ful, with plenty of sunshine and fresh air; a window should be open practically all the time, for oxygen and sunshine are two of the best restoratives. The diet must be easily digested and very nutritious. The patient should be urged not to use her mind at all. Carefully selected short stories may be read aloud by the nurse; the reading should not be continued for more than haK an hour at a time. A great deal may be done to ehminate these toxins from the system by the proper use of electric-Hght baths, fol- lowed by the shampoo and the percussion douche; mass- age with salt water, salt rubs, and electricity. In most cases a month of this absolute rest is as long as is beneficial to the patient. And for most of them the seashore is the best. There should be enough going on to be diverting without being overtaxing, and a climate should be selected which is warm enough for the patient to live out-of-doors. There should be short walks, drives, sails, etc., and this outdoor Hfe, with a contemplation of nature, is the most powerful restorative. The grandeur of nature, whether it is the mighty forests, with their re- freshing shade and quiet, or even stretched in a hammock watching the sky and trees, or the constant surging of the vast sea, bringing rest in its unceasing restlessness, with NERVOUS SYSTEM BALANCE OF POWER IN BODY 211 the ships sailing lazily along, until the whole fades away in the distant horizon. In the vastness of the universe, the ego becomes contemptibly unimportant and insignificant. After several months spent in this way the body has gotten rid of its toxins, nerves and muscles are rested, and through the soothing influence of nature the neurasthenic is gradually trained back to a healthier habit of thought and a more rational frame of mind. There is substituted for the morbid emotional complex a feeling of pleasure and energy. Reason and judgment reassert their sway; outdoor life quickens the perceptions, and forms tranquil- izing memory pictures on the brain that return later to solace and refresh the individual. There is another, and a very large class, of cases among women of leisure who have suffered all their lives from a lack of a vocation ; they have nothing to think of except themselves. They do not know what it is to be quite well; they travel from one part of the country to another, and from one country to another, but they never rise above a certain level of invahdism. They are self centered, and what they need is the work cure. In the majority of cases, before these patients can be restored to health, powerful habits must be eradicated, new interests in others must be supplied to supplant the most intense egot- ism, new paths must be hewn out in the brain, the will must be recreated, and character can only be imparted by those who possess it. CHAPTER VI THE HYGIENE OF THE MIND AND ITS RELATION TO THE PHYSICAL HEALTH Heredity; Temperament; Social Instincts; Fear. Mental Development; Self-control, the Moral Sense, the Religious Instincts; the Advantages of College Life; Balance of the Mental Faculties; the Effects of the Higher Education of Women. The Environment; the Choice of Friends; Literature. The Power of the Will or Inhibition; the Effect of the Mental Attitude on the Physical Health; A Definite Occupation a Physical Necessity; the Psychology of Success. The solidarity of brain and mind is an axiom of modem medicine, and it is a fundamental principle that must be kept constantly in view in all physical and mental training. Hitherto unsoundness, inefficiency, and weakness of mind have only been lightly touched upon in preventive medi- cine, but the importance of the mind as the chief factor in health and disease is so paramount that it can no longer be ignored. The problems that present themselves to the mother and the educator to-day are practically the same, and the mother is one of the most potent educators that we have — how the mind can best be strengthened, broadened, and be made the most efficient working instrument possible through the application of modem scientific and physio- logic knowledge. These are questions of vital importance to the human race. Heredity. — Holmes says: "Each one of us is only the footing up of a double column of figures that goes back to the first pair. Every unit tells, and some of them are plus and some of them are minus. We are mainly nothing but the answer to a long sum in addition and subtraction. 212 HYGIENE OF MIND AND ITS RELATION TO HEALTH 213 Slight obliquities are what we most have to do with in education." There are certain hereditary predispositions that will develop under certain conditions; some of them are good, some are evil; that is, with the natural development of the mind, certain pecuHarities of the ancestors wih be repro- duced. The problems suggested are how the mind can best be developed, educated, and trained, so that heredi- tary weaknesses may be counteracted or held in abeyance, and that latent hereditary talents may be discovered and developed. The first proposition that we have to face is that Hke produces like. There are modes of education, of conduct in hfe, and of occupation that should be avoided where a boy or girl is handicapped by a bad heredity. There are special precautions and attention to physiologic laws which would save the minds of many young men and women with a bad heredity from passing into a state of inefiiciency and actual disease. Heredity implies only potentiahty toward good or evil, and the latter may be averted by knowledge and the proper practice. Temperament. — This comprises the general make up of the individual, the shape of the head, the appearance of the eyes, the mobility of the features, the texture of the hair and skin, and the kind of movement. The recog- nition of the kind of temperament, and a suitable training for its best development, is of the greatest importance in attaining good health and success in life. There are four general typeQ of temperaments — the nervous, the phlegmatic, the arthritic, and the scrofulous or lymphatic. The nervous temperament has certain marked char- acteristics, as the small, wiry figure, the well-shaped head, the bright, restless eye, nervous bearing, highly strung and sensitive nerves, feehng pain keenly and bearing it badly. This woman is imaginative, sensitive, fond of intellectual work, often artistic and ambitious. In her the brain and mind are dominant above aU else. When 214 PERSONAL HYGIENE FOR WOMEN run down, this woman will be difficult to bring up again to the normal level. She will grow thin, dyspeptic, irritable, and often neuralgic. She will be peculiarly liable to ner- vous disorders. This temperament has its special temptations — alcohol and sedative drugs are two of them. Alcohol is not taken steadily or for social reasons, but for the effect of alcohol on the brain, and there is the greatest danger of becoming addicted to alcoholic habits, and finally of becoming an uncontrollable dipsomaniac. The phlegmatic or bilious temperament relates more to the training of the body, since in this class of cases the mind is not exposed to the same dangers, but the oversanguine temperament has its own dangers, which may lead to lack of effort, speculation, and financial ruin. The arthritic have a predisposition to both rheumatism and gouty disorders, to which they are distinctly more liable than others, and the fact that there is this latent tendency should be taken into consideration during child- hood and youth. Social Instincts. — Social instincts lie at the foundation on which the family and community is based. It may be said that any individual who is destitute of them is in an abnormal condition, hence a right training of the social instincts is, beyond doubt, one of the most important means of securing happiness to the individual and order to society. The child's or youth's relation to others, her affection for others, and her altruistic practices, all go for the making of society, good citizenship, and patriotism in the race. At the school age the social instincts are one of the strongest elements in life, and one of the most powerful adjuncts in developing mind and body. The cravings of young women for social amenities are stronger, and her deprivation of them more hurtful, than in the case of young men. There are few girls in whom it does not re- quire some regulation. The strain of too much social life is injurious; social dissipation cannot be combined with school life without wrecking the health of the young HYGIENE OF MIND AND ITS RELATION TO HEALTH 215 woman; nervousness, anemia, and mental depression follow. That individual cannot be said to be healthy mentally whose social instincts are poor and perverted. Commonly one of the first symptoms of a disordered mind is the dimi- nution of the social instinct. The insane are notoriously asocial. Fear. — This is one of the most elemental and primitive of the emotions. Biologists assure us that fear and sur- prise were the first of the emotions to be developed, and that the feeling of the ludicrous was the last. Darwin says that the earthworm knows fear, and darts into its burrow Hke a rabbit when alarmed. So we see that fear is common to all forms of animal existence, even to the lowest. This universality of fear has come about through the working of the laws of natural selection, which pre- scribe that only those creatures shall survive that can best adjust themselves to their environment. Within limits, fear as a primary instinct has been and is eminently useful. It is the cry of alarm raised by the senses which act as guardians of the body, and, at a signal, in virtue of the nervous automatism, the organism is put in a position of defense. On the other hand, fear may serve to paralyze, as has been observed in the case of birds, many of which, though scarcely wounded by the small shot, fall to the ground as if struck by Hghtning, panting with wide-open eyes. In human life, while fear incites to activity, it may also paralyze that activity. Mosso says that the fear that young children have of cats and dogs, before they have learned why they are to be feared, is a consequence of heredity. We are born to a heritage of fear. If we fear ghosts and demons less, we fear microbes and bacteria more. The professional or business man fears failure, but fear should be a guardian, not a jailer. A healthy fear of indigence will lead to thrift, industry, and such measures as will secure one's personal independence. Up to a certain point, fear is a protection, but beyond that it paralyzes. 216 PERSONAL HYGIENE FOR WOMEN Mental Development. — We note that at birth the brain is mindless, and that the brain-cells, which are the vehicle of the mind, undergo their greatest development during childhood from stimuli coming from without the body. The brain-cells possess infinite possibilities and potentialities. They are developed from the stimuH from without through the eyes, ears, touch, taste, and smell. There is another series of constant impressions which are received from within the body, and these come from the muscles. These impressions, conveyed to the brain-cells from the body, and from the outer world beyond the body, leave a fixed registration, the writing on the brain-cells has begun, and this constitutes memory; and the imprint on these cells is similar to that which type leaves of letters and words on the page of the printed book. These printed impressions on the cells can be revived and seen and heard by the mental consciousness, just as a printed book can be opened and seen and read by its owner. The natural quahties of the mind are imitation, acquisit- iveness, emotionalism, and imagination. The force of example in the home, at school, and in the book world is among the most potent influences in molding character. The young girl instinctively imi- tates her mother, her friends in real life, and in her book world, and the woman will be the composite production, combining traits of all of these, which will be ingrafted on the ancestral traits which have been inherited. In young children it is difficult to decide where the imagination leaves off and the spirit of tmtruthfulness begins. In any case, the tendency to exaggeration and untruthfulness are so prevalent in childhood that it must be checked at the earfiest signs of its appearance. The vice becomes so deep rooted that it affects the mind in aU its workings and the entire fife as well. It follows men and women into their business careers, their scientific life, and their professions. Professor Swift, in a very interesting study of the devel- HYGIENE OF MIND AND ITS RELATION TO HEALTH 217 opment of the mind, invokes the aid of biology to show that all children are but little animals, having no inborn notions of right and wrong, inheriting no sense of justice; savage, by nature, and predatory by instinct. He finds a psychic justification for fighting among boys. "Fighting in some form," he says, "is one of the first means by which the mind becomes accustomed to intense action. To fight well, a boy must be capable of severe concentration of attention." And he has found the age at which boys come to think that laws and the recognized rules of right conduct should be voluntarily respected varies from fifteen to seventeen years and older. These figures are approximately correct for girls. Absolute truthfulness, square dealing, honesty, honor, and an es'prit de corps should be demanded. Hitherto these principles have not been sufiiciently inculcated in girls as the fundamental principles on which life must be met. The discipline has been too lax in the home and in the school ; it is that of implicit and prompt obedience on the word of command; the proper subjection to and res- pect for those placed in authority; the kind of discipline given in business life, the hospital, and the army, and the lack of which has cost so much happiness and so many thousands of lives. Self-control. — The perfect capacity for self-control in all directions and at aU times is the ideal state at which we aim. It is the standard aimed at by developing the power of the will and the strength of inhibition. The great difii- culties, the magnitude of the task, may be conceived of from the saying of the wisest of aU men : " He who conquers his own spirit is greater than he who taketh a city." The reason is plainly evident — aU the hardest battles of fife must be fought out alone, there is a feeling of isolation, as if one were struggling alone against the combined forces of the imiverse, and, at the same time, there is going on the struggle for the mastery between the two conflicting natures; " When I would do good, evil is present with me." 218 PERSONAL HYGIENE FOR WOMEN ^Vllel■eas, in concerted action there is a feeling of sympathy, of reinforcement from outside help, and the pleasant stim- ulation of competition. If youth were taught that certain enemies were going to present themselves on the field, that they come for the most part in the first instance single handed, and if grappled with one at a time, and the contest between right, and perhaps inclination, be then and there fought to a finish, each successive time the conflict would be easier and the victory more certain ; that in losing such a battle there must always be a certain loss of self-respect, a feeling of moral weakness, it may be even so slight a fault as the exaggeration of facts; while, on the other hand, a victory always gives something of the same feehng of exultation that one has in any fairly won contest or game. A feeling of pleasurable superiority, of having one's self well in hand. In the moral habits every gain on the wrong side undoes the effects of many conquests on the right. The training of the wiU becomes the most vital of all problems. Noth- ing that is learned in youth is really so valuable as the power and habit of self-restraint, of self-sacrifice, of ener- getic, continuous, and concentrated effort. The Moral Sense. — From fifteen to twenty-five years of age is the most crucial period of life in regard to the hygiene of the mind. It is during this period that the brain first exhibits some of its strongest hereditary tendencies. While such mental factors in human life as conduct and character are being consolidated, as they now are, heredi- tary predispositions manifest themselves, teUing for good or evil, for success or failure. The acquisitions then made are critical in the extreme and often final. The real love of right, hatred of wrong, duty, conscience, religion, become soHd and effective in forming character. The emotional nature instinctively shows a leaning toward the opposite sex ; love between the sexes toward the close of adolescence is the most intense and most unreason- ing of human passions. The sense of right, wrong, and HYGIENE OF MIND AND ITS RELATION TO HEALTH 219 duty become active principles, dominating the character, There are yearnings after the ideal, an intense scorn of and hatred of evil. The purposes in life are then shaped. The impressions and resolutions then formed affect the whole tenor of the woman's life, as a rule, more than at any other time. The capacity to feel pleasure reaches its greatest inten- sity. The sex relations are built up on safe and natural lines, regulated by family Hfe, social feelings, and the carry- ing of the thoughts and the emotions into other channels, controlled by certain instinctive natural tendencies, by morality and rehgion. To think and feel properly should mean to act rightly as a physiologic corollary. Music, hterature, and art, imaginative works of aU sorts, mix themselves up with the sex feeling, so that the two help to form the emotional nature. Far-away glimpses of poetic feeling, pleasurable altruism, citizenship, and patriotism show themselves in the earlier stages and give direction to hfe in the later. The whole period is one of immense importance for the health and happiness of the remainder of hfe, and the risks to the body and mind are then very great. A fact which is of great importance, and which is especially true of adolescence, is that it is possible by undue pressure to use up stores of energy that should have been spread out over very long periods. Through such overexertion in study or in games too heavy a drain is made on futurity, and mental disorders at this time are by no means infrequent, mental depression being generally the first to appear. This is more especially true in the descendants of neurotic famihes. The subjects are troubled with neuralgias, insomnias, and there is a pessimistic view taken of Hfe. The Religious Instincts. — Mobius says, " We reckon the downfall of reHgion as one of the causes of mental and nervous diseases. Rehgion is essentially a comforter. It builds for the man, who stands amid the evil and misery of the world, another and fairer world. Besides his daily careful hfe, it lets him lead a second and purer hfe. The 220 PERSONAL HYGIENE FOR WOMEN consciousness of being within the hand of Providence, and the confident hope of a future redemption, is a support to the believer in his work and care, for which unbeHef has no compensation. Meditation calms and refreshes him like a heaHng bath. Worship breaks in upon the daily- drudgery of his days with rest and meeting." The moral- ity of a nation suffers most severely through the downfall of its rehgion, as experience has always and everywhere proved. The rehgious instinct has a very close relation to the emotions, morals, esthetic feelings, to social instinct, and to sex. The feelings of reverence and awe, and the con- sciousness of the infinite in man are vague, but are the most powerful parts of his nature. Religion furnishes the only pure ideals that half of the world has access to. It has proved an intellectual stimu- lus, and roused a metaphysical frame of mind in some of the most vigorous nations, such as the German and Scotch. It leads more toward refinement of Hfe than any other agency. It stimulates the benevolent and altruistic feel- ings, and leads to their practical demonstrations; it fights vice and immorality; it seizes on the best that is in man and transforms the character. The Advantages of College Life.— College Hfe is of the greatest possible advantage to girls in many ways: it is broadening to the mind; discipline is maintained, and, at the same time, the girl is thrown on her own resources; adequate means are provided for developing both mind and body to their greatest capacity. Whether the girl comes from the country, a country town or city, her social group is comparatively Hmited; her world is very httle and the ego is very large. The dis- cipHne that any large body of students bring to bear on the conduct and behavior of the individual is one of the important advantages of a coUege training. The insignificance of the ego, who is only a unit in this large community, is quickly impressed on the gi'ay matter of the brain, and the rough and unpleasant angles are soon HYGIENE OF MIND AND ITS RELATION TO HEALTH 221 smoothed off. This, in addition to the discipline afforded by the college officers, and the total lack of discipline is the weakest point in the average girl's education. To be brought into intimate relation with the members of a large and educated community is in itself a Hberal educa- tion. To learn to respect the rights and the opinions of others, to perceive that any given subject has a great num- ber of points of view, is attaining toward a healthy mental balance that will make the woman broader minded, more sympathetic, more companionable, and more charitable in her views of life. In addition to the regular college curriculum are the opportunities afforded, not only to special students, but to the entire body of students, for a Hberal education in music and art, and so a broad foundation for general culture is laid that will greatly increase the opportunities for pleasure all through Hfe. So that, in addition to the actual knowledge acquired by a college education, there are also the advantages of the discipline of and development of mind and body; the knowledge of how and what is worth whUe to study; the power to study and solve Hfe's greatest problems for her- self and those dependent on her; the firm muscles, the clear brain, the steady nerves, the power of judgment, the control of the will, and the formation of character — on all of which the ultimate happiness and success in hfe depend. Dr. Beard gives to brain workers a value of Hfe of four- teen years above the average. The brain-working classes are less apt to worry, less apprehensive of indefinite evils, and less disposed to magnify minute trials than those who Hve by the labor of their hands. Spinoza says that every advance toward perfection gives us happiness, and it is safe to say that the buoyancy which characterizes contemporary thought, the hopeful outlook amidst the dangers which threaten us, the sense of the added cubit to the man's stature, are due largely to the recognition of the power for good within his soul of which he was not formerly aware. 222 PERSONAL HYGIENE FOR WOMEN Balance of the Mental Faculties. — There must exist a certain balance between the various faculties of the brain in order to insure sanity. A high order of intelligence without much will, or keen emotions without a corres- ponding power of inhibition, and overmastering will and slight moral sense, vivid imagination without common sense, intense social instinct without much conscience, fervid religious instinct without much sense of duty or altruism, must invariably produce one-sided and unbal- anced individuals, and the results would be bad for society; and too many of these one-sided or unbalanced people would impair if not endanger the safety of the State. Excessive ambition, misdirected energy, longing for the unattainable, regret for the unalterable, anticipation of future unhappiness, lack of a sense of perspective, fretting over non-essentials, indecision, reopening of troublesome questions already settled, avarice, selfishness, excessive emotions, uncontrolled passions, and the actual cultiva- tion of the melanchohc state are some of the causes of mental anguish and subsequent physical suffering. Well-balanced mental faculties give a philosophic view of life; guard the mental and hold the emotional in check; grasp the true relationships in life, and view it in the proper perspective. The Effect of the Higher Education of Women. — Nothing is so convincing as actual experience and statistics;^ and nothing is so broadening to the mind as the study of history. Never before in the history of the human race has any such large body of young women been given the edu- cational advantages for the development of body and mind which they enjoy to-day. From antiquity there have been exceptional women, who were highly educated and cultured, as in Alexandria, Athens, and in the old European universities, but up to the present day any tendency toward the education of the masses of women * " Education as the Controlling Factor in the Physical Life of Woman," Four Epochs of Woman's Life. HYGIENE OF MIND AND ITS RELATION TO HEALTH 223 has been looked at askance, and in this respect the position of the people of the United States was long peculiarly provincial. To two men belong the great credit and honor of con- ceiving the idea of a liberal college education, and a medi- cal college training, for women in this country. In 1865 Mathew Vassar, ''having recognized in woman the same intellectual constitution as in man," founded a college for women only, and thus gave women the oppor- tunity for the same education that young men enjoyed at their colleges. In 1850 the Woman's Medical CoUege of Pennsylvania was incorporated. The idea of establishing a college for the medical education of women originated with Dr. Bartholomew Fussel, of Chester County. The query arose in his mind, " Why should women not have the same opportunities in Hfe as men?" Just how strong the public sentiment was against these movements, and the leaders of the opposition comprised the most prominent educators and physicians of the day, and what impediments they placed in the way, it is now difficult to realize. The opponents of the higher education of women urged three final objections: First, women were mentally in- capable of receiving the same kind of intellectual educa- tion as was given to young men at college. Second, they lacked the physical endurance to bear the strain of mental work. And, third, such an education would render the young woman masculine — she would no longer be willing to look after the ways of her house, her natural affections and power to love would vanish, she would become unwil- ling to marry and bear children. Ex-President EHot, of Harvard University, who has so long been the great educational leader in this country, in his paper on "The Higher Education of Women," says: "During the past thirty-five years three distinct apprehensions concerning the effect of the higher educa- tion of women seem to me to have been removed. In the 224 PERSONAL HYGIENE FOR WOMEN first place, there was a perfectly sincere doubt (because there was httle experience to go upon) whether young women were so capable as young men of receiving what was then called the higher education; or, in other words, whether the young woman had the capacity to master by study the traditional subjects of the higher education. That doubt has been completely removed. "Secondly, it was feared that if the young women studied in the colleges three or four years, beginning at about eighteen years of age, that such study would have serious effect on their health and on their fitness for their natural functions in after-life. This apprehen- sion was felt by many physicians and was warmly ex- pressed. For a whole generation we have been trying the experiment, and the result is perfectly clear. These apprehensions have not been justified. It is apparent that young women can do much mental work for three or four years between the age of eighteen and twenty- two, not only without impairing their physical vigor, but all the time improving it, if they live wisely and under right conditions. "And thirdly, there was the strong apprehension felt by many excellent people, lest in the process of the higher education young women would be denatured. They admitted that young men were not denatured in any way by the higher education at college, but they thought that there was a serious chance that young women would be altered in their feminine nature by the process of education. It has turned out that a young woman who studies in college, from the age of eighteen to twenty- two, is no more altered in her nature than a young man is who goes through a similar process. It takes a great deal more than that to alter the nature of a woman. "I suppose that this apprehension was based on the fact that women seem, to men at least, more tender, fragile, and delicate than men, and, therefore, more liable to be bruised or coarsened than men; it was feared that the kind of public life, so to speak, in large groups would HYGIENE OF MIND AND ITS EELATION TO HEALTH 225 have some tendency to deprive them of their natural delicacy, refinement, and tenderness. It has not turned out so, and everybody recognizes that it has not turned out so." When higher education, the professions, and industrial pursuits are all unquestioningly thrown open to women, then it can be reasonably supposed that they will come to possess those traits of mind — judicial, logical, creative, etc., now generally considered as masculine traits, and they will not only be more attractive and companionable for their husbands, but will be far more competent teachers for their children, their enlarged range of thought and vision inspiring greater confidence in their sons, and stimulating higher ideals in both sons and daughters. The Environment. — ^As we have seen, the brain registers every impression from within and from without; if the impressions are those of discomfort, gloom, darkness, ughness, those things, being inharmonious to the con- stitutional working of the brain, do harm and tend to set up bad habits. First, the body must be healthy, and the environment good in order to insure a healthy, vigorous mentality. Too much thought and care cannot be given to the environment of the child, youth, and adult. Careful attention must be given to the toilet. The quahty and condition of the underhnen, the cut and fit of the clothes, aU tell on the mind. It has been said that a man tries to five up to his clothes; hence, the uniform of the soldier and the cassock of the priest. Clothes are not only an index of the character, but they help to make it. The clothing that comes into intimate contact with our bodies has a soothing or irritating effect upon the mind. It has also been said that for a woman to know that she was properly dressed had a soothing influence on the mind, second only to that of religion itself. In the evening, laying aside the business suit of the day with all the anxieties and dust of toil, and replacing it by a tasteful house-gown, brings a sense of freshness that brightens the mind and stimulates the appetite. 15 226 PERSONAL HYGIENE FOR WOMEN The clothing should always be suitable to the employment, to the purse, and to the surroundings, or good taste is violated, and, again there is an unhealthy reaction on the mind. To live in a gloomy house, with a dull ugly wall-papers, and no sunshine entering the room, may produce in their inhabitants want of appetite, interfere with nutrition, make them gloomy, unhappy, and hard to live with. While esthetic surroundings render life happier, brighter, and higher. If one cannot afford expensive paintings to hang on her walls, she can select photographs of the old masters, neatly framed, which, placed in harmonious surroundings, elevate the mind, cause a love of the beautiful, develop the taste, and lay the foundation for a broad culture that will increase the enjoyment of nature as well as of art. The Choice of Friends. — We have seen that the impres- sions conveyed to the brain-cells leave a fixed registration and are indehbly stamped there. These may be called the sensitive plates of the mind, and it is because of this writing on the brain that the selection of our friends and associates is a matter of such vital importance. The subconscious mind, of which we hear so much to- day, does not originate thought; it can only elaborate and develop it, and the most important fact which has as yet been discovered in regard to the subconscious mind is that it is suggestible; that is, it is subject to moral influence and direction. A few words of commendation and praise brighten the whole day; if we can forget our pain for a little while, it is apt to cease. All our greatest intellectual leaders, from time immem- orial, have been unanimous in their teachings that one of the most important elements in the molding of the mind and character was the nature of our friendships. Tennyson says, " I am a part of all that I have met." "A man's friendships shape his life more than aught else, or more than all else." The immortal bard puts it, "It HYGIENE OF MIND AND ITS RELATION TO HEALTH 227 is certain that either wise bearing or ignorant carriage is caught, as men take disease of one another; therefore, let men take heed of their company." And again, " 'T is meet that noble minds keep ever with their hke, for who so firm that cannot be seduced?" Certain requirements and standards should be met, and the girl or woman should be sure that the individual, whether man or woman, comes up to the standards of her own clan. A friend should be congenial, with similar tastes, oppor- tunities, and training; frank in criticism, yet sympathetic in spirit; loyal and staunch in adversity, and one who disseminates an atmosphere which is broadening, elevat- ing, and uphfting. Such a friend is to be desired and to be sought after. Literature. — Not one of the least of the great molding influences on the mind and the social life of to-day is its literature, and the form of this which reaches the greatest masses of the people are the daily press, the hterary magazines, and the modem novel. It is scarcely pos- sible for the young to conceive the great impression which is made on the mind and character by the kind of books which they read. Carlyle said, " We cannot look however imperfectly upon a great man without gaining something from him." And to this statement might well be added, it is impossible for the mind to be brought into intimate contact with the lives of dissolute men and women, so vividly portrayed in many of the novels of the day, without being smirched by it. It is no more safe to read such a class of books, hoping to escape contamination, than it would be to live in the malarial districts of Africa, and hope to escape contracting that insidious disease. However limited the geniuses may be in our immediate circle of friends, each of us may have for her most intimate friends the greatest geniuses the world has ever known, and have them at their best. Two axioms should always be kept in mind — a real love 228 PERSONAL HYGIENE FOR WOMEN for books is formed in early life or not at all, and to have books for friends one must own them, have them on her own shelves, to take down and put up at will, to mark, to compare, and study. So whatever else one lacks, she should always have her own hbraiy, even if it is a Hmited one. Next in importance to the recognition of good reading must necessarily be a recognition of the Hmitations of one's reading. Whether in the capacity of student, housewife, mother, or business woman, the time that can be devoted to general hterature is very Hmited. A careful study of history and biography should always precede fiction. It is a fundamental part of a Hberal edu- cation to know something of the world's history, and the history of the EngHsh nation, as well as the biographies of the men and women who were such important factors in making its various epochs. This should be followed by a study of the classics, and that education has not been hberal which has not included a study of the modem classics. German Hterature opens up a new and deHghtful world. A study of the classics forms the taste, elevates the mind, broadens the vision and the power of judgment, and it is a profound help in the formation of character. After such reading as this, who would be wilHng to spend her time on the cheap and trashy novels of the day. Good modem fiction should be taken up as a recreation by the woman whose life is laborious, its questions per- plexing, and its compHcations tiresome; in other words, after the woman has left the high-school or college and has entered on her life's vocation. For young girls, not only is too much time apt to be given to fiction which should be devoted to other and more important matters, but it is apt to do much harm by giving them a wrong impression of life. The Power of the Will or Inhibition. — The conduct of mankind is chiefly governed by the emotions, instincts, and impulses. Spencer traces aU human action to the HYGIENE OF MIND AND ITS RELATION TO HEALTH 229 desire for pleasure in the large and philosopliic sense of the term. If this be so, then the education and hygiene of the emotions and impulses must be of the very highest im- portance in the life of each individual and in the social world. The question arises, and it is all important, can those inhibitory centers be so developed in youth, and so cultivated in Hfe, that they can act as antagonists to what is morbid? Can they be used as direct preventive and curative agencies against tendencies and impulses which are foolish and hurtful? And the answer of educators, as the result of large experience and observation, is emphatic- ally, yes. But the training, to be efficient, has to be systematic, persistent, and along well-defined lines. The first step in this training must be the strict avoidance of all that has a tendency to lower the standards of morality, whether this is in the Hne of companions, Hterature, the stage, music, or art. To do otherwise is not brave, but as foolhardy as it would be for a weak army to advance against a power- ful foe; it means annihilation or to be taken prisoners of war. To overcome obsessions and delusional beliefs by vo- litional effort, the effort should be made to direct the mind to other subjects which have nothing whatever to do with the obsession, rather than to make a direct stand of the will against it, since the will may put forth its ut- most strength in the way of direct repression of the temptation to any immoral action, and may entirely fail, while, by directing the same amount of force in chang- ing the direction of thought, complete success may be attained. The influence of the will upon the emotions is a matter of the highest importance in regard to the direction of the current of thought and the determination of actions. Control your passions; govern your temper. We can no more avoid feeling mentally hurt than we can feeling phy- sical hurt, but we have exactly the same power of the with- drawal of the attention from the mental hurt as from the 230 PERSONAL HYGIENE FOR WOMEN bodily pain, by determinately fixing it upon some other object. "I am, I ought, I can, I will," are, as has been well said, the only firm foundation-stones upon which we can base our attempts to chmb into a higher sphere of exist- ence. The first impfies a faculty of introspection, the second a moral judgment, the third a consciousness of freedom to act, the fourth a determination to exercise that power. The influence of the will on the conduct is first auto- matic, through previously acquired habits; second, through the emotional state, and third, by our notions of right and wrong. In the fundamental principles of Hving must be included a genuine consideration of the right of others. The memory is an automatic reproduction of ideas, the mechanism of recording processes. The education of the will, the power of breasting the current of the desires, and doing for long periods of time what is distasteful and painful, all tend to increase the power of inhibition and strength of the will. Nothing that is learned in youth is really so valuable as the power and habit of self-restraint, of self-sacrifice, of energetic, continuous, and concentrated effort. Seneca claims that difficulties strengthen the mind as labor does the body. Plato said, that "self-conquest is the greatest of all the victories." Character fies preeminently in the sphere of the will, and anything which weakens the will saps the worth of life at aU points. The strength of will bears not only on char- acter, but on happiness and influence as well. The leader must show reserved power, and make it plain that she has herself well in hand, to secure confidence. " Will makes men giants." The Effect of Mental Attitude on the Physical Health. — The ordinary operations of the mind have little effect on the physical condition, but such emotions as fear, worry, anxiety, grief, despair, anger, hatred, and the Hke depressing emotions act directly upon the muscular and HYGIENE OF MIND AND ITS RELATION TO HEALTH 231 nervous mechanisms, profoundly affecting the secretions and the excretions, and stamp themselves upon the very tissues of the organism. Of all the mental attributes the emotions are the most exhausting. A woman can spend more of her strength in five minutes of unnatural excitement than in a clay of calm, steady brain work. A perfect temper is not only a prime requisite for a club president, but for every man and woman in this hard workaday world, with its fierce competitions, its petty jealousies, and the stiletto practices of the cowardly, and it is one of the greatest preventives of indigestion, insomnia, and nervous prostration. Forget your gTievances. Every time that one repeats them to herself or to a friend she lives them over again, and the original trouble was but the merest moiety of suffering compared to a wound torn open afresh every day. To cherish a vindictive spirit does a vast amount of injury to the possessor of that spirit. In view of the facts of the beneficial effects of fighting upon small boys, and that the combative propensities of the Irish peasant commonly evaporates with his shiUelagh, it would seem commendable to introduce boxing matches among women as a way to settle their differences. From the standpoint of health, the intense excitement attendant on playing for high stakes, the loss of sleep, the unnatural Hfe, the loss of money that one can iU afford to lose, must eventually lead to a serious if not to a fatal breakdown. It is not the natural and reasonable intellectual work that injures the brain, but the various emotions — ambi- tion, anxiety, disappointment, the hopes and fears, the loves and hatreds of our fives — that w^ear out the nervous system and endanger the balance of the brain. Powerful emotion is Hke concentration attended with dissociation, it occupies the mind to the exclusion of all else, even to the dictates of self-preservation and reason. 