COLUMBIA LIBRARIES OFFSITE HEALTH SCIENCES STANDARD HX64075338 RA776 L49 Personal hyg iene, ed RECAP "-'■ M35k M? Colum&ta Wlnibmity g>c&ool of Cental anb 0tal burger? Reference Hibvavp ir. _.,v-« A, _,*- ternts^iillyiiifA'wtimi: THE LIBRARY OF HOME ECONOMICS A COMPLETE HOME-STUDY COURSE ON THE NEW PROFESSION OF HOME-MAKING AND ART OF RIGHT LIVING ; THE PRACTICAL APPLICATION OF THE MOST RECENT ADVANCES IN THE ARTS AND SCIENCES TO HOME AND HEALTH PREPARED BY TEACHERS OF RECOGNIZED AUTHORITY FOR HOME-MAKERS, MOTHERS, TEACHERS, PHYSICIANS, NURSES, DIETITIANS, PROFESSIONAL HOUSE MANAGERS, AND ALL INTERESTED IN HOME, HEALTH, ECONOMY AND CHILDREN TWELVE VOLUMES NEARLY THREE THOUSAND PAGES, ONE THOUSAND ILLUSTRATIONS TESTED BY USE IN CORRESPONDENCE INSTRUCTION REVISED AND SUPPLEMENTED CHICAGO AMERICAN SCHOOL OF HOME ECONOMICS 1907 Copyright, 1907 BY Home Economics Association Entered at Stationers' Hall, London All Rights Reserved. AUTHORS ISABEL BEVIER, Ph. M. Professor of Household Science, University of Illinois. Author U. S. Government Bulletins, " Development of the Home Economics Movement in America," etc. ALICE PELOUBET NORTON, M. A. Assistant Professor of Home Economics, School of Education, Uni- versity of Chicago ; Director of the Chautauqua School of Domestic Science. S. MARIA ELLIOTT Instructor in Home Economics, Simmons College; Formerly Instruc- tor School of Housekeeping, Boston. ANNA BARROWS Director Chautauqua School of Cookery ; Lecturer Teachers' College, Columbia University, and Simmons College ; formerly Editor "Ameri- can Kitchen Magazine;" Author " Home Science Cook Book." ALFRED CLEVELAND COTTON, A. M., M. D. Professor Diseases of Children, Rush Medical College, University of Chicago ; Visiting Physician Presbyterian Hospital, Chicago; Author of " Diseases of Children." BERTHA M. TERRILL, A. B. Professor in Home Economics in Hartford School of Pedagogy; Author of U. S. Government Bulletins. KATE HEINTZ WATSON Formerly Instructor in Domestic Economy, Lewis Institute ; Lecturer University of Chicago. MARION FOSTER WASHBURNE Editor "The Mothers' Magazine;" Lecturer Chicago Froebel Asso- ciation; Author " Everyday Essays," "Family Secrets," etc. MARGARET E. DODD Graduate Massachusetts Institute of Technology ; Teacher of Science, Woodward Institute. AMY ELIZABETH POPE With the Panama Canal Commission ; Formerly Instructor in Practical and Theoretical Nursing, Training School for Nurses, Presbyterian Hospital, New York City. MAURICE LE BOSQUET, S. B. Director American School of Home Economics ; Member American Public Health Association and American Chemical Society. CONTRIBUTORS AND EDITORS ELLEN H. RICHARDS Author " Cost of Food," " Cost of Living," " Cost of Shelter," " Food Materials and Their Adulteration," etc., etc.; Chairman Lake Placid Conference on Home Economics. MARY HINMAN ABEL Author of U. S. Government Bulletins, " Practical Sanitary and Econ- omic Cooking," "Safe Food," etc. THOMAS D. WOOD, M. D. Professor of Physical Education, Columbia University. H. M. LUFKIN, M. D. Professor of Physical Diagnosis and Clinical Medicine, University of Minnesota. OTTO FOLIN, Ph. D. Special Investigator, McLean Hospital, Waverly, Mass. T. MITCHELL PRUDDEN, M. D., LL. D. Author "Dust and Its Dangers " "The Story of the Bacteria," "Drink- ing Water and Ice Supplies," etc. FRANK CHOUTEAU BROWN Architect, Boston, Mass.; Author of "The Five Orders of Architec- ture," " Letters and Lettering." MRS. MELVIL DEWEY Secretary Lake Placid Conference on Home Economics. HELEN LOUISE JOHNSON Professor of Home Economics, JamesMillikan University, Decatur. FRANK W. ALLIN, M. D, Instructor Rush Medical College, University of Chicago. MANAGING EDITOR MAURICE LE BOSQUET, S. B. Director American School of Home Economics. BOARD OF TRUSTEES OF THE AMERICAN SCHOOL OF HOME ECONOMICS MRS. ARTHUR COURTENAY NEVILLE President of the Board. MISS MARIA PARLOA Founder of the first Cooking School in Boston; Author of "Home Economics," " Young Housekeeper," U. S. Government Bulletins, etc. MRS. MARY HINMAN ABEL Co-worker in the "New England Kitchen," and the "Rumford Food Laboratory," Author of U. S. Government Bulletins, " Practical Sanitary and Economic Cooking," etc. MISS ALICE RAVENHILL Special Commissioner sent by the British Government to report on the Schools of Home Economics in the United States; Fellow of the Royal Sanitary Institute, London. MRS. ELLEN M. HENROTIN Honorary President General Federation of Woman's Clubs. MRS. FREDERIC W. SCHOFF President National Congress of Mothers. MRS. LINDA HULL LARNED Past President National Household Economics Association ; Author of " Hostess of To-day." MRS. WALTER McNAB MILLER Chairman of the Pure Food Committee of the General Federation of Woman's Clubs. MRS. J. A. KIMBERLY Vice President of National Household Economics Association. MRS. JOHN HOODLESS Government Superintendent of Domestic Science for the province of Ontario; Founder Ontario Normal School of Domestic Science, now the MacDonald Institute. VENUS DE M1L0 Personal Hygiene EDITED BY MAURICE LE BOSQUET, S. B. DIRECTOR AMERICAN SCHOOL OF HOME ECONOMICS MEMBER AMERICAN PUBLIC HEALTH ASSOCIATION CHICAGO AMERICAN SCHOOL OF HOME ECONOMICS IQ07 Copyright, 1907 BY Home Economics Association Entered at Stationers' Hall, London All Rights Reserved. Ui CONTENTS Letter to Students . Precepts for Right Living, by Ellen H. Richards Introduction The Human Machine Structure of the Body The Bones The Muscles The Nervous System The Skin and Connections The Sense Organs The Sense of Sight . The Sense of Hearing . Running the Machine Digestion of Food . The Blood .... The Circulation Respiration Nutrition Temperature Regulation . Elimination Care of the Machine Hygiene of the Nervous System Hygiene of Feeding . Care of the Teeth ..... When, How Much, and What to Eat Drink ....... Hygiene of the Skin and Its Modifications Baths ....... Care of the Hair ..... Care of the Complexion ill VI viii i 5 12 is 19 24 29 33 39 47 Si 66 68 75 81 94 98 i°5 106 114 114 121 i35 i37 138 141 145 iv CONTENTS Care of the Mucous Membrance — Colds . .. 149 Hygiene of Clothing ..... 153 Shoes ......... 158 Physical Exercise ..... 161 Ethics of H::alth, by Thomas D. Wood, M. D. . 191 The Use and Abuse of Drugs, by H. M. Lufkin, M. D. 202 Public Health in the United States . . 216 Plea for a National Department of Health, J. Pease Norton, Ph. D. . . . . . 222 Program for Supplemental Study . . .225 Index . . . . . . . 229 EDITOR'S NOTE Arrangements were originally made to have this series of lessons on Personal Hygiene prepared by Professor Thomas D. Wood of Columbia University. An operation for appen- dicitis, resulting seriously, compelled him to abandon all work for nearly two years, consequently the preparation of the lessons was turned over to his co-worker, Dr. George L. Meylan, whose manuscript followed after some time. Mean- while, the whole course had developed in length, breadth, and depth and the work on Personal Hygiene was found to be too elementary and not to fit into its particular niche in the enlarged scheme. As Dr. Meylan could not give the time for revision, he asked to be released from further responsibility of authorship. After endeavoring in vain to induce half a dozen others to write the book in the time set, the editor was compelled to undertake the difficult task himself, with such assistance as could be obtained. Dr. Meylan's material has been drawn upon, especially in Part I, but the subject-matter has been rearranged and for the most part rewritten. All the up-to_ date books on the subject — a meager list — have been con- sulted, and ideas borrowed freely. For the latest facts in physiology I have depended mainly on A Text-Book of Physiology by Professor William H. Howell of the Johns Hopkins University, Recent Advances in Phys- iology and Bio-chemistry, edited by Leonard Hill, Pawlow's classic book, The Work of the Digestive Glands, and the ately published college text-book, The Human Mechanism, by Professors Hough and Sedgwick. I wish to make grateful acknowledgment for help and suggestions given by Mrs. Ellen H. Richards and Miss S. Maria Elliott, to Miss Helen Louise Johnson for assistance in editorial work, and to Dr. Frank W. Allin of Rush Medical College for checking the technical statements in the text. Chicago, December, 1906. AMERICAN SCHOOL OP HOME ECONOMICS 3323 ARMOUR AVENUg CHICAGO January 1, 1907. Dear Madam : As the lessons on Personal Hy- giene have been so long delayed, many of our students have about completed their courses. Nearly all the letters received giving the reason for slow progress speak of personal ill health or sickness in the family, and I realize now more clearly than ever before that these lessons should form the keystone in the arch of health which we are trying to build with our course. I undertook the preparation of these lessons with full recognition of the diffi- culties of the subject. If I might have had two years instead of two months to write them, the result might have been more satis- factory to me. The words to carry convic- tion and compel action are hard to find. Personal health is so necessary, -few things are worth while without it.. It is above price and cannot be bought with money — it must be worked for like nearly everything else worth having. Its value is hard to re- alize until lost and then it maybe too late. The tragedies, the sorrows, the heart aches that come from lack of knowledge and lack of self control in the matters of health are beyond reckoning. I hope these lessons may be only the beginning of your study of personal health. Follow the "Supplemental Program" if possible. In problems of health the application of principles must always be a most personal one. Of course here as elsewhere it is a mistake to look for trouble- to expect things to go wrong. The hypochondriac never fails to find looked for ills, fe must live in faith. Nature takes wonderful care of us if we will only give her co operation. Put yourself