232 PERSONAL HYGIENE FOR WOMEN The will is more or less suspended and held in abeyance during the emotional states. The too great concentration of the attention on one's business or occupation is a self-indulgence that often ignores the importance of the Hghter side of life and the legitimate claims of family and friends. Less ambition and more philosophy would greatly lessen the number of cases of nervous prostration and aUied neuroses. All of one's fortune is not staked on one throw of the dice; if the woman fails in one direction, there are other resources left. Concentration of the mind on the physical suffering leads to the so-called habits in disease; there may have, in the first place, been a real physical cause. For example, in case of injuiy to a Hmb followed by severe pain in that member it has happened that after amputation of the limb the consciousness of pain persisted in the brain. In the functional neuroses, the first cause may have been a real physical one, but the individual becomes so self- centered, it is with difficulty that the mind can be with- drawn from the ego, and a cure can only be effected by supplanting the intense egotism by new interests. Medical Hterature contains numerous observations of ailment caused by fright, and even of death itself so caused. It is not uncommon for medical students to con- tract the disease about which they are studying. In the old small-pox epidemics it was a very generally observed fact that those who feared contracting the disease were the most apt to get it. The reason is very easily explained — fear so suppressed the functional activities of circulation and nutrition, as to predispose the individual to take any disease to which she was exposed. Autosuggestion is the predominant element in the con- centration of the thought on one particular subject, and of the narrowing of the perspective to a single point of view. Prolonged anxiety or grief will cause an emaciation, second only to that of tuberculosis itself, by the depression HYGIENE OF MIND AND ITS RELATION TO HEALTH 233 of the heart's action and the circulation, the loss of ap- petite, the interference with nutrition, and the loss of sleep. Worry is, as we have seen, in the first instance most frequently bred of exhaustion, but, if indulged in, it readily becomes a fixed habit, and the mind rapidly settles into a state of fixed gloom. Worry is a type of fear. It is a futile regret over past mistakes and the miserable forecasting of the future. It has been called the great shortener of hfe under civiliza- tion — of all forms the financial one is the most frequent and, for ordinary minds, the most distressing. Anxiety and the anxious frame of mind is in readiness to take fright in connection with our most vulnerable points on all occasions of apprehension or uncertainty. As no one's future can be clear throughout, there is never wanting the matter of anxiety to a mind susceptible of this state. It is a significant fact that our asylums are recruited from the classes who spend their fives amid narrow monot- onous surroundings; hence the large proportion of women, especially of farmers' wives, whose lives are probably the most narrow and the most monotonous. From this result the fixed ideas, the obsessions, and all the absorbing egotism of insanity. With a variety of valuable and permanent interests, the mind is well safeguarded against attacks of worry. The overworked woman should increase her recreations, leave home for short intervals, travel, and have entire rest and change of scene. With increased vigor of body will come increased power of the will and the capacity to aboHsh worry. Anger fioods the brain with blood, and if the arteries are brittle, as they are in old age, and the individual is just as old as her arteries, the rise in arterial tension may result in the rupture of a blood-vessel, and the subse- quent hemorrhage into the brain may cause an attack of apoplexy, paralysis, or even death. Attacks of anger 234 PERSONAL HYGIENE FOR WOMEN hasten the deterioration of the arteries; in this way anger has been known to cause death. Every violent physical sensation will react on the lungs; every powerful normal emotion, whatever its cause, will also make its influence felt on the respiratory functions. An exercise which is performed with tranquil breathing if the mind is free from care, quickly produces respiratory disturbances if the mind is brooding and preoccupied. Those who have acted as seconds in a duel to men accus- tomed to the use of the sword know that they become breathless in the duel much more quickly than they do in the fencing school. Depressing emotions make themselves felt in the respir- ations of animals as well as of man. A sensitive horse, which is badly used at its work, or even roughly spoken to, rapidly becomes breathless. The dog is incomparably less swift than the hare, but is able to catch it; the fright of the hunted animal disturbs its breathing and robs it of much of its strength. In fright the disorder of the respiratory movements destroys the reg-ularity of the interchange of gases which takes place in the lungs, between the venous blood and the atmospheric air, and thus profoundly hinders the function of the aeration of the blood. The more impressionable the subject, the more easily do the emotions influence his respiratory actions. Hence, the superiority in certain bodily exercises of men whose minds are calm and masters of themselves. Emotional causes, such as worry, anxiety, and grief, as well as the more tangible physical factors, cause soften- ing and disease of the tissues, which frequently accounts for the arteriosclerosis and premature seniHty. Alienists have long found abundant evidence that abnormal physical conditions are capable of producing mental diseases, but the reverse is quite as true. And not only the imagination, but the intellect, the emotions, and the will have or may have a powerful in- fluence over the sensations and organic functions. HYGIENE OF MIND AND ITS RELATION TO HEALTH 235 It is not only profoundly true that mental attitude has much to do with bodily function, capable of producing changes in its nutrition and secretion, but we may go further and say that healthful and hopeful habits of thought do much to put the body on the defensive against the assaults of disease. Mental attitude refers not to the will or the emotions, but to the mind in its entirety. The trend of a woman's thoughts, the use she makes of her intellect, the strength of the volition, the sense of responsibility, and the objects of her hfe are all questions that have a distinct bearing upon the bodily functions and the health of the individual. A Definite Occupation a Physical Necessity. — It is now generally conceded by the leading sociologists of the day that women who are not engaged in the duties of maternity need the same intellectual and industrial ac- tivities as men. Many go further, and it is their opinion that there is no reason for excluding women, who are ful- filing the duties of maternity, from exercising full intel- lectual and physical activities in other directions. And the proof that this is not a mere theoretic assumption is to be found in the fact that many women have not only given birth to a family of children, but have successfully reared them, and, in addition, have been eminent in other pursuits and callings. Well-known illustrations of this fact are to be found among the most noted sovereigns that Europe has ever had — Catherine de Medici, Maria Theresa, Catherine II of Russia, and Queen Victoria. Pleasure seeking, as the end and object of Hfe, leads to ennui, disgust, and physical and mental deterioration, while the slavery of housework, the childish vanities, and petty cares and vexations are most injurious to the nervous system, so that for the life of the housewife the education preceding it should be broad ; and the more highly educated the woman is, so much the more effectually can she free herself from attaching too much importance to every little detail, and so neglecting what is higher and more import- ant, and it wiU be a great preventive of irritability of 236 PERSONAL HYGIENE FOR WOMEN temper, quarrelsomeness, and even melancholia and mental derangement, from which so many of these women suffer in consequence of the monotony of their lives. Every girl when she leaves school, which she should consider the very alphabet of her education, should prepare herself for some definite occupation, just as her brother does. Glouston, in answer to the question as to how the powers of the mind can best be developed, conserved, and made the best use of for life's work, says: "It is a most fortunate thing, if, during the later period of ado- lescence, an occupation in life has been selected which really suits the capacity of the individual and goes with his innate tendencies. The seriousness and the settled- ness of the Hfe of the period, with the bracing of eveiy nerve and sinew to do the work, to gain a reasonable position in society, and to enjoy a fair amount of happi- ness, is in itself a tonic of no mean value, while over- taxing of body and mind is always a risk, as well as an ambition which overreaches itself. The repressions of woman's life in civilized society constitute one of her serious strains and dangers. The life and conditions of a working woman who has six or seven children in a few years, who has small means, and but Httle help, is in my judgment the very hardest of any human being in our modern social system." Thomas^ thus sums up his views as to the evils result- ing from the non-occupation of women of the better classes. "Human nature was made for action; and perhaps the most distressing and disconcerting situation which confronts it is to be played on by the stimulations without the abihty to functionate. The mere super- inducing of passivity, as in the extreme case of solitary confinement, is sufficient to produce insanity, and the emotion of dread or of passive fear is said to be the most painful of the emotions, because there is no possibility of relief by action. i"Sex and Society." HYGIENE OF MIND AND ITS RELATION TO HEALTH 237 " The American woman of the better class has superior rights and no duties, yet she is worrying herself to death; not over specific troubles, but because she has lost her connection with reaHties. Many women, more energetic and more intelligent than their husbands or brothers, have no more serious occupation than to play the house cat, with or without ornament. It is a wonder that more of them do not lose their minds; that more of them do not break with the system entirely, is due solely to the inhibitive effect of early habits and suggestions. "The remedy for the irregularity, pettiness, Ul health, and unserviceableness of modem women seems, therefore, to He along educational hues. Not in general and cultural lines alone, but in a special and occupational interest and practice for women, married or unmarried. This should preferably be gainful, though not onerous or incessant. Normal life without normal stimulation is impossible, and the stimulation best suited to the nervous system is some form of interesting work." The Psychology of Success. — Success has been defined as the accomphshment, the reahzation of what has been willed or wanted, the ripe fruition of the well-tended tree. The achievement of fame or fortune is what the world generally regards as success. Before entering on an enterprise, all the premises in the case must be had in order to form correct judgments, otherwise incomplete and imperfect knowledge of the case will lead to error in judgment, in which there could be said to be "no chance of failure, it was a cer- tainty." An element that always makes for success is to be able to supply a want of the public; it is partly a question of demand and supply. It is sometimes possible to create a demand. But, as a rule, success is the fruition of patience and weU-directed energy. There is nothing which tends so much to the success of volitional effort as the confident expectation of its success, while nothing is so likely to induce failure as the appro- 238 PERSONAL HYGIENE FOR WOMEN hension of it. Since the tendency of the cheerful and joyful emotions is to suggest and keep aHve the favorable anticipations, while that of the depressing emotions is to bring before the view all the chances of failure, the former will increase the power of volitional effort and the latter will diminish it. The mental condition also exerts a direct influence upon the physical powers, through the organs of the circulation and of the respiration, the heart's impulse being more vigorous and regular, the aeration of the blood being more efficiently performed, in the former of these conditions than in the latter. Success too easily won, or won early in life, may reaUy be a cause of failure, because, having been once achieved, the individual may be content with what she has and not proceed to higher development. And so a very inferior success may be the tomb of energy and the satisfied goal of ambition, instead of a stimulus to higher things. Lack of success may also be caused by indulgence or lack of courage, the individual preferring to sail along the chartered course of mediocrity rather than to strike out a new path for herself, involving risk, anxiety, and endless work. And perhaps jealousy in the rank and file of the lazy, in- different, and mediocre far more often impedes effectually the road to success than is dreamed of, so that a greater degree of secretiveness, warding off the scent, of the intentions, the aspirations, and the methods of work, untU the object shall have finally been achieved. Another and most important secret of success is to recognize failure as only a stepping-stone to higher things. Eggleston says, " Persistent people begin their success where others end — in failure." The people who succeed in this world are the people who get up and look around for the circumstances they want; if they cannot find them, make them. "Circum- stances," said Napoleon, "I make circumstances." HYGIENE OF MIND AND ITS RELATION TO HEALTH 239 There are four mental requisites necessary to the achievement of success, namely: a clear view of the end; a judicious indifference to the sentiment around by the sweeping away of obstacles; an indomitable energy; and the power to resist the temptation to rest on the soporific plane of mediocrity. CHAPTER VII DRESS THE FUNDAMENTAL CAUSE OF WOMAN'S PHYSICAL DETERIORATION The History of Woman's Dress; the Corset in History; the Crusade Against the Corset; the Influence of the Corset on the Female Body; the Curved Front Corset; the Relation of Corsets to Ab- dominal and Pelvic Disorders; the Effects of Corsets on the Muscles; the Straight Front Corset; the Abdominal Corset; the Wearing of Corsets by Yomig Girls; What Style of Corset is the Least Injurious, the Shoe; the Stockings; the Essential Qualities for Winter Under- clothing; the Length of the Walking Skirt; the Winter Street Dress. A CAREFUL study of the history of woman's dress affords a forcible demonstration of the fact that the fmidamental cause of the inferior physique and lowered vitality of the modem woman of civiHzation is to be found in not only her own, but also in her female ancestors' unhygienic mode of dress for many centuries. Study the physique and dress of the ancient Greeks, then follow the history of dress down through the Middle Ages and the Renaissance to the present time, and, if further proof be needed, visit, as has been done, the savage races of the earth to-day, and behold women of powerful and classic physique still exist in lands where the body is not molded according to the barbarous decrees of the "modiste of fashion." The History of Woman's Dress. — The history of Greek costume is for the most part free from what is known as change of fashion, for the reason that the Greeks did not attempt to reconcile the two opposite principles of covering, and at the same time displaying the figure; that is to say, of cutting the dress to fit the body. The dress of the Greeks, when at the height of their civilization — and that of the Assyrians, Egyptians, and 240 PLATE II ■^^- r/ ^ Greek costumes. " Queen and two attendants.' CAUSE OF woman's PHYSICAL DETEEIORATION 241 ancient Romans was not essentially different — was very simple. It often consisted of a simple garment, the tunic, which pleased the eye by the gracefulness of its drapery, and at the same time was comfortable by reason of its looseness. The chief and indispensable article of female dress was the chiton, or tunic, consisting of one piece of material, sewed together in the form of a sack, open at top and bottom, in height reaching from the neck to the feet of the wearer, and in width equal to that of the extended arms. Within this stands the figure, and first it is girt around under the breasts by a girdle, to keep it from falling; next the upper edges are fastened together on the top of the shoulders by a brooch, and the arms are either left bare, pressing down into folds at each side the masses of material, or these masses may be gathered around each arm, and fastened down the outside with buttons and loops, so as to form sleeves. To secure greater warmth on the breast and shoulders the chiton was made long enough to be doubled back at the top, and this part reached to the waist. Underneath the chiton was worn a band of cloth, to support the breasts, and, in addition to this, a cord was sometimes crossed round the breasts outside the chiton, to assist either in supporting them or in bringing out their form. Round the loins was sometimes worn either a short petticoat of thick woolen stuff or a sort of bathing drawers, such as acrobats wore. This was all of the essential dress for indoor wear. The chiton was made of a variety of fabrics, though gen- erally of hnen. For outdoor wear was the himation, a garment also worn by men; it was made of woolen stuff and was worn fike a plaid. The chiton and himation, as above described, continued to be the standard dress from 450 B. C. onward. The hair was most usually worn gathered back from the temples, and fastened in a knot behind by hair-pins of ivory or bone, either plain or mounted with gold. 16 242 PERSONAL HYGIENE FOR WOMEN For the feet, sandals were usually worn, in exceptional cases shoes, and for hunting, high boots. Gloves were never worn by the Greeks, except to protect the hands in working. From the time of Pericles, the great European distinc- tion between male and female dress consisted in the length of the skirt, old men, priests, and officials being allowed the privilege of wearing long or women's skirts, and young girls being permitted to wear the short or man's skirt. Among the Romans, this single garment, worn by both sexes, was called the toga. As time roUed on, this loose cord, which had formed the girdle, was reinforced by a broad belt or band to support the breasts. Among the Assyrians this belt was made of stiffened Unen or thin metal; the Egyptians wore a folded belt; a broad belt for supporting the breasts was also worn by the Roman ladies. But whatever the material used, this stay-belt does not show any signs of tight laces or of vertical ribs of iron or bone. It was, however, the fore- runner of "stays," and when the moral fiber of the Greeks grew lax, the courtesans set the fashions, and dress was used to display rather than to conceal the figure, and, in order to make the hips more prominent, the waist was con- stricted by a many-layered belt. At the same time, the use of cosemtics was introduced. The Mediaeval or Middle Ages. — From the end of the fifth century to the beginning of the seventeenth there was a singular resemblance in many marked particulars between the dress of the two sexes. It now became the object of dress in both sexes not merely to clothe the person, but also to display the figure and adorn it. In the temperate climates there are always greater changes in fashion than in the very hot or very cold. Subjugation by the Romans in the first centuries of the Christian era was followed by a general conformity to their mode of dress, so that the Roman dress may be considered to have become European. In marked contrast to the loose, flowing robes worn by CAUSE OF woman's PHYSICAL DETERIORATION 243 the southern nations of Europe in their decadence were the short skirts and jackets clinging to the Hmbs, which were worn by the hardy nations of the North, who were given to constant fighting and the pursuit of the chase. The Norman lords, following the fashion of the south, swept about in long tunics and flowing robes. In the twelfth century the Anglo-Saxon women, dressed in their loose garments, were indebted to the Norman ladies for the introduction of ''stays," and the fashion of tightly lacing the body with a robe, laced down in front in order to show its undulations, as well as the use of cos- metics. In the household register of Eleanor, Countess of Leices- ter, which bears the date of May 24, 1265, is one of the earliest places in which the word corset occurs. The word is again found in reference to the wardrobe of Richard King of the Normans, and Edward his son. Corsets were at this time worn by men as weU as women. The author of the life of St. Thais, who lived in the twelfth centuiy, teUs us that the French were so tightly laced that they could bend neither their bodies nor their arms. Peter the Great wrote that the robes are so tightly stretched over the body, that the ladies can scarcely breathe in them, and often suffer very great pain in order to make their bodies slender. It was in the thirteenth to the fourteenth century that the last trace of the Roman drapery gradually disappeared : the women adopted for the most part the robes with the tightly fitting corsage, leaving ordinarily uncovered the neck and the skin of the breast ; this closely fitting corsage was closed in the back by lacing. Boots and shoes of this period had their pointed toes made two or three times the length of the wearer's foot. The fashions of England were the same as those of France, though apparently they were not carried to quite the same excess as on the continent. The singular aim of each sex was not only to emulate the other in the sumptuous style 244 PERSONAL HYGIENE FOR WOMEN of dress and its profuse adornment, but also to imitate the form and fashion of the other's attire; this obtained in both countries. The Renaissance. — In the sixteenth century a distinct separation between ancient and modem dress took place, and our present fashions took their origin from about that time. It was during this century that men adopted clothes closely fitting about the body, overcoats with tight sleeves, felt hats with more or less rigid brims, and closed boots or shoes. The women also wore their dresses tightly fitting to the figure, with tight sleeves, low-crowned hats, and richly trimmed petticoats. These garments, which differ wholly from antiquity, constitute, as it were, the common type, from which has risen the endless variety of modern male and female dress. At this time the general resemblance between the cloth- ing of the two sexes, which may be traced to the earliest times, became decided. After the accession of Queen Elizabeth in 1558, the well-known costume, associated with herself from about the middle to the close of her reign, gradually became established. The long-peaked and tight stomachers of the ladies, and the padded quilted doublets of the men — it might truthfully be said that each garment was a parody of the other. Ruffs of an exaggerated amplitude and of a painfully severe stiffness were worn by both sexes. At the beginning of the seventeenth century the dresses were tight at the waist, but begun to be made very full around the hips, by means of large padded rolls, which were still more enlarged by a monstrous arrangement of padded whalebone and steel. To both boots and shoes high heels were added, in place of the flat heels previously worn. About 1710 the hooped petticoat was introduced, and about 1740 they obtained enormous dimensions. When traced to their original sources, we find that all of the extremes of fashion were made to conceal some deform- ity of the figure, or to give to a part of it undue prominence, as in the case of the corset, which was first introduced when CAUSE OF woman's PHYSICAL DETERIOKATION 245 clothes were not wanted for the conceahnent of the person, but to make more prominent the curves and undulations of the figure. The ruff grew out of a scrofulous complaint on a royal neck; the hoop-skirt, to conceal the enceinte condition of a French queen. The Corset in History. — Dr. Bouvier divided into five epochs the transformations undergone by the corset, or by that part of the clothing which took its place from earliest antiquity to 1853. The first epoch is that of antiquity; in this, as we have seen, the band or girdle, which was worn by the Greek and Roman ladies, was the forerunner of the corset. The second epoch comprises a great part of the Middle Ages. This was a period of transition which partook of the styles which preceded and followed it. At first there was an abandonment of the narrow Roman band, and later the introduction of the corsage fitting tightly about the body. The third epoch embraces the end of the Middle Ages and the first part of the Renaissance, which was marked by the general adoption of robes with a very tightly laced corsage. The fourth epoch is that of the whaleboned corset, which extended from the middle of the sixteenth century to the end of the eighteenth. The fifth epoch is that of the modem corset. The busk, known since the fourth century, was intro- duced into France in the sixteenth century; men also wore busks or stomachers. The busk relates closely to the history of corsets. The middle of the sixteenth century is the epoch of transition from the corsage to the whale-boned waist, which constituted a sensible approach to the modem corset. We find that the reign of Queen Elizabeth was marked by the first use of the whalebone stays. These were much affected by her successor James, who insisted that aU his courtiers, male as weU as female, should cultivate the appearance of the wasp. 246 PERSONAL HYGIENE FOR WOMEN The corset of George II, represented in Hogarth's pictures, is said to have been one of the most harrowing forms of screw torture. We are told that the doughty war- riors of Gustavus Adolphus wore stays almost to a man. To Catherine de Medici is generally attributed the introduction of the closely whaleboned waist into France, and the corset which she invented resembled in more than looks that instrument of torture — ''The Machine Virgin of the Inquisition." This corset was made of steel, and was as inflexible as a suit of armor, and, like a war- rior's breast-plate, consisted of two pieces. It opened longitudinally by hinges, secured by a hasp and pin, made like an ordinary box fastening. In the front and back a rod or bar of steel projected in a curved direction downward, and on their bars depended the adjustment of the long-peaked body of the dresses and the set of the skirt behind. During the forty years in which she ruled at court a thirteen-inch waist measure became the accepted standard. Madame de S6vign6, born thirty years after the death of Catherine de Medici, formulated the axiom which has since been a law to the French modiste, " Les hommes ont la permission d'etre laid; les femmes ne I'ont pas; aussi n'en est-il aucune qui consente a I'etre." The idea of the waist was unfortunately that which concerned the execution. Instead of being adapted to the body or figure, in accordance with its form, to bend with its movements, as the supple corsage which preceded it had done, this new garment became an inflexible mold, which distorted the natural contours and imposed upon them a conventional mold, and prevented the least variation of size or situation of the contained organs, as weU as their continued integrity and the proper per- formance of their functions. The use of the whaleboned corset prevailed even among infants scarcely out of their swaddling clothes. This was the natural consequence of the pretended necessity to mold the human form in order to obtain beautiful pro- CAUSE OF woman's PHYSICAL DETERIORATION 247 portions, to reform nature, and prevent her mistakes, and one could never take too much care to obtain such laudable ends. Mothers would have been considered culpably indifferent of their children who had neglected these first indispensable cares for the regulation of the formation of their bodies. The Crusade Against the Corset. — From the time of Galen, 130 A.D,, to the present day, in spite of the ana- themas hurled against it by the state and medical profes- sion, denouncing this great injury which woman does herself, has the corset still prevailed. In the thirteenth century, Henry III, having per- mitted its use for some time, proclaimed a very severe edict against the wearing of corsets, which was considered so pernicious to the health of women, but of no avail. In the fourteenth century an edict was issued by the Emperor Joseph of Austria, forbidding the use of corsets in aU nunneries and places where girls were educated, and caUing upon the Church to aid him, threatening excom- munication to those evil-disposed damsels who should persist in operating upon their waists. The CoUege of Physicians of that day took up the subject with activity and zeal, and dissertations upon the evils of tight lacing were scattered broadcast. Professor Virchow, that eminent pathologist, wrote, " What is the use of introducing the principles and appli- ances of hygiene into the huts of the poor and ignorant, when the scions of wealth and pretended intelligence, especially of the gentler sex, show their contempt of hygiene by their dress and general wearing apparel. In days gone by I have battled against that diabolical invention called the corset, but this crusade has been given up by me as absolutely futile." The modem hygienist has taken the stand that, since the corset cannot be suppressed, it must be reformed. About 1880, for the first time, some attention began to be given to the hygienic consideration of the style of the corset. 248 PERSONAL HYGIENE FOR WOMEN The Influence of the Corset on the Female Body. — As a result of the four hundred years in which the corset has molded the plastic form of woman, she has become physically so degenerated that it is necessary to have recourse to the artifices of the modiste in order to have even the appearance of a good figure, and the support afforded by the corset to maintain the erect position. The modern corsets, made of one piece, can be classified in three categories, according to the region of the body Fig. 13. — Normal chest. Fig. 14. — Effects of tight lacing on bony thorax. on which they exert the greatest pressure. First, the "curved front" corset, enveloping the thorax and abdomen, but making the strongest compression at the base of the thorax; second, the "straight front" corset, enveloping the thorax and abdomen, but making the strongest pressure upon the abdomen; and third, the "abdominal corset," only embracing the abdomen, and supporting neither the breasts nor the base of the thorax. CAUSE OF woman's PHYSICAL DETERIORATION 249 In studying the effects of the corset on the body they will be considered in this order. The Curved Front Corset. — The corset is applied to the trunk of the body, consisting of the thoracic cavity, a distensible cage containing and filled by the heart and lungs; second, the abdominal cavity, whose walls are almost wholly composed of muscles, and containing the Kver and the entire digestive apparatus; and third, the pelvic cavity, whose walls are partly bony and partly muscular. When the anterior wall of the body is forced to take the shape of this curved corset, it is pressed back toward the vertebral column, and even when the corset is not laced tightly, there is always more or less constriction of the base of the thorax, so that a serious deformity of the lower part of the thorax and abdomen is produced; instead of the normal outward curve of the anterior surface of the body, with its most prominent part in the region of the umbilicus, there results a broken line at the waist, and an obtuse angle is formed here, pointing outward. This causes a marked incurvation of the lower part of the chest and its approach toward the spinal column, with a corresponding flatness of the chest and lessening of the respiratory capacity of the lungs, and the action of the heart is seriously interfered with. The chest or thorax is forced into the shape of a cone, the lower opening is narrowed, and its walls are brought too near together. The lower ribs become too short, and, if the corset is worn early in life, the upper ribs become too long; and the thorax as a whole is too long. The greatest constriction produced by the coraet occurs in the plane extending from the ninth to the twelfth ribs, which corresponds to the position of the diaphragm, stomach, and fiver. Just how seriously the curved corsets interfered with the expansion of the lungs was shown in a paper pub- fished by Dr. Sargent in 1889. He foimd that the average lung capacity when corsets were worn was one hundred 250 PERSONAL HYGIENE FOR WOMEN and thirty-four cubic inches; when corsets were removed, the lungs showed a capacity of one hundred and sixty- seven cubic inches — a gain of thirty-three cubic inches; that is, corsets crippled the lungs to the extent of one- fifth of their entire capacity. Nature endeavors to make up this loss by the increased rapidity of the heart's action and more frequent respira- tions, but this is at the ex- pense of greater wear and friction of the machinery. Palpitation and shortness of breath follow, and the woman is obliged to give up all active exercise. Through this failure of the suction power of the heart there result disproportionately larger lower limbs and an ac- cumulation of adipose tissue below the waist. This condi- tion is much more common in women than in men, and is due to the lack of power of the heart to draw the blood back from the lower limbs against the force of gravity. Hence, the blood tends to finger in the lower extremities and the oxidation of the tissues is interfered with. The Relation of Corsets to Abdominal and Pelvic Dis- orders. — By the constriction of the lower part of the thorax, as we have seen, the action of the diaphragm is very greatly impaired; this not only seriously interferes with its respiratory function, but with digestion as weU, since, by the active contraction of the diaphragm in in- spiration, it presses down the fiver and other abdominal contents, and produces a powerful massage of those organs, Fig. 15. — Diagram show- ing the action of the curved front corset (O'FolIowell). CAUSE OF woman's PHYSICAL DETERIORATION 251 which aids in the digestion of food and in the unloading of the bowels, and, at the same time, the pelvic circulation is interfered with and pelvic congestion is favored. The direct pressure of the corset upon the side waUs of the chest forces the ribs in upon the abdominal contents; the Hver suffers most from this, and not only does the Hver sometimes actually show furrows upon its surface from the pressure of the ribs^ but, in the postmortem room Fig. 16. — Relation of bony thorax to lungs, heart, liver, and stomach, with artificial outline produced by corsets (after Gray). of the great Vienna Hospital deep grooves upon the liver were repeatedly found with great distorsions of the body caused by the corsets, and, in a few instances, the left lobe of the Hver was found to be nearly separated from the right. By the constriction of the waist, the liver and all the abdominal contents are pushed downward below their normal position, and their functions are greatly inter- fered with. The effects of this pressure upon the stomach 252 PERSONAL HYGIENE FOR WOMEN are most disastrous, and cause a host of digestive and ner- vous troubles. There is very frequently a prolapsus of the kidneys; the right one is more frequently prolapsed than the left, owing to the relation of the right kidney to the Hver. In a study of 50 cases Dr. Gallant found that in 90 per cent, the stomach was pushed down below its normal level, and in 80 per cent, there was prolapsus of the right kidney. The constriction of the waist crowds the small intestines, with the accompanying mesentery and colon, into the pelvis; if the rectum is loaded with feces and the bladder empty, there follows an anterior displacement of the uterus; if, on the other hand, the rectum is empty and the bladder distended, there is a backward displacement of the uterus. In very many of these cases the compression and constriction are great enough to interfere with and retard the peristaltic action of the intestines, and con- stipation is produced. Gynecologists are unanimous in the opinion that tight lacing is a most serious impediment to the development of the pelvic organs, and is a prominent factor in causing disease of these organs. Tight lacing displaces the uterus downward from two to three inches, and, at the same time, the pelvic floor is bulged downward from two and one- half to three inches and the circulation rendered sluggish. When there is no interference with the respiratory movements the uterus rises and falls with every breath, and the movements of the uterus promote the circulation of the blood in the pelvis. A high corset compresses the breasts, and so interferes with their development. The low corsets of the present day support rather than compress the breasts. The Effects of Corsets on the Muscles. — In the back the corset forms an extended plane from top to bottom, destined to support the posterior part of the thorax and to diminish as much as possible the size and pro- jection of the shoulder-blades. This compression of the CAUSE OF woman's PHYSICAL DETERIOEATION 253 muscles of the back leads to their atrophy, and, as it is their fimction to hold the spinal column erect and to ap- proximate the shoulder-blades to the thorax, when they become atrophied the bony parts become much more salient. Further, the corset, in weakening the muscles of the dorsal region, interferes with the nomial forvv"ard projection of the chest, and so leads to its flatness. The corset atrophies the articulations of the vertebral column, produces a round back, an inequahty in the height of the hips and shoulders, with the resulting familiar awkward, waddling gait. When the healthy skeleton offers to the muscles of the body a soHd base of support, the action of the muscles of the back are not interfered with, there is nothing to prevent their contraction, and the body is held erect. With a perfect muscular development, the shoulders are effaced, the back is admirably straight, and the carriage is erect and graceful. The strong compression of the muscles of the abdomen not only destroys the normal contour of the body, but, by the atrophy of the abdominal muscles, a partial paralysis is caused, and so the support which should be afforded the viscera by these muscles is weakened, and a prolapsus of the abdominal contents follows. It will be seen that the two bony cavities of the body are connected in the back by means of the vertebral column and are not immovably fixed in relation to each other, but by reason of the flexibility of the spinal column, they can be approximated or the distance extended. The suppleness which results from this mobility corresponds to the physio- logic needs, and constitutes one of the most essential con- ditions for gracefulness of carriage. The movements of extension of the chest are rendered possible by the action of the muscles of the back, which hold the trunk erect and extend the vertebral column. When the corset is apphed, the compression and con- striction fix aU those portions of the muscles at and below the waist; the action of the muscles between the chest 254 PERSONAL HYGIENE FOR WOMEN and pelvis is diminished at least one-half, so that these muscles become atrophied from disuse, and when the corseted woman wishes to straighten up the movement must be executed by the entire trunk. Sternum The vertical dotted line indicates the straight muscles of the an- terior surface of the trunk shown in Fig. 18. ^Pelvis Fig. 17. — Skeleton of head and trunk (O'Followell). Without the corset, the pelvis remains fixed and furnishes the normal base of support for the thorax, which gains the erect position through the action of the muscles of the back acting on the vertebral column. CAUSE OF woman's PHYSICAL DETERIORATION 255 Whereas, with the corset on, the pelvis is immobilized, and it follows the movements of the thorax. The move- ment of extension of the thorax, instead of taking place in the region between the false ribs and pelvis, take place at the hip-joints — the vertebral coluron remains rigid, it takes no part in these movements. Then, as a result of the incurvation of the anterior surface of the trunk, there is an interference with the Fig. 18. — Muscles of the anterior surface of the triink (O 'Folio well). movements of extension of the spine and its immobiliza- tion, which causes the propulsion forward en masse of the abdominal contents. The anterior portion of the chest is shortened, and an exaggeration of the sacro- lumbar angle is produced. On the sides of the body lateral flexion of the trunk is possible, through the contraction of the muscles between 256 PERSONAL HYGIENE FOR WOMEN the chest and pelvis, but with corsets on this is impossible. The two cavities are fixed by the rigid armature which composes the corset. This not only prevents the lateral flexions of the body, but also causes an unnatural depres- sion above the crests of the ilium. The waist is con- stricted to such an extent that the woman can only fasten her corsets in front by having them widely separated in the back. All these conditions cause a complete immobilization of the thorax on the pelvis, so that the movements of the upper part of the body are characteristic in corseted women, and she moves all in one piece. The Straight Front Corset. ■ — This corset, when worn loose, is a great improvement on the curved-front corset. "When properly fitted, all the compression comes at the hips and across the lower part of the abdomen, which is Kf ted up, and the waist-line is increased in size. This corset has for its base of support the bony pelvis, and there should be sufficient space to easily introduce the hand between the lower part of the thorax and the corset. In this case there is great freedom of movement of the entire chest cavity, so that respiration is not nearly so much interfered with as in the curved-front corset, and if the corset is properly fitted, the lower part of the abdomen is raised together with the contained viscera, and, indeed, this style corset is prescribed in cases of prolapsus of the kidneys. Fig. 19. — Diagram showing the action of the straight front corset (OTollowell). CAUSE OF woman's PHYSICAL DETERIORATION 257 By having the base of support from the bony pelvis, the chest is left free, and a good chest expansion and its throwing forward is favored, and at the same time an erect carriage is secured. The waist-Hne runs below the short ribs, which lengthens the waist, producing graceful hues without compression. But not all straight front corsets fill these conditions. Unless sufficiently long and well fitted about the hips, they may fail to raise and support the abdomen, and when too tightly worn may press too strongly upon the abdomen in the pretext of obliterating it, with the result that it is placed in a vice from before back. Pressed down, the intestines find a means of escape at the lower border of the corset. The front of the corset is frequently carried too high up, and does not leave the epigastric region sufficiently free. The corset must absolutely not be thoracic, and must definitely renounce the support of the breasts, which should be accomplished when necessary by an extra bust supporter. The long straight corset im- mobilizes the trunk in the same manner as the curved front corset. The Abdominal Corset. — In 1902 Madame Gaches- Sarraute proposed to abandon the thoracic corset and to introduce instead the abdominal corset. This corset embraces the pelvis without compressing it, and takes as the foundation of its support the bony girdle; the plan of the Hne of support is obfique, and inclined forward in such a way that there can be no compression. In this way the pressure, instead of coming from above and annuling the contractions of the abdominal muscles, comes below and reinforces their action; the stomach resumes its normal position, and is supported in the plane of its greater curvature, facilitating its functions, so that digestion will be performed under the most favorable conditions. The abdominal corset should not exceed the height of the false pelvis, should have as the base of support the bony 17 258 PERSONAL HYGIENE FOR WOMEN girdle of the pelvis, and should be rectilinear in front and very slightly curved in the back and below. The hips should be simply surrounded and their projection preserved. A curve which follows the normal sinuosity of this plane joins the piece from the hips with that of the abdomen. The part corresponding to the back must be sufficiently wide and free, so that the pos- terior borders of the corset will be parallel when it is put on, and the plane preserved for the back in the pieces which form the corset. This garment will be adjusted without strain in the back, and it will embrace the form of the body so exactly that it can be put on without being unlaced. The frame of the corset must be reduced to a minimum — a rigid busk in front and some whalebones in the back; the hips remain free, and a slight, separate brace supports the breasts. The Wearing of Corsets by Young Girls. — The greatest dangers come from putting cor- sets on young girls who are still growing and are veiy imperfectly developed, and later by an undue constric- tion of the lower part of the thorax and the waist, so that the development of the entire body and its organs is seriously interfered with and all beauty of form is prevented. The muscles of the back, like those of the abdomen, are prevented from their full development, and, later. Fig. 20. — ^The abdominal cor- set (O'Followell). CAUSE OF woman's PHYSICAL DETERIORATION 259 in their action, by the use of the corset. The earlier the corset is put on, the more pernicious will be the effects, because during the period of growth the bony frame- work is more pUable and delicate, so that a relative slight compression is sufficient to make an indehble impression upon the form. Before the complete development of the hips and the entire bony framework an enormous amount of harm is done by the wearing of corsets. In early youth the heart lies higher than in the adult. By narrowing the intercostal spaces, the heart is retained, as it were, in its youthful position; in the adult female the heart is found to He higher than in the male, and the contraction of the space in which the heart has to play is one of the causes of woman's fainting, and it is also a cause of organic disease of the heart. At puberty, when the girl is rapidly increasing in stature, and her menses begin to be a drain on the system, relentless custom adds the compression of the corset and long skirts, suspended from tightly drawn bands around the waist. The spinal column at this age lengthens rapidly, and it should carry upward all the viscera attached to it; but, owing to the weight of the clothing and the com- pression at the waist, this normal process cannot take place; instead, there is stretching of the ligaments, and the viscera are prevented from rising and hang at a level much below the normal. A girl of this class is apt to be slender, with under- sized hips, and has a characteristic configuration of the anterior surface of the body, a hollowing out of the region over the stomach, and a very great protrusion of the abdomen. The uterus remains undeveloped and in an infantile state until near the approach of puberty, when it develops rapidly, and continues to increase in size until the normal size is attained — about twenty years of age. By the putting on of corsets the free mobility of the uterus and its appendages and their normal development are inter- fered with. 260 PERSONAL HYGIENE FOR WOMEN This period of growth and development is one of the greatest importance for the future health of the woman, both physically and mentally, and the most intelligent care should be given the girl at this impressionable age. By putting corsets on their daughters at this time, mothers are doing them a very great wrong, which can never be entirely atoned for. The corset prevents growth, develop- ment, and the participation in those exercises which make for physical vigor and good health. To the well-developed girl corsets are as much of a superfluity as crutches would be, and nothing but the prevaiHng style of dress causes girls to put them on. It has been suggested that the wearing of any kind of corsets before thirty years of age should be a penal offense; and in case of a minor, the parents should be fined from one hundred to one thousand dollars. As regards the wearing of corsets after the age of thirty, opinion is divided into three clases — first, those who utterly condemn their use: second, those who approve of it; and third, those who tolerate the wearing of corsets, but only under the condition that they shall cause ab- solutely no constriction. What Style of Corset is the Least Injurious? — From the nature of the structure of the chest and abdomen and the functions of respiration, circulation, digestion, and the pelvic organs, the wearing of any style of corset must be more or less detrimental to the health and vigor of woman, and a perfectly developed woman, in perfect health, does not need a corset if she lives under normal conditions of dress and life; but in our present state of civilization, with the present style of dress, and with the very imperfect muscular development, women in and past the prime of life may wear hygienic corsets without any very great amount of injury. The type of feminine beauty which approaches most nearly the ideal is that of harmony of proportions and modulations of lines. The waist proportions of the Venus de Milo is 47.7 per cent., while that of the Grecian man is CAUSE OF woman's PHYSICAL DETERIOKATION 261 46.4 per cent. In proportion to her height the hips of the modem woman exceed the girth of those of a man by about four inches, and a woman of the same height as a man exceeds in hip girth by six inches. If the muscles which pass from the thorax to the pelvis were properly developed, the artistic proportions would be preserved, and the waist of the woman would be proportionately larger than those of a man. The ideal figures of the Greek women show a torso bounded by outward curves, softly melting into one an- other, until the broadest part is reached at the hips, thence again declining to the feet. The line from the armpit to the ankle is one of the chief Hues of beauty in sculpture, while the anterior surface of the body should present, in the median Hne, a gentle curve from the upper end of the breast-bone to the brim of the pelvis, the convexity of the curve coming about the umbiHcus. An inward curve of this Hne is a deformity artificially produced. In order that the corset should become an inoffensive garment it must be well adapted to the figure, so that it shaU not embarrass the action of the diaphragm or the vital organs or the movements of the body. The injurious effects of wearing the curved front corset have been given, and this style of corset should be con- demned without appeal, since its use is dangerous from every point of view. The straight front corset is much less injurious than the curved front, but its use is detrimental to health, and prevents the free movements of the body, so that the abdominal corset remains the only one which is perfectly safe and at the same time esthetic. The chief role of the corset must be to sustain the cloth- ing and to prevent the constriction of the fines about the waist and to prevent the falling of the viscera. This can only be accompfished by selecting the proper points of support for the corset ; this is in the lumbar region of the spine and the crest of the bony pelvis, a region of several centimeters in height. Except for the vertebral 262 PERSONAL HYGIENE FOR WOMEN column, the viscera of the region immediately above this have no bony protection, and are subject to the greatest amount of constriction, the organs being piled up on top of each other, as it were, and thereby suffer very great dis- placement and impairment of function, while, on the other hand, the solidity of the bones of the pelvis permits of their use as a base of support for the corset, as well as for the clothing. It is based on this idea that the hygienic abdominal corsets are built, and, further, this style of corset does not sacrifice the normal curve of the anterior surface of the body. That the abdominal corsets do not support the bust is no detriment, as the woman with very fully developed breasts can wear a bust supporter, entirely separate from the corset, and in those pathologic conditions of ptoses of the abdominal contents — and from an orthopedic point of view, the abdominal corset affords an excellent solution. In order to prevent misfits, all corsets should be made to order; the measurements must be taken with the corsets removed. The corset must be shaped so as to fit exactly over the hips, with the lower parts of the busks very slightly curved, following the normal curve of the body. The upper part of the corset must be a Httle loose, in order to permit of the easy movements of the body. Behind, the line of the corset must correspond to the line of the body, in order not to interfere with the erection of the body. In front, the corset overlaps the pubic bones, and must be tight enough to give the abdominal contents some support. Instead of the lacings forming two "V's," the lower V, with its apex at the waist-line, and the longer V superim- posed on top of this, the ensemble of the lacings to be normal must form only one V, with the inferior point very elongated. The corset is too tightly laced if, when, with the strings untied at the waist, the upper parts of the corset separates. The corset should be put on with the lacings wide open, be carefully adjusted in the proper position, and fastened CAUSE OF woman's PHYSICAL DETERIORATION 263 from below up. After the stocking supporters have been attached, the lower part of the corset is held down with one hand, while the other hand gently draws up the abdomen by means of drawing on the undervest, or slipping the hand within the corset; in this way the abdominal organs are Hfted up. The corset is then laced from its lowest point to the waist-line, and from the top to the waist-line, in such a way that only one long "V" is formed. The laces are then firmly tied and slipped in under the corset. Corsets that sHp up are probably either too long waisted, too tight over the fulness of the hips, or there is not suffi- cient curve in the back and sides at the waist-line. High- backed corsets are apt to make the woman look round shouldered, while a low back gives smoother and more desirable lines. The Shoe. — The style of the shoe is very closely related to the corset in the amount of harm it is capable of doing. Considering the fact that the feet form the base of sup- port for the entire body, and that on their condition depends the woman's ability to take a sufficient amount of exercise and maintain her good health, surprisingly httle attention is given to their care. The compression of the foot into a rigid body, not unUke the shoemaker's last, destroys the natural relation of the parts, prevents the growth, interferes with the circulation, compresses the nerves, weakens muscles and ligaments which should support the arch, and is the prohfic source of corns, bunions, weak ankles, and "flat" foot. But, in addition to the direct injuries to the feet, the excessive elevation of the heel displaces the center of gravity, and transfers the weight of the body for the most part from the heel to the line of union of the instep with the toes, a series of joints with shallow sockets not formed to bear the brunt of the body weight. In addition to which the equilibrium of the body can only be maintained by an increase of the natural curves of the bony framework, with the resulting increased curvature forward at the small of the back, is an increase in the 264 PERSONAL HYGIENE FOR WOMEN prominence of the buttocks and abdomen. This tilting forward of the pelvis interferes with the circulation of the pelvic organs, and their congestion and inflammation follow. By walking around in her bedroom sHppers any one can easily convince herself of the greater grip that the foot has on the floor when so clad, and of the greater ease and sureness in walking; this is chiefly due to the greater breadth of the sole, and the fact that the shpper has no heel. The greater firmness of men on their feet on shppery pavements is doubtless due to the difference in the cut of the shoe and the lower and broader heel. The front part of the sole of the shoe must be so de- signed that the great toe will retain its normal position and rest on the inner border of the sole. In many shoes the great toe is forced out of its natural position toward the middle of the sole, and the tip, instead of pointing straight forward, is thrust toward the hne of the sole. This not only lessens the thrust of the great toe as it leaves the ground in walking, but also leads to a malforma- tion of the foot and ingrowing toe-nails. The soles of the shoe should project a reasonable distance beyond the uppers, to give firmer support to the foot and to protect the soft parts in walking. The front part of the upper leather must be broad enough for the free movement of all the toes in walking and in springing; when it does not give room enough for the toes to spread outward and forward in walking, they are bent on themselves. This makes the descent of hills and all active exercise and games very painful. Tight upper leather is also productive of chilblains and corns. The shoe should be shghtly longer than the foot when the entire weight of the body is placed upon it, and sufficiently broad for the foot to spread in walking; but, at the same time, the shoe must fit snugly about the heel and instep, or else the foot will slip forward in walking, and all the evil effects of too short a shoe will result. The heel of the shoe must be broad and low. High CAUSE OF woman's PHYSICAL DETERIORATION 265 heels force the foot to keep perpetually and unnaturally on the stretch; if they are worn in early youth, they may bring about permanent deformity of the skeleton and of the foot. Moreover, the high heel interferes with the natural walk, in which the pressure of the foot on the ground passes from the heel to the toes. The high heel requires that the front of the foot should be set down first instead of the heel. The result is an awkward trip- ping gait and a short step, which is very fatiguing. This is one of the causes for woman's frequent dislike for exercise in the open air, such as walking, mountaineering, games, etc., and so the general health is affected. Again, from the esthetic point of view, the size of the foot must be in proportion to that of the body. Artists declare that every foot that has worn a shoe is deformed, and so, when they wish to make a study of the foot, they go to the shores of Italy, where the peasant women have never worn shoes. Paget's description of a perfect female foot is great breadth and fulness of instep, a well-marked great toe, a long second toe, projecting a Httle beyond the great toe, and a very small Kttle toe. Since the feet are the part of the body to come in direct contact with the greatest amount of cold, whether on the floor of the house or the pavement of the street, it is a matter of prime importance to the entire body that they should be warmly clad. While for house wear and in the summer time a French kid is a most comfortable shoe, for street wear and outdoor exercise in cold weather a heavier leather with thick soles is requisite as a protec- tion against the cold and damp. Rubbers should always be worn when the pavements are damp, even if it is not raining, and in snow-storms and very heavy rains cloth gaiters should be worn over the shoes, to keep the ankles dry, and later to protect them from the wet skirts. The Stockings. — Great care must be taken to have the foot of the stockings suflSciently long and loose; this 266 PERSONAL HYGIENE FOR WOMEN is doubly the case with woolen stockings, which are apt to shrink so much in the wash. A too tight or too short a foot of the stocking interferes with the circulation and causes a cold foot, and when the stocking foot is too short, it produces the same deformities that too short a shoe does. The trouble generally begins in childhood; mothers forget in buying stockings for their children that stockings shrink in the laundry and that children's feet grow. The result is that the stocking-foot is apt to be too short before it is worn out, and so the toes are bent or cramped together, and there is the starting-point for deformities of the feet as well as corns and bunions. As much harm may come from wearing too short a stocking-foot as too short a shoe. Again, with the present mode of wearing the stocking supporters attached to the corset, or, indeed, one of the functions of the stocking-supporters may be said to be the holding down of the corsets, the supporters are shortened for this purpose, and as a result the entire foot of the stocking is pulled on, and an artificial shorten- ing of the stocking-foot is produced; and this point must be borne in mind in purchasing stockings. Woolen stockings should always be worn during the cold weather. Garters should never be worn around the leg, whether above or below the knees, since, in order to be sufficiently tight to hold the stockings up, they interfere with the circulation by the constriction of the leg, and so cause cold feet and greatly increase the trouble in case of varicose veins. The Essential Qualities for Winter Underclothing. — These are that the clothing must be light, loose, warm, and equally distributed over the body. From the hygienic standpoint, the underclothing is the most important part of the dress. We have seen that much of the energy of the body is spent in maintaining its normal temperature, and that the two main functions of the skin are the preservation of the CAUSE OF woman's PHYSICAL DETERIORATION 267 normal body temperature and the excretion of certain effete matters in the form of watery vapors. In the temperate zones two qualities are required of underclothing — that it shall prevent the too rapid radia- tion of heat from the body and that it shall be absorbent. No material is warm fer se. The warmth is necessarily derived from the body, so that what is required of the underclothing is that it shall confine the warmth in its meshes; atmospheric air being one of the poorest con- ductors of heat, the material should be so constructed as to imprison a considerable quantity of air in its meshes. The second necessity is that the excrementitious matters should be rapidly absorbed, as they are being constantly poured out from the skin, so that the material must be absorbent in the highest degree, otherwise the fluids re- main in contact with the skin to irritate it, and the atmos- pheric air confined between the undergarment and the skin rapidly becomes surcharged with gases and moisture, and so acts like a warm jacket around the skin. Heat radiation is interfered with and the skin becomes extremely sensitive to changes of temperature and to drafts. Wool is a poor conductor of heat and a great absorber of water. Its powers of hygroscopic absorption is at least double in proportion to its weight, either cotton or linen, and this property is an important one. During perspiration the evaporation from the surface of the body is necessary to reduce the heat which is generated by ex- ercise. When exercise is finished, evapora.tion still goes on, and, if unchecked, to such an extent as to chill the body. If dry woolen clothing is put on after exertion, the vapor from the surface of the body is condensed in the wool, and gives out again the large amount of heat which had become latent when the water was vaporized, and from this cause alone a woolen covering feels warm during sweating. In the case of tightly woven cotton and linen fabrics, the perspiration passes through them, and evapor- ates from the external surface without condensation; the loss of heat then continues. 268 PERSONAL HYGIENE FOR WOMEN In addition to this, the texture of wool is warmest from its poor conducting powers, and it is less easily penetrated by cold winds. The more readily material conducts heat, the cooler it feels. The property of the conduction of heat is in proportion to the closeness of the weave and the amount of air which it contains. For this reason all loosely woven fabrics feel warmer than closely woven ones, on the same principle that the more layers of clothing there are, the more layers of air will be retained between them. The recent methods of weaving cotton and linen fabrics more loosely have materially reduced their general defects as underclothing in cold weather, and if cotton or linen is worn next the skin it must be so woven as to give both thickness and porosity to the fabric. For the majority of people, during the wet and cold seasons woolen undergarments are the best. If cotton is worn, it must be loosely woven, so that it may entangle a large quantity of air within its meshes. The underclothing should fit tolerably closely the out- lines of the figure, without impeding the movements. Combination undersuits, which reach from the neck to the ankles, are the best ; the weight should be adapted to the season of the year, and should be changed with the weather, regardless of the date of the calendar. The great disadvantage of woolen undergarments is the way in which its soft fibers shrink in washing, and after a time become smaller, harder, and less absorbent. To avoid this, the greatest care must be exercised in the wash. Woolen fabrics are sometimes very irritating to the skin, in which case some of the loosely woven cotton or linen fabrics must be substituted. In the choice of woolen undergarments the touch is the best guide; there should be smoothness and great softness of texture. In very cold weather the combination undersuit worn in the house should be reinforced by "equestrian tights" for outdoor wear. These come in black and can be drawn on over the shoes. They are a much greater protection against the cold and wind than a flannel skirt, and do not CAUSE OF woman's PHYSICAL DETERIORATION 269 possess the grave objection of winding about the legs in walking in the wind. Lack of proper clothing of the lower part of the body- is beyond question one of the chief causes of the great prevalence of pelvic inflammation and of Bright's disease in women. But not only is there to be considered the danger of laying the seeds of disease from going out into the cold air while the body is too lightly clad, but also that, in order to maintain the normal temperature of the body in winter without the aid of warm clothing, requires a greater ex- penditure of nervous energy, which in turn is the equival- ent of a large amount of life force. It is not only impru- dent, but most injurious, to exhaust unnecessarily the powers, of the body, when mere mechanical appliances, like clothing, wUl obviate this continuous expenditure of vital energy. Another way in which clothes save the wear and tear of the body is by diminishing the amount of heat the system must produce by the oxidation of the elements of food. When properly clad, there is less loss to the body of its heat, and consequently there is less food needed to supply this loss. The Length of the Walking Skirt. — The present vogue of having the walking skirt five inches from the ground is an excellent one, as it not only considerably diminishes the weight of the skirt, but it interferes much less vnth the forward swing of the leg in walking, which otherwise has to be overcome by the muscular force of the leg. In walk- ing, the length of the step should be proportionate to the length of the limb; the leg is carried forward by the un- conscious swing at the hip. The chief exertion in walking is caused by the raising of the foot and leg to the point at which it goes forward and downward. By any artificial shortening of the step, such as is caused, for instance, by long skirts, it requires much more muscular effort to walk the same distance. Besides which, there is the additional friction of the skirts, 270 PERSONAL HYGIENE FOR WOMEN which is increased by the slightest wind; this has been likened to the process of eternally walking through a field of long grass. Another most important reason for not wearing long dresses on the street is that they stir up the dust and col- lect microbes, and thus contribute materially to the dis- semination of the germs of disease and subject the wearer and her family to the risk of infection. The question of clothing takes an important place in the hygiene of the lungs. All clothing may be approved which is sufficiently warm, and which allows of modifica- tions according to the variations in the temperature, and does not hinder the movements of the body, and particu- larly those which are carried out by the respiratory muscles. In the first place, it is very important that the muscles about the shoulders should have perfect freedom of motion, in order that the expansion of the apices of the lungs should not be interfered with. Clothes which hang heavily on the shoulders, and especially those which grasp the neck tightly, are unsuitable. Special attention must be given to this point in the selection of winter clothing. In going up long flights of stairs furs and heavy top coats should be taken off and carried over the arm; this will prevent much shortness of breath and gasping when one reaches the top of many flights. The Winter Street Dress. — The street dress for winter should be warm enough to prevent a feeling of chilliness, and yet be light enough to prevent the wearer from be- coming overheated while walking, or from feeling a sense of weight of the clothing, which is always a sign of being too warmly clad. For outside coats impregnated woolen materials, water- proof, but at the same time porous, are the best, except in very heavy rains. A storm coat of some kind should complete the costume for rain or snow. The woman should never stay indoors on account of very cold or in- clement weather, as being housed up and the lack of suffi- cient exercise make one very susceptible to the very sud- den changes for which our climate is so notable. CHAPTER VIII PHYSICAL TRAINING THE KEY TO HEALTH AND BEAUTY The Ancient Greeks the Most Perfect Type of Beauty; the Cause of the Inferior Physique of American Women; the Physical Training of the Japanese Women; Improved Physique as the Result of Physical Training; Increasing Stature and Improved Physique of American Men; Report of the Royal Commission of Great Britain on Physical Training; Physical Training Among the Ancients; the Influence of Physical Training on the Health and Life of the Indi- vidual; the Effect of Exercise on Brain Development and Character; the Physiology and Pathology of Exercise; the Relative Proportions of a Perfect Female Form; Table of Standard Weights for Women; the Muscular System; the Benefits of Exercise; Passive Exercise; Massage; the Balance and Carriage of the Body; Co mm on Defects in the Carriage of the Body; the Heart's Need of Exercise; the Gym- nasium in the Campaign against Disease; Gymnastic versus Ath- letic Training; Exercise after Eating; Effect of Brain Fatigue on Body Fatigue, and vice versa; Marks for Physical Efficiency; Advantages Derived from Athletic Sports; Ethical Value of Sports for Women; Forms of Athletic Games Best Suited to Women. Physical training is the key to aU beauty of form and face as weU as grace of motion. Beauty without health is inconceivable. The Greeks were the devotees of the beautiful, and they were the most perfect embodiments of health and beauty the world has ever seen. Their splendid physique was due to their outdoor life, physical training, which began in childhood and youth, and was systematically carried on throughout Hfe, their public baths, and their athletics, sports and national games. Beauty is the in- evitable corollary of health. And the Greek artists bequeathed to all future genera- tions a legacy of untold value, using the men and women of the golden age of Greece as the prototypes for the most 271 272 PERSONAL HYGIENE FOR WOMAN beautiful statues which the world has ever seen, proving that through the perfect development of the muscular system alone can an ideal type of beauty be attained, and these statues also show that the women of that day were the physical