into your answers and give expression to your own ideas. Ask ques- tions freely and so allow me to supplement the lessons. I may not be able to answer all your questions but perhaps can give a little more help. Of course advice in cases of illness cannot be given at "pen and ink distance." Sincerely yours, Instructor Right Living Live to accomplish something — not merely to exist. To live means to eat, to -work, to sleep, to be amused and refreshed after -work. Eat for satisfying legitimate Lunger of the body cells — not only to please the palate. Sleep for restoration of energy — see to it that such is the result. Exercise is as essential as sleep — learn what and how much shakes out the dead ashes from the living coals. Life processes go on best unwatched. "All the world's a stage — enjoy the play. Live for a worthy purpose — some incentive, some goal to reach keeps the traveller on the safe road. Adapt habits to environments, control surroundings as far as possible to the great end — - effective life. Educate the young from the first to value life and health, to find happiness in right living. Above all, believe that it pays to know the truth and to follow it. PERSONAL HYGIENE LJYGIENE is the technical application of biology Definition •*■ and physiology to the problem of health. The old dictionary definition of Hygiene, which stated it to be "that which has to do with the preservation and restoration of health" has of later years given way to a higher ideal, and we may define it now as "that which has to do with the preservation and improve- ment of health." Most people consider themselves well as long as they are not ill and do not consciously endeavor to bet- ter their physical condition, but those who have inter- preted anew the definition of hygiene seek the higher ideal. A most important factor in the study of health is value of an appreciation of the value of health. This means much more than merely to wish one's self well. It involves a realization that the first and most important duty is to be well. The second factor is the willingness to do anything that is necessary to acquire ideal health. Many are willing to be patient, to take time, money and trouble to regain the blessing of health once lost; few are found willing to do all this to attain a higher standard. Economy of Health Personal Responsibility for Health 2 PERSONAL HYGIENE The third factor is in a measure involved in the sec- ond, but needs to be stated more forcibly. It is the realization that the time and strength and money used for the improvement of health are not taken from greater or more necessary things, but that health is a fundamental necessity. Some do accomplish much in spite of physical limitations and many who seem to be fine physically have never achieved greatness elsewhere. But it remains that to do one's best it is necessary to be one's best. Finally the personal responsibility for health should be appreciated. Health is the natural condition of the body. The organism is constantly endeavoring to maintain itself in this normal state and it is only when conditions are so unfavorable that the body cannot ad- just itself to them that illness results and the organism demands rest for recuperation. Statistics show that only ten per cent of mankind die from natural causes, — the wearing out of the ma- chine through old age. It is safe to say that poor health and illness result in nine cases out of ten from ignorance, carelessness, or intemperance of some kind. Most people have certain notions and theories as to the requirements for personal health, but very few have studied the subject systematically in the light of present-day scientific developments. Knowledge of personal hygiene is not yet considered an essential part of a liberal education. Few people live up to the knowledge that they have INTRODUCTION of healthful living, but a falling short of ideals is com- mon in all lines of human endeavor. What is needed is greater knowledge and higher ideals. Much illness results from carelessness, for all con- tagious or infectious diseases (communicable dis- eases) are preventable. As far as known, each case comes from some previous case, near or remote, so that all such illness may be attributed to carelessness and ignorance, chiefly perhaps of those who are ill or their attendants, but often through lack of ordinary precaution on the part of those contracting communi- cable disease. The body in perfect health is a fortress against the invasion of the germs of disease, but some seemingly trivial weakness may give the germs the chance to develop and affect their dread results. Intemperance has many forms besides the over in- dulgence in alcoholic liquors. Intemperance in eating is probably as common and nearly as disastrous. We may be intemperate in work as in play. The individual "strength of constitution" so called, differs greatly, it is true. Each one has his personal limitations and these should be studied, but a certain measure of health is possible for everyone who is will- ing to work for it, unless the attempt is made too late. Through childhood the mother is chiefly responsible for the health of the child, after which each individual is alone responsible for maintaining the degree of health that he has and improving upon it. That a poor Preventable Diseases Intemperance Personal Limitations Happiness 4 PERSONAL HYGIENE constitution may be improved greatly and oftentimes developed into a vigorous one has been proved repeat- edly. A notable example is that of President Roose- velt who when a youth was unpromising physically. Health and But as man is more than animal and has a mental and spiritual life as well as a physical life, these must be considered in any study of right living. As there can be no perfect happiness without physical health, so there can be no perfect physical health without the mental and spiritual health which gives happiness, and further, this higher health depends upon a true phil- osophy of life, a proper adjustment between work and recreation, some purpose in living, service, ideals. The problem of right living is always one of ad- justment and it is necessary to know as much about the body as possible to make the most perfect adjust- ment to the ever-increasing complexity of modern life. In this series of lessons we shall study something of (i) The Human Machine, (2) The Running of the Machine, and (3) Care of the Machine. THE HUMAN MACHINE The human body is a living machine in that the function of a machine is simply to convert one kind of energy into another. This is precisely what the body does. Biology is concerned with the origin of this machine, physiology with the running of it. The facts discovered in connection with the organic cell and protoplasm seem to hold the key to the inter- pretation of the life phenomena. Life itself is inex- plicable. Yet what we believe to be true of the origin of the living machine assists us in the difficult task of properly adjusting this organism to its environ- ment. If we compare a dead body with a living one, we find the form the same, the weight the same; if we analyze them chemically, we still find them the same. Yet we know there is an essential difference between the two and that difference is given by a wonderful something called life. A living body has the property of movement, takes in food and builds it into living tissue, reacts to its surroundings, maintains an even temperature, reproduces itself, and finally dies. All living things from the lowest to the highest forms are called organisms. One of the lowest forms of animal life is a little body found in muddy water, called the amoeba. This small organism is barely visible to the naked eye and if looked at under the microscope appears like a tiny round mass of jelly. Nature of Life Organisms 6 PERSONAL HYGIENE But this very small body moves about, takes in food, changes that food into living substance, and grows ; it responds if irritated ; it reproduces itself, and finally it dies. This tiny mass, therefore, has all the proper- ties of a living organism. Unit Cells THE AMOEBA, A TYPE OF A UNICELLULAR ORGANISM If we cut the amoeba into several pieces, we find that each part is like every other part. This represents the simplest possible living thing capable of an inde- pendent existence. It is a single cell. The study of the amoeba is interesting because the human body is developed from a single cell called an ovum which is very similar to the amoeba. The process of develop- ment may be divided into three stages. Development ^ n the first stage the ovum or cell divides into two ovum cells and each again divides into,, two until there are many cells all alike, which are held together and form a mass something like the little round parts making up a raspberry. Up to this point each cell is like every other cell. The change that takes place in the second stage has been likened to the transformation of a savage into a civilized man. The savage lives an independent life; he procures his own food, makes his clothes, builds his hut, and fights his own battles. Little by little, one THE HUMAN MACHINE 7 man finds that he can build huts better than other men and he builds a hut for another man who is a successful hunter, and exchanges the hut for food. In the same way one man is very skillful in making clothes and he makes the clothes for a man who makes very good tools. Gradually differentiation of labor takes place ; that is, one man learns to do one thing well and does that only, while other men do the things for which they are best fitted. A condition very similar to this division of labor takes place in the second and third stages of the de- BODY CELLS. A, Muscle Cells; B, Liver Cells; C, White Corpuscles; D, Ciliated Cells; E, Nerve Centers or Cells. Differentiation of Labor velopment of the full grown man from the mass of similar cells. At the first stage, each cell is like the savage who does everything for himself. As the cells grow and multiply they begin to show some differences and the end of the second stage shows three distinct kinds of cells which may be denoted as the outside, middle, and inside cells. 8 PERSONAL HYGIENE During the third stage the process of division of labor by differentiation of cells continues and there is developed gradually the final specialized cells, each having some particular work or function to perform. Some are bone cells, some are muscle cells, others liver cells, nerve cells, — every kind of cell necessary to a complete organism. The organs A group of one kind of cells doing the same work is called an organ, and the body is composed of various organs. The heart, the stomach, the lungs, the muscles, and the brain are all organs, each having its partic- ular and definite work to do in maintaining life. Returning now to the comparison of the human body to the conditions of modern civilization, — we know that with the far-reaching specialization of the various occupations, the welfare and happiness of the people depend on each class of workers doing its share. When there is a great strike, as for instance, when all coal miners stop working, homes and fac- tories which must have coal for fuel are much dis- turbed and suffer greatly. In the same way, if all the bakers or butchers go on strike, much trouble and distress is caused to society, inter-relation Similar conditions exist in the human body. Each organs organ has a particular work to do and the well-being of the body as a whole depends upon the proper work- ing of each and all the organs. When all do their work well, we have in the body the condition known as health. When some of the organs are impaired THE HUMAN MACHINE and their work is poorly done, we have the condition known as disease. It is essential, then, to know the principles underlying the proper working of all the organs in order that we may keep them in a condi- tion favorable to the body as a whole. The health and efficiency of the various cells depend on (i) proper nourishment, (2) functional activity, and (3) free discharge of waste matter. All the organs and functions of the body have a share in supplying these conditions. The organs of digestion and respira- tion supply the body with nourishment; the organs of elimination carry off waste matter ; the muscles furnish the necessary functional activity ; the blood serves as a vehicle for nourishment and waste matter, and all the organs are governed by the nervous system. We have seen that if any of these organs performs its work inadequately, the condition of health is im- possible. The reason that so many people are in the condition of imperfect health is that the human body depends for its health on its environment; that the environment best suited to its needs is one of simple active outdoor life, and that civilization has so modi- fied man's environment that his life is complex, seden- tary and indoors. These conditions are unfavorable to perfect health. It has taken thousands of years of evolution to de- velop the human organism to its present state — its adaptation to an active outdoor life, but in the last hundred years civilization has brought about such rad- Health of the Cells Health of the Body Evolution of the Body io PERSONAL HYGIENE ical changes in man's environment that it is at present difficult for his body to adapt itself to the new de- mands. The marked decrease in the amount of muscu- lar exercise, the enormous changes in shelter and food, the great increase in nervous activity, necessitate great modifications in the various functions of the body. That most of the functional disorders common to our city population would be easily remedied by a change to a simple, active, outdoor life, is shown by the marked improvement in health which takes place when a man or woman spends a summer camping out. Degrees of From the standpoint of health, people may be di- iy vided into three classes. In the first class are those who possess a large amount of vitality or resistance to disease. They maintain good health under all cir- cumstances — hard work and unhygienic surroundings have no apparent effect upon them. In the second class are those who are well and strong when living under favorable conditions of work, air, food, exercise and rest, but who fall ready victims to epidemics and easily affected by adverse conditions. The third class, small in number, includes all persons having inherited or acquired weakness who are in- capable of a high degree of health, even when sur- rounded by the most favorable conditions. Most people belong to the second class. They thrive when the environment is favorable, but are easily af- fected by bad air, poor food, overwork, and other ex- ternal circumstances. THE HUMAN MACHINE ii Health, then, may be said to depend on two main factors, (i) the strength, vitality or constitution of the individual, and (2) the environment in which the individual is placed. A natural question is : What is constitution and how may it be improved? The constitution or vital- ity of an adult depends on two things, heredity and nurture. It is a common law of nature that children of healthy parents are much more likely to be strong and vigorous than the children of weak, sickly parents. It has also been demonstrated that children brought up under favorable conditions of air, food, bathing, ex- ercise, rest and play, are likely to grow up healthy and vigorous even with poor inheritance. Health also depends on the immediate influence of environment. A man or woman who has inherited a vigorous constitution from his parents and has been brought up under favorable conditions of life, may ruin his health in a short time by exposing himself to an unhealthy climate, overwork, bad air, poor food, filth, worry or dissipation. In these lessons we shall study the important func- tions of the body and the conditions most favorable to them. In all this we should keep in mind that in our attempt to enhance the influences which improve the health, we are not studying simply to increase the efficiency, usefulness and happiness of the Individual but we are building permanently by increasing the vitality of the fathers and mothers of future genera- tions. Factors in Health Environment and Care STRUCTURE OF THE BODY The many dissimilar parts of the body, such as bones, muscles, nerves, lungs, etc., upon close exami- nation may be resolved into the elementary structure called tissues. The body, then, is composed of solid tissues and fluids. Tissues Microscopical examination of any tissue shows that it is Gomposed of the living physiological units called cells and the cells of any tissue are similar in structure and function. These are the fundamental structural elements, and it is by the combination and transforma- tion of these, and material derived from them, that all the tissues, seemingly so different, are formed which make up the structure of the human body. The bones which give the fixed figure and form as well as support to other organs; the ligaments and cartilage connecting the bones ; the muscles which make motion possible ; the organs of nutrition, secretion and excretion ; the nervous tissue, and that composing the organs of the special senses, are primarily made up of cellular tissue corresponding to the frame-work of any Luilding with its intricate steel, brick, mortar and board formation. Fluids The fluids are intimately connected with the life of the structure. If they become stagnant or contami- nated, trouble ensues. Upon their purity and renewal life depends. These fluids are the blood or circulating medium ; the fluids connected with the process of assim- BONES 13 ilation such as lymph; the digestive juices, as saliva, the gastric, pancreatic; and the excretory fluids. For purposes of classification the body may be sep- arated into head, trunk and limbs. The head may be sub-divided into skull and face; the trunk into chest or thorax and the belly or abdomen. The arms are sub-divided into upper, fore-arm, wrist and fingers, roughly corresponding with thigh, leg, ankle and toes. The thorax or chest is separated from the abdomen by a peculiar partly fleshy, partly membranous organ called the diaphragm. The alimentary canal lying in front goes through the diaphragm and is composed of oesophagus, stomach and intestines. The abdomen also contains the kidneys, liver, bladder, pancreas and spleen. The thorax contains the heart and lungs. The cavity of the skull connects with the spinal canal. This cavity contains the brain which is con- tinuous with the spinal cord, the brain and spinal cord constituting the cerebro-spinal system. BONE Bones are made up of osseous tissue which consists essentially of animal matter similar to connective tissue impregnated chiefly with calcium salts which give rig- idity. In general, a bone is a hard, tough body, flex- ible and elastic within narrow limits, but breaking if pressed too far. When a long bone is broken across, it is found not to be a solid mass of ossified tissue, but to contain a cavity filled with a mass of con- nective tissue, called the medulla or marrow. This Divisions of the Body Structure of Bone H PERSONAL HYGIENE medullar cavity extends through the shaft or bone, but as it reaches a joint becomes sub-divided by bony partitions and shows numerous smaller cavities. The walls of this cavity are seemingly dense, but are trav- ersed by a net work of narrow vessels known as the Haversian canals which have intimate association with the nutrition, hence with formation of the bone. Kinds of Bones Development of the Bones STRUCTURE OF BONE, SHOWING CANALS AND THE LIVING CELLS (THE BLACK SPOTS) There are two kinds of bones classified as to their origin : ( i ) Membrane bones developed from fibrous tissut including most of the bones of the head, (2) Cartilage bones developed from cartilage, including most of the bones of the skeleton. The growth of bone takes place largely in two places, at the epiphyseal line or cartilage between