compeers of the men. The greatest attention to the physical development of her citizens was given in Sparta. Girls and young women were subjected to a similar, though less severe, training than men and boys. It included running, leaping, wrest- ling, and throwing the lance; these formed the favorite contests in the national games. Xenophen says: "The Spartans are the healthiest of all the Greeks, and among them are found the finest men and the handsomest women in Greece." The women of the Teutonic tribes frequently accompanied their husbands to war, and exhibited in- tances of the most daring bravery. History, as well as these magnificent legacies in marble and on canvas, teaches us that no greater fallacy could be imagined than that "we are women, and therefore weak." On the contrary, " We are weak, because it never entered into our thoughts that we might be strong/' and it has been repeatedly proved that physical deterioration can be overcome by exercise, and that the same means greatly increases the mental capacity. In savage races women are the equal, if not the su- perior, of the men, and woman's smallness of stature, physical inferiority, and lessened powers of endurance must be attributed to the customs of civilized society carried on for hundreds of years. The Cause of the Inferior Physique of American Women. — The majority of American girls and women of the present day have undeveloped muscles, a bad carriage, an impaired digestion, and are without skill in outdoor games, and unable to ride, row, or swim. From the measurements of twelve hundred boys and girls. Professor Sargent ascertained that at the age of fifteen years boys are three-quarters of an inch taller than girls, but that the mean height in the two sexes is the same, PHYSICAL TRAINING THE KEY TO HEALTH 273 and that, taking the sum of the measurements of the head, chest, waist, legs, and arms, the mean total was equal in boys and girls. The sum of these measurements is regarded as indicative of the strength of the individual, but that, as a matter of fact, it was found that the girls did not com- pare favorably with the boys in point of strength. In capacity of lungs the girls were seventy cubic inches be- hind the boys, and that, in strength of the expiratory muscles, the weakest boy was stronger than the average girl. In strength of back, leg, chest, and arms, the show- ing of the girls was a little better, though considerably below what it should have been. At twenty years of age the man was found to be five inches taUer and twenty pounds heavier. The superiority of the male in strength was now much more apparent than at an earlier age. He now presented ninety cubic inches greater lung capacity and one hundred and forty-three pounds, greater strength of legs, while the muscular power of the arms and chest was more than double that of woman. The charts showed that women were physically inferior to men in almost every particular. Dr. Sargent then goes on to say, "The principal char- acteristics of general form that distinguish civilized women from men are smaller muscles, sloping shoulders, broader hips, and shorter legs. The smaller muscles and the shorter legs may be said to be embryonic, while the super- ior breadth of the hips indicates a greater evolutionary advancement in this part of the body than has taken place in man. The constricted waist must be regarded as a deformity artificially produced. When the hips are large in the male or female, the waist wiU naturally be larger if the muscles which connect the trunk with the pelvis have nothing to constrict them. Since the hips of women are much wider than those of men, we should expect to find the waist proportionately larger in women than in men. In close antithesis to these observations of Dr. Sargent's on the physical inferiority of American women to men, it is both interesting and instructive to note those of Dr. 18 274 PERSONAL HYGIENE FOR WOMEN Hancock in his work on ''Physical Training for Women by Japanese Methods." The Physical Training of the Japanese Women. — A Japanese woman is usually the peer of a man of her own race who is of the same age and height, especially when weights are about equal. This is due to the fact that the Japanese women exercise in much the same way that the men do, and devote fully as much time in the endeavor to gain strength. In the Japanese system of bodily training, known as jiu-jitsu, it is considered advisable in the initial stages to have boy and girl contestants as nearly equal in age and height as possible. The girls enter the arena upon equal terms with the boys, and have proved their fitness to do so. Grown men and women practise together; other conditions being equal, the women show an equal amount of strength with the men. The back of the average Anglo-Saxon woman is gener- ally the weakest part of her body, while the normal Jap- anese woman satisfies the artist's ideals as well as the surgeon's. The average Japanese woman of to-day shows a figure as perfectly molded, and of as true proportions, as the women of ancient Greece were able to display. First of all, the Japanese women are taught that life is impossible without a sufiicient supply of fresh air. This internal cleansing with air is deemed of more impor- tance than the bath which follows soon after. That the Japanese woman is a deep breather is shown by the firm muscles that stand out on the abdomen. Consumption is a rare disease in Japan; even winter coughs are of rare occurrence. The Japanese look upon full, deep breathing as being the most vital function in life; food is not so important, although it is necessary. The best exercises are of little importance when the breath- ing which accompanies them is not properly done. Improved Physique as the Result of Physical Train- ing. — Dr. Mary Taylor Bissell, formerly the medical director of the New York Berkeley Ladies Athletic Glub, PHYSICAL TRAINING THE KEY TO HEALTH 275 and one of the pioneers in the systematic physical training for women, gave as the result of her experience there, "The gain of twelve months' exercise in the gymnasium is, for the chest two inches, stature two inches, and an in- crease of 30 per cent, in the lung capacity; many of the strength tests were doubled, the spine became erect and the arm vigorous, and the girl gained for herself the con- sciousness of controlling her own body instead of having it control her." Increasing Stature and Improved Physique of American Men. — Dr. Born's measurements of Yale athletes and students suggest the inference that American men are becoming physically greater than any other known race. Comparing averages in 1903 and 1908, it appears that Yale men are one inch and a half taller than their predecessors of five years ago; they are twenty-seven pounds heavier, broader chested, and have an increased lung capacity of seventy-two cubic inches. The measurements of Harvard students, published last fall by Dr. Sargent, corroborate Dr. Born's deductions, that American college men have larger and more vigorous bodies than their fathers. Dr. Sargent's association of vigorous brains with strong bodies is borne out by Professor W. T. Porter's examina- tion of 30,000 school-children in St. Louis in 1893, and by subsequent observations made by other men. It is the opinion of Dr. Crampton, director of physical training in the New York city schools, that this improved physique in American men, observed in the universities, is not in a small measure due to the fact that within the last five years athletics have been introduced into the pubfic schools, so that there are now hundreds of teams of base- ball, football, basket-ball, and track athletics, where there was only one before, so that already the colleges are re- porting that the young men entering them are bigger than they were ten years ago. Professor Phillips of Amherst thinks that the young women are certainly one inch taller and five pounds heavier 276 PERSONAL HYGIENE FOR WOMEN than they were ten years ago. This improved physique of Americans he attributes, like Dr. Crampton, to the fact that the American boy has now come in for his heritage of athletic sports, and he makes a strong plea for "adult play" — that every man and woman should have as good an opportunity as boys and girls to get out on an open space and play baseball, football, hockey, run, jump, and have a good time. To show the importance which Great Britain places on physical training for boys and girls the following report of the Royal Commission of that country for 1903 is given under the caption " A National System of Physical Training." Report of Royal Commission of Great Britain on Physical Training. — " (1) Physical training should be regarded as of equal importance with mental training. " (2) During school life physical training is quite as important for girls as for boys. " (3) Systematic physical training is necessary both for country and town children. ''The daily walk to school is exercise, but not exercise which develops the body as a whole, or counteracts the hability to stoop, to be round-shouldered, or to be slovenly in gait. Moreover, all children during school life must spend many hours with but little change of position, the effects of which can only be corrected by systematic physical exercise. " It should aim at the healthy development of the body, as well as of the mind, by the regular development of all the muscles, the quickening of the intelligence and activity, and the formation of the habits of prompt obedience, precision, smartness, and discipline. The exercises should not be for mere display or entertain- ment, but each should have its particular purpose and value to develop all parts of the body. ''A certain amount of physical exercise once a day or oftener is preferable to even a greater amount, at longer or irregular intervals. PHYSICAL TRAINING THE KEY TO HEALTH 277 "Games are very useful and ought to be encouraged, but they cannot be played by all children, and usually the weaker ones go to the wall ; that is, those most needing systematic development are excluded. Games affording opportunities for violent exercise are useful for the development of reserve strength, and form an admirable field for the cultivation of social and public spirit. We strongly favor their organization and development at all schools, "For boys, in addition to the regular games, country runs, leaping and dancing the Highland Fling; for girls, skipping and hockey. For both, swimming is strongly advised." Physical Training Among the Ancients. — Greek culture regarded the individual as valuable in and for himself, and sought to promote first of all his full and free development. The idea was symmetry and balance of parts, and, to attain complete and harmonious man- hood, mind and body were trained together. Games played an important part in the life of the Athenians, and their importance in the education of children was early recogTiized. From the age of seven to sixteen it is probable that one-half of the day of the Athenian boy was spent in intellectual and the other half in physical education. The aim of the Athenian education was to produce men, independent but respectful, freedom loving but law abiding, healthy in mind and body, clear in thought, ready in action, and devoted to their families, their fatherland, and their gods. Gymnastics included everything reb,ting to the culture of the body. The cu lmi nation of the Athenian education was danc- ing. As a supplement to gymnastic culture, it toned down the ardent exercise of the gymnasium and the over- energy of muscular development to the ease and grace which was the Athenian ideal. The Romans. — The early Romans possessed some traits 278 PERSONAL HYGIENE FOR WOMEN in common with the Spartans. They were intensely prac- tical and interested in those things whose usefulness was apparent. Education should fit a man for his work in the world. A Roman structure, quite as characteristic as the Greek gymnasium, was the public bath or therma, found not only in Rome, but in every important provincial town in the days of the empire. Both made provision for exercise and contained a system of baths, but in the thermae the baths occupied the greater part of the space, and the rooms and courts for exercise were smaller and fewer. The Influence of Physical Training on the Health and Life of the Individual. — If we believe, with Spencer, that "Education is preparation for complete living," we must appreciate that good carriage, bodily control, physical judgment, will power, and courage are an im- portant part of the equipment of every man and woman. These qualities are intimately associated with motor coordination, and they are best developed through physical training. The power of self-preservation, by which the individual is enabled to handle his body easily under all conditions, and so escape physical injury and death, depends upon physical judgment of time and distance, and the ability to run, jump, vault, climb, and swim. These are all fundamental exercises. The love of play and the ability to play a number of games contribute very largely to health and happiness. The play habit must be acquired in youth or it will never be developed. The best qualities of mind and character can only be obtained through physical experience and physical struggle. With stalwart physique comes a vigorous type of womanhood, physical courage ; with flabby muscles there is apt to result flabby thinking and flabby acting, superficiality, and inefiiciency. Next to hunger the most dominant instinct is the play instinct. PHYSICAL TRAINING THE KEY TO HEALTH 279 The Effect of Exercise on Brain Development and Character. — The growing interest in preventive medicine, and the very great popularity of the opportunities afforded for athletic training, attest to the value which people are beginning to place upon health as an asset in their social, domestic, business, and professional lives. But it is not generally or sufficiently understood just how great is the effect of physical training on the develop- ment of the brain or upon the mental activities. With a strong, vigorous action of the heart there is a feeling of courage and general exaltation, whereas with a weak heart and enfeebled circulation, fear and impaired mental activity predominate. The manner in which the organic functions are per- formed not only determine the health of the body, but the temperament and character as well. There is a conserva- tion of energy in the fashioning of the will — only part of the energy is expended in the outward effort, while the rest goes to lay the foundation of a future will, so that exercise builds up faculty and conduct character. We cannot perform an act voluntarily unless we know what we are going to do, and we cannot know exactly what we are going to do until we have learned to do it. The very simplest movement brings about a change in the organic structure of the brain, and this change leads to more complex movements and further improve- ment in brain structure. Most skilled movements give more exercise to the central nervous system than to the muscles. Movements calling for a high degree of skill, correlation of the different senses, sense discrimination, fine coordinations, and a rapid and responsible exercise of judgment, all tend, through the action of the association fibers, to a high degree of brain development. An essential feature of exercise is that a part of it at least shall afford amusement, diversion, and recreation to the overwearied and harassed brain. Hence, the necessity to introduce dancing, field sports, etc. By these means industrial efficiency, communal morality, 280 PERSONAL HYGIENE FOR WOMEN and social consciousness are promoted. Public amuse- ments of a proper sort are a public necessity. The great menace to the city is the limited opportunities for healthful play, and over one-third of the population of the United States live in towns. The physical side of the question is the largest, for it involves health, and consequently poise and self-control. It involves a legiti- mate occupation of surplus energy and its wise direction, and it also involves companionship. The great object of physical training is then to secure the most perfect development of the body, with the corresponding development of the brain, so that the highest physical and mental efficiency of the individual may be attained. The possession of a large reserve of muscle and nerve force, ready to be used in any emergency, gives confidence to the individual, increases the spirit of taking the initia- tive and undertaking grave responsibilities that come into the life of everj^ woman, especially those who are engaged in the business or professional world, and the building up of this necessary reserve force is one of the inestimable advantages of a gymnastic and athletic training. The Physiology and Pathology of Exercise. — Exer- cise is divided into active or voluntary and passive. Passive exercise does not require any exertion of the will power. Massage increases the local nutrition of the parts, stimulates the nerves, and is restful, rather than exhausting, to the overwrought brain and wearied nerves. ' Active exercise is further divided into exercise of effort and exercise of endurance. Under exercise of effort are classed all gymnastic feats. The primary object of a gymnastic training or education is to produce a symmetric development of the entire body, while, on the other hand, the training necessary to execute gym- nastic feats produces an overdevelopment of one part of the body at the expense of the rest, as is seen in the arm of the blacksmith and the leg of the danseuse. All PHYSICAL TRAINING THE KEY TO HEALTH 281 exercises of effort, whether of strength, skill, or speed, demand and cultivate mental concentration, a rapid response of the muscle to the orders of the will, develop the power to accomplish complicated coordinations, and the knowledge of how these difficult movements may be performed with the least expenditure of nerve and muscle force. Exercising a muscle develops it up to its physiologic capacity, but if a muscle is habitually over- worked, pathologic results occur, and instead of a quick, sharp contraction of the muscle, the contractions will be weak and uncertain, and, if carried too far, the muscle may eventually atrophy from overwork. Exercises of endurance include walking, running, swim- ming, and rowing — the range of^movement in these is much more hmited than in exercises of effort. In these, each movement is well within the individual's powers, yet, by increasing the rapidity of the movements, or by their prolonged continuance, the total amount of muscular work accomplished may be very great. Normally, the contraction and relaxation of the muscles are compara- tively slow, so that the poisonous waste matter produc- ing fatigue is continually being removed from the tissues, and not allowed to accumulate; whereas, in exercises of effort, there is no time allowed for the scavengers to work, and fatigue of the most active muscles sets in rapidly. Fatigue may appear in several forms, depending on the character of the exercise which produced it. When the exercise is sufficiently active, the amount of waste matter thrown into the circulation is greater than can be ehmin- ated by the lungs; breathlessness and palpitation of the heart result; so soon as the equilibrium between waste production and elimination is estabhshed, the individual is said to have gotten his second wind. Or, again, a slow pace, too long kept up, will produce exhaustion, so that the products of tissue waste accumulate, the beat of the heart is fast, irregular and weak, the nervous system becomes stupefied, and the muscles fail to respond to the normal 282 PERSONAL HYGIENE FOR WOMEN physiologic stimulus. This is a form of fatigue not in- frequently found among zealous housewives, in which the demands made upon the nervous system by continual and carking family cares, added to the very strenuous work of the household, exhausts both nervous and muscular sys- tems. Recovery from this form of fatigue takes a much longer time than the preceding. The individual is too tired to sleep, the night is troubled by disturbed dreams, there is a soreness and stiffness of the muscles and joints which remain for some days. There may be an actual rise in temperature, and the urine passed has a high specific gravity, with sometimes even albumin. If, now, this overwork is continued over prolonged per- iods of time, without allowing suSicient time for the neces- sary recuperation, there follows a slow and profound ex- haustion, which is much more difficult to overcome. In this condition the temperature becomes subnormal, the weight decreases, the skin and muscles become fiabby, and the skin is pale, the eyes are duU and listless, and the indi- vidual is without ambition to rouse herself from her lethargy. During a contraction each muscle-cell shortens and thickens, giving off some of its substance into the lymph- space which surrounds it, and absorbing food, consisting of carbohydrates and oxygen, from the surrounding plasma. Exercise improves nutrition by the rhythmic, automatic massage caused by the contraction and relaxation of the muscles on the vessels which they contain, while warmth favors the efimination of waste matter. It has been proved by Hawk, of the University of Penn- sylvania, in his experiments on the blood-count of an athlete in training, that various forms of active muscular exercise produce an average increase of 16.8 per cent, in the number of red corpuscles. T\Tien exercise is long- continued, the rate of increase lessens, and, further, the number may be decreased in greatly prolonged violent exercise. The explanation of this is that a large number PLATE III Senegalese woman. (From Stratz, after Dr. Eykens, in Shufeldt's "Studies of the Human Form.") PHYSICAL TRAINING THE KEY TO HEALTH 283 of cells lie inactive in various tissues of the body until they are brought into the circulation by muscular exer- cise. Athletic training has been called "mainly heart train- ing," Exercises of endurance do not require supreme efforts, but they do accelerate the action of the heart and lungs, and the aggregate of work done is very much greater than in exercises of strength, but the exercise must be sufficiently active to provide for the free circulation of lymph, which is carried on mainly through the massage of muscular contraction. If a walk be so Hstless that there is not sufficient move- ment of the muscles to overcome the pernicious influence of gravity acting on the colunm of blood contained in the veins of the abdomen, thighs, and legs, the vessel-walls may become permanently overstretched and varicose. The exercise must be sufficiently active for the muscular contractions to empty the lymph-spaces and hasten the circulation. It usually raises the general bodily, as well as the local, temperature of the parts, and so facilitates the removal of the waste-products. The acquirement of skill lies in the training of the nerve rather than the muscle. A simple movement requires only a nerve impulse to the acting muscle, while a com- plicated movement requires a wave of impulses to the accessory and antagonistic groups of muscles which control and steady the movement. It is easy to see how, in the first efforts to perform comphcated movements, the con- tractions of the muscles wiU be jerky and inaccurate, many useless muscles wiU be employed, and the expendi- ture of nervous energy will be out of all proportion to the result, and these first attempts at new feats of skiU rapidly exhaust the attention. This is well illustrated in the first efforts of a child learning to walk. Exercises of strength and skill train that alertness of mind so essential in ordinary life. They shorten the period between thought and action, producing what is known as "presence of mind." 284 PERSONAL HYGIENE FOR WOMEN The Relative Proportions of a Perfect Female Form. — The relative proportions of a perfect female form, as deduced by modern sculptors from the Greek statues, are as follows: With a height of five feet five inches, the weight should be one hundred and thirty-eight pounds. The woman should, with the arms extended, measure from tip to tip of the middle finger, five feet five inches; that is, exactly her own height. The length of the hand should be one-tenth, the foot one-seventh, and the di- ameter of the chest one-fifth that of the height. The distance from the perineum to the ground should meas- ure the same as from the perineum to the top of the head. The knee should be exactly midway between the perineum and the heel. The distance from the elbow to the httle finger should be the same as the distance from the elbow to the middle of the chest. The measurement from the top of the head to the chin should be the same as the length of the foot, and there should be the same dis- tance between the chin and the armpits. A woman of this height should measure twenty-nine inches around the waist, thirty-four inches around the bust, if taken under the arms, and forty-three inches if measured over them. The upper arm should measure thirteen inches and the wrist six inches. The calf of the leg should measure fourteen and one-haK inches, the thigh twenty-five inches, and the ankle eight inches. The table on page 285, compiled by Dr. Weisse, the Med- ical Statistician of the New York Life Insurance Company, "A Table of Standard Weights for Women," is based on the average weights of over 58,000 insured women, and is given to show the normal relation between the height and weight. A point of extreme interest in the table, and one that is not generally recognized, is the variation in weight, independent of the height, at different ages. PLATE IV Juno. PLATE V Venus de Capua. PHYSICAL TRAINING THE KEY TO HEALTH 285 C7iCJtOiOiC7iC;i&^CJiC7»CnOi>t' r r r r i^ r r i" r r r r 1—1 )— 1 00 00t>.COtOi-iOH-' CD CD . to OS H-lH-ll-'l— i|—l|—l|—l|— 11—11— IV-iK-i Oi-J^COCOlOtOtOtOH-'i-'i-'H-i *-OC5tOOOOTCOO^CTCOI-' 1— I an 1 CO to l—ll—lh— ll— '1—11— 11—11— ll—ll—ll—ll—l rfi.'rf^as^cocobotobOi-'i— 1-11-1 Mi^^OCntOOOCiitOOOOrf^CO to o 1 to 1— ' to Cn*>4^COC0C0lOtOlOi-'wi-i H--aC0tOCni-i-COCOCOlOtOlOi-' OCflr-MCOOliiH-^rfi^tOO CO r CO CO 1— ' CO CO OCnO-iOirf^O^COCOCOtOtOtO OOCOCfiOOiCOCOtifcOCXlOitO ? 1—1 to OCiOiOiCn*^*-COCOCOtOtO MCOGC4^H-^tO00*>-l— GCCji 1 CO t-1 ^OC30iCnrf^*<.*-COCOCOtO OCii-iMCOcOOiH^^COOGO o 1 Cji 1^ »0- -jC2C3 0io-COCOC7iH^-.COCOtOlO OC7iOCnlOCZ)*'OOlOOO o 1 h- ' CO CO CnCrn;s-i4i.COCOCOto5tOtol^ Oii-iVlCOOCni-iOOCjitOOOO CD CD 2^P p S ■D B 286 PERSONAL HYGIENE FOR WOMEN Dr. Weisse found the average height of women to be five feet four inches, and the average weight one hundred and thirty-three pounds, and that the average male height was three inches greater than that of the female. Women should range in weight from one and eight-tenths to two and two-thirds pounds to each inch in height. In order to determine your own factor in this respect divide your weight in pounds by your height in inches. Any weight above two and one-half pounds to the inch in stature may be considered as excessive, inasmuch as it adds nothing to one's mental or physical efhciency, and is fre- quently the forerunner of obesity, the remedy for which is to live on a selected diet and to burn up more through exercise. In an ideal condition there is a sufficient quantity of fat to give a pleasing rotundity of outUne. In women the tendency is for fat to accumulate, especially after forty years of age, about the waist, abdomen, and upper part of the thighs. In addition to the unsightliness which this gives to the figure, it is often the indication of the fatty degeneration of the muscles, and the heart is liable to become involved, and fatty degeneration of the heart is one of the frequent causes of death. The lack of use of the muscles in these regions of the body, which is caused by wearing corsets, is the reason for the accumulation of fat here. It can be reduced by the proper exercises and regulated diet. The Muscular System. — The bony skeleton forms simply the framework of the body, and, while it determines the general outlines and height for the most part, the weight and general size of the body depend upon the muscular development and the amount of adipose tissue. The bones are not only padded about with muscles, but the muscles are inserted into the bony sheaths in such a way that a development of the muscles causes a develop- ment of the bones as well. Again, the stature is increased by the erect position of the spinal column, and this can only be attained by great strength of the muscles which PLATE VI Venus de Medici. PLATE VII Venus de Milo. PHYSICAL TRAINING THE KEY TO HEALTH 287 hold the spine erect. The inequalities of the muscles are filled out with adipose tissue, giving a pleasing contour to the face and figure. There are some five hundred muscles in the human body; these muscles vary in size and form, according to Fig. 21.— The skeleton (Lewis). their situations in the body and the functions which they are called on to perform. Nearly all the muscles in the body are arranged in two different or antagonistic sets, and are placed on the opposite sides of the part, so that in acting — that is, by 288 PERSONAL HYGIENE FOR WOMEN their contractions or shortening — they move the Hmb in opposite directions, and it is by the alternate contrac- tion, or shortening and relaxation of the two sets of muscles, that the movements of the body are accomplished. The muscles which bend the joints are called flexors, while those that extend the joints are called extensors, so that in order to perform their work, which is that of contraction, the muscles must exert enough force to elongate the opposing muscles, overcome the tonicity of the antagonizing muscles, and lift the weight of that portion of the limb into which they are inserted. It is Fig. 22. — ^Muscular fibers, highly magnified. Fig. 23. — Different directions of fibers in the three layers of abdom- inal muscles. by the action of the muscles that the body is held upright. Action of the Muscles of the Abdomen. — The trunk is maintained from falling backward by the action of those huge muscles on its anterior surface. The space between the pelvis and the thorax is called the abdominal cavity. Its walls are almost wholly composed of muscles. There are several important facts to be noted about these muscles. First, that they extend from the brim of the pelvis, into which they are inserted, to the ribs and breast bone, to which the other ends of these muscles are attached; PHYSICAL TRAINING THE KEY TO HEALTH 289 that there are three layers of these muscles; and, lastly, that the fibers of the different layers run in different directions, so that they cross each other, as shown in the figure. The reenforcement of the layers, the arrange- ment of their fibers, and the manner in which they dove- Fig. 24. — Muscles of the anterior surface of the tnuik (left side, superficial; right side, deep). tail into the adjacent groups of fibers give a structure of the greatest possible strength. Action of the Muscles of the Back. — The tmnk is kept from falling forward by the action of the muscles of the back. These are arranged in six layers. The cut shows the direction of the fibers. The first, or outside layer, consists of the trapezius and latissimus dorsi, or, in other 19 290 PERSONAL HYGIENE FOR WOMEN words, the broad muscle of the back. On the one side these muscles are attached to the spines of the vertebrae; the sharp ridge which is felt in the middle of the back, and the broad attachment to the pelvis afford a firm base of support. There are other muscles which run parallel Fig. 25. — ^Muscles of the posterior surface of the trunk (left side, superficial; right side, deep). with the spinal column, whose function it is to hold the spinal column erect. Standing erect calls into action almost all the muscles of the lower extremities, trunk, and neck. So long as the line of gravity falls within the line of the feet, the muscular effort required is so slight that it is little more than the tonicity contained in all living muscle. The PHYSICAL TRAINING THE KEY TO HEALTH 291 greater the displacement of the line of gravity, the greater the muscular effort required to maintain the equilibrium of the body. Muscular Energy. — The muscles of the body, even when at rest, are under a slight degree of tension. When stimu- lated, the muscle contracts — that is, it becomes shorter and thicker. A muscle can only remain in a state of contraction for a few seconds, because the force of the muscular fibers is more or less exhausted during contrac- tion. The more rapid the contractions, the sooner does fatigue manifest itself. Like the steam engine, the muscles of the body, in performing their work, produce heat and motion. The fuel which supplies this force is taken into the body in the shape of food; it is prepared for use in the intestinal tract, and from there carried by the blood, to be stored up in the muscles and various tissues as latent force. The muscles contain one-fourth of all the blood in the body. Heat Production. — By watching a muscle when con- tracting, we see that there is not only a change of shape, but a dilatation of its blood-vessels, that is, more blood passes through a muscle when it is contracting than when it is at rest, and this increased flow continues for some little time after the contraction has ceased; there is also a rise of temperature. Nearly three-fourths of the heat developed in the body is produced in the muscles at the actual moment of muscular contraction. Hence, we learn that the whole body is heated by muscular exercise; the even temperature of the various parts is maintained through the circulation of the blood. This combustion, going on throughout the entire economy, is the source of all force or energy in the body. In every movement, every breath taken, in the change even of a muscle of expression or the conception of a passing fancy, combustion has occurred and potential force has been liberated. Muscular Fatigue. — The fatigue produced by muscular 292 PERSONAL HYGIENE FOR WOMEN contraction may be due to the consumption of the readily available material present in the muscle, to the consump- tion of the supply of oxygen, or to the presence of the products of combustion, and, if Weichardt's theory is correct, to these must be added the presence of a definite "fatigue toxin." During repose the internal changes of the tissue manu- facture new explosive material out of the comparatively raw material already present in the fiber, and the directly hurtful products of the act of combustion are either carried off, or undergo changes by which they are converted into comparatively inert bodies. A stream of fresh blood may exert its restorative influence, not only by quickening both of these events, but also by carrying off the immediate waste-products, while, at the same time, it brings new raw material. Every movement of the body depends as much upon the proper coordination of the muscles for its accuracy, grace, and force as upon the strength of their contraction, and while the fatigue, of which we are conscious in our own bodies after prolonged or unusual exertion, arises partly from the exhaustion of the motor nerves, it is chiefly from the exhaustion of the central nervous system con- cerned in the production of voluntary impulses. A man who feels absolutely exhausted may, under excitement, perform a very large amount of work with his already wearied muscles. The will rarely, if ever, calls forth the greatest amount of contraction of which the muscle is capable. Passive Exercise : Massage. — Massage has been de- fined as the systematic manipulation of the surface of the body by the hands of the operator in movements of strok- ing, pinching, kneading, and striking. The passive move- ments consist of flexions, extensions, rotations, and other movements of joints and limbs by an operator or machine without the cooperation or resistance of the patient. Massage takes the place of voluntaiy muscular move- ment, in promoting the flow of lymph and the flow of PHYSICAL TRAINING THE KEY TO HEALTH 293 venous blood toward the heart, if the proper direction, that of rubbing toward the heart, be followed; while, on the contrary, rubbing down a limb or from the heart actually retards the process which it is meant to facilitate. Gentle rubbing of any part of the body promotes growth, while vigorous rubbing removes superfluous fat. Massage finds its widest field of usefulness in conditions of fatigue, where the elimination of waste matter must be assisted, and where the nutrition of a part is impaired or destroyed. Muscles can be improved in size, tone, and nutrition; ligaments can be stretched and lengthened, the general circulation accelerated, and overloaded veins made to disgorge their blood. The digestive tract can be stimulated, and overwrought nerves soothed and relieved of their hypersensibility. The nourishment of the muscle-cell is improved by forc- ing out the products of fatigue and keeping it bathed in a constantly renewed stream of arterial blood. This alone is sufficient to prevent wasting of substance in conditions where active movements are impossible. Massage relieves the nervous system by maintaining the nutrition of the muscles, without the expenditure of nerve force required to make them contract. It acts on the central nervous system through the nerves of sense, stimu- lating or soothing them, according to the nature and the amount of the manipulation. Mosso and Maggiora, of Turin, have proved, by their experiments as to the effect of massage on the muscles, that muscles were capable of doing twice as much work after massage. It was also discovered that extending of the period of the massage did not produce any greater results in the capacity for work; the full effect was obtained in five minutes. The action of massage in improving muscle tone, in postponing the onset of fatigue, and hastening recovery from it has long been recognized by athletic trainers. After a hard race or other contest, it is a matter of knowl- edge among trainers that a five minutes' treatment will 294 PERSONAL HYGIENE FOR WOMEN enable an athlete to repeat or continue a performance otherwise impossible. Massage is the most economic form of exercise on the nervous system. Its potency is shown by the increase of the red-blood corpuscles and hemoglobin, and by the in- creased rate and force of the heart's beat without a corres- ponding change in the arterial tension. It accomplishes these results by decreasing the resistance in the peripheral vessels, by the removal of the products of oxidation, and by mechanically moving the blood-current forward in the lymph-spaces and