the shaft and head, and at the outside covering or peri- osteum. In the embryo "centers of ossification" appear in these membranes and cartilages and calcium salts are deposited to form bone. In long bones usually there are three centers of ossification, one for the shaft and one at each end. These grow toward each other but of Bones MUSCLE 1 5 do not completely unite until the skeleton nears the adult size. Consequently in childhood there is danger of fracture at this line of union since it is cartilage and not fully developed bone. The periosteum is the essential living and growing Living Part part, much like the inner bark of a tree. During the growing period especially, new bone is constantly be- ing laid down on the outside, thus increasing the size of the bone, while destruction is going on within, hollowing out the center. In youth the building pro- cess exceeds the destruction. In old age the building has nearly ceased and destruction continues until bones become very brittle. When these bones are broken they unite with great difficulty. MUSCLE Bones, cartilage and connective tissue form the framework of the living machine. The origin of the energy manifested by this machine, we will consider later. Its active power is largely manifested in the form of motion or movement, in which the voluntary muscles or "organs of the will" play a large part. There are certain cells exhibiting amoeboid movement, and ciliated cells which also produce partial move- ments of the human body, but the various kinds of muscles are of prime importance in its various acts. We are familiar with muscles in the form of red meat from the butcher shop. Muscles constitute about one-half of the body in bulk. There are two main i6 PERSONAL HYGIENE EXTERNAL LAYER OF MUSCLES OF THE BODY MUSCLE 17 classes of mucles, the voluntary which are under the control of the will, and the involuntary which do their work independently of the will. In general the volun- tary muscles are attached to bones and for this reason are sometimes called skeletal muscles. They are about 500 in number. The involuntary muscles are found in the organs of the body, as in the walls of the stomach, intestines, and blood vessels. Their particular func- tion is to assist in the work of the various organs by moving their contents, as illustrated by the movements of the stomach and intestines during the process of digestion. If a single muscle is examined carefully, it is found Fibres and to be made up of a number of bundles of red fibres bound together by means of white connective tissue. At each end of most of the voluntary muscles is a strong white cord — a tendon, which serves to connect the muscle to the bone. Every muscle is supplied with nerves and blood vessels which ramify throughout the bundles of fibres. The special property of the living muscle is that of contractility, — the power of shortening in length while it increases correspondingly in width. The two ends of a muscle being attached to separate bones, the short- ening produces motion. This action leads to those motions which make locomotion and other activities possible. The muscles are found passing over all the joints, one or more on each side, thus making it possible to 1 8 PERSONAL HYGIENE move the joint forward and backward. In some places, as in the shoulder joint, the arrangement is such that the arm can be movea in all directions. The muscles which bend a joint are usually three or four times as strong as those which straighten it. This fact is easily- demonstrated by comparing the strength of the muscles used in closing the hand with those used in opening it. Muscles which are used for heavy work tend to in- crease in size and strength, and also to shorten. Un- used muscles become small and weak and tend to lengthen. Muscles The proper relation of one bone to the other in a Bones in joint depends on a definite relation between the length and the strength of the muscles which bend and those which straighten the joint. If the muscles which bend the joint are overdeveloped they shorten and stretch the extensor muscles. This gives a bent or crooked position of the joint, as illustrated in the half closed hand of the manual laborer, resulting from the constant grasping of tools, or the stooping attitude of the far- mer from bending over in hoeing and other farm work. The same crooked position may result from great weakness of the extensor muscles even when the flex- ors are not overdeveloped. Furthermore, joints tend to maintain the position in which they are held most frequently. The drooping head, round back and pro- truding abdomen of the weak and undeveloped are all too familiar. This condition is the result of general muscular THE NERVOUS SYSTEM 19 weakness, and lengthening of the extensor mus- cles, particularly of the muscles on the back of the neck and chest, the abdominal walls, the hips, and the knees. The proper relation between the flexor and the ex- tensor muscles of the various joints is essential to beauty of form and grace of movement in the human body. When this relation exists the muscles being of exactly the proper length and strength they are bal- anced. THE NERVOUS SYSTEM The nervous system is the governing mechanism of the body. It controls and regulates every activity of the body, brings the individual into conscious rela- tionship with external nature by means of sensation, motion, language and all the mental manifestations. The cerebro-spinal nervous system consists of the brain, the spinal cord and the nerves. Every organ and part of the body is connected with the brain by means of the nerves. Every movement we make is the result of muscular contractions which have been ordered or stimulated by the brain. A nerve consists of the nerve center, located in the ANerveCeii brain, spinal column, or ganglia, from which extends the nerve fiber. The nerve centers are the sending and receiving stations — the fibers, the wires. We do not know just what a nervous impulse is, but it seems to be electrical in nature, although the nervous im- 20 PERSONAL HYGIENE The Brain Special Centers Kinds of Nerves pulse travels much more slowly than the electric current. In a general way the brain consists of nerve cen- ters which have for their function the regulating of the various activities of the body. There is, for in- stance, a center regulating eyesight, another has to do with hearing. In the same way there are centers for speech, smell, breathing, coughing, the beating of the heart, the secreting of the various glands, the move- ment of each group of muscles, and all the other activities of the body. The nerve centers in the brain are numerous and their functions very complex. For example, when a muscle is exercised vigorously, it requires an increased supply of blood and its sensory nerves carry a stimulus to a particular center in the brain. This center sends stimuli to the centers which regulate the breathing and the beating of the heart, and these centers, in turn, send stimuli through motor nerves to the heart and muscles of respiration to increase their activity. All the muscles and other organs are connected in a similar way with the various centers in the brain by means of the nerves. A nerve fiber carries impulses only in one direction, to a center or from a center. In general the nerves which carry stimuli from the parts of the body to the brain are called sensory nerves, and the nerves which carry stimuli from the brain are called motor nerves, because nearly all the stimuli coming from the brain produce movement or activity. THE NERVOUS SYSTEM 21 All nervous impulses are thought to be alike. They vary only in intensity and in the method of stimula- tion, thus the nerves in the retina of the eye are sensi- tive only to light; those in the inner ear, to sound. If it were possible to change the nerve fibers about, so that those coming from the eye were connected with the centers which interpret hearing and vice versa, we would, as has been said, "hear the lightning and see the thunder." It is a common experience that a per- son who has lost a foot or arm still interprets stimuli of the nerves which formerly came from the lost mem- ber as if the foot or hand were still present. Most activities are under the control of the will. When we get up from a chair or carry a glass of water to the mouth, we call it a conscious act because the stimuli to the various muscles involved originate in the will. But if every act depended on the will for its instigation and direction we would remain helpless as an infant. The development and training of the nervous system results in many acts becoming automatic. The child learning to walk takes months of repeated conscious effort to learn to stand, and several more months to learn the movements of walk- ing. Gradually the act of balancing, and the move- ments involved in placing one foot in front of the other, are performed unconsciously or automatically, and the child is able to walk, and later to run, without any conscious effort. In the same way we learn to speak, to eat, to put on our clothes, to write, and to make a Nature of Nervous Impulses Voluntary Nervous System 22 PERSONAL HYGIENE great many complicated movements which at first re- quire conscious effort, but gradually are performed automatically. Automatic The back of the brain and the spinal cord have for their particular functions the regulating of these auto- matic acts, and this results in a tremendous saving of time and energy. If it were not for this provision, we should spend most of our time and energy in dressing, for the fastening of every button and hook would require many conscious efforts on our part. Every new movement has to be repeated a great num- ber of times as a conscious effort before it can be directed by an automatic center. Reflex Acts There is still another class of nervous reactions not under the control of the will, called reflex acts. A wink is a typical reflex act. A sudden strong light causes the eyes to close before we have time to think about it, or even to prevent it. Reflex acts are largely associated with the protection of the body from harm- ful conditions. Too strong light or dust irritating the eye causes the lids to close; heat coming in contact with the hand causes the arm to be snatched away ; a pin pricking the sole of the foot causes the leg to be drawn up quickly. All these movements take place with great rapidity and without conscious effort. The irritant stimulates the sensory nerves in the part; the stimulus is carried to a sensory center; from there, another stimulus is sent to the proper motor centers, and these in turn send stimuli to the muscles THE NERVOUS SYSTEM 23 which by their contraction protect the part from injury. Besides the central nervous system, there are nu- merous little bodies or nervous tissue called ganglia which are for the most part independent of the brain and spinal cord, although connected with them. There are two chains of these ganglia in front of the spine and others in the heart and other organs, all of which send out numerous nerve fibers. They are connected with the activities of the organs not under the control of the will like the heart, the blood vessels, the stom- ach and other digestive organs, and in fact all involun- tary activity. This is what is called the sympathetic nervous system. In many places in the body, numerous nerve fibers interlace, forming plexuses, especially around the blood vessels. The great plexus of nerve fibres in the abdo- men is called the "solar plexus." Many of the organs controlled by the involuntary sjstem have two sets of nerves opposite in their action; for example, one set of nerves accelerates the heart beats, another retards, or "inhibits," action ; in the stomach, one set brings about the secretion of the gas- tric juice, another is inhibitory. In health all this marvelous complexity of nervous organization is in perfect co-ordination. The nervous system is wonderfully protected in all parts of the body, for it controls the growth and function of all the cells. Sympathetic or Ganglia Nervous System Stimulation and Inhibition THE SKIN AND CONNECTIVE TISSUES The Skin Dermis Mucous Membrane There are various complicated classifications of the tissues. It is enough for our purposes to divide them arbitrarily into skin or protective covering, and con- nective tissue, the latter term covering many sub- divisions. The skin consists of layers of tissue of varying thickness which cover the whole body. If we examine a piece of skin in cross-section, we find on the surface a thin layer of hard, flat cells without nerves or blood vessels. This outer surface is called the epidermis, is composed of minute particles of horny matter and is constantly being shed. The sensation of touch and the effect of temperature on the surface of the body are greatly diminished in intensity because of this covering, as it contains no nerves or blood vessels. The great sensibility of the under skin when the outer covering is removed, is illustrated by the practice of a famous burglar who was able to open bank safes by pressing the ends of his fingers, from which he had removed the outer skin, against the lock on the safe and thus feeling the clicks as the knob was turned. The under skin or dermis is filled with a meshwork of nerves, blood vessels and glands. While it is dense and fibrous, if wounded gives rise to pain and easily bleeds. At the margins of the various apertures of the body is a layer of skin, redder, more sensitive, and continu- THE SKIN 25 ally moistened by a fluid which it exudes. This is mucous membrane and lines all interior cavities. This is a skin and consists of two layers now called the dermis and the epithelium. The ducts of the glands in the dermis pierce the outer skin, but the nerves and blood vessels are all below the epidermis. There are two kinds of glands in the outer skin, the sweat glands which secrete water and waste mat- ter dissolved in perspiration, and the oil glands which secrete an oily material useful in keeping the skin soft and pliable. The sweat glands are very numerous. They are eliminating perspiration continuously, but most of it dries on the skin without giving a sensation of moist- ure. It is only when these glands are stimulated to great activity by vigorous muscular exercise, nervous- ness, emotion or heat, that the sweat accumulates in drops which perceptibly moisten the skin. These glands in an adult secrete on an average about one quart of perspiration in 24 hours, and a much larger quantity in hot weather. The sweat glands serve to regulate the temperature of the body. Under active muscular exercise in the heat of summer, or in overheated rooms, large quan- tities of blood flow through the capillaries of the skin, the sweat glands are stimulated to greater ac- tivity, and the sweat poured out of these glands serves to cool the body by evaporation. Evaporation, as we know, requires a large amount of heat. Glands of the Skin Sweat Glands Temperature Regulation 26 PERSONAL HYGIENE Experiment. Rub a drop of ether, alcohol, or gaso- line on the back of the hand. The skin is chilled by the evaporation. A like quantity of water in evap- orating will carry away much more heat, but as the volatilization is not so rapid the cooling is not so noticeable. The process is reversed when the body temperature is too low and the surrounding air is very cold. Under these conditions the capillaries in the skin contract, very little blood flows through them, the sweat glands almost cease their activity and a very small amount of heat is lost from the body by evaporation. The normal activity of the skin therefore is an important factor in maintaining health and preserving energy. Sebaceous The oil glands are found ail over the body except in Hairs the palms of the hands and the soles of the feet. Each gland is located at the root of a hair and opens into the depression in the skin or hair follicle which con- tains the hair. The hairs are so small and short in many places that they are practically invisible. When a cold draft strikes the skin suddenly, we have what is called "goose flesh," due to the contraction of a tiny muscle . near the bottom of each hair follicle which causes the hair to straighten up or "to stand on end." The amount of oil secreted by these glands varies in different persons, and in different races. It is well known that negroes have much more oil in the skin than whites. A certain amount of oil is essential to the health of the skin and to keep it soft and pliable. The skin 27 In the deeper part of the dermis is found a coloring complexion matter which determines the complexion. The amount varies greatly in different individuals and in different races. A dark skin is due to the presence of a large quantity of this pigment in the dermis. Negroes have a very great amount of coloring matter, whereas per- sons with fair complexions have very little. Freckles are caused by the accumulation of pigment in spots. The amount of pigment in the dermis cannot be altered by the application of medicinal preparations or the taking of medicine internally. The various facial preparations advertised to bleach and beautify the skin consist of some form of scented pomade usually con- taining arsenic. Such preparations are harmful. The arsenic does not decrease the amount of pigment in the skin, it simply interferes with the circulation of blood in the capillaries and produces a certain pallor characteristic of arsenical poisoning. In the deeper layer or dermis, and just beneath it, Fat in is found a layer of fat. The amount varies greatly in different persons at different ages, and in the sexes. This fat protects the body from cold, rounds out the form and serves as reserve fuel supply for the body. The angular form of thin persons and the wrinkles of old age are largely due to a diminution of fat under the skin. The skin varies in thickness in different parts of the body. On the eyelids and most of the covered parts of the body the skin is quite thin, but on the palms of the 28 PERSONAL HYGIEXE Cartilage Connective Tissue hands, the soles of the feet, and the scalp, it is often very thick. This is especially true of people who do manual labor and walk or stand all day. Under these conditions the skin thickens to protect the delicate parts beneath from the constant pressure on the sur- face. This thickening becomes excessive and causes great pain when the pressure or friction is too long continued, as when a callous is formed on the hand by doing manual work, or a corn on the foot by wear- ing too small or ill-fitting shoes. The nails and hairs, like the callous, are only modi- fications of the skin, serving for protection of exposed and delicate parts of the body. In early years many parts of the supporting frame- work which later became bone consist of cartilage. The infant softness comes from the cartilaginous con- dition of many bones, these being known as the tem- porary- cartilages, as later ossification will take place and the cartilaginous be replaced by true bony tissue. In certain portions of the body, however, the carti- laginous or permanent tissue remains such through life unless calcified or hardened and made unyielding by deposits, as often happens in old age. In its pure form, cartilage is flexible and elastic, and contains few blood vessels and living cells. The connective tissue constitutes the final group of the supporting tissues and has many diversions, from a white fibrous variety mainly connected with muscles and joints to the jelly-like connective tissue making up the vitreous humor of the eye. THE SENSE ORGANS Something of the structure of the organs which sup- port the frame-work of the living machine, the bones and connective tissue, has been described. Those which move it, the muscles and cerebro-spinal nervous system, have been briefly considered. There remains to touch upon, the sensory organs, before considering those