venous channels. It is thus shown to stimulate the circulation, the respiration, nutrition, and excretion. Mezger describes four principal manipulations: First, stroking or effleurage, in which the hand is passed lightly over the skin, with the pressure from the periphery to the center, following the course of the venous circulation, and the long direction of the muscles from their insertion to their origin. It may be performed by stroking with the palm of one or both hands, with the thumb or tips of the fingers. The two hands are used upon the large fleshy parts of the thighs and buttocks, the back, chest, and neck. Second, Friction. — This is a deep circular movement, per- formed with the thumbs and tips of the fingers, or by one hand open or clenched. The products of fatigue collect- ing in deep muscular tissues are thus thrown into the cir- culation, the gentle manipulations of stroking carrying them into the superficial veins. The friction should pro- ceed in the same direction as the stroking movements. Third, petrissage, also described as pinching and grasping, is performed by picking up the skin and subcu- taneous tissues between the thumb and fingers, and manip- ulating it with an amount of force not sufficient to cause pain. In this procedure the skin moves with the hand of the operator, and the underlying structures are thus massaged by it under the pressure of the fingers. The thumb and fingers are used to reach the individual muscles PHYSICAL TRAINING THE KEY TO HEALTH 295 and small groups. The movements should proceed from the periphery toward the center. It is used to improve muscular nutrition in case of fatigue, in atrophy, in obesity, and other forms of muscular degeneration. Fourth, Striking, Tapotement, or Percussion. — Other names are clapping, beating, knocking, or hacking. It has a stimulating action on the skin, superficial nerves, and vessels. Hacking is performed by the ulnar border of the hand, and is used along the nerve-trunks. Fifth, Shaking or Vibration. — Shaking involves move- ments of the whole body or region to be treated, while vibration is a lesser motion in which the body or region remains at rest, while the surface and the structures im- mediately beneath it are affected. General massage is best given at an hour midway between meals, and never immediately after eating. The parts are at first lubricated with cocoa-butter or vaselin, to avoid the irritation which may follow the friction of the surface. The first process of massage is the simple stroking to empty out the lymph-channels; the next process is directed to the deeper tissues. This is deep kneading, and skill is particularly required here. As the result of this, the muscles are toned up and the nerves are soothed, so that the total effect is that of sedation, and is followed by the removal of the fatigue toxins, so that if necessary it will be possible to undertake work after the massage that would have been impossible before. The operator starts with the feet. After both surfaces of the foot have been well covered, the foot is firmly grasped and all the natural movements of the toes and ankles are gone through with. Next the region of the ankle, the leg, which is treated by circular friction by the fingers, by deep grasping of the areolar tissues, and, last, by deep pinching of the larger muscle masses. At brief intervals upward stroking is given from the ankle to the knee, to favor the venous flow of blood-currents. The same proc- ess is gone through with in the case of the hands and arms. Especial care is next given to the muscles of the loins, back, 296 PERSONAL HYGIENE FOR WOMEN and neck. The abdomen is then treated. Massage of this region concludes with deep kneading by the heel of the hand in the direction of the colon. The chest is manip- ulated upward, from the sternum along the Hne of the pectoral muscles. The face is not usually treated in general massage, but the sides of the neck are stroked from above downward, along the course of the internal jugular veins. Each part operated upon should be carefully covered as soon as finished. There is a constant rise of temperature after the treat- ment, and there should be a rapid improvement in the tone and reaction of the whole muscular system. The usual fault in giving massage is that too much is given at one time; the maximum effect on a part is ob- tained in five minutes. Another mistake is to employ too heavy a hand. A patient should never feel bruised or ex- hausted after the treatment; there should be simply a pleasant lassitude and feeling of drowsiness. While massage is not essential for the health, it aids materially in maintaining good health, but, in order to be efficient, a skilful masseuse is necessary, as a considerable amount of manipulative skill is essential, which can only be acquired by proper training. Massage, especially when taken in connection with the Turkish bath, is most valuable to remove weariness of nerves and muscles, as well as sHght aches and pains. The Balance and Carriage of the Body. — The erect position of the body is maintained through the exertion or more or less muscular force. The base of the erect human body is the soles of the feet; the smaller the base, the more danger of a fall. The base is the smallest when one stands on the toes. The way in which the spinal column is carried by the pelvis determines the way in which the whole body is carried. An erect and graceful carriage in standing and walking is not only desirable from an esthetic point of view, but it is most essential to good health. Without a proper development of the chest, it is impossible to secure PHYSICAL TRAINING THE KEY TO HEALTH 297 a normal development of the lungs and vigor of the heart. It is upon the erectness, suppleness, and strength of the spinal column that most of the power and grace of the body depend. In the proper caniage the natural lines of the spinal column form a graceful and undulating line, and the body stands erect without any particular effort. The curves of the spinal column are of great value in protecting the brain, as they weaken the force of any shock, which may be caused by striking the bones of the feet. Common Defects in the Carriage of the Body. — Owing to the common faulty position of school children at their desks, the sedentary occupations of women, and their lack of physical training curvature of the spine is very common. A stooping carriage is the most common. The head is bent forward, the chest is sunken, the back is round, the shoulder-blades hang outward, the inner edges standing out like wings, and the abdomen is protuberant. The muscles are poorly developed and are weak and flabby. This stooping carriage interferes with the freedom in breathing, and prevents the proper development of the upper part of the chest and lungs. Hence, it predisposes to lung diseases and tuberculosis, a weak heart, poor circu- lation, shortness of breath, inability to take proper exer- cise, and thirmess of the blood (anemia). Spinal Curvatures. — The spinal column is normally directly in the middle of the back; any deviation of this column to either side is abnormal, and the lungs become cramped in a small and non-distensible bony cage. This spinal curvature is most apt to take place in young girls or in adult women after a severe illness, when the muscles of the back have become particularly flabby, and, while stiU in this condition, improper attitudes are assumed at the desk or other sedentary occupations. Preventive measures are of the utmost importance. First of all, comes the general strengthening of the body, 298 PERSONAL HYGIENE FOR WOMEN and of the muscles and bones in particular, by plenty of exercise in the open air. The habitual attitude at the desk and work should al- ways be carefully observed, and in all sedentary occupa- tions the work should be frequently interrupted to take systematic breathing exercises before an open window. Where spinal curvature has actually taken place, es- pecial exercises must be taken under the supervision of a physician and instmctor. Gymnastic exercises must be supplemented by outdoor games and sports. The Heart's Need of Exercise. — The first essential for the maintenance of health, capacity for work, and power of resistance of disease is a normally developed and strong heart. First, there must be secured a vigorous circulation of the blood, and the two greatest helps to this are exercise and deep breathing. In the sedentary posture the heart works at a disadvantage. For the young, exercise of the heart is the chief object of physical exercises; this object is best attained by ex- ercises of speed, especially in the form of games which require rapid movement. In youth the recuperative powers of the heart and lungs are at the highest. An adult cannot race and scamper about like a child who plays for hours together, and a disturbance of the heart's action brought about by strenuous exercise to the point of fatigue of the heart is not so quickly compensated. On the other hand, severe exercises of strength and endur- ance are not so apt to prove injurious after the completion of growth as they are in the growing youth. Up to the age of eighteen years no feats of strength or of endurance should be attempted. From eighteen to thirty years is the period of life when any kind of athletic exercise can be taken, not only without any injurious, but with beneficial, results. After the period of youth new conditions begin to make themselves felt, and more care must be exercised in the demands made upon the heart. In some persons obesity sets in before they have reached thirty and im- pedes the action of the heart. About the fortieth year the PHYSICAL TRAINING THE KEY TO HEALTH 299 walls of the arteries begin to lose their elasticity, they become more rigid, and chalk salts are deposited in them. Golf and lawn-tennis are now excellent. And now it is most essential that exercise be kept up; the heart must still be trained and practised. The fibers of every muscle degenerates when their work is reduced to a minimum. Proper health without proper breathing is a physical impossibility. It is necessary that those portions of the lungs which do take part in ordinary breathing, and which would atrophy from lack of use, should be fully developed and kept ready for suitable exercise. As soon as the lungs grow weary and the power of breathing is exhausted, the most powerful muscles of the body give way. The pleasure of vigorous walking, especially in mountainous places, is alone for her who can respond easily and readily to the enormously increased demands on the power of the respiration. The direct result of exercise is an increased demand for oxygen by the tissues, and, to meet this demand, respira- tion is deepened and quickened, and the beat of the heart is more rapid and more forcible. But the phenomena of increased breathing power and increased heart action benefit other parts of the body. At the commencement of an exercise the contraction of the voluntary muscles called into action compresses the blood-vessels, and im- pels the venous blood actively toward the heart, which, thus stimulated, contracts vigorously, and propels the blood in increased quantity toward the lungs. Stimulated by the pressure of a large amount of venous blood, the in- spiratory muscles contract and elevate the bony structure of the chest, the diaphragm pushes down the abdominal contents, and the air rushes in to fill the vacuum thus produced and to supply the oxygen necessary for the puri- fication of the blood. Supplied with this life-giving element, the blood is returned to the heart, to be distrib- uted again throughout the system, and to restore the loss incurred in the original muscular movements. 300 PERSONAL HYGIENE FOR WOMEN In this manner are not only the voluntary muscles en- larged and strengthened, but also the involuntary muscles, particularly the heart and the diaphragm. The increased activity of the circulation stimulates other organs to in- creased activity. The quantity of perspiration from the skin is more than doubled, the appetite is increased, diges- tion is more perfect, absorption is more rapid, the hepatic circulation is more active, and the abdominal circulation is carried on more vigorously. But, on the other hand, actual harm may be done if any one who has been accustomed to lead a sedentary life, or who is not vigorous, suddenly engages in the more violent forms of exercise. In this extreme exertion the heart may be embarrassed by the respiratory action. At the end of deep inspiration the increased pressure of the lungs impedes the flow of blood from the right side of the heart, while the compression of the heart itself by the distended lungs tends to overfill the large veins, and to further endanger the right side of the heart. During general muscular contraction the arterial pres- sure is increased at the outset of exertion, before the arteries have become relaxed, and this in turn may lead to the engorgement of the left side of the heart and the circulation through the lungs. To these conditions may be added still another; that is, the exhaustion of the respiratory muscles, partly because of the unusual amount of labor thrown upon them, and partly from the inade- quate supply of properly oxygenated blood. If the dis- turbance of the pulmonocardiac equilibrium be severe and the condition unrelieved, general prostration ensues long before the muscles engaged in the work are exhausted. If, on the other hand, the equilibrium be restored, or when the heart and lungs have been trained to accomplish the restitution, the distress disappears, and the individual is said to have gotten his second wind. The Gymnasium in the Campaign against Disease. — Women, generally speaking, do not take sufficient exer- cise. The trend of the present day is for girls of the richer PHYSICAL TRAINING THE KEY TO HEALTH 301 classes to lead an outdoor life, but the women of the middle and lower classes do not obtain enough variety of exercise or enough fresh air, and to the lack of proper outdoor exercise is due their anemic condition, pallor, flabby muscles, and generally ill-nourished appearance. With the division of labor and the increase of wealth it has become possible for a large proportion of the com- munity to Hve without much all-round mental or physical activity. As a consequence, there are faulty circulation and defective nutrition, the vital resistance of the body is lowered, and some of its various organs or tissues are ever ready to take on disease. The lowering of the tone of the body through dissipation, want of fresh air and sunshine, insufficient sleep, lack of proper occupation or recreation, also increases the susceptibility of the body to disease. Senile decay is by no means only a matter of years, but the manner of hfe led. And very many people over forty years of age fall into a condition of senile decay, merely because they do not take a sufficient amount of active ex- ercise. In consequence the joints stiffen, the muscles relax, and the arteries harden prematurely. The prime of life would be very greatly extended, and old age delayed, if women only continued their active interest in work and systematically kept up gynmastic exercises and outdoor sports. For all classes of women provision must be made, and sufficient time afforded, to be devoted to some form of mental and physical recuperation and systematic physical training. Gymnastic versus Athletic Training. — The actual experience of the past few decades has proved that the most effective way of developing the mental and physical powers and the constitutional vigor is through a judicious system of gymnastics, athletics, and carefully supervised plays, sports, and games. To show which of the two contestants was the " better man" was the primary object of all contests, and this is the fundamental source of the love of games and athletics. 302 PERSONAL HYGIENE FOR WOMEN England has relied for her physical training upon a large variety of games and sports, instead of an elaborate system of gymnastics. The Englishwomen live an outdoor life, are great walkers, horseback riders, and go in for athletics and sports, and we find that the English women have a much more vigorous physique and healthy and ruddy ap- pearance than their American sisters. In Norway, Sweden, Denmark, Finland, France, Ger- many, and Italy more stress is laid on the gymnastic training, and in the Olympic contests, held in London in 1908, the twenty-five women from Denmark afforded a revelation to many of the Americans present. Medical gymnastics had their origin in Sweden, and are practised largely in that country and on the Continent. In gymnastic exercises the work done on each piece of apparatus must be tried repeatedly, in order to be learned, and then must be practised assiduously, in order to be well performed. This is what makes gymnastics so valu- able as a means of physical training and development. The first essential is to learn to handle one's own weight, and to have the muscles of the body under complete con- trol, and much of the interest and fascination found in practising heavy gymnastics come from this acquired power over one's own body, and the ability to make it do the feats and stunts which one desires it to do. This is one reason why children love to climb fences, trees, etc., and test their abihty to handle and master themselves in new and untried situations. But, in order that good and not actual harm may be done, gymnastics must be carried on under medical super- vision. Bodily exercises should, as far as possible, occupy the mind at the same time. The fact that gymnastic train- ing is being taken up in our high-schools and colleges for girls is a great gain, not only to the individual, but to the race as well. The proper development of the body, the clear skin and eye, the upright and graceful carriage, the free swing of the body and limbs when they move, give happiness to PHYSICAL TRAINING THE KEY TO HEALTH 303 the possessor as well as to the onlookers. The esthetic advantages of health are very considerable. Among the mental and moral advantages to be derived from the practice of exercises and games are a greater amount of self-control, persistence, regularity, prompt- ness, and of general self-confidence. In the playing of games there is opportunity for originahty as well as for observation. The unwritten code of honor, the need of accuracy — all these qualities are essential for a successful and happy issue in the great battle of Hfe. The ideal physical training requires that systematic gymnastic exercises should be supplemented by outdoor games and sports. Gymnastics are not sufficient for an all-round means of development, because the movements are too regular, too expected, and too dehberate, but they are invaluable for health and physical development, for the correction of physical deformities, as a foundation for many games and sports, and for supplementing the same. Many games are so one-sided that gymnastic ex- ercises are essential to prevent the body from becoming unsymmetrically developed, and, further, gymnastic ex- ercises must invariably be the foundation for all games; no games can do what they are really capable of doing without the firm foundation of the best gymnastic train- ing. Those exercises and games should be selected which are the most fundamental and the most healthy, which will cause the all-round development of the body, the muscles, heart, lungs, chest, a good condition of the blood, good circulation, breathing, digestion, and the getting rid of the waste-products. Such exercises should teach obedience to law, self-con- trol, regularity, promptitude, and readiness to meet fresh conditions or emergencies, persistence, pluck, and the ready cooperation of nerves and muscles. The aim of gymnastic exercises should be to secure a symmetric development of all the muscles the body, to correct one-sidedness, spinal curvatures, and other 304 PERSONAL HYGIENE FOR WOMEN physical defects, and to strengthen all the muscles of the body. In the gymnasium especial attention must always be given to the development and strengthening of the muscles of the back and chest, as these are the ones that are apt to be the most poorly developed in women, since they are less called into play in walking, which is the only exercise that most women take, and on their good develop- ment and strength depend the upright carriage of the body, a good chest capacity, and, hence, good respiratory capacity, a vigorous heart, and good circulation. Exercise after Eating. — Severe mental and vigorous bodily exercise immediately after a meal retards gastric digestion. The entrance of food into the stomach excites the free flow of gastric juice, which, like all the secreting processes, is dependent upon a flux of blood to the secret- ing glands. Other parts of the body, notably the brain, suffer from temporary anemia, and hence the great ten- dency to drowsiness after eating a hearty meal. At such a time severe mental work or vigorous bodily exercise must necessarily cause a corresponding withdrawal of blood from the ahmentary canal to the brain, or, in the case of physical labor, to the extremities, in order to furnish the amount of blood necessary for the proper performance of the functions of these parts. The withdrawal of blood from the digestive organs has the effect of inhibiting gastric digestion, since there has been an interruption of a free flow of gastric juice. We are safe then in beheving that digestion is favored by rest of the stomach before eating, by gentle exercise of the mind and body after eating, and by an undisturbed mental condition. An athletic training is productive of a more complete oxidation of the nitrogenous materials of the body, and, therefore, of a more economic utilization of these sub- stances. In those cases in which there is lack of physical training, sudden muscular exertion is followed by a waste of nitrogenous matter. The Effect of Brain Fatigue on Body Fatigue and - PHYSICAL TRAINING THE KEY TO HEALTH 305 Vice Versa. — Brain fatigue makes the sense of touch less delicate. Similarly, muscle fatigue affects brain power; severe muscular exertion may bring a disinclination and incapacity for brain work. Hard exercise uses up nerve force, and also causes the circulation of waste-products in the blood, and so the action of the brain is hindered. On the other hand, many people who do a great deal of brain work know that an early morning walk, a puU on the river, is most refreshing and stimulating, and actually makes them more capable of doing good brain work; that is, if they are in fair training and do not take enough exercise to make them tired. It is beyond question that a duU gymnastic driU, com- ing after hours of hard school work, may be a very heavy tax on the brain and nerves, and can hardly be a relaxa- tion. Outdoor exercises, which require practically no brain work and a good deal of muscular exercise, would do good, such as walking, running, jumping, and various kinds of games; while, on the contrary, exercises of skill would be a serious tax. The suggestion has been widely accepted, that brain work should occupy the morning hours, while technical education, such as singing, drawing, and physical training, should be given in the afternoon. Marks for Physical Efficiency. — The tests suggested some fifteen years ago by Sir Francis Galton, the eminent English scientist, for assigning marks for physical qualifi- cations were the following: First, breathing capacity; second, strength tests, both of them to be regarded with reference to the stature and the weight; third, quickness of response to a signal, made either to the eye or ear; fourth, keenness of eye-sight; fifth, keenness of hearing; sixth, color sense. Dr. Sargent, realizing the usefulness of these tests in measuring physical efficiency, included them in the phy- sical examinations of the Harvard students. The strength tests consist in the strength of each forearm, of the back of the legs, the dip, the pull up, and the lung capacity. The 20 306 PERSONAL HYGIENE FOR WOMEN combination of these seven tests is known as the inter- collegiate strength test, and is the best means as yet de- vised for measuring the general muscular strength and the respiratory power. The Advantages Derived from Athletic Sports. — Nothing can take the place of athletic sports to develop strong vigorous bodies in girls and young women. While formal gymnastics have both an educational and correct- ive value, and lay the foundation for athletic sports, they cannot take the place of outdoor sports to develop organic vigor, physical and moral courage, self-reliance, judg- ment, self-control, decision, and ethical training, a consid- eration for the rights of others, and a relaxation, particu- larly from mental work. Athletics are to youth what play is to children. Groos tells us that a function of play is to furnish an outlet for exuberance and animal spirits in the young. The Ethical Value of Sports for Women. — First come the benefits to the individual and second the bene- fits to the community, and it is a self-evident fact that that which promotes the highest development of the in- dividual raises the standard of the community. The benefits accruing to the individual are physical, esthetic, and psychologic; and as the result of the de- velopment of the individual along these lines will result the fourth benefit, the social or the "community good." Municipal governments are beginning to recognize the fact that the maintenance of public playgrounds not merely promote the good of the individual, but lessen the death-rate, the poverty rate, the criminal rate, and it has been found that the working capacity of the people depend in some way upon the recreation afforded them. Sports for women are essential, not only to better fit the individual for her place in life, but as an offset to the deadly monotony of her work. The predominating note of sports should be joy, exhilaration, and the social fea- tures of games. Women's sports, like women's clubs, are and should be PHYSICAL TRAINING THE KEY TO HEALTH 307 run along different lines from men's. The object of women's games are for their development and individual good, and should, therefore, never be played before indiscriminate audiences who pay an admission fee. Women have the same necessity as children and men for a wholesome physical outlet for the exuberance of animal spirits and energy. The esthetic value of games has been found to be ex- pressed in the improvement of the personal habits and appearance, which indicates a higher standard of living. And the psychologic value has been found to be a development of the mental and the moral qualities, and so the individual is the better enabled to direct her efforts wisely and so more successfully in life's activities. All of this is not a matter of theory, but it is the uni- versal testimony of the directors of the various athletic associations for women all over the country. Among other developments along the physical line are endurance, skill, precision, and coordination. To be able to do physical things well has an ethical value in the indi- vidual's attitude toward life in all its phases. The esthetic value lays stress upon the beauty and good form of games. It is essential in playing games that women should stand well, walk well, run well, throw well, and have a neat appearance. The manners and habits of the players on the field are also part of the esthetic training. It has also been noted that for reasons largely beyond her control the primitive occupations of women have been taken out of her hands, and have forced her, in order to secure a maintenance for herself, or those depending on her for support, out of the home into the industries and occupations of the world, together with a fierce competi- tion which this necessitates. In other words, success is based upon competition, and competition is the keynote of organized games. So that one of the values of games is to maintain fair, economic, and cooperative rules of com- petition. Other things being equal, the athletic man or 308 PERSONAL HYGIENE FOR WOMEN woman who has played according to the rules of the games is likely to be fairer than he who knows nothing of clean sport. Some of the mental qualities developed are observation, attention, concentration, memory, imagination, initiative, reason, and will power. These qualities are most highly developed in the various ball games, from its simplest forms to team work, as baseball and basket-ball. The moral qualities developed are self-control, unselfish- ness, a sense of honor, self-sacrifice, self-confidence, fair- ness, democracy of spirit, modesty, and decision. One of the qualities which characterizes a good player is that she will do the things which are assigned her. Prompt- ness and obedience to order are the first laws in any game. Throughout the game self-confidence is taught. Each player has her own responsibilities, decisions must be quickly and accurately made, while overconfidence brings a sure defeat. If competition underlies all games, it is equally true that unselfishness is the basis of all team work. The ability to work together requires at every point unselfish adjust- ment. One of the first things learned is to appreciate another's ability, and the individual egotism, so marked in the beginning of the work, is rapidly toned down. Closely allied with unselfishness is the spirit of fair play, and closely linked with fairness is loyalty and a sense of honor, the lack of which makes girls the contempt of boys and women the despair of men. It has been averred that the social position of woman and her dependence upon her lord and master have lead her to become indirect and devious, hence her lack of perfect truthfulness and sense of honor, so that when put upon her honor she does not realize her responsibility. Another great advantage that games possess for women is that many of them, from their weak physical condition, are abnormally sensitive and introspective; they live too much on the subjective side of life. While sports are pri- marily objective, they afford no opportunity for analysis PHYSICAL TRAINING THE KEY TO HEALTH 309 of feeling; the thought must be riveted on the thing to be done. Every girl's school and woman's club which pro- vides opportunities for games and sports erect barriers against nervousness, morbidity, and too much introspec- tion. These qualities which games develop are not mas- culine, but human; qualities needed for human fellowship. The Forms of Athletic Games Best Suited to Women. — Dr. Sargent's conclusions as to the form of athletic games best suited to women, coming from a man of his wide observation and great experience, should be more generally known, and he says, without hesitation, that there is no athletic sport practised in which some women cannot enter, not only without fear of injury, but with great prospect of success. But the feminine type of build, whether found in men or women, is a handicap in many athletic contests. But these Umitations do not apply to girls between ten and fourteen years of age. During this period girls, if properly trained, will often sur- pass boys of the same age in any kind of athletic per- formance. Moreover, if girls were given the same kind of physical training as boys receive all through their growing and developing period, they would be able to make a much more creditable showing as athletes when they became adult women. In the early history of mankind the men and women lead Hves more nearly alike, and were conse- quently more ahke physically and mentally than they have become subsequently in the history of highly civil- ized people. From a physiologic standpoint, woman needs exercise just as much as man does, but, in taking up athletics, these must be regulated on a different basis. Women, as a class, cannot stand prolonged physical or mental strain as well as men do, but give them frequent intervals of rest and relaxation, and they will often accomplish as much in the twenty-four hours as men do. From her physical configuration and her inability to bear prolonged physical and mental strain, there are certain athletic sports and games that would be likely 310 PERSONAL HYGIENE FOR WOMEN to prove injurious to most women if played in the form in which they are played by men. In this group are foot- ball, ice hockey, polo, basket-ball, boxing, fencing, pole vaulting, and heavy gymnastics. If these sports and games should be so modified as to meet the peculiar char- acteristics of women, there are none of them that could not be played with reasonable hopes of physical, mental, and moral improvement. The athletic exercises and games to which women are best adapted, and in which they are most likely to excel, are all forms of dancing, calisthenics and light gymnastics, archery, lawn-tennis, swimming, field hockey, lacrosse, sprint running, bicycling, rowing, canoeing, golf, skating, fencing, basket-ball, and all gymnastic plays and games. In all athletic exercises in which women engage, good form, rather than great records, should be striven for. Women may be excused for not being as strong and en- during as men, but they cannot be excused for not being more finished and graceful. Good carriage, perfect poise, self-command, and exquisite grace and refinement should enter into women's athletic performances, and these quahties should be taken into consideration by the judges in making their awards. CHAPTER IX SYMMETRIC DEVELOPMENT: GOOD CARRIAGE AND GRACE OF MOTION THROUGH GYMNAS- TICS AND ATHLETICS Gymnasiums, Baths, and Athletic Association: a Fimdamental Part of a Woman's College and a Model Woman's Club; the Vassar College Gymnasium; the New York Colony Club; the Yoimg Women's Christian Association; Self-made Good Physique through Physical Training; Rules for Taking Exercise; Gymnastic Dress; the Con- figuration of the Foot; Correct Attitude in Standing. Corrective Exercises: Exercises for Developing the Various Regions of the Body; Shoulder-blade Exercises; Respiratory Exer- cises; Exercise for Forward Projection of Chest and Retraction of Abdomen; Shoulder and Back Exercises; Leg Exercises; Squatting Exercises for Muscles of Spine and Abdomen; Alternate Kneeling; Abdominal Exercises; Balancing Exercises for Poise and Carriage; Balancing Exercises for Extending Depth of Chest; Lateral Tnmk and Waist Exercises; Exercises for Muscles of Back; Exercises for Muscles of Abdomen; Swimming Exercises, for Back, Thighs, and Abdomen; Rope PuUing-exercises for Back, Chest, Waist, Legs, and Arms; Exercises in Tnmk Flexions for Back, Abdomen, and Legs; Exercises with Chest Weights for Chest, Shoulders, and Arms; Boxing and Fencing; Classic and Esthetic Dancing an Essential Feature in Physical Training. Outdoor Exercises: Effect of Walking on the Heart and Lungs; Rimning; Moxmtain Climbing; Swimming; Horseback Riding as an Exercise; Rowing. Athletic Sports: Croquet; Lawn-tennis; Golf; Hockey; Basket- ball. Gymnasiums, Baths, and Athletic Associations a Fundamental Part of a Woman's College and a Model Woman's Club. — It has been repeatedly and con- clusively proved, in a large series of cases, that the phy- sique, carriage, and health of woman can be wonderfully improved by regular and systematic gymnastic exercises, combined with outdoor exercise and athletic sports. 3H 312 PERSONAL HYGIENE FOR WOMEN Briefly stated, the facts in the matter are these : the bony and the muscular systems and the vital organs are the same in both men and women, and hence the general scheme of physical training, which has been found to be so highly beneficial to men, would, if properly modified, be equally beneficial to women, and such a training for women is urged by the most competent authorities of the day. Two-thirds of the body weight consists of bones and muscles, and the development, growth, nutrition, and vigor of the muscular and bony system can only be maintained by such exercises as will call into play the action of all of the muscles of the body, that is, the stature, breadth of shoulders, and size of the chest, as well as firm, hard muscles, are dependent on regular and systematic exer- cises of every part of the body, and through the beneficial effects produced through exercise on the respiration, cir- culation, and digestion, etc., the brain, nerves, heart, lungs, in short, all the organs and tissues of the body, are kept in a healthy condition. The fife of the masses of women to-day is being spent under artificial and the most unhealthy conditions; for the most part in overheated, ill-ventilated houses, with very little time spent in the open air, and without any knowledge or practice in games and outdoor sports. The occupation, or lack of occupation, of the majority of women scarcely calls into play the muscles of the upper part of the body. This lack of use of the muscles about the shoulders and upper part of the chest is fatal to the development of the chest and lungs. Outside of housewives and domestics, the majority of professional, business, and working women live under a very high nei-vous tension, with but a very slight range of physical activity. What they all need is a sufficient variety of exercises to call into play all the muscles and the vari- ous regions of the body, together with plenty of fresh air, amusements, and recreations. And already some of our large, wide-awake, manufacturing establishments, con- vinced that the practical application of these truths in SYMMETRIC DEVELOPMENT 313 their own factories would both improve the health of their employees and be to the financial interest of the firm, are now providing well-equipped gymnasiums, under the direction of competent instructors, furnished with baths, resting-rooms, restaurants, etc., for their employees, and these experiments have demonstrated that the improved quantity and quality of the work, the lessened amount of sickness among the employees, more than compensate the employers for the expenditure of money and the time consumed in physical recreation. It is only within the past decade that the great benefits to be derived from a systematic, gymnastic training, combined with athletic sports for girls and women, has been generally recognized. To-day all our best colleges for girls and young women have well-equipped gym- nasiums, with a corps of competent instructors, where a scientific and systematic course in physical training is given during the winter months, supplemented during the fall and spring months by outdoor athletics and games. And, further, this course is obfigatory during the fresh- man, sophomore, and junior years. The result of the gymnastic and athletic work done at Vassar College for the past fifteen years shows a very great improvement in the physical development, the lung capacity, and the general health of the students. The average lung capacity for women is given as one hundred and fifty cubic inches; at Vassar the average lung capacity is one hundred and sixty-five cubic inches. The Vassar College Gymnasium. — As Vassar College has a model gymnasium, an unusually fine corps of in- structors, and gives the greatest attention to all the details of the physical training of its students, it may very properly serve as a model for schools and women's clubs throughout the country. The instructors all received their training at the Sar- gent Normal School, Cambridge, under the direction of Dr. Dudley A. Sargent. Hence, it is naturally run along the same Hnes. 314 PERSONAL HYGIENE FOR WOMEN Gymnasium work is carried on from the middle of November until the end of March. The gymnasium is furnished with the usual apparatus for hght and heavy work. The entire student body is divided into four classes ; each class meets three times a week, and the period of work in the gymnasium lasts forty-five minutes. This is followed by the shower and needle baths. The wands and dumb-bells used are wooden ones, and vary in weight from three-fourths of a pound to two and a half pounds. Other apparatus that might be used in the home gymnasium are the chest-weights and the rowing machine with a movable seat. Instruction in classic dancing is part of the regular gym- nastic work. The Vassar gymnasium is also furnished with a fine swimming pool. The temperature of the water is kept at from 75° to 80° F. For beginners it is necessaiy to have a much higher temperature than for expert swimmers. Women will be greatly encouraged to learn to swim from the fact of the incredibly short time in which the art is taught here. Students learn to swim well in ten lessons of fifteen minutes each, and the great popularity of these lessons renders it necessary to Hmit the instruction to ten lessons. Later in the season, if there is space in the pool, the lessons may be resumed. Before entering the gymnasium the girl is first of all carefully examined by the resident physician and gym- nasium director, and the results of these examinations recorded. A detailed series of measurements and strength tests is made and recorded on the gymnasium register. On completing the tests, the following card is filled out and given to each girl. It has been found that these cards, kept by the girls, increase the interest of each in her development, and stimulate her to further exertion to improve her physique. PLATE VIII SYMMETRIC DEVELOPMENT 315 VASSAR COLLEGE GYMNASIUM.