which are more intimately connected with the ''running of the machine." There are only certain organs which convey the various impressions from without. Any surface of the body may be sensitive to, or "feel" the sensation of heat or of cold, but only certain portions of the body are capable of reporting sound, light, or smell. Therefore, those organs which put us in some par- ticular relation with the outer world are termed sensory organs. Since between these sense organs and the sensory centers, the brain, the nervous impulses are the only means of communication, it is of prime importance that the nervous system be a perfectly working part of the human machine. It is of course important that the special sense organs of sight, sound, smell and taste be highly developed, educated and healthy, but it is through the sense of touch and motor activities as well as what we call thought that the higher nerv- ous organization of man has been evolved. It is Sensation Sense Organs Develop the Brain 29 End Organ 30 PERSONAL HYGIENE through the sense and motor activities that man has been able to modify his primitive instinct. It is through the education of the senses that man is raised above the animal. In many animals the special senses of sight, hearing, taste and smell are more highly de- veloped than in man, but in no animal does the ability to make complicated movements approach that of man. sense The fundamental part of every sense organ is what may be termed the end organs. These are masses of highly sensitive tissue so placed as to be normally acted upon by one of the modes of motion met with in the external world. This end organ must have a sensory nerve fibre connecting with a nerve center in the brain. Seeing and hearing are the two most specialized senses and will be considered separately. The others are the sense of touch, the senses of heat and cold, the senses of smell and taste, the sense of pain, the muscular sense, and what may be termed common sensation, as hunger, thirst, fatigue, restless- ness, and the like. Tactile The sense of touch which is really the pressure sense is located in the skin and mucous membrane. It varies in acuteness in different portions of the body, being most marked at the tip of the tongue, fingers, and lips. The tactile impression is a very necessary one in edu- cation and should be developed far more than is usually the case, and those who, like Helen Keller, are both deaf and blind receive all their education through the tactile sensations. Senses THE SENSE ORGANS 3i According to the older view, the temperature sense as well as the sense of pain was thought to be a part of the sense of touch. It is now known, however, that in the skin there are distinct and separate nerve end- ings for heat, for cold, and for pain, as well as for pressure. The distribution of the hot and cold spots on the skin can be localized by passing a hot and a cold wire successively slowly over any part of the skin, as on the back of the hand. The nerve endings for the sense of pain are most numerous in the skin. The internal sensations of pain are usually referred indefinitely to some part of the surface of the body — for the heart to the region of the shoulder blades, for the intestines to the back, from the stomach to the end of the sternum. We are not usually distinctly conscious of muscular sensibility. Our ideas of weight and resistance, al- though depending in part on the sense of pressure, are largely determined by the muscular sense. Judgment of distance depends on visual impression combined with the contraction of the ciliary muscles in focusing, especially for near objects. The muscular sense is thought to have much to do with the proper contraction of the muscles and thus becomes important in all vol- untary movements. It is probable that through the muscular sense is received the impression of fatigue. The sense of smell is located in the mucous mem- brane lining the upper part of the nasal cavity in which the olfactory nerves are distributed. Its important Temperature Sense Sense of Pain Muscular Sense Sense of Smell Sense of Taste 32 PERSONAL HYGIENE function is to guard us against the breathing of im- pure air. The sense of taste may be a highly specialized sense and is so needful a part of the acts of nutrition that it SECTION OF THE NASAL CAVITY, OLFACTORY NERVE INDICATED Primary Taste Sensations should be considered a most important sense. It is localized mainly in the mucous membrane covering the upper surface of the tongue. The sensation of taste may be resolved into four pri- mary tastes — sour, sweet, bitter, and salty. All our sensations of taste are the result of the mingling of these primary tastes with the sense of smell. Many of SIGHT 33 the so-called tastes are in reality given through stimu- lus of the olfactory nerves. This is largely so in the case of fragrant fruits, the bouquet of wines, and in fact all substances of which we say that the taste and smell is alike. The expired air, passing over the food, carries some of the delicate ethers across the olfactory nerves, thus we have a combination sensation of taste and smell. This fact is recognized when one has a bad cold; many things "do not taste." Holding the nose is a common practice when disagreeable medicines must be taken. As we shall see later when considering gastric diges- tion, taste and smell have a marked effect on the flow of the gastric juices so that we need to cultivate these senses, and pay more attention to their proper function than is often the case. THE SENSE OF SIGHT The eyes are in some ways the most important or- structure gans in the body. The eye consists of the eye-ball and the optic nerve. From the front of the eye-ball to the retina at the back, the light passes through a small, transparent body called the lens which answers the same purpose as the lens in a camera in making an image. The retina corresponds to the photographic plate and the lens focuses the image upon it. Normal vision depends on the proper distance between the lens and the retina. In focusing a camera, the lens is moved back and forth until a point is found where the 34 PERSONAL HYGIENE Accommoda- tion The Iris Defects of Vision distance between the plate and the lens is just right to give a clear reflection. Clear vision depends upon the same principle, except that the lens in the eye is not moved backward and forward from the retina, but the shape or curvature of the lens is changed, thus giving the same result. The change in the shape of the lens is accomplished by a little muscle called the ciliary muscle which, by pulling on the suspensory ligament, changes the shape of the lens according as we wish to look at an object near or far away. This mechanism for focusing the eye on objects at various distances is called accom- modation. Another structure on the eye-ball, called the iris, is important. It is a little curtain-like arrangement placed in front of the lens and serves to regulate the amount of light entering the eye. The change in the size of the opening, or pupil, may be seen by placing the hand on the eye for a few minutes and then removing it quickly, when the pupil will appear very large but will soon become much smaller as it is exposed to the light. The pupil is largest when we open our eyes in the dark, and smallest when we look at a bright light. In many persons the shape of the eye-ball is such that perfect vision is impossible. The eye-ball is some- times too long. When this occurs, the clear image falls in front of the retina, and in order to see clearly it is necessary for the ciliary muscle to be in a state of constant contraction. This causes eye strain with its SIGHT 35 many disagreeable symptoms. This condition is called near-sightedness or myopia, and is corrected by wear- ing a concave lens in front of the eye. The opposite condition, or far-sightedness, is caused by the eye-ball being too short and the clear image falling behind the retina. This may be corrected by a convex lens in front of the eye. In old age the elasticity of the lens become im- paired and it cannot be sufficiently contracted to bring ^0 EE^ CURVATURE OF THE EYE-BALL A. Normal. B, In Near-Sightedness. C, In Far-Sightedness. near objects into focus, so that convex glasses are re- quired. Another very common defect of sight is astigma- tism. This is due to irregularity in the curvature of the cornea, which prevents a clear image in all parts of the retina. To correct this a cylindrically ground lens is necessary. In many persons the two eyes are not alike. One eye may be defective while the other is normal, or the two eyes may have similar or opposite defects. Eye strain results from over-exertion of the ciliary muscle. Some of the most common symptoms are pain in the eyes, a headache located on the forehead or in the back of the head, and inflamed eye-lids. Dis- Astigmatism Eye Strain 36 PERSONAL HYGIENE turbance of the appetite, indigestion, and even nervous prostration may result from long continued eye strain. When any of these symptoms are felt the eyes should be examined carefully by an oculist and suitable glasses worn. The eyes are moved upward and downward, from side to side, or rotated, by means of small muscles which hold the eye-balls in the sockets. Both eyes should move exactly together and in the same direc- tion. When some of the muscles in one eye are too weak to do their work properly, squinting results. By operating on the muscles the proper balance between the muscles of one eye-ball and those of the other may sometimes be re-established. color Color blindness is inability to distinguish all the colors. In most cases it is limited to inability to recog- nize red and green, but occasionally the defect ex- tends to yellow and blue. Those who are unable to distinguish these colors see them all gray. There is no cure for this condition, but a certain amount of improvement is possible by education. care of To preserve the eyesight it is necessary to avoid the Eyes exce ssive use of the eyes in work requiring close ap- plication, reading and sewing in a poor light, reading matter printed in small type and on glazed paper, and reading in the cars. When reading at night the pages should be held in such a position that there is no reflected glare from the paper. If the eyes begin to smart or burn when reading or Blindness LIGHT 37 sewing they should be rested by looking away, and if this symptom reappears after reading or sewing for a short time only, the eyes should be examined by an oculist. The light as far as possible should fall on the page Lighting or work from above and behind; thus when writing, the light should fall from the left side to avoid a shadow cast by the hand. There should be a shade over the source of artificial light and the room should have general illumination as well as the reading light. Reading in street cars and railroad trains is injuri- ous because the light is frequently poor and the jolting necessitates rapid accommodation of the eyes which very soon tires out the ciliary muscles and produces eye strain. As there is a definite relation between good eyesight and general health, no efforts should be spared to maintain a normal condition of the eyes. Nature has provided considerable natural protection Foreign for the eyes. They are located in deep, bony sockets in°theEye and receive additional protection from the nose, the eyelids, and the eyelashes. Injury to the eyes often results from foreign bodies entering the eye or blows received on the eye-ball. A cinder or other foreign substance on the eye-ball may cause much pain and considerable inflammation. If the foreign body is a piece of steel or anything sharp and hard which has fallen against the eye-ball with great force, it may penetrate and produce permanent injury. Very seri- ous results from foreign bodies and wounds on the 38 PERSONAL HYGIENE eye-ball are caused by injury to the cornea, leaving scar tissue after the wound is healed. A cinder or a speck of dust in the eye may be re- moved with the corner of a clean handkerchief by drawing back the upper lid gently. If the speck is im- bedded in the eye-ball, the services of a physician should be secured at once, cataract Cataract is not a growth on the eye, as is often be- lieved, but an opacity or loss of transparency of the lens. It is an affection of old people, with no apparent cause except old age. This trouble can be cured per- manently by removing the optic lens — an operation which is not very serious. Tears The lachrymal gland is a small gland located in the outer corner of the eye and secreting a clear fluid for the purpose of lubricating the eye-ball. This fluid flows down the tear passage at the inner corner of the eye to the nose. The lachrymal gland secretes nor- mally an amount of fluid just sufficient to keep the eyes lubricated. Emotional excitement, irritating gases, inflammation of the eyes, and eye-strain stimu- late this gland to greatly increased activity. The size and shape of the opening between the eye- lids has much to do with the expression and with the beauty of the face. The size of the eye-balls does not vary greatly in different persons, but the appearance of large eyes which is considered an element of beauty is due to the long opening between the lids. The eyelashes are subject to a disease called "blear- HEARING 39 eye" or red lids, in which the roots of the lashes are inflamed, the edges of the lids become swollen, most of the lashes fall, and when new ones grow they are short and frequently grow inward, causing much irri- tation and pain. This disease does not respond easily to treatment and in every case an oculist should be consulted. The eyebrows consist of muscles, thick skin, and Eyebrows hairs. Abundance of hair, mobility, and the shape of the eyebrows are important features in determining the expression of the face. The growth of the hair on the brows is subject to the same limitations as the hair on the scalp and should receive the same care. THE SENSE OF HEARING The ear is a very important organ but it usually receives much less attention and care than the eye. That part of the ear which is seen is the least impor- tant. If we look in the canal of the ear we see a curved passage ending in a very thin pink mem- brane, which closes the inner end of the canal. But if we could look through this membrane, commonly called the ear drum, we should see a small cavity, the middle ear, containing three little bones connected with each other, resting at one end against a small body shaped like a shell. All these parts, the external ear, the external canal, the ear drum, and the three little bones, serve the pur- The Ear 4o PERSONAL HYGIENE pose of receiving sound waves and conveying them to the delicate auditory nerve which ends in many little nerve fibres in the well-shaped body in the inner ear. DIAGRAM OF THE EAR The "auditory canal*' is about an inch long, ending in the drum membrane T. The "middle ear"j» contains the three small bones which transmit the vibrations of the membrane; B, Semi circular canal; 5, Cochlea; E, Eustachian Tube. Semicircular Canals The auditory nerves receive impressions of sound from the vibration of little bones and transmit the impres- sions to the brain. In the little body of the inner ear is a small cavity containing a liquid. The function of this little cavity is to help to maintain our equilibrium ; it is really a HEARING 41 kind of spirit-level which helps us to determine our relation to the horizon. There is a nervous connec- tion between this little spirit-level and the stomach. When we lose our bearings, as for instance when we are on a ship, rocking and pitching, it is believed that the symptoms of nausea known as seasickness are caused by a disturbance of this little spirit-level in the ear. The cavity of the middle ear is connected with the Eustachian J Tube back part of the nasal cavity by a small passage about the size of a goose quill, called the Eustachian tube. The walls of the middle ear, the Eustachian tubes, and the nose are all lined with mucous membrane. A very common trouble in our climate is a catarrhal inflamma- tion of the mucous membrane. As the nose is the most common seat of this affliction, the connection be- tween the nose and ears is exceedingly important, because cartarrh spreads easily from one organ to the other. Often deafness results from catarrh of the middle ear and every precaution should be taken to prevent inflammation of the post- nasal space. The disease not infrequently spreads from the nose to the ears as a result of the common habit of sniffing salt water to relieve a cold in the head or as a treat- ment for chronic catarrh. The act of sniffing has a tendency to draw secretions from the nose into the ears. The use of a nasal douche or oil atomizer is far better for the nose and there is no danger of injuring the ears. 42 PERSONAL HYGIENE Earache Foreign Bodies in the Ear Ear 'Wax Acute inflammation of the ears which not infre- quenty results in an abscess is a condition fraught with much danger. If the abscess involves the "mastoid cells" in the round hard bone behind the ear, there is always a possibility that it may break into the brain cavity and result in death. When a child complains of earache, a hot water bag should be placed over the painful ear and a doctor sent for at once. It happens quite often that children will put beans or other foreign bodies in their ears and be unable to remove them. In such a case no attempt should be made to remove the foreign body by prying it out with a toothpick or button-hook. The best thing to do is to send for a physician at once. If it is positively known that the foreign body is not a vegetable, the following procedure may be tried: Make a solution of soap and warm water, put it in a fountain syringe, hang the syringe a foot above the child's ear and allow the water to flow in the ear. This treatment would be very dangerous if the foreign body were a bean or pea because the water would cause the vegetable to swell and give intense pain. Another most disagreeable condition of the ears is when a mass of hard wax accumulates near the drum ; this causes much pain and the sufferer hears all sorts of loud noises. The treatment for this condition is exactly the same as for the removal of a foreign body. It is sometimes necessary to continue the use of the HEARING 43 syringe for twenty or thirty minutes before the wax is sufficiently softened to be washed out by the water. This condition is very common and may not give pain but simply make one a little hard of hearing. The ear canal should be kept clean by rolling the corner of a soft moist towel and wiping the wax and dust which accumulates in the ear. Hair-pins, button- hooks, and toothpicks should never be used to remove wax from the ear, for there is danger of injuring the delicate ear-drum. Deafness results from various causes. Catarrh, Deafness measles, and scarlet fever are often followed by deaf- ness of one or both ears. The ears of patients suffer- ing from any of these diseases should be watched carefully. Having very briefly considered the human machine and -the means by which its relations to the external is established, w r e will next take up the "running of the machine." TEST QUESTIONS The following questions constitute the "written reci- tation" which the regular members of the A. S. H. E. answer in writing and send in for the correction and comment of the instructor. They are intended to emphasize and fix in the memory the most important points in the lesson. PERSONAL HYGIENE PART I Read Carefully. This is so essentially a personal subject that many of the questions are made personal. To obtain the greatest benefit from these lessons such questions should be answered fully. It will be desirable if possible to supplement the text by reading some of the books mentioned in the program for supplemental study. Your questions should enable the in- structor to supplement the text. Write on one side of the paper only and leave space between answers. i. To what extent have you studied the subject of personal health before reading these lessons ? 