— RECORD OF PHYSICAL MEASUREMENTS MiSB Examinations First. Second. Third. Fourth. Fifth. Height Centimeters. Weight Pounds. Lung capacity .... Cubic inches. Girth, chest Centimeters. Girth, chest, full . . . " Girth, chest, ninth rib. " Girth, chest, ninth rib, full " Strength, back .... Kilos. Strength, legs " Strength, chest .... " Strength, right forearm " Strength, left forearm. ■• The instruments needed for making these tests are the spirometer and two dynamometers, one to test the strength of the muscles of the back and legs and the other to test the muscles of the arms. Outdoor sports and athletics are begun in the fall, on the opening of the college, and are continued as long as the weather permits. The students then take up the regular gymnastic work until the spring of the year, when athletics are again resumed. Here again three hours a week are obhgatory. It should be stated here that during the menstrual period the girls are not only excused from gym- nastics and athletics, but absolutely forbidden to take part in these exercises. The list of games include croquet, lawn-tennis, hockey, and basket-ball. Rowing has always been a favorite 316 PERSONAL HYGIENE FOR WOMEN out-door sport at Vassar. In 1909 horseback riding was again taken up; riding lessons were begun in April, and two hundred girls took lessons. With the exception of about twenty, they all rode astride. An ordinary man's saddle can be used, but a somewhat narrower saddle, with a higher front, is more comfortable. The New York Colony Club. — This has a model club- house, with its gymnasium, baths, swimming pool, lecture, and reading rooms, as well as bedrooms, for the out-of- town members who may be guests. It is, therefore, a natural center for the physical and mental development of its members. To this should be added an athletic associa- tion. This might well, then, serve as a model for the women's clubs over the country. In the large cities the numbers of these should be commensurate with the population. In smaU towns and villages the entire citizenship should club together, as a great civic movement affecting the health and welfare of the entire town, and in the resulting good men would benefit reflexly through their wives and daughters. The branches of the Young Women's Christian Associa- tion over the country are the logical centers for the begin- nings of this great movement, just as the Young Men's Christian Associations have been the centers for the erec- tion of gymnasiums, the formation of athletic associations and social clubs for boys and men. One has only to look at the magnificent results that they have accomplished to form some idea of what might be done by a similar movement for women. And not until the physique of woman has been developed to its full capacity can it be known what her mental capac- ity for initiative, creative, and inventive genius reaUy is. Self-made Good Physique Through Physical Train- ing. — It has not infrequently happened that, by outdoor life and physical training, young men and women of frail constitutions have developed into strong, robust, and even physically powerful men and women. SYMMETRIC DEVELOPMENT 317 While membersliip in a well-appointed gymnasium and athletic association offers the most favorable conditions for the symmetric and fullest development of the body, and when possible it is advised always to take at least a short course in physical training under the direction of a competent instructor, yet every woman has it in her power to very greatly improve her physical condition without these aids. Systematic physical training should be begun in child- hood and continued all through life. Before twelve years of age physical training should be the same for both sexes, and girls and boys should have their sports and games together. The beneficial influence of this will be manifest for both— girls will grow stronger, less timid, and more resourceful, and boys will grow more refined and thoughtful. But even the case of the adult woman, where not only physical training but most of the laws of health have been neglected, is far from hopeless. A poorly developed chest, round shoulders, a beginning spinal curvature, a poor car- riage, bad skin, poor circulation, indigestion, constipation, and low vitality, with poor powers of resistance to changes in the weather and environment, are not insurmountable obstacles. But a woman in this condition cannot manage her own case. She must consult and place herself under the care of a competent physician. Physical Examination. — Before any kind of exercise is undertaken, a careful examination should be made by a competent physician. This will include an examination of the heart, lungs, blood, urine analysis, to ascertain the condition of the kidneys, an investigation of the digestive apparatus, and the character of the stools. Only in this way can the best results be obtained, and all danger of harm averted by the avoidance of those exercises which, by being too violent, would be actually harmful, and that, where needed, corrective exercises may be prescribed, together with the length of time that any one exercise should be continued. 318 PERSONAL HYGIENE FOR WOMEN Where there are marked symptoms of serious pelvic disorders, a local examination should be made by a gyne- cologist, and, in case of tendency to spinal curvature, the advice of an orthopedic surgeon should be sought at once, as otherwise very valuable time may be lost, and a shght curvature, that could have been cured in the first place, is allowed to grow into a deformity for Ufe. Two charts should be made out; the first should be a detailed outhne of her present condition; to the Vassar chart already given should be added the physical defects needing correction, as round shoulders, poor chest develop- ment, palpitation of the heart on exertion, length of walk that can be taken comfortably, also the time required per mDe. As the strength of the heart and lungs increases, as shown not only by the actual tests, but also by the increased powers of endurance, this first chart will be a matter of great encouragement to the woman and a great incentive to further effort. In a parallel column to the defects should be written the corrective measure for those defects. The second chart should contain the ideal measurements and strength tests for a woman of her height and weight. Rules for Taking Exercise. — The first things to be aimed at are the proper ventilation of the lungs, together with their development, and the strengthening of the heart. During the exercise the windows must be thrown wide open, or the very object of the exercise is defeated. Always begin with the simplest exercises and stop at the first sign of fatigue. The very first exercise will, therefore, be the simple respiratory exercises, taken in bed until one acquires some control of the muscles; they are then taken standing before a mirror, to insure the exercises being taken correctly, and after this they should be taken before an open window. The respiratory should be alternated with the abdominal exercises, and all of these should be taken for twenty minutes at a time, at least twice a day, on rising and immediately before retiring. Two hours should be spent out-of-doors every day. If the woman is weak and unused to taking exercise, she SYMMETRIC DEVELOPMENT 319 should walk until she feels the first signs of fatigue, rest, and then continue her walk. If the weather is too cold for sitting out-of-doors the woman should preferably take two short walks each day, one in the morning and the other in the afternoon. For invalids about ten in the morning and two in the afternoon are the best hours in winter, because of the greater warmth of the sun at those times. To be effective, exercise out-of-doors must be taken every day without regard to the weather, since the system, when in a state of activity, is less susceptible to sudden changes of temperature than when at rest. Exercise should not be taken after long fasting; hence, never before breakfast, nor immediately after a hearty meal. An hour after breakfast or a light lunch, or two hours after dinner, is the best time for regular exercise. A certain amount of daily exercise is essential for the preservation of the health. A healthy woman should be able to walk five miles a day, at the rate of three miles an hour, without feehng any sense of fatigue. In order to secure the greatest amount of benefit from exercise, the mind should be entirely free from care during the exercise, so that the woman should leave her cares at home and give up her mind and body to recreation while she is out-of-doors. Regularity in taking exercise is absolutely essential to secure good physical development and to maintain the body in a condition of health. A fixed hour should be set aside for this purpose every day. No definite rules can be given for the exact amount of exercise to be taken at one time, but the occurrence of fatigue is the signal for rest; after a five minutes' rest, exercise may be again resumed, to be stopped again at the same signal of fatigue. Perhaps three periods of exercise, alternating with rest, may be taken, but, in order to do good and not harm, the individual must always stop be- fore she is tired. A period of free exercises should begin with a twenty minutes' practice, including movements for arms, legs, 320 PEKSONAL HYGIENE FOR WOMEN back, chest, and abdomen, with especial emphasis on the correct poise and carriage of the body and deep breathing, and it should terminate with running; or, if in a class, with a running game. For those of mature age and sedentary habits especial care must be taken not to overtax the heart, always be- ginning with the simplest movements and stopping at the first signs of fatigue. In the gymnasium the periods of exercise generally cover forty-five minutes, with frequent intervals of rest in between. Even here an invariable rule should be never to exercise to extreme weariness. All exercise should be followed by a shower or needle bath, and a vigorous rubbing with or without alcohol. Very delicate women who have been unaccustomed to tak- ing exercise should rest on the couch or bed for one hour before proceeding to dress. It is well to sleep, if possible, and in this way they will find the good effects of the exer- cise very greatly increased. Gymnastic Dress. — The usual and best style of gym- nastic dress is a bloomer costume, the bloomers coming above the knees, long stockings, and thin, flat-soled shoes without any heels. The dress must be loose at the neck and waist, or it may be cut low in the neck. The sleeves are preferably short elbow sleeves. If the exercises are taken at home, the woman may wear a combination undersuit, with stockings and broad-soled heelless slippers. The lighter the dress, the better, so that there shall be no sense of weight or restriction about the neck, waist, or shoulders. By putting on her bedroom slippers any one can easily convince herself of the greater grip the foot has on the floor when so clad, and of the greater ease and sureness of the foot in walking. For outdoor athletics a short skirt, coming just below the knees, may be worn over the bloomer costume. Ten- nis shoes should always be worn. All rooms used for exercise, gymnasiums, and ball- SYMMETRIC DEVELOPMENT 321 rooms must be thorouglily ventilated before the assem- blage of the people. The air must be kept cool, between 50° and 60° F., and proper arrangements must be made to keep the room well ventilated while in use without causing direct drafts. Well-waxed, hard-wood floors are the best, because they can be kept freest from dust. Students should never be allowed to enter the gymnasium with their street shoes on, as they carry with them much dust that will be thrown in motion and inhaled during the performance of the vari- es Caids. Astragalus, Metatarsal Booo. Phalanges. Fig. 26. — Upper surface, bones of foot (Allen). ous exercises, and there follows not only the irritation caused by the inhalation of the particles of dust, but also the danger of inspiring all kinds of germs of disease with which the air is laden. The Configuration of the Foot. — No study of the correct attitude of the body at rest or in motion would be complete without some knowledge of the structural ar- rangement of the foot. The feet form the base of support for the entire body, and at every step are subjected to a pressure of from one hundred to two hundred pounds. 21 322 PERSONAL HYGIENE FOR WOMEN This base is in the form of two arches, a transverse and an anteroposterior. The latter is the most important, and has been subdivided into two by an imaginary line, drawn between the third and fourth metatarsal bones. The inner portion of this arch is much more curved than the outer, and forms the instep. The arch is supported by two piers. The posterior pier is formed by the os calcis, or heel bone, and the posterior part of the astragulus. It is shorter, has but one joint, is more curved, and is, at the same time, more solid than the anterior pier, and receives the greater part of the weight of the body. The anterior pier includes all the bones in front of the astragulus to the junction of the three metatarsal bones with the toes. It is much the longer, is less curved, and has many joints, giving it greater elasticity, and also enabling it to diminish the force of shocks transmitted to the arch. The summit of the arch is the ankle. It is evident that the superincumbent pressure, by flattening the arches, both lengthens and broadens the foot. The anteroposterior arch is further lengthened by a turning upward of the toes, which form a hinge-joint with the instep. In extension the foot normally rests upon the heel, the tips of the metatarsal bones, and the outer side of the sole. In walking, running, or dancing the direction of the weight upon the arches is constantly changing, and it is only through the action of certain muscles that the normal arches are conserved. This healthy condition of the plantar arch can only be maintained by the evenly balanced action of those muscles which surround and strengthen the weak parts of the arch. Dr. Busey's description of the foot in walking, and the injurious effects of the high-heeled shoe, is as follows: "In walking the heel touches the ground first, and sup- ports the whole weight of the body for a moment. A little later the point of the foot touches, and assists in preserv- ing the equilibrium by increasing the base. During the second movement of walking the heel is raised (see Fig. SYMMETRIC DEVELOPMENT 323 27, 2), and the weight of the body is shifted more and more to the center of the foot and toes, the latter spread- ing and pushing the body forward. This last is the movement which displays to the greatest advantage the suppleness and elasticity of the articulations of the foot, and the adaptat»ion of the arch to receive the weight of the body, and to transfer it to the distal pier, while the body is being moved forward by the same act. It is the exe~ Fig. 27. — The natural and artificial positions of the foot (Camper). cution of this movement which gives to the gait of woman that elegance and those graceful undulations which are so attractive. "The narrow high-heeled shoe, on the other hand, by displacing the supporting base, causes both piers of the double-spanned arch to strike at the ground simultane- ously. In consequence of which the gait, instead of being undulating, is stiff and hobbling, and the body advances by jerks. 324 PERSONAL HYGIENE FOR WOMEN "When standing on the heel bone {NLM, Fig. 27, 1), the joint at K, and the great toe C, touch the support upon the Une A-B. When the feet are shod according to the present fashion, the Hne A-B is made to assume the concave form shown in Fig. 27, 3, by BTu. The instep is made more convex and rounded, and the foot is actually shortened (see a-h, Fig. 27, 3). The constant elevation of the heel places the body of the pedestrian in the same position as when standing upon an inclined plane. Again, the heel is so shaped and located that it forces up the keystone of the arch and weakens the whole structure." The Correct Attitude in Standing (See Fig. 28). — The heels are placed nearly together, the toes pointed very slightly outward, the legs are rigid, the trunk and head are held erect, and the shoulders somewhat back, so that the chest shall expand freely. The arms should hang easily at the sides ; the fingers are slightly bent, with the thumbs in front. This position of "attention" can only be maintained comfortably for a very short length of time, since the actively contracting muscles soon tire. If the standing position has to be maintained for any great length of time, one foot should be placed slightly in advance of the other, the weight being borne upon the straight leg and the active supporting foot, the other being relatively passive. This asymmetric position has the important advantage that the two extremities may be brought alternately into play. The most common defect in standing is that the entire weight is usually borne upon the same leg, generally the right one, while the left, being inactive, is placed out to one side; the habitual maintenance of this position leads, as we shall see later, to a tilting of the pelvis to one side, with a consequent spinal curvature and lowering of one shoulder. Persons with strong feet, especially primitive unshod feet, mountaineers, runners, and young children, walk SYMMETRIC DEVELOPMENT 325 with the inner borders of the feet nearly parallel to each other and the direction of motion. The best sculpture, both ancient and modern, shows the straight supporting foot, which in standing is not necessarily parallel with its mate, since the resting foot may assume almost any angle of divergence. The influence of the stability of a correct base is well illustrated by standing on one foot and swinging the other leg backward and forward, which is much more difficult if the supporting foot be turned to one side. A runner finds it very difficult to run with the toes turned out, although the heels never touch the ground. Corrective Exercises. — Many of the most common defects, such as a droopmg head, round shoulders, flat chest, beginning spinal curvature, etc., result from a weak and relaxed condition of the muscles, whose function it is to move and support these parts. If the head is con- stantly bent forward in studying and writing at the desk, the muscles at the back of the neck gradually lose then- tone, and stretch out like a piece of elastic that is con- stantly kept on the strain. The exercises selected must be such as will strengthen these particular groups of muscles, and, while taking the exercises, the entire attention must be concentrated on the part being exercised. Any lack of symmetry in the chest, spinal curvature, or actual weakness of the lungs will necessitate the pre- scribing of special and carefully selected exercises. As to the exercises themselves, they should be so arranged as to bring into play in a methodic manner all the muscles. All special and corrective work must be supplemented by general work, which will increase the organic vigor of the heart, lungs, and chest necessary to meet the vital demands of the whole system. Games are, of course, most useful for this purpose, but the games should not be too violent. In most free exercises the limbs are used for weights of resistance. In a man weighing one hundred and fifty 326 PERSONAL HYGIENE FOR WOMEN .eervfeot verf«ime futtUtiraB pounds the arms usually weigh about ten pounds each and the legs twenty pounds. The Causes of Round Shoulders. — The general conditions are those that produce muscular or constitu- tional weakness, as rapid growth, overwork, the impure air of ill- ven- tilated rooms, acute illness, near- sightedness uncorrected by glasses, lack of proper exercise, and the wearing of clothing supported by suspenders bearing on the points of the shoulders, tending to pull them downward and forward, or even to produce a painful deformity of the scapula. It is the rule rather than the ex- ception to find, with round shoul- ders, some inequality in the height. The right shoulder is apt to be the lower, owing to the carrjdng of burdens on the right arm. Habitual standing with the weight on the right leg contributes to a good many cases. Games in which the right arm is almost exclusively used is another cause. The Causes of Spinal Curvature. — The spinal column forms the central support of the body, and, for grace and suppleness of motion, its thirty-four joints should be con- stantly exercised, as well as the muscles which hold it erect and support the head upon it, as well as attach the shoulders, hips, and legs more or less closely to it. In brief, all the muscles of the back need varied and regular exercise to maintain rvembmc ibar fSaePttffl >coa/x Fig. 29.— The spinal column (Church and Peterson). SYMMETRIC DEVELOPMENT 327 the erect position of the body, and from early child- hood especial attention should be given to develop and strengthen this region of the body. The normal movements of the spinal column are flexion, extension, side bending, and torsion. Flexion and ex- tension take place, for the most part, in the lumbar and cervical regions. Gould believes that astigmatism is a prominent factor in the causation of spinal curvature; the curvature is affected by the tilting of the head to one side in reading or writing. But a faulty postural habit is probably the most fre- quent cause both in standing and at the desk. When the weight is supported by the right leg, the left being used merely as a prop; there is a marked C-shaped curve pro- duced, with a lowering of the right shoulder and promi- nence of the right hip. This position is assumed by school children for long periods of time, and there is a consequent overstretching of the ligaments of the spine and hip. These cases are generally accompanied by round shoulders and flat chest, protrusion of the abdomen, and rotation of the vertebrae. A muscle can be developed only by the active con- traction and relaxation of its fibers. Continuous tension quickly tires and lowers its tone, so that exercises given for increasing muscular power should be comparatively quick and frequently repeated, while those that aim at the stretching of muscles and ligaments should be slow and long maintained. In all cases where corrective treatment is needed the first thing to be attended to is the general condition, and the best hygienic conditions must be provided, the general health inquired into and attended to. In all cases the eyes should be examined by a competent oculist. All exercises and stretching movements should be given daily, with a period of rest after three or four movements, and they should be so alternated and combined that no 328 PERSONAL HYGIENE FOR WOMEN two, employing the same muscles in the same way, should follow one another, and so cause excessive fatigue. The Muscles of the Abdomen. — These muscles are most important for breathing and therefore for health, for the retention in their normal position of the various abdominal viscera, for good digestion and regularity of the evacua- tion of the bowels. Sluggish digestion and constipation are among the commonest evils in life, and they are gen- erally connected with relaxed abdominal walls and flabbi- ness of the abdominal muscles. Active pressure of the abdominal muscles on the viscera massages the liver and presses onward the contents of the intestines. The protuberant abdomen may either be due to a faulty position in standing or an excess of fat in the great omen- tum, a membrane intended to protect the bowels. This excess of fat may be in turn due to lack of exercise or an excess of sweets and starchy foods, and the reduction of this superfluous fat by suitable exercises, properly taken, together with the attention to the diet, not starvation, is the only common sense and safe way for a woman to reduce her size. The abdominal muscles are used in bending, in stooping forward, in raising up from the recumbent position, some- what in climbing, and in many other movements. Trunk bending forward and backward; lateral flexions of the trunk ; bending of the knees down to a squatting position, together with torsions, and all exercises derived from these types, bring into play and exercise the abdominal muscles. EXERCISES FOR DEVELOPING THE VARIOUS REGIONS OF THE BODY The following list of free exercises has been selected primarily for developing the lungs and chest and correcting deformities, such as round shoulders, stooping attitude, and beginning spinal curvature, when due only to muscular weakness and faulty attitude in standing, sitting, and walking. Fig. 28. — Correct attitude in standing. Fig. 30. — Correct attitude in walking. First position. Fig. 31. — Correct attitude in walking. Second position. Fig. 32. — Shoulder-blade exercise. First position. Fig. 33. — Shoulder-blade exercise. Second position. SYMMETRIC DEVELOPMENT 329 While each exercise calls into play many other muscles than the ones for whose development the exercise is given, the exercise is classed under the group for the region which it is especially designed to benefit. The dances were selected, hoping that the graceful attitude of the dance shown would be a forcible object- lesson of what might be attained in the correct poise, carriage, and grace of motion, not only in walking, but in all the movements of the body. A study of the poses of the dance will demonstrate that, for developing the arms, strengthening and giving grace to the movements of the wrists, they are greatly superior to the free exercises. As the poses of the dance can be readily studied from the plates, no further description was thought necessary. Shoulder-blade Exercises (Fig. 32). — First Position. — Stand erect, with the feet nearly together, and the palms of the hands brought together above the head in the manner shown in the figure. Second Position (Fig. 33) . — Throw hands and forearms backward, keeping the arms on a line with the shoulders, the elbows bent, and turn the palms forward, as repre- sented in the second position of the figure. Return to the first position, and repeat ten times. These exercises strengthen particularly the muscles between the shoulder- blades, whose function it is to hold the shoulders back. The first point in taking each exercise is to learn the correct attitude before a mirror; after this has been mastered, the exercises should be taken with a considerable amount of rapidity and force, but not so forcibly that the collar-bone projects at its junction with the breast-bone. In throwing the hands and forearms back, the force of the motion should come at the elbows, not at the hands, and the shoulders should be carried as far back as possible. Shoulder-blade Exercises, Number 2 (Fig. 34). — Stand erect, with the feet nearly together, and with the hands clasped behind the neck, as seen in the figure. Then force the head and elbows strongly back. 330 PERSONAL HYGIENE FOR WOMEN Relax, letting the elbows come forward. Repeat ten times. It will be readily seen that these shoulder-blade move- ments are exercises for the arms and chest as well. The object being to raise and broaden the chest. Respiratory Exercises (Figs. 35, 36, 37). — First Posi- tion. — Stand with the feet nearly together, the chin down, the arms extended downward, with the backs of the hands touching, as shown in the figure. Second Position. — The chin should be raised with the arms, so that in the second position the head is held erect. Third Position. — The movements of the hands are car- ried upward still further and separated as shown in the figure. From this position the hands should be brought downward in the large sweep of a circle to the original position. When these various movements have been accurately acquired, forcible respiratory movements should be added. Begin to inhale forcibly as the hands are raised, and hold the breath as long as possible while the hands are held above the head, and exhale forcibly while the arms are be- ing brought down. These exercises bring into play the muscles of natural and forced respiration. Exercises for Forward Projection of the Chest and Retraction of the Abdomen (Figs. 38, 39). — First Posi- tion. — Stand erect, with the arms behind the back, the hands resting in the small of the back, the fingers inter- locked, and the palms facing backward. Second Position. — Straighten the arms, turn the palms inward and then downward, and lastly out, all the while keeping the fingers interlocked. Roll the shoulders and arms into supination, and extend the neck, as in the atti- tude of the second position of the figure. Retain this position for a moment, then reverse slowly back into the first position. When the fingers cannot be held in this position, start by holding a loop of cord in the hands, instead of interlock- ing the fingers. Fie. 34. — Shoulder-blade exercise. Number 2. Fig. 35. — Respiratory' exercise. First position. Fig. 36. — Respiratorjr exercise. Second position. Fig. 37. — Respiratoiy exercise. Tliird position. Fiff. 38.- -Exercise for forward projection of chest and retraction of abdomen. First position. Fig. 39.- -Exercise for fora^ard projection of chest and retraction of abdomen. Second position. Fig. 40. — Shoulder and back exercises. First position. Fig. 41. — Shoulder and back exercises. Second position. Fig. 42. — Leg exercises. First position. Fig. 43. — Leg exercises. Second position. Fig. 44. — Squatting exercises for muscles of spine and abdomen. SYMMETRIC DEVELOPMENT 331 This exercise is particularly valuable for projecting the chest forward, stretching the shortened ligaments, and drawing in the abdomen. Care should be taken to have the chin pressed backward when the arms are brought downward and turned outward. Shoulder and Back Exercises (Figs. 40, 41). — First Po- sition. — Stand erect, with the feet together, and both arms extended on a plane with the shoulders, so that in the first position the left arm is extended directly in front of the body and the right arm on the same plane directly behind the body. The arms must be held rigidly on the same plane. Second Position. — By a circular movement, the position of the left arm is assumed by the right, and vice versa. During the entire movement the feet must be kept firmly planted on the floor, pivoting at the hips only, while mak- ing the continuous circular movement of the arms. These movements consist in a torsion of the body around the axis of the spinal column, and to these can be added deep inspirations from left to right, with expira- tions from right to left. In addition to the effect on the circulation, the respiratory movements keep up the nu- trition and efiiciency of the lungs, which in old age undergo a kind of atrophy, and also maintain the elasticity of the chest-walls, which are apt to become stiff through disuse, and so interfere with the movements of the lungs and pleura. Leg Exercises (Figs. 42, 43) . — First Position. — Stand erect, with the hands resting on the hips and the legs crossed at the knees, with the right foot in front, as shown in the figure. Second Position. — Swing the right leg outward and around back to about eighteen inches back of the left foot, as is shown in the second position. Then swing the right leg outward and around, back to the first position. Reverse the position of the feet, and perform the same movements with the left leg. The weight of the body must always be thrown on the advanced leg, and perfect 332 PERSONAL HYGIENE FOR WOMEN poise and balance should be maintained throughout the entire movement. Leg exercises are useful for purposes of relieving the engorged veins of the fatigued leg, because the movements of such large masses of muscles as those of the legs and thighs demand large supplies of blood, and consequent quick action on the part of the heart to supply it, and this blood, pouring swiftly back to the lungs for purification, requires frequent and deeper inspirations on their part to effect the purification; leg exercises cause greater develop- ment of the chest than do arm exercises. Squatting Exercises for Muscles of the Spine and Abdomen (Fig. 44). — Stand erect, with the feet near together and the hands resting on the hips, rise upon the toes, then sink the body to the floor, bending the knees sharply, until the thighs and legs are doubled upon each other and the weight of the entire body is supported by the toes. The trunk must be maintained perfectly erect throughout the movement. Then return to the original position. Repeat ten times. These exercises strengthen the muscles of the spine and abdomen, and aid in reducing superfluous abdominal fat. They also strengthen the ankles and increase the flexibility of the knee-joints. Alternate Kneeling; Abdominal Exercise (Fig. 45). — While these exercises also strengthen the muscles of the spine and legs, they are primarily abdominal exer- cises, and are given for the strengthening of the abdominal muscles and improving the circulation in the abdominal viscera. First Position. — Kneel on the left knee, with the face directed forward, the right arm extended perpendicularly up at the side of the head, and the left hand resting on the hip. The head and entire trunk are then turned slowly to the left, the right arm all the while being held rigidly up at the side of the head, then returns slowly to the original position. Second Position. — Kneel on the right knee, with the face Fig. 45. — Alternate kneeling; abdominal exercise. Fig. 46. — Balancing exercise for poise and carriage. fill Fig. 47. — Balancing exercise for extending depth of chest. First position. Fig. 48. — Balancing exercise for extending depth of chest. Second position. i , Fig. 49. — Lateral trunk and waist exercise. First position. Fig. 50. — Lateral trunk and waist exercise. Second position. SYMMETRIC DEVELOPMENT 333 looking directly forward, and the left hand extended above the head, and the right hand resting on the hip. The head and entire trunk are then turned slowly toward the right, and the position maintained for a moment, then return to the original position. Repeat five times for each leg. These exercises strengthen the abdominal muscles, those at the side of the waist, and groins. Balancing Exercises for Poise and Carriage (Fig. 46) . — These exercises, for maintaining the equilibrium of the body while it is poised upon the smallest possible base, are among the most difficult positions to maintain, requir- ing a high degree of coordination of movement. They are given to improve the poise and carriage of the body. The position of the right foot in the figure is incorrect, since the object of the movement is to have the body balanced throughout on the toes only. Stand erect on the tiptoes, with the arms and hands extended at the sides and above the head, as shown in the figure; then walk in the same position, with the hands carried up perpendicu- larly at the sides of the head. Further benefits in the carriage of the body may be ob- tained by carrying light weights upon the head while per- forming these exercises, as a light book. These exercises, when properly performed, expand the chest and bring into play all the extensors of the back and elevators of the shoulders. They also round out the muscles of the throat and neck. Balancing Exercises for Extending Depth of Chest (Figs. 47, 48). — First Position. — Stand erect, with the heels together and the hands resting on the hips. Straighten out the right arm, and extend it perpendicularly up at the side of the head, and at the same time carry the left leg outward and upward as far as possible, according to the pose assumed in the figure. Then lower the leg and arm, returning to the original position. Second Position. — Stand erect, with the heels together and the hands resting on the hips, as in the first position. Then take the same movements with the left arm and right 334 PERSONAL HYGIENE FOR WOMEN leg as were taken in the first position. The arm and leg should be raised and lowered simultaneously. All these exercises increase the vertical diameters of the chest, and strengthen the muscles of ordinary and forced respiration. These movements also relieve the engorged veins of fatigued legs. Lateral Trunk and Waist Exercises (Figs. 49, 50). — First Position. — Stand with the feet nearly together and the arms extended above the head ; the arms are relaxed at the wrists and elbows, so that a slightly curved line is formed, as is shown in the figure. First sway to the left, bending at the waist line as far as possible, and re- turn to the original position. Second Position. — The attitude is the same as in the first position; sway to the left in the same manner. These exercises strengthen the muscles on the sides of the abdomen and the lower part of the back, and are an excellent means to reduce the size of the waist in case of corpulency. Exercises for the Muscles of the Back (Fig. 51). — These exercises may be taken lying prone on the floor, with the feet caught under any piece of furniture which is strong and low enough to act as a cross-bar, as a lounge or dressing case. No one but an athlete could take this exercise without having the feet held down. The feet should be held firmly down, and the hands may be at the sides or clasped behind the waist; the body is then slowly raised and carried backward to the half -sitting posture, then gradually lowered to the original position. These movements should be taken slowly and not repeated more than five times in the beginning. In case of stooping or round shoulders, the hands should be clasped at the back of the neck instead of at the waist. Raise the head and extend the spine, pressing the elbows backward. This exercise is a severe one on the extensors of the back and the rotators of the shoulders. Fig. 51. — Exercises for muscles of back. '^^^^^t^WMMSHJClvM gslBBfe"- Fig. 52. — Exercises for muscles of abdomen. Fig. 53. — Swimming exercises: for back, thighs, and abdomen. First position. Fig. 54. — Swimming exercises : for back, tliighs, and abdomen. Second position. Fig. 55. — Rope-pulling exercises: for back, chest, waist, legs, and arms. First position. Fig, 56. -Rope-pulling exercises: for back, chest, waist, legs, and arms. Second position. Fig. 57. — Exercises in lateral trunk flexions: for shoulders, chest, hips, and legs. First position. SYMMETRIC DEVELOPMENT 335 Exercises for the Muscles of the Abdomen (Fig. 52). — Lie supine on the floor, with the feet firmly fixed under a cross bar, or a piece of furniture which will answer this purpose, and the hands resting on the hips, as shown in the figure; slowly raise the body to the upright posi- tion, maintain for a moment, and return to the first position. This and the preceding exercise are both excellent for strengthening the abdominal muscles and reducing an excessive accumulation of fat in case of obesity of this region. Swimming Exercises : for Back, Thighs, and Abdo- men (Figs. 53, 54). — First Position. — The movements given here are those for the breast-stroke in swimming. Stand with the feet about eighteen inches apart, with the right foot advanced and the right leg straight ; the weight is thrown on the left leg, and the arms bent at right angles, ready for the beginning of the stroke, as shown in the pose. Second Position. — Shoot the arms directly forward, incline the whole body forward, straighten the left leg, and throw the weight on the right, which should be bent, as shown in the second pose. Then sweep the hands and arms outward in a horizontal plane, until the arms, trunk, and legs are brought into the original position. Then take the same exercises, reversing the positions of the right and left legs. In taking these exercises the arms, body, and legs must work simultaneously. Special stress must be placed on the alternate flexion and extension of the front and rear leg and the inclination of the body forward with each stroke. While these exercises strengthen the muscles of the arms, shoulders, and chest, they are especially intended for the extensor muscles of the back and thighs and muscles of the abdomen. Rope-pulling Exercises: for Back, Chest, Waist, Legs, and Arms (Figs. 55, ^'o).— First Position. — Stand with the feet about eighteen inches apart, the arms ex- 336 PERSONAL HYGIENE FOR WOMEN tended out in front of the body and well out from the sides; the right foot is advanced, and the weight rests mainly on the right leg. Second Position. — Clinch the hands tightly, as though grasping a rope, and sway to the left side, at the same time straightening the right leg; bend the left knee, and pull the hands toward the waist, as though pulling the rope in; then extend the arms and return to the first position. Repeat the exercise with the position of the legs re- versed. The arms must be extended well out from the sides, bending at the waist-line, so as to increase the reach, and the swaying back and forth must be done with perfect regularity. This is a good all-around exercise, as it brings into play and strengthens the adductors of the thighs, calves, and extensors of the legs, the broad muscles of the back, the muscles of the chest, waist, and the flexors and extensors of the arms. Exercises in Lateral Trunk Flexions : for Shoulders, Chest, Hips, and Legs (Figs. 57, 58). — First Position. — Stand with the feet eighteen inches apart, with the right arm extended upward and the left downward, and the weight of the body thrown on the right leg, while the left leg is extended directly to the side. Second Position. — Change the weight to the left leg, and bend the left knee while the right leg is extended. At the same time bring the right arm down and carry the left up and sway the body at the hips to the right side. The feet are kept flat on the floor during the entire exer- cise, and it will be noticed that the arm, which is extended downward, is on the same side as the extended leg. These exercises increase the flexibility of the chest, strengthen the muscles at the sides of the waist, and cause some massage of the liver. Exercises in Trunk Flexions : for Muscles of the Back, Abdomen, and Leg (Figs. 59, 60). — First Position. — Stand with the feet about six inches apart, the body bent Fig. 58. — Exercises in lateral trunk flexions: for shoulders, chest, hips, and legs. Second position. Fig. 59. — Exercises in trunk flexions; for back, abdomen, and legs, First position. Fig. 60. — Exercises in trxink flexions: for back, abdomen, and legs. Second position. Fig. 61. — Chest weight exercises tor arms and shoulders. First position. SYMMETRIC DEVELOPMENT 337 well forward at the waist-line, while the legs are rigidly extended at the knees. Increase the bend gradually at the waist until the tips of the fingers touch the floor be- tween the feet, as shown in the pose. Second Position. — From the first position carry the arms directly forward, upward, and backward until they reach the position shown in the second pose, with the knees and ankles flexed ; bend the trunk as far backward as possible, while the arms are extended over the head. Maintain for a moment, and return to the original position. These movements must all be taken slowly, and in the beginning do not attempt to go far back of the vertical line. Nearly all the muscles on the front and back of the body are involved in these exercises, but the greatest strain comes on the muscles of the back and abdomen and the muscles on the back of the thighs. The bending and rising bring into powerful action the extensors of the back and neck and the retractors of the shoulders. After this exercise has been mastered, it can be used to still further expand the lungs, by forcible inspiration when the chest is in the most favorable position for expansion; retain the breath while the trunk is flexed, forcing the air into the cells of the lungs under pressure. This last fea- ture of the exercise should not be attempted by any one with weak lungs. Boxing and Fencing. — Boxing and fencing are both excellent exercises for the lungs, for both sides of the body, for balance, for rapidity, for endurance, variety, prompti- tude, and sudden adaptation; for originality, up to a certain point, as well as for self-reliance and fearlessness. They have the advantage of cheapness, and are best prac- tised in the open air. Exercises with Chest Weights : for Chest Expan- sion, Shoulders, and Arms. — These exercises are excel- lent for developing the muscles of the upper part of the chest, and for rounding out the chest, shoulders, and arms. They are also good flesh-reducing exercises. The weights should be fairly light at first, beginning 22 338 PERSONAL HYGIENE FOR WOMEN with perhaps two and one-half pounds, and gradually in- creasing until five pounds are used. The weights should only be increased with the increase of the strength of the individual. All the movements should be performed consecutively from ten to twenty times each; then pro- ceed to the next movement. In taking any heavy exercise great care must be used not to overfatigue the muscles, or more harm than good wUl be done. As soon as the muscles have become too tired to perform any exercise vigorously, it should be discon- tinued, and a rest of a few minutes taken, when the exer- cise may be resumed. When a point is reached at which the muscles feel tired at the commencement of the exer- cise stop at once for the day. ChestWeight Exercises for Arms and Shoulders (Figs, 61, 62). — First Position. — Face the chest weights, grasp the handles firmly, and hold the arms straight out in front of the chest. Stand with the heels nearly together, and far enough away from the weights to raise them a little distance from the floor. Second Position. — Draw the two handles to the chest and almost under the arm-pits, letting the elbows and shoulders go well back; then extend the arms. Repeat ten times. Chest Weight Exercises for Shoulders and Chest Expansion (Figs. 63, 64). — First Position. — Hold the arms straight out in front. Second Position. — Then, still keeping them in a horizon- tal position, throw them back as far as possible. Chest Weight Exercise for Extending Depth of Chest (Figs. 65, 66). — First Position. — Stand with the back to the chest weights, palms forward, arms straight. Second Position. — Let the arms go past the sides, back and up as far as possible; then bring them down and for- ward and return to first position. ChestWeight Exercise for Chest Expansion (Figs. 67, 68). — First Position. — Stand with the back to the chest weights, holding the arms straight out in front. Second Position. — Then, keeping them straight and in a Fig. 62. — Chest weight exercises for arms and shoulders. Second position. Fig. 63. — Chest weight exercises for slioulders and chest expansion. First position. Fig. 64. — Chest weight exercises for shoulders and chest expansion. Second position. Fig. 65. — Chest weight exercises for extending depth of chest. First position. Fig. 66. — Chest weight exercises for extending depth of chest. Second position. Fig. 67. — Clieyt weiglit exercises for cliest expansion. First position. Fig. 68. — Chest weight exercises for chest expansion. Second position. Fig. 69. — Figures of the dance. First position of the hands and feet. SYMMETKIC DEVELOPMENT 339 horizontal position, throw them back as far as possible. With the arms still extended on a straight line with the shoulders, bring them forward until the hands meet in front. This is an excellent exercise to expand and develop the chest. Classic and Esthetic Dancing: an Essential Feature in Physical Training. — From earliest antiquity the dance has been of universal practice among all peoples of the earth, both savage and civiHzed, and it has been made to express all the emotions of which the mind is capable of feeling. Dancing held a prominent position among the gymnastic exercises of the Greeks. The teachers of physical training have long felt that even the combination of gymnastics and athletic sports left much to be desired in the carriage and movements of the body, so classic and esthetic dancing, which stands between the two, more closely allied to gymnastics in its movements and to games in its spirit, was introduced as an additional gynmastic exercise, to harmonize the move- ments of the body, and to produce an ease of manner with a grace of beauty and of motion. Society Dancing. — A sharp distinction must be made between the modern gymnastic dancing and society danc- ing. In the latter, the waltz and the two-step always require a partner. The dancing is ordinarily confined to the ball-room, with its poor ventilation and overheated air; add to these the constriction of the waist, so that the free action of the heart and lungs is interfered with, and under these conditions it may even prove a dangerous pastime to the young woman with weak heart or lungs. As a physical exercise, the waxed floor of the ball-room still further reduces its value. Gymnasium or Classic and Esthetic Dancing. — For the gymnasium dancing there must be, first of all, the loose dress and heelless slippers, and an abundant supply of fresh air at a proper temperature, while the foot grips the floor as tenaciously as in boxing or fencing; a smooth floor renders an artistic execution impossible. The floor 340 PERSONAL HYGIENE FOR WOMEN should be rough or covered with canvas, when dancing becomes as good a developer of the heart and lungs as running or swimming. Girls in good physical condition can keep up esthetic dancing for an hour with very few rests or pauses. The work done in one hour is about equivalent to a walk of ten miles. The first steps in the attainment of grace of motion is to avoid short, angular, jerky movements, and to learn to do everything, even the most difficult exercises, with the least expenditure of power and energy. This implies considerable muscular strength and great muscular en- durance and control. As soon as the dancer loses her balance or poise, holds one arm too straight, and bends the other one at too sharp an angle, or puts too much stress on this movement and too little on that, or makes too much effort, the harmony is lost and gracefulness is not attained. The modern gymnasium dancing conforms more com- pletely with the requirements of good exercise than ball- room dancing, because the trunk, arms, and legs are brought more generally into action. While the exercises of the feet and calves are not so intense or so concentrated as in ballet dancing, the range and the extent of the movement are much greater. Not only are the shoulder, back, and chest muscles considerably developed by the free use of the arms, but so many of the muscles of the lower part of the back, abdomen, and thighs are used that greater respira- tory power is acquired to sustain the extended action; hence, the chest-walls are expanded by the effort, and the abandonment of the corset during dancing gives the utmost freedom to all respiratory movements. Statistics show that some of the benefits accruing from a conscientious study and practice of aesthetic dancing are, that it raises and develops the chest, lengthens the waist, and also reduces its circumference; the hips are reduced in size, the thighs and calves are enlarged, while the ankles are made smaller and the insteps are raised and given a Fig. 70. — Figures of the dance. Second position of hands; second position of right foot. Fig. 71. — Figures of the dance. Third position of hands; third position of right foot. Fig. 72. — Figures of the dance. Third position ("amplified") of hands; fourth position of right foot, in front. N. B. — When the arms are not in motion, the palms must be turned down. Fig. 73. — Figures of the dance. Fourth po.sition of hands; fourth po.s Fig, 74. — Figures of the dance. Fifth position of hands; fifth jwsition of right foot. vW^^*^ Fis;. 75. — Fii>:ures of the dance. Forward balance. Fig. 70. — Figures of the dance. Backward balance. Fig. 77. — Courtesy. Fig. 78. — Highland fling. Fig. 79. — Hornpipe step "on lieels, " pulling down the small ropes. Fig. 80. — Swedish step from "Kulldansen." Fig. 81. — Circles ^vith hands, from Spanish dances. Fig. 82. — Combination of dance steps. First position. Fig. 83. — Combination of dance steps. Second position. Fig. 84. — Combination of dance steps. Third position. Fig. 85.— On the toe tips. SYMMETRIC DEVELOPMENT 341 higher arch. Properly applied and directed, dancing ex- ercises are even a cure for flat-foot. The improvement noted in thirteen young ladies during twenty-five days by M. B, Gilbert is as follows: The average increase in the normal chest measure, from half an inch to one and a half inches; with the chest inflated, from half an inch to one and three-fourth inches. The foundation for this coordinate work, from which an unlimited variety of the most valuable developing exercises is formed, consists of the long-estabhshed five positions of the feet and five positions of the arms, to- gether with positions of the whole body, known as atti- tudes, arabesques, poses, elevations, groupings, etc. From these precepts are established, whereby steps, attitudes, and motions are systematically arranged, according to the method, and in strict harmony with time and cadence of music. The freedom given by such dancing softens the crude awkward positions so universal among young people; the general carriage invariably improves as the head goes up and the shoulders go back; a more elastic tread and an easier propelling of the body in walking is gained. Not only is the chest broadened and deepened, and fat removed from waists and hips, and weak backs strengthened, but students gain in quickness of perception, coordination, and judgment, as well as in agility and power to keep their feet in correct rhythm. Esthetic dancing is particularly recommended in all factories, stores, and schools where there are any large number of girls and women as a recess exercise, because in this way they get a great deal of vigorous exercise in a very short time. It brings all the large muscle groups into action, causes a rapid circulation of the blood, aerates the lungs, and it affords the best possible sort of a contrast to their monotonous and cramped positions; it is most exhilarating and it is good fun. It is an excellent mental tonic and physical invigorator; it brightens the day, and enables the women to do better work. 342 PERSONAL HYGIENE FOR WOMEN Outdoor Exercise. — Outdoor exercise must be regarded as one of the essentials to good health, and as such must be classed with food, clothing, bathing, and sleep. In addition to the beneficial effects of exercise on the muscles, circulation, and all the functions of the body, are the soothing effects of outdoor life on the nerves. It is only out-of-doors, in the parks, in the country, or by the sea that one is soothed into entire oblivion and forgetful- ness of the cares of life, and to such a degree that the in- dividual may be said to be hypnotized by the powers of nature, so that the mind is almost as perfectly at rest as in a sound sleep. The time spent out-of-doors should not be less than two hours daily. Actual experience of busy workers will prove that not only is this time not lost, but that actually more and better work can be done in the day, and that the resulting improvement in the general health will be so great that much less time will be lost through indisposition and actual sickness, so that the daily outdoor exercise will be found to be a great economic gain. Outdoor exercises, such as walking, running, swimming, and hill and mountain climbing, possess the very great advantage that indulging in them demands no expense, and are, therefore, open to all. All these exercises de- velop the lungs and chest and strengthen the heart, and are, therefore, classed under exercises of endurance. The Effect of Walking on the Heart and Lungs. — In a slow walk the respiratory action is almost double the ordinary amount; in walking at an ordinary pace, that is, about three miles an hour, it is four times as great ; while in a vigorous or hasty walk, that is, at a rate of from four to six miles an hour, it is from seven to nine times as great. The change of speed from three to five miles an hour elevates an automatic, listless occupation into a vigorous exercise, employing many new muscle groups and stimu- lating the heart, lungs, and skin, while the change from a smooth, level road to the broken ground of the mountain- SYMMETRIC DEVELOPMENT 343 side may be dangerous for many a one who is able to walk at a moderate speed on level ground. In walking the clothing must be sufiiciently loose not to interfere with the more rapid respirations and the increased action of the heart. When the heart cannot keep pace with the demanded speed of the circulation, a "stitch" ensues, and getting one's second wind means that the heart has succeeded in accommodating itself to the strain. Too great a "stitch," resulting in absolute breathlessness, is a warning that must not be disregarded. This increase in the respiratory action is important, as compared with the brief and transient increase from exercise with apparatus, because a quick walk can easily be kept up for several hours. The fatigue is small, because, in the first place, of the abundant supply of oxygen; the will is scarcely used, and walking is almost automatic, partly because the muscle areas used are large, and each movement prepares for the next. Walking is a heart and lung exercise of a very ex- cellent sort. The Effect of Walking on the Movements of the Blood in the Legs. — The circulation of the blood depends on the pumping of the heart, which is in turn affected by the suc- tion action of the lungs and the muscular movements of contraction and relaxation which go on rhythmically. "''^"J^ile in prolonged standing the veins of the legs become fuller, and the circulation of blood in them more sluggish, and by the laws of gravitation the blood is kept down in them. Hence also in walking slowly with short steps the legs remain overfull of blood and become heavy. Instead of being quickened, the circulation is actually hindered, for the waste-products are not carried away quickly enough. Hence, slow walking soon causes a feeling of fatigue, while the vigorous walker, going along with long strides, keeps fresh. Rules for Long Walks. — In walking, not only the dis- tance should be taken into account, but the character of the road and the incline of the ascent, A distance that 344 PERSONAL HYGIENE FOR WOMEN could be easily covered on a smooth, level highway may mean double the expenditure of muscle and nerve force if the ground is sandy or veiy damp. Other hindrances to be taken into consideration are opposing winds, not only because of the resistance, but also because of the inhala- tion of dust and rain. The walk should be occasionally broken for short periods of rest. The pauses should be short, about five minutes, and during this time the body should be erect. Experi- ence proves that sitting down makes one more tired on getting up again. A short halt should be made before climbing a steep ascent, so as to begin with fresh strength and easy breathing, as this means increased work for the heart and lungs. In starting out for a walk, one should begin slowly, and gradually increase the pace, and in returning the same rule should be observed. Running. — The force exerted in running is enormous. In running it is the length of the step more than anything else which increases the speed of the run ; hence, the runner should learn to take long steps. But the greatest speed can only be kept up for a limited time; the distance is one hundred yards. Running is the most effective of all exercises of speed, and, like all exercises of speed, can be changed into one of endurance by a certain moderation in the pace. By running the heart and lungs are developed more than by any other exercise. Age Limit for Running. — All ages are not equally well adapted for running: they do not all share in its good results. Running is best for all young people, before and at the age of puberty. Running is then quite a necessity. The growing child is always ready for a run. From the fortieth year on running, as an exercise of speed, becomes less and less desirable, and, when the organs of circula- tion or breathing are impaired, it must be absolutely forbidden. In running always begin slowly — running moderately, SYMMETRIC DEVELOPMENT 345 for instance, for fifty feet ; then increase the speed gradually, but when running for exercise, never speed to the utmost, as this is not necessary for the benefits of the exercise. Always close the run with the same moderation with which it was commenced ; that is, never stop short, as this sudden arrest of action gives a most undesirable shock to the heart. The movements of running may easily be imitated in the house, while standing in one place, and simply lifting the feet in the same quick alternation from the floor. Mountain Climbing. — The advantages of mountain climbing are manifold. The weight of the body has to be carried up a certain height. To accomplish this the work of the muscles is increased; the breathing must be deeper to satisfy the increased demands for oxygen; fresh air is admitted into the apices of the lungs, which do not, as a rule, participate in respiration. A more powerful action of the heart takes place, but care must be taken that this is not carried too far. Slow climbing, without any un- necessary waste of energy and with appropriate pauses, to allow the heart to recover, is advantageous. One should not talk too much while climbing. The dress should be suitable ; the neck must be free and the shoulders not heavily weighted, so that they may be drawn back and the chest fully expanded. Swimming. — Of all outdoor exercises for women, swimming is one of the most perfect. It not only calls into vigorous action most of the muscles of the body, but spares many of those muscles which are so commonly overworked, most of the work being performed by muscles which are so little used as to have become weak and flabby. For instance, the extensors of the fingers and the hand, that are so constantly stretched in sewing and writing, are in constant use in swimming, while the corresponding flexors, the slaves of the needle and the pen, are relaxed. Again, the muscles passing from the shoulder-blades to the trunk, on which depends much of the erect carriage and strength of the chest, which have become wasted from 346 PERSONAL HYGIENE FOR WOMEN disuse while the woman sat at the desk or bent over her sewing, are the very muscles by which the movements of the upper half of the body are executed, while all the muscles of the lower extremity are brought into use. Of especial value is the free movement of the hip-joint, a joint that is seldom moved with any degree of freedom from the time a girl leaves climbing trees, unless she has the advantage of special gymnastic training. The vigor- ous action demanded of the respiratory muscles greatly increases the chest capacity. The body is lighter than the water, and is perfectly supported by it, so the weight is taken off the spine, and the muscles of the back are relieved from their normal state of tension. The head is the only part of the body that is held up by muscular action, and, in floating, even this is supported by the water. The disadvantages arise from the fact that the tempera- ture of the water is very much below that of the body, so that there is a greatly increased conduction of heat from the body, and, unless this loss is made good by exercise, there is very great danger of a chill. In most persons a prolonged stay in cool or cold water produces a liability to cramp. During the month of August the temperature of the ocean reaches its maximum of 66.65° F. This is about 32 degrees below the temperature of the body. Upon entering the water the first effect noticed is a sensation of cold ; this varies with the susceptibility of the individual, and the difference between the temperature of the water and the surrounding air. The skin assumes the appear- ance of "goose-flesh," the face is pale and anxious, and the lips are blue; the pulse decreases in frequency, a sense of oppression is manifest, and there may be spasmodic shivering; that is, the first effect of immersion is to cause a contraction of the blood-vessels of the surface of the body. This should be quickly followed by a secondary reaction, in which there is a sensation of warmth, a quick- ened pulse, and an increase of energy. When, by taking SYMMETRIC DEVELOPMENT 347 the proper precautions, this reaction does not occur, it is a contraindication to sea-bathing and swimming. If the immersion has been too prolonged, there is a second sensation of chilliness, a signal that the bather must leave the water at once. The best time for bathing is between eleven o'clock in the morning and four in the afternoon, depending on the tide. No one should go into the water within two hours after meals, nor should she on leaving the bath proceed at once to the table, since digestion draws the blood from the periphery to the stomach, and to eat immediately after bathing is to lose most of the benefit of the saline treatment. All should avoid cold-water bathing when fatigued, and swimmers ought to pay especial attention to this point, on account of the demand they are going to make on their muscular system; and on no account must one enter the water when in a perspiration; a moderate walk along the shore should be taken until the perspiration has subsided. These precautions are of the highest importance, and dis- regard of them may prove fatal. Enter the water quickly until it reaches the waist, then plunge headlong, or cover the body to the neck. Care should be taken to wet the chest and abdomen immedi- ately on entering the water, since these parts are the most sensitive to the impression of cold. Every one should learn to swim, and those who cannot must move the arms and legs about vigorously. The duration of the bath should depend on the state of the health of the individual, on the state of the weather, and on whether the water is rough or calm. The average dura- tion of the time spent in the water should be from three to fifteen minutes, the latter being the maximum time for any one. No benefit will accrue from spending a longer time than this in the water, and much harm may result. The sea-bath should be followed by moderate exercise, in order to insure a perfect reaction, and to aid in expend- ing the superfluous energy which sea-water imparts. 348 PERSONAL HYGIENE FOR WOMEN Swimming and sea-bathing should be avoided by per- sons who have weak hearts and a poor circulation, in whom the reaction after a plunge into cold water is never well established. Also by persons with heart or kidney disease, and by all feeble and old persons. Persons with feeble constitutions, but with no actual disease, as in various forms of nervous disorders, insomnia, etc., generally derive marked benefit from sea-bathuig. Persons who are weak should walk and not plunge into the water. As in all other exercises, a determination on the part of the weak to equal the strong is a fertUe cause of mischief. Horseback Riding as an Exercise. — The advantages claimed for horseback riding are that it acts on nearly every muscle of the body, while the mind is interested and refreshed. An insuperable disadvantage to the majority of women living in large towns and cities is the enormous cost of the exercise. The value of horseback riding for women has been greatly diminished by the very faulty position caused by the side- saddle, which produced a cramped position of the body and a tendency to lateral curvature of the spine. Then, too, women ride too tightly corsetted, thereby preventing much good that would otherwise acciTie to the circulation and digestive organs. When the woman rides astride, the body is held erect and in a natural position, and she sits much more firmly on her horse and, if not corsetted, it becomes an exhUaratuig and delightful form of exercise. The best results wUl probably be found in a neurasthenic class of women, who are not strong enough to take more active exercise, and for them it will be of decided therapeutic value to both mind and body. Rowing. — This is one of the most beneficial of exercises; it has the advantages of scenery, freedom from dust, and companionship ; it exercises equally both sides of the body and most of the muscles. It is an excellent exercise for strength, rapidity, and endurance. SYMMETRIC DEVELOPMENT 349 In correct and graceful rowing there is a pendulum-like movement from the hips. The rower should sit with the trunk fully extended, the head up, the eyes to the front, the chest thrown forward, and the weight of the trunk equally distributed upon the two sides of her seat. The feet rest against the stretcher, the two hands should be near together, and should be held symmetrically at an equal distance from the body. Stretching. — The body and extended arms are brought forward as far as possible. The spinal column should be kept extended, not bent so as to make a crooked back, and the trunk should be thrown forward from the hip- joints. When the stretch has reached its forward limit, the oar is dipped into the water just far enough to cover it; then immediately the pull begins, and it must be continued evenly to the end. The Pull. — The body rises erect from the hips and swings backward. The hands should not reach the front of the chest until the body has passed the perpendicular and is sinking back. When the pull is finished, the hands are dropped and suddenly bent toward the wrists. This lifts the oar out of the water, and keeps its lower surface parallel with it; during the stretching forward, the oar is kept parallel with the water, so that it has not much resistance from the air. The muscles brought chiefly into play are the long muscles of the back in the backward swing, and the ab- dominal muscles in the forward swing. But the muscles of the pelvis, thighs, and legs all have to work, likewise the muscles of the arms, chest, and shoulders. And it is one of the best exercises for developing the lungs and chest, as well as of strengthening the heart. Fatigue will be felt most in the muscles of the legs, hips, and arms, but the exertion is so well distributed that it causes much less fatigue than would otherwise be the case. Athletic Sports. — Athletic sports possess three distinct advantages — they are played out-of-doors, and give an incentive to taking the proper amount of exercise; they are 350 PERSONAL HYGIENE FOR WOMEN all team games, and so develop the social and cooperative spirit ; and last, but by no means least, they afford a great deal of amusement and real recreation. Formal and systematic gymnastics are essential for the development of the body and the correction of its defects; out-of-door exercise is excellent, but the solitary walk, climb, swim, or row leaves much to be desired, while in walking especially the mind is free to pursue the same trains of thought which with it was occupied at the desk, and so it fails to be properly refreshing to the mind and body. Whereas in all athletic sports the ego has to be pushed into the background, with all its interests, the day's work left behind, and the entire attention concen- trated on the play. This is a very distinct advantage to the individual. Women at all ages take themselves and life too seriously. This is in all probability due to a defective early education; between the long school hours, home study, housework, and sewing, they had neither time nor opportunity to cul- tivate a love for play and games, and so the play instinct was not developed, and if not developed in youth, the chances are that it never will be. In middle and advanced age, when the stress and storm are at their height, nothing is so sure a restorative to overtaxed brains and over- wrought nerves as games, sports, and a love of fun. As a result of our unnatural mode of life in youth, it has come to pass that American women especially have been defrauded out of their birthright of the love of games and sports. Athletic games and sports are as essential to a scheme of education as are reading, writing, and arith- metic. Other distinct advantages accruing to athletic games are that here the individual becomes acquainted with her powers and weaknesses. In formal gymnastics the move- ments follow each other in a regular sequence, through lines already carefully laid out; in games, on the contrary, no two plays or combination of plays are exactly alike. One can never tell what her opponent is going to do, and SYMMETRIC DEVELOPMENT 351 yet what one's opponent does is so vital to the success or failure of the game that the player must decide quickly and accurately how that move in the game can best be met, so that intense concentration, quickness, alertness, prolonged attention, self-control, and even self-sacrifice are called for, for in the team game the individual inter- ests must be submerged, in order that the side may win; and so the individual power, sense of responsibility, and an esprit de corps are developed, in a manner almost im- possible in the same degree in any other way. The principal outdoor games for women are croquet, lawn-tennis, hockey, golf, hand-ball, basket-ball, baseball, boxing, and fencing. Croquet. — Of all these games, croquet is the mildest, and for that reason is a good beginning game for a woman who has always led a sedentary life, or for a woman who has become enfeebled through serious illness. It is also an excellent game for old age. To be beneficial and not detrimental, the exercise must be very gradually increased, both in the length of time oc- cupied and in the vigor of the movements. The muscles must be slowly built up and improved in tone, the lungs developed, and the heart strengthened. Another advantage of croquet is that it is inexpensive and requires a limited amount of ground. Lawn-tennis. — Tennis is a much more violent exercise than croquet, and is a game for young people and youth. Now, as to just what constitutes youth: it is altogether a question of the condition of the arteries, heart, and mus- cular system, and is not a question of years per se. The game is moderately expensive; played with four, it is not at all violent. It is an excellent game for social purposes, and can be kept up until late in life, but it cannot be begun late in life. It has just the proper amount of variety, activity, and endurance to suit hundreds of people for whom croquet would be too mild, and for whom ball-games would be too severe. Golf. — Golf is deservedly a very popular game at all 352 PERSONAL HYGIENE FOR WOMEN ages. Perhaps the greatest drawback for the city dweller is the inaccessibility of the golf links and the great expense of the game. It combines scenery, walking for several miles, some hill climbing, and a considerable amount of exercise for the right side of the body, particularly for the right arm, and the muscles of the right side of the back and chest. The great drawback, from the physical standpoint, is an over- development of the muscles of the right side of the body, which, in the majority of people, are already better devel- oped than those of the left side ; the muscles of the left side of the body are brought very slightly into play. While the distinct advantages of the game are combined with walking, the healthy body swings, the accuracy needed in making the drives, the distance of the drives, the variety of implements as well as of stroke, and many other features, and, further, it is a game that keeps one pleasantly employed in a company of one's choosing for several hours. Hockey. — Hockey is among the finest of games for most young people, and should rank at least third among games. It has most of the advantages of foot-ball, and many of the advantages of cricket. It involves a consider- able amount of running and a great deal of real sport and fun. Basket-ball. — This is another of the most popular games for young people, and possesses in a very great degree all the advantages of a team game. The confi- dence that follows a successful throw proves of considerable value, unless it leads to the carelessness of overconfidence. Faith in the ability to get out of a desperate situation in the tossing increases with success. This leaves the atten- tion imperturbed, and one does not go to pieces. Ac- cording to Mosso, movements develop the brain, and it has been repeatedly noticed that intelligence in animals in- creases with the increased motility of their extremities. INDEX Abdomen, protuberant, 328 causes of, 328 treatment, 37, 46, 91, 286, 328 Abdominal exercises, 328, 330, 332 muscles, 328 development of, 328, 330, 332 flabby, 135 function of, 134, 328 Ablutions, 21-23 cold, 22, 23 hot, 22 Acne, 61-65 causes of, 61 treatment, 62-65 Air, amoimt breathed daily, 133 "bouquet" of, 137 chemical properties of, 137 country, 137 degree of moisture for house, 143, 144 impurities in, causes of, 140 cmnulative effects of, 140, 141 injurious effects of, 141 indoor, 139 infection of, 138 overheated, injurious effects of, 143 pure, test of, 141 23 Air, town, 137 vitiation of, from combustion of Ughts, 140 from respiration, 140 from imhygienic conditions, 140 Alcohol, 115-124 absorption of, 117 anemia from use of, 120 as a food, 116, 117 cumulative effects of, 116 narcotic effects of, 116 physiologic action of, 115-118 obesity caused by, 120 on blood, 119 on brain activity, 123 on digestion, 104, 105, 118 on heart and blood-vessels, 120, 121 on kidneys, 121 on hver, 118 on metabolism, 118 on muscular system, 122 on nervous system, 116, 122, 123, 181 on oxidation, interference with, 120 on self-control, 123 rub, directions for, 23 AlcohoUc beverages, amount of alcohol in, 116 353 354 INDEX Alimentary canal, microorgan- isms of, 208 Ambition, excessive, 222, 232 American men, improved physique of, 275 women, inferior physique of, 272 Ammonia, aromatic spirits of, dose of, 206 Anemia, causes of, 101, 141 Anger, injurious effects of, 233 Anxiety, injurious effects of, 234 Arteries, description of, 127 effect of cold on calibre of, 18, 128 of muscular work on calibre of, 127 Astigmatic chart, 196 Astigmatism, correction of, 196 injurious effects of imcorrected, 196, 327 test for, 196 Athletic games and sports, 306- 310, 349-352 and municipial govern- ments, 306 advantages derived from, 306, 349-351 basket-ball, 352 benefits of, 307-308 best suited for women, 309, 310 croquet, 352 ethical value of, 306-309 hockey, 352 lawn-tennis, 351 Attitude, correct, at desk, 153 in standing, 324 faulty, injurious effects of, 152, 326, 327 Auto-infection, 109, 158 Autosuggestion, 232 Avocation, 186-188 nature of, 186 physiologic necessity for, 188 Back, muscles of, 289, 290 exercises for, 329, 331, 334, 335 function of, 289, 290 Bacteria, action of sunlight on, 139 role played by, 138 Bacterial flora, 147, 208 Baldness, causes of, 71 treatment for, 71-74 Basket-ball, 352 Baths, action of, in health, 12, 54 alkaUne, 26 cold, 18-21 contraindications to, 19, 25 heat loss in, 18 physiologic effects of, 18 reaction after, 18, 19 tonic effect of, 18, 20, 21 training for, 55, 56 dip, 24 contraindications to, 25 duration of, 25 temperature of, 24 effects of, 12 electric-light, 35-38 directions for, 35, 36, 38 indications for its use, 36, 37, 210 foot, 27, 28 directions for, 27 indications for, 28 mustard, 171 friction after, 20 hot, 17, 18 effects of, 17 reaction after, 17 restorative effects of, 17, 18 INDEX 355 Baths, neutral, effects of, 17, 21 temperature of, 17 proper time for, 55 Roman, 35 Russian, 34 contraindications for, 34 indications for, 34 saline, 26 as cleansing agent, 26 salt ablution, 32, 33 indications for its use, 33 method of taking, 32, 33 glow, 32 shower, or rain douche, 26, 27 cold, 27 directions for, 27 effects of, 27 hot, 27 indications for, 27 neutral, 27 temperature of, 27 sitz, 28, 29 duration of, 29 indications for, 29 temperature, 28 sponge, 21-23 tub, 23, 24 fuU, 24 contraindications to, 24 half, 23 temperature of cold, 24 of hot, 23 of neutral, 24 Turkish, 33-42 contraindications for use of, 35 essential features of estab- hshment, 33 indications for its use, 35 loss of weight from, 37 method of procedure, 33, 34 Baths, Turkish, necessity for cold water drinking, 34 varieties of, 21 wet hand rubbing, 30-32 class of cases used in, 31 method of procedure, 30, 31 temperature of room, 31 of water, 31 sheet, 29, 30 indications for, 30 preliminary procedures, 29 technic of, 30 temperature of room, 29 Bathtub hose, fallacy in use of, 27 Bedrooms, ventilation of, 144 Beef sandwiches, directions for making. 111 Bile, action of, 89 BiHous attacks, 108, 109 Biliousness, 108 causes of 1.08, 118 symptoms of, 108, 109 treatment, 46, 109 Bladder, 167 capacity of, 167 frequency of emptying, 167 location of, 167 Blood, 130 corpuscles of, 119, 130 distribution of, 130 functions of, 14, 119, 130 length of time for passage through body, 129 thinness of. See Anemia. vascular areas of, 15, 17 Body, balance and carriage of, 296, 310, 339 common defects in, 297 fatigue of, 181 position of, 152, 153 Boracic acid, solution of, 202 356 INDEX Boxing, 337 Brain and nervous system, 172- 176 blood supply to, during sleep, 181 development of, 177, 216-218, 221, 229, 283, 308 fatigue of, 173 effect of body fatigue on, 182, 209, 304, 305 functions of, 172 habit and automatism, 174 master organ of body, 172 physiology of, 175 repair of, 173, 174 rest of, 181, 185 workers, average of life of, 221 Brains vigorous and strong bod- ies, 278, 280 Breathing, art of, 155 difficult, treatment of, 155 exercises. See Respiratory. normal, 154 types of, 155 Bromid mixtm-e, prescription for, 206 Bronchial tubes, 131 Bronchitis, cause of, 138 chronic, cure of, through exer- cise, 156, 157 Butter, 92, 94 Buttermilk, 93 Calomel, dose of, 109 frequency of taking, 109 Capillaries, 127 Carriage, good, exercises for, 329, 333, 339 Castor oil, administration of, 110 Cataract, 203 Character, formation of, 219, 226, 229 Character influenced by example, 216, 226 mental poise, 222 power of will, 230 Chest, description of, 126 development of, 328, 340, 342 exercises for, 330, 333, 335, 337, 338 importance of good, 135 flat, causes of, 153, 249, 253, 297 corrective exercises for, 153- 156 measurements minimum under arm, consistent with good health, 135 relation between height, weight, and, 136 weights, exercises with, 337- 339 for arms, 338 for chest expansion, 338 for shoulders, 338 rules for taking, 337, 338 Chilliness, cause of, 134 Circulation, maintenance of equi- libriiun, 131 mechanics of, 126-130 Circulatory apparatus, 127 system, 125 Clothing, measurements for, 152 suspension of, from shoulders, 152, 270 Clouston, necessity for definite occupation, 236 Club, New York Colony, 316 Clubs, literary, 187 model, 316 women's, 316 benefits of, 187 Young Women's Christian As- sociation, 316 INDEX 357 Clysters, colo-, 49 directions for, 49, 50 Cocoa, 95 Coffee, action on digestion, 105 Cold, effects of prolonged appli- cation of, 18 physiologic effects of, 18-21, 127, 128 reaction following, 18, 19 condition unfavorable to, 19 how promoted, 19, 20 injurious effects following poor, 20 tonic effects of, 20, 21 Colds, causes of, 139, 141, 144, 158 common, 158 contagiousness of, 151 frequency of, 158 reinfection from, 158 relation of, to influenza, 157 to pneumonia, 157 to tuberculosis, 157 treatment of, 133, 158, 159 prescription for, 159 quininin, 159 College life, advantages of, 220, 221 discipline of, 221 Vassar, 223 woman's medical, 223 Coloclysters, directions for, 49, 50 Color blindness, 203 Complexion, 53, 54 care of, 58, 59 good, 53, 54 sallow, 60 Conjunctivitis, causes of, 201 granular. See Trachoma. symptoms of, 202 treatment of, 202 Conjunctivitis, treatment of, acute, 202 chronic, 202 Constipation, 112, 115 and mental troubles, 113, 114 causes of, 106, 115, 328 chronic, 112, 113 injurious effects of, 98, 106, 208 appendicitis, 113 autointoxication, 114 hemorrhoids, 113 uterine displacements, 114, 115 symptoms of, 106 treatment, 46, 49, 50, 114, 115 Corns, treatment, 79 varieties, 78 Corsets, 243, 244-263 abdominal, 257, 258 crusade against, 247 curved front, 249, 250 directions for adjusting, 262 effect on lung capacity, 249, 250 on muscles, 252-256 on thorax, 248 history of, 245-247 hygienic, 257 influence on female body, 248- 258 injurious effects of, 248-257 relation to abdominal and pel- vic disorders, 250-252 straight front, 256, 257 tight lacing and, 248, 249, 262 wearing by young girls, 258- 260 what style is least injurious, 260-262 Cosmetics for the face, 59, 60 Cough, fimction of, 157 358 INDEX Country folks, outings by, 188 recreations for, 187 Crampton, Dr., and school ath- letics, 275 Croquet, 351 Cures, French, of the Vosges, 46-48 Contrex^ville, 46-48 Martigny'les-Bains, 46 Vittel, 46, 47 Dancing, 277, 314, 329 aim of, 339 benefits of, 339-341 esthetic and classic, 339-341 requisites for, 339 society, 339 Dandruff, 69-71 causes of, 69 contagiousness of, 70 treatment, 71-73 Deafness, causes of, 151 prevention of, 151 Debility due to underfeeding, 101, 102 signs of, 204 Defecation, 98 Desk, correct attitude at, 153 Development, necessity for good, 286, 299-302 symmetric, 280, 303 Diaphragm, 129, 130, 132, 249 relative importance of, 132, 135, 250 Diarrhea, acute, diet in, 112 treatment, 112 chronic, 112 Diet, deficient, 101-103 finical, 90, 160 importance of fats in, 90, 91, 94 of varied, 90 Diet, relation of, to tuberculosis, 90, 102, 160 Dietary in health, 62 in indigestion, 110-112 in sedentary occupations, 99- 101 breakfast, 99 dinner, 99 limcheon, 99 objections to cereals in, 99 Digestion, chemical process, 84 factors which favor, 96, 99 gastric, 86-88 length of time required for, 87 retarded by alcohol, coffee, tea, 95 habits of, 90 intestinal, 88 maintenance of good, 80-101 mastication and, 86, 99 nervous system and, 87, 97 psychical influence on, 97 Digestive disorders, 103-113 fluids, 89 bile, action of, 89 gastric juice, 86 intestinal juice, 89 pancreatic, 89 saliva, 85 system, 80 tract, 80 Discipline, 216, 217, 220 Disinfectants, carbolic acid, 163 formaldehyd, 162, 163 sulphur, 162 Disinfection after tuberculosis, directions for, 162, 163 Douche, 38-42 after-treatment, 41 application of, directions for, 39-41 INDEX 359 Douche, application of, mass, 38 pressure, 38, 40 temperature, 38, 40 cold, contraindications to, 42 long applications, 41, 42 mechanical effects of, 41 physician's prescription for, 42 physiologic effects of, 41, 42 fan, 38 horizontal jet, 38 neutral, 40 indications for, 42 percussion, 38-41 physiologic effects of, 39 rain, 26, 27 directions for, 26, 27 effects of pressure in, 27 rationale of, 41 relation between temperature, duration, and pressure, 41 Scotch, 38 temperature of, 40 and its effects, 41 cold, 40 hot, 40 neutral, 40, 42 time for taking, 41 working, 40 Dress and woman's physical deterioration, 240-270 corsets, 245-263 gymnastic, 320 history of woman's, 240-247 French, 243-247 Greek, 240-242 mediaeval, 242-244 renaissance, 244, 245 Roman, 241, 242 shoes, 263-265 street, winter, 270 Drinks, temperature of, 96 Drudgery, joyless, 186 Duodenum, 88 effects of distention of, on gas- tric digestion, 88, 89 Dust, its relation to disease, 137 Ear, 150 ache, treatment of, 152 description of, 150 douching, 52 wax, 151 removal of, 151 Eczema, 61 chronic, 61 seborrheic, 70 causes of, 71 symptoms of, 70 treatment, 72, 73 Education and the health of girls, 222 coUege, 220 discipUne, 220, 221, 308 effect on home, 225 on physical health, 222, 224 higher, of women, 222-225 President EKot on, 223-225 mental development, 216-220, 308 faculties, balancing of, 222 habits, 174, 175 moral sense, 218, 219 physical, influence on health, 298-304, 312 religious instincts, 219 self-control, 217 truthfuhiess, 216, 217 Eggs, digestibihty of, 93, 100 nutritive value of, 93 Electric-Hght baths, 35-38 comparison of, with other heating procedures, 36 360 INDEX Electric-Kght baths, description of cabinet, 35 indications for use of, 36, 37 length of stay in, 36 reduction of weight through, 37 symptoms of too prolonged stay in, 37, 38 treatment, finishing, 36 Eliot, President, on higher edu- cation of women, 223-225 Emotional nature, 218, 219 Emotions, depressing, 234 physical effects of, 234 the natural, 214, 215, 218, 219 violent, 231 Employees, care of, 312, 313, 341 Enemas, 49, 60 injurious effect of daily, 50 Envirormient, 225-228 friends, 226 harm done by bad, 226, 227 literature, 227, 228 toilet, 225, 226 Eustachian tube, 150 Exercise after eating, 304 after fasting, 319 and amusement, 341, 349, 350 benefits of, 299, 300, 301, 311- 313 effects of, on brain develop- ment, 279 on character, 279, 308 on heart and lungs, 283, 298 on muscles and blood-vessels, 281, 282, 283, 300 gradual training in, 300 heart's need of, 298 increase of red blood cells through, 282 length of time for, 318, 342 Exercise, outdoor, horseback rid- ing, 316, 348 mountain climbing, 345 rowing, 348, 349 running, 325, 344 swimming, 345-348 walking, 342-344 passive. See Massage. physiology and pathology of, 280, 299, 300 regularity in, 276, 319, 342 rules for taking, 318-320 Exercises, corrective, for develop- ing various regions of the body, 325-339 abdominal, 330, 332, 335, 336 alternate kneeling, 332 arms, 329, 335, 337, 338 balancing, 333 back, for muscles of, 331, 334, 335, 336 carriage, 333 chest, 335, 336, 337, 338 for extending depth of, 333 forward projection of, 330 hips, 336 legs, 331, 335, 336 poise, 333 respiratory, 330 rope-pulling, 335, 336 shoulder-blade, 329, 330, 331 spine, 332 squatting, 332 standing, correct attitude in, 324 swimming, 335 thighs, 335 trimk flexions, 336, 337 lateral, 334, 336 waist, 334, 335 exhaustion, recovery from, 281; 282 INDEX 361 Exercises, free, rules for taking, 327 of endurance, 280, 281, 283 of strength and skill, 280, 281, 283 Exhaustion, injurious results of, 181, 182, 185, 209 recovery from, 282 symptoms of, 182-184 Eyes, 192-199 care of, 200 healthy, 197 injuries to, 201 interruption of work of, 197, 198 protection of, 199 removal of foreign bodies from, 201. See Vistud apparatus. Eyestrain, 192 general symptoms of, 197 local symptoms of, 197 mechanism of, 197 prevention of, 198 Face as index of health, 53 cleansing of, 58 dryness of skin of, 58 lotions, 59 massage of, 64 with cupping glass, 64 powders, 59, 60 protection of, 59 steaming, 63 use of cosmetics, 59 of soap, 58 Facial blemishes, 61-67 eczema, 61 causes of, 61 general treatment, 62, 63 freckles, 60, 65 liver spots, 60, 65 pimples and acne, 61 Facial pimples, causes of, 61 prescriptions for, 65 treatment of, 62-65 sallow complexion, 60 treatment, 62, 63 superfluous hairs, removal of, 66 wrinkles, 66-68 Far-sightedness, 195 Fatigue, imdue, 282 causes of, 187, 291, 292 danger signal, 181 economic waste of, 182 effect of brain, on body fatigue, 304, 305 effect of, on nerve cells, 180 mental symptoms of, 180 muscular, 291, 292 normal, 180 recovery from, 282 toxins of, 178-180, 191 treatment, 210, 293 Fear, 215 forms of, 215 physical effects of, 215, 232 universality of, 215 Feet, care of, 78, 79 corns, treatment of, 74 ingrowing nails, 78 perspiration of, 65, 78 protection of, 264, 265 Female form, relative proportion of, 284 generative organs, 167 Fallopian tubes, 167 function of, 167 ovaries, 167 physiology of, 167 uterus, 168 functions of, 168 respiratory movements of, 168 362 INDEX Fencing, 337 Food, amount required in twenty- four hours, 92 at too frequent intervals, 96, 104 digestibility of, 104 beef, 93 buttermilk, 93 chicken, 93 eggs, 93 koumiss, 93 milk, 93 mutton, 93 pork, 93 excessive quantity, 98, 103 indigestibiUty of, 104 preparation of, 62, 63 temperature of, 96 Food-stuffs, classification of, 91 carbohydrates, 92 starches, 92 sugars, 92, 94, 112 fats, 92 butter, 94 proteids, 91 as source of energy, 91 daily amoimt required, 62, 92, 102 injurious effects of excess of, 92 salt, 94 water, 97 Foot, configuration of, 321, 322 description of, in walking, 322- 324 Freckles, 60 treatment of, 65 French cures of the Vosges, 46-48 rules for taking waters, 47, 48 dressing for salad, 101 injurious effects of vinegar in, 94, 95 Friction, mechanical effects of, 20, 294 Friends, choice of, 226 molding effects of, 226, 227 requirements for, 227 Gaches-Sarraute, Madame, hy- gienic corsets, 257 Games as supplement to gym- nastics. See Athletic games and sports. Golf, 351, 352 Greek costumes, 240-242 Gymnasixmi in campaign against disease, 311-313 Vassar College, 313-316 Gymnasiiuns, 320, 321 against disease, 300, 301, 311- 313 and factories, 312, 313, 341 and women's clubs, 316 colleges, 313 Yoimg Women's Christian As- sociation, 316 Gymnastic dress, 320 Gymnastics, benefits from, 302- 304 for symmetric development, 303 medical, 302 physical examination for, 314, 315 practice of, 302 versus athletics, 301 Habit and automatism, 174 Habits and disease, 232 age hmit for, 174, 175 bad, 174 Hair, 69-75 brushing, 72 care of, 71-73 INDEX 363 Hair, cutting of, 74 dandruff, 69 description of, 69, 70 dressing, 74 gray, 74 causes of, 74 treatment of, 75 premature thinness of, 69 treatment of, 71, 72 scalp, dry, treatment of, 73, 74 massage of, 73 oily, prescriptions for, 73 seborrheic eczema, 70 shampoo, 72 treatment of, 72 Hair-brush, 72, 73 care of, 73 Hairs, superfluous, 66 treatment by electrolysis, 66 by lotions, 66 Hancock, Dr., physical training for women, 274 Hands, care of, 75-77 chapped, 76 nails, care of, 76 cleansing of, 77 infection from lack of clean- liness, 76 Headache, 204-207 causes of, 197, 204, 205, 209 symptoms of, 205 treatment of, 205-207 varieties of, 205 neuralgic, 205 Health, good, and vacations, 189, 190 evidences of, 203 Hearing, impairment of, causes of, 151 Heart, description of, 127 failure due to underfeeding, 101-103 Heart, frequency of beat, 128 functions of, 127 location of, 127 Heart's need of exercise, 298 Heat, animal, 14-16 dissipation of, 15 physiologic effects of, 15, 16 production of, 14, 15, 291, 296 Height, weight, and chest meas- urements, relative proportion of, 136, 285 Hemorrhoids, 113 Hereditary predispositions, 213 Heredity, influence of, on health, 212-214 Hockey, 352 Horseback riding, 316 Hot-water bottle, action of, 18 Houses, degree of moisture of air of, 143 disinfection of, after tubercu- losis, 162, 163 effects of gloomy, 226 temperature of, 143 ventilation of, 139-143 Hydrotherapy defined, 11 value of, 11. See Baths and douches. Hygiene of mind, 212-239 Hygrometer, 144 Hyperidrosis, treatment of, 65 Idleness as cause of nervous prostration, 211, 235 Thomas on ill effects of, 236, 237 Indigestion, 103-108 causes of, 103-106, 118 diet in, 110-112 intestinal, 107 symptoms of, 108, 109 treatment of, 36, 45, 109 364 INDEX Indigestion, nature of, 105 symptoms of, 106-108 Industrial training of women, necessity for, 235 Infectious diseases, 157-163 bronchitis, 147, 148, 156, 157 causes of, 137-139, 141, 147 common colds, 147, 157-159 influenza, 147, 157, 158 pharyngitis, 139, 147, 148 Influenza, 157 cause of, 138, 147 relation of, to pneumonia, 159 to tuberculosis, 157, 161 Ingrowing toe-nails, causes of, 78 treatment of, 78 Inhibition, 228-230 importance of, 230 training in, 229 Insomnia, 184 causes of, 182, 184, 208 injurious effects of, 191, 207 treatment of, 27, 192 Intestinal catarrh, 112 treatment of, 110 Irrigations, vaginal, 50-52 Kidneys, description of, 163 diseases of, treatment of, 45 function of, 163-167 relation of, to skin and lungs, 164 Knee-chest position, description of, 49 Lamp shades, 199, 200 Larynx, 131 Laughter, physiologic necessity for, 188, 189 Life, prolongation of, 121, 301 Lighting, artificial, 199, 200 natural, 200 Literature, 227, 228 molding influence on the mind, 227 taste for, formed in youth, 228 Lungs, 131 description of, 131 frequency of diseases of, 125 good development of, 125, 299 exercises for, 153-156, 330, 333, 337 hygiene of, clothes in relation to, 152 relation of, to good health, 134 secretion of, 133 ventilation of, 153-156 vital capacity of, 136 weakness of, causes of, 125 Massage defined, 292 benefits of, 292-294 mode of procedure, 295 movements of, 294 friction, 294 grasping and pinching, 294 striking, 295 stroking, 295 vibration, 295 rise of temperature after, 296 time for giving, 295 Mastication, 82, 85, 99 imperfect, 103 Meals, arrangement of, 96 Meats, fresh, digestibility of, 93 nutritive properties of, 92 roast, how to prepare, 92 Menstruation, 169-171 anomalies of, 171 painful, 171 profuse, 171 scanty, 171 suppressed, 171 treatment of, 170, 171 INDEX 365 Menstruation, hygiene of, 169 normal, average duration of, 169 character of, 169 cold baths during, 169, 170 exercise during, 170 premonitory symptoms of, 169 Mental activity, attitude and bodily fimction of, 230 depression, 219 development, 177, 178, 216- 220, 221, 229 and physical training, 278- 280, 283, 303, 308 disorders of adolescence, 219 emotions, exhausting nature of, 233-235 faculties, balance of, 222 habits, 174, 175 hygiene, 212-235 hurry, effect of, 178 quahties, 216 Metabohsm, cmnulative effects of impure air on, 141 Microorganisms in alimentary canal, 90 growth inhibited in health, 90 in imcooked food, 90 Migraine, treatment of, 206 Milk, digestion of, 93 Mind hygiene, relation of, to physical health, 212-239, 308 subconscious, 226 Mineral waters, Contrex^ville, 47, 48 Vichy, 111 Vittel, 45, 47 Moral sense, 218, 219 Mothers as educators, 212 exhausted, 185 Mountain cHmbing, 345 Mouth, care of, 82 Mouth, cleansing of, 82 Muscular system, 286-292 action of muscles of abdo- men, 288 of back, 289 coordination, 292 development prevented by cor- sets, 248, 249, 252-256, 258, 259 energy, 291 fatigue, 291 heat production, 291 Nasal catarrh, causes of, 147 general treatment, 149 local, 148, 149 prevention of, 148 douche, 149 passages, obstruction of, 146 sprays, 148 prescriptions for, 149 Nature's restoratives, 184-188 recreation, 186, 188 rest, 185 sleep, 186, 190, 191 Near-sightedness, causes of, 194, 195 correction of, 195 Nervous breakdowns, prevention of, 185, 187, 189 disorders, causes of, 204 functional, 203, 211 headache, 204-207 neurasthenia, 207 system as balance of power, 172 brain as master organ of body, 172 function of, 172 physiology of , 175 cerebrospinal nerves, 175 spinal cord, 175 366 INDEX Nervous system, sympathetic, 176 Nervousness, 184 causes of, 184 treatment of, 293 Neurasthenia, 207-211 causes of, 207, 208 rational treatment of, 30-32, 209-211, 293 symptoms of, 209 New York Colony Club, 316 Nose, care of, 145 fimctions of, 145 Obesity, causes of, 120, 286 treatment of, 37, 46, 91, 286, 328 Occupation, definite, a physical necessity, 235 Clouston on, 236. See Voca- tion. sedentary, 153 Optical defects and their correc- tion, 194-197 astigmatism, 196 hyperopia or far-sightedness, 195 myopia or near-sightedness, 194 causes of, 195, 197 treatment of, 195 presbyopia or loss of ac- commodation, 195 Out-door exercise, 342 daily length of time for, 342 Overeating, 98 experiments of Prof. Chitten- den, 98, 99 factors leading to, 99 iU-effects of, 99 Overwork, 181, 182 danger signals, 181 Overwork, signs of, 182-184 stimulants in, 181 worry and, 183 Overworked class, rest treatment for, 210, 211 Oxygen, importance of, 133 Palate, soft, 146 Pancreatic juice, 89 action of, on food-stuffs, 89 Perspiration, daily amount of, 14 effect of, on tone of skin, 17 rate of increase in hot baths, 17 Pharynx. See Throat. Physical efficiency, marks for, 305 examination, 317, 318 exercise, rules for, 318-320 measurements, record for, 315, 318 training key to health and beauty, 271-310 among the ancients, 271, 272, 277 before twelve years of age, 317 dancing, 277, 314, 329 examinations for, 314, 315 for invaUds, 317 improved physique from, 274, 313 influence on life and health, 278 of girls, 276, 277, 309, 317 of Japanese women, 274 report of Royal Commission, on, 276 Physique, good, through physical training, 316, 317 improved, of American women, 275 of school children, 275 Play, adult, 276 INDEX 367 Pleasure seeking as the object of life, 177, 235, 237 Pneumonia following influenza, 157 mortality from, 159 Proteids as source of energy, 91 daily amount required to pro- tect organism against body loss, 102 injurious results of excess of, 99 Ptomain poisoning, 109, 110 treatment of, 110 PuUey weights, exercises with. See Chest weights. Pulse, frequency of, 128 Reading, distance of book from eyes, 153 fine type, 200 hygienic precautions, 200, 201 length of line, 200 position of reader in, 200 Recreation, necessity for, 208 ReUgion, 220 Religious instincts, 219, 220 Respiration during sleep, 154 forced, benefits of, 153, 154 impediments to normal, 152 mechanics of, 126, 129 normal, relation to body heat, 134 types of, 155 costal, 155 diaphragmatic, 155 thoracic, 155 vitiation of air in, 140 Respiratory exercises, 153-156, 330 beneficial results of, 299 best time for, 154, 155 dress for, 154 frequency of, practice of, 154 Respiratory system, 125-145 air cells, 131 bronchial tubes, 132 expiration, 131 inspiration, 131 forced, 132 function of abdominal muscles, 134, 328 larynx, 131 lungs, 131 hygiene of, and relation to general health, 134 secretion of, 133 vital capacity of, 132 thorax, 126 trachea, 131 Rest, 185 days of, 188, 189 proper way to, 185, 186 regularity of, 185 Roman baths, 35 Rowing, 348, 349 Runmng, 281, 344, 345 age hmit for, 344 benefits of, 298 rules for, 325 Saliva, 82 fimction of, 85, 86 Salt, common, 94 normal, solution, 49 sea, 32, 33 Sargent, Dr. Dudley A., 272, 273, 275, 305, 309 Scalp, massage of, 73 Sebaceous glands, function of, 13 infection through, 13 Self-control, 217, 218 difficulty of, 217 standards aimed at, 217 training in, 218 Senihty, causes of, 121 368 INDEX Sewing, hygienic precautions in, 200, 201 Shoe, 263-265 compression of foot by, 263 flat heels, 264 French heels, 265 awkward gait due to, 265, 323 deformities caused by, 265 injurious effects of, 265 proper length of, 264 soles of, 264 Shoulder-blade exercises, 329, 330 Shoulders, round, and inequality of height of, 326 causes of, 326 corrective exercises for, 329, 330 Sims' position described, 49 Skin, absorption through, 16 care of, 53-68 description of, 12-14 diseases, acne, 61 eczema, 61 treatment of, 62-65 functions of, 14-16 respiration through, 16 role played in maintaining body temperature, 14-16 sebaceous glands, 13 sweat glands, 13 perspiration, daily amount of, 14 temperature of, 19 tone of, 13 Skirt, walking, 190-192 Sleep, 190-192 amoimt necessary, 184, 191 dreamless, 192 favorable conditions for, 192 habits of, 186, 191 Sleep, physiologic necessity for, 173, 180, 181, 191 Sleepiness, causes of, 191 Soap, 54 castile, 57 sand, 57 tincture of green, 72 Social instincts, 214 at school age, 214 right training of, 229 Sore throat, prevention of, 148 treatment of, 148, 149 Spinal cord center of reflex acts, 175 curvature;, 297 causes of, 152, 326, 327 general treatment for, 327 Spine, muscles of, exercises for strengthening, 332, 333 Spirometer, 136 Sponge as article of toilet, 21 Spray apparatus, description of, 148 hqmds for, 149 oil, formula for, 149 Standing, common defects in, 324 correct attitude in, 324 Stocking supporters, 266 Stockings, evils of short, 265 Stomach, capacity of, 98 description of, 86 location of, 86 work done in, 87 Street dress, winter, 270 Styes, treatment of, 203 Success defined, 237 elements of, 237 lack of, 238 mental condition and, 238 psychology of, 237-239 Sugar, injurious effects of excess of, 94 INDEX 369 Sunlight, action on respiration, 137 on tubercle bacillus, 139 Swimming, 345-348 contraindications to, 348 exercises, 335 pool, temperature of, 314 rules for, 346, 347 Swift, Prof., theories regarding children, 216, 217 fighting among boys, 217 Tea, effect of, on digestion, 95, 105 proper way to make, 95 Teeth, 82 care of, 82, 83 cleansing of, 83 defective, 103 septic, 103 tartar, 83 tooth-brush, 83 Temperament, 213, 214 arthritic, 214 nervous, 213 temptations of, 214 phlegmatic, 214 Temperature for house, 143 normal body, 16 axilla, 16 how maintained, 16 mouth, 16 rectum, 16 surface, 19 Thomas, Prof., on effect of idle- ness, 236 on necessity of definite vo- cation, 237 Throat or pharynx, 125 bacterial flora in, 139 description of, 146 24 Throat, diseases of, causes of, 146 effect of lowered vitaUty on, 139 importance of healthy condi- tion of, 139, 147 pillars of, 146 sore, prevention of, 148 treatment of, 148, 149 Toe-nails, ingrowing, 78 Tonsils, chronic enlargement of, 147 Trachea, 131 Trachoma, 202, 203 Tubercle bacillus, 138 destruction of, 162 Tuberculosis, causes of, 125, 138, 297 diet in, 102, 160 disinfection after, 162, 163 due to underfeeding, 102 expectoration in, 138, 161 infection in, 138, 161 source of, 161 mortahty in, 125 prevention of, 102, 159-162 Turkish baths, 33-35 cold plunge, 34 contraindications to, 19,25 contraindications for their use, 35 essential features of estab- lishment, 33 harmful results of too pro- longed stay in, 34 indications for their use, 35 methods of procedure, 33-35 necessity for cold water drinking, 34 physician's prescription for, 35 370 INDEX Turkish baths, shampoo, 34 steam room, 34 contraindications for use of, 34 Underclothing, combination suits, 268 winter, 266-269 equestrian tights, 268 essential qualities of, 266 Underfeeding, chronic, 101 dyspepsia as result of, 101, 102 heart failure, 101 mental depression, 102 tuberculosis, 102 Uric acid, treatment of, 36 Urinary excretory apparatus, 167 Urine, 166 daily amount of, 166 secretion of, 164 specific gravity of, 166 toxicity of, 166, 167 urea, 166 uric acid, 166 value of study of, 166 Uvula, relaxation of, 146 Vacations and health, 189, 190 resorts, requisites for, 190 rules for, 190 Vaginal irrigations, 50-52 directions for, 50, 51 indications for use of, 51 Vassar College, 223 gymnasium, 313-316 Veils, 198 Ventilation, 139-143 method of, 142 necessity for indoor, 139 hourly amount of fresh air needed, 139 of bed-clothes, 145 Ventilation of bed-rooms, 144 of houses, 139-143 of lungs, 153-156 Vinegar, 94 Vision, defective. See Optical dejects. Visual apparatus, 193, 194 accommodation, mechanism of, 194 conjxmctiva, 193 description of, 193 eyeball, 193 eyelashes, 193 eyelids, 193 image, formation of, 194 iris, 193 function of, 194 lachrymal glands, 193 tears, function of, 193 Vocation, physiologic necessity for, 235 Clouston on, 236 Thomas on, 236, 237 Waist exercises, 334, 335, 340 Walk, listless, bad effects of, 343 Walking, clothing for, 270, 343 effect of speed in, 281 on blood-vessels and mus- cles, 343 on heart and lungs, 342, 343 position of feet in, 325 skirt, 269 proper length of, 269 Walks, rules for long, 343 Warts, treatment of, 77 Wash cloths, care of, 57 danger of infection from, 57 Water, internal use of, 42-46 action on digestion, 44 on heart and blood, 43 at meals, 44 INDEX 371 Water, internal use of, boiled, 43 classification of tempera- ture of, 16 cold, contraindications to, 46 infection, vehicle for, 43 mineral, 98 physiologic effects of, 16 therapeutic indications for, 44-46 time required for its ab- sorption 44 Weichardt, Dr., experiments on guinea-pigs, 179 Weights for women, table of, relation between height and, 284, 285 Weisse, Dr., table of weights, etc., 284, 285 Will, education of, 229-233 influence of, on conduct, 229, 230 inhibition, 228-230 obsessions, overcoming, of, 229 power of, and strong muscles, 279, 280 Will, training of, 229 Women, American, cause of in- ferior physique of, 272-274 average height of, 286 higher education of, 222-225 in business activities, 225, 236 Japanese, 274 non-occupation of, 236, 237 noted sovereigns as mothers, 235 Women's clubs, 316 Woolen undergarments, 267, 268 Work, hygiene of, 176 number of hours allotted to, 182 philosophy of, 176 physiologic necessity for, 177 Worry, 183, 184 defined, 233 results of, 234 Wrinkles, 66-68 causes of, 66, 67 results of, 67, 68 Writing, use of typewriter, 153 Young Women's Christian Asso- ciation, 316 Books for Nurses PUBLISHED BY W. B. SAUNDERS COMPANY West Washington Square Philadelphia London: 9, Henrietta Street, Covent Garden Sanders' Nursing a new work Miss Sanders' new book is undoubtedly the most complete and most practical work on nursing ever published. Ever3'thing about every subject with which the nurse should be familiar is detailed in a clean cut, definite way. There is no other nursing book so full of good, practical informa- tion — information you need. Modern Methods in Nursing. By Georgiana J. SANDERS, formerly Superintendent of Nurses at Massachusetts Gen- eral Hospital. i2mo of 88i pages, with 227 illustrations. Cloth, $2.50 net. Aikens' Home Nurse's Handbook PRACTICAL The point about this work is this: It tells you, and shows you just how to do those little — but none the less important — things entirely omitted from other nursing books, or at best only inci- dentally treated. The chapters on "Home Treat- ments" and "Every-Day Care of the Baby," stand out as particularly practical. 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New York Medical Record SB-xs: " Every side of the question has been fully taken into consideration." Nursing in Diseases of the Eye, Ear, Nose and Throat. By the Committee on Nurses of the Manhattan Eye, Ear, and Throat Hospital: J. Edward Giles, M. D., Surgeon In Eye Department; Arthur B. Duel, M. D., (chairman). Surgeon in Ear Department; HARMON Smith, M. D., Surgeon in Throat Department. Assisted by JOHN R. Shannon, M. D., Assistant Surgeon in E^e Department; and John R. Page, M. D., Assistant Surgeon in Ear Department. With chap- ters by Herbert B. Wilcox, M. D., Attending Physician to the Hos- pital; and Mils Eugenia D. Ayers, Superintendent of Nurses. i2mo of 260 pages, illustrated. Cloth, $1.50 net. Friedenwald and Ruhrah's Dietetics ror IN urses new (2d) edition This work has been prepared to meet the needs of the nurse, both in training school and after graduation. American J ozir- nal of Nzirsing says it "is exactly the book for which nurses and others have long and .vainly sought." Dietetics for Nurses. By Julius Friedenwald, M. D., Professor of Diseases of the Stomach, and John Ruhrah, M. D., Professor of Diseases of Children, College of Physicians and Surgeons, Baltimore. i2mo volume of 395 pages. Cloth, $1.50 net Friedenwald & Ruhrah on Diet Diet in Health and Disease. By Julius Frieden- WAi^D, M.D., and John Ruhrah, M.D. Octavo vol- ume of 764 pages. Cloth, $4.00 net. Galbraith's Personal Hygiene and Physical Training for Women illustrated Personal Hygiene and Physical Training for Women. By Anna M. Galbraith, M. D., Fellow New York Academy of Medicine. i2mo of 371 pages, illustrated. Cloth, $2.00 net. Galbraith's Four Epochs of Woman's Life THE NEW (2d) EDITION The Four Epochs of Woman's Life. By Anna M. Galbraith, M.D. With an Introductory Note by John H. Musser, M. D., University of Pennsylvania, izmo of 247 pages. Cloth, $1.50 net. THIRD EDITION McCombs' Diseases of Children for Nurses NEW (2d) EDITION . Dr. McCombs' experience in lecturing to nurses has enabled him to emphasize 7/^9^' those poi7its thai nurses viost need to know. National Hospital Record says: "We have needed a good book on children's diseases and this volume admirably fills the want." The nurse's side has been written by head nurses, very valuable being the work of Miss Jennie Manly. Diseases of Children for Nurses. By Robert S. McCoa\BS, M. D., Instructor of Nurses at the Children's Hospital of Philadelphia. i2mo of 470 pages, illustrated. Cloth,- $2.00 net NEW (2d) EDITION Wilson's Obstetric Nursing In Dr. Wilson's work the entire subject is covered frcm the beginning of pregnancy, its course, signs, labor, its actual accomplishment, the puerperium and care of the infant. AiJierican Journal of Obstetrics says: " Every page empasizes the nurse's relation to the case." . A Reference Handbook of Obstetric Nursing. By W. Reynolds Wilson, M.D., Visiting Physician to the Philadelphia Lying-in Char- ity. 32mo of 355 pages, illustrated. Flexible leather, $1.25 net American Pocket Dictionary new (7th) edition The Trained Nurse and Hospital Review says: "We have had many occasions to refer to this dictionary, and in every instance we have found the desired information." American Pocket Medical Dictionary. Edited by W. A. Newa\an DORLAND, A. M., M. D., Loyola University, Chicago. Flexible leather, gold edges, $i.oo net; with patent thumb index, $1.25 net. SECOND EDITION Lewis' Anatomy and Physiology Nurses Joarnal of Pacific Coast sa3'S "it is not in any sense rudimentary, but comprehensive in its treatment of the sub- jects." The low price makes this book particularly attractive. Anatomy and Physiology for Nurses. By LeRoy Lewis, M.D., Lec- turer on Anatomy and Physiology for Nurses, Levyis Hospital, Bay City, Mich. i2mo of 375 pages, 150 illustrations. Cloth, $1.7=; net Bovd's State Registration for Nurses State uate Cc Paul's Materia Medica new (z-u edition Paul's Fever Nursing new (211 edition Hoxie & Laptad's Medicine for Nurses JUST READY-NEW (2d) EDITION, REWRITTEN of 351 pages, illustrated. ^'"' t SECOND Grafstrom's Mechano-therapy edition Nancrede's Anatomy new (vtt,) edhion Essentials of Anatomy. ^haRles B G. deNancRBDE M^D Unive^^ ity of Michigan. i2mo, 400 pages, i8o illustrations, v-iuu , ,p Morrow's Immediate Care of Injured Register's Fever Nm'sing A Text Book on Practical Fever Nu -sing. ^y.^^^Z^so^S^^ll- M.D., North Carolina Medical ColU>ge. Octavo or 35°^^^ S^^;^^ ^^^^ trated. Pyle's Personal Hygiene new (sth) edition Morris' Materia Medica new (7th) edition Griffith's Care of the Baby new (s.h) edition DATE DUE . ^ ^ 'iQftl] ' OC' . Y ^ ^>>- '' ''^ . 7Aj?>.$ ^0 C7 y ^ 200 t OCT ^ 1 ^aM' OCTo n 9nA4 '-bsj! ^1^' 'I 9?0IJf ,_^. :;■-.-• , , 1 i Demco, Inc. 38-293 COLUMBIA UNIVERSITY LIBRARIES 0043053106