2. On what factors does personal health depend ? In your own case, which is the most important? 3. What can you say from your personal standpoint of the value of health? 4. What are the fundamental living units of the body? How are they combined and how is their life governed? 5. Describe the structure of a bone; a muscle; a nerve. 6. What are the functions of the nervous system? Answer fully. 7. Through what means is the brain developed? 8. How should the eyes be cared for? What attention do you give to your own eyesight? 9. Describe the ear. How may deafness be brought about ? 10. What is the aim of personal hygiene? 11. What questions have you to ask ? Note. — After completing the answers, sign your full name. 45 DIAGRAM SHOWING POSITION OF LARGER ORGANS IN THE BODY. PERSONAL HYGIENE PART II Energy Running the Machine THE living body cannot create energy. It can only, in common with other machines, use the energy provided, and transform it into other forms of energy — heat energy, mechanical energy, and, perhaps, electrical energy. Food is, as we know, the fuel of the human machine, but it is only by com- bining with oxygen that the nutriments of food can yield their store of energy to the body. The primary source of all terrestrial energy is the Source of light and heat coming from the sun, except the small amount from the internal heat of the earth and that from the tides. This energy is stored up by plant life — by the greenery of nature. It is only by means of the chlorophyl of green leaves that the energy in light and heat can be used to build up the complex compounds which are broken down by animals and plants in the construction of their cells, and in main- taining life. Every life process, vegetable and ani- mal, except the action of the chlorophyl, uses this stored energy and dissipates a part chiefly in the form of heat. Thus, the human machine uses the energy from the sun, stored up in food, for main- taining its bodily temperature, for muscular work, for the digestion of food, for thinking, even. 48 PERSONAL HYGIENE Trans- formation of Energy Use of the Energy Heat Losses of the Body All forms of energy are easily transformed into heat. For example, energy from the sun may be stored up by the corn plant in seed, part of the grain may be transferred into the flesh of an ox, and the meat consumed by man as food. Through the energy of this food a man may carry a stone up a mountain. In rolling down the mountain side, the energy of position of the stone is changed into heat through friction. Thus the energy stored up from the light and heat rays of the sun, through a devious path, is changed again into heat. The scientists suppose that the ultimate end of all forms of energy will be "uniformity diffused heat. " The part that each one of us has to play in this mighty cycle is to make the best possible use of the energy given him to trans- form. Of the energy supplied to the body in food, only about 20 per cent can be used for external work, as in walking, the lifting of weights, or riding a bicycle. The remainder leaves the body as heat. Some of the energy leaving the body as heat is first used in internal work, i.e., in circulating the blood, in the digestion of food, etc. By far the largest part of the energy is expended in maintaining the tempera- ture of the body. The U. S. Department of Agriculture has deter- mined, in the respiration calorimeter, the outgo of energy from the human body under various condi- tions. (See Food and Dietetics, pages 32-52.) The ENERGY OF THE BODY 49 results for an average sized man per hour are given as follows : HOURLY OUTGO Average (154 lbs.) Carbon Dioxide (gms.) Calories Foot Tons Man at rest (asleep) .... 25 65 100 Sitting up (awake) 35 100 . 154 Light exercise 55 170 262 Moderate exercise 100 290 447 Severe exercise 150 450 694 Very severe exercise. ... 210 600 926 Note. — A calory is the qantity of heat required to increase the temperature of 1 kilogram of water i° Centigrade (or about a pound of water 4 F.) .This is equivalent in mechan- ical energy to about 1.54 foot-tons. A foot-ton is the energy required to lift one ton a foot high against gravity. With body weight greater or less than 154 pounds, the energy outgo would proportionally be greater or less, disregarding unusual fat. The efficiency of the body in performing external Effic^enc * 1 work varies greatly in different individuals and at of the Bod y different times. Some persons may be capable of doing twice as much work as others on the same amount of food. A tall, thin person loses more heat (and so energy), proportionally, than one with a more compact body, because of the greater skin surface compared to weight. When all the organs are in perfect condition, the efficiency of the body is high. Indeed, the mechanical efficiency of the well-trained body is higher than that of most ma- chines — a locomotive for instance can use only about one-tenth of the energy supplied to it in coal. But muscular efficiency is not the highest human efficiency; mental efficiency is of a higher order. This, too, depends upon the proper workings of all 50 PERSONAL HYGIENE Work of the Organs ■Work of the Nervous System parts of the machine — on right living. Although the human body is a machine — a self repairing auto- mobile — it is dominated by the mind, and has imagin- ation as well as reasoning powers. So in considering the body as a machine, we must not forget that mental conditions may make mechanical rules false. The organs of the body which convert food into nutriment are the alimentary. Those which convey this nutritious material to all parts of the machine are the circulatory, and those which eliminate waste matters are the excretory. The respiratory organs play a double part, being both eliminators of waste and importers of the most necessary factor in all this process— OXYGEN. All this intricate machiney, however, would be of little value without the engineer. The machine would stand idle and rust away without the co-ordi- nating action of the nervous system. The nervous system stands as does the engineer regulating the functions of the organs, demanding food for the machine, discriminating in kinds and amounts. It guides the muscles, directs the digestion of food, the circulation of the blood, the excretory and res- piratory processes. All these processes are depend- ent upon the normal healthy condition of the ner- vous system, which is, therefore, of paramount im- portance. Yet, this is intimately related with the healthy condition and normal action of every organ of the living machine, and, as we know, the over lord of the nervous system is the brain, the mind. DIGESTION OF FOOD The function of digestion is to render food solu- ble and capable of being absorbed into the blood, and thus brought to all the cells of the body. The ailmentary canal is lined throughout with mucous membrane, which is much modified in parts. It is supplied with two layers of muscles (the stom- ach three) and covered with the serous membrane, which serves as protection, and for lubrication. Mastication is the only voluntary part' of diges- tion, and that doubtless would be better performed if it was not under the control of the will. As the time of solution is dependent on the fineness of the particles to be dissolved, mastication is an import- ant part of digestion. It is only necessary to note the difference in time required to dissolve large and fine crystal in water to appreciate this fact. The time of complete solution is dependent on the size of the largest crystal or mass. During mastication food is moistened with saliva, which is secreted by three sets of salivary glands — the parotid in the cheek, the sub-maxillary at the side of the tongue, and the sublingual under the tongue. The quantity and composition of the secretion varies with the character of the food being eaten. With dry food the flow is abundant, and the saliva contains the ferment ptyalin, which is capable of changing cooked starch into maltose and dextrine. 51 Mastication Saliva 52 PERSONAL HYGIENE Enzymes or Ferments Salivary Digestion These ferments or enzymes are very important in affecting chemical transformations of both animal and vegetable life. Their action is similar to that of so-called "catalytic" bodies — substances which by their presence bring about, or greatly hasten, chemi- cal changes, but which, apparently, do not enter into the chemical actions themselves. A familiar example of catalysis is the changing of starch into glucose by boiling it for some time with a small amount of acid. There is just as much acid at the end of the action as at the beginning, and if it could be extracted and used over and over again, an in- finite amount of starch might be transformed into glucose with a very small amount of acid. Now, if the acid had acted on an alkali, certain metals or oxides, it would combine with it and the acid would no longer exist as acid. It is thus apparent that the action in catalysis is quite different from the more common chemical action. Moreover, it is clear that calalysis is a most economical means of effecting chemical change. A large quantity of an enzyme will make the action more rapid than a smaller amount, but the small amount would do the work if given sufficient time. The action of the enzymes is specific, that is, one kind of ferment affects only one kind of a chemical change. To return to salivary digestion. The saliva is slightly alkaline in reaction and ptyalin cannot work DIGESTION 53 in an acid medium. As the stomach secretions are acid, it was formerly thought that salivary diges- tion was of little importance, but it is now known that the food may remain in the large end of the stomach for an hour or more before it becomes acid, and so the digestion of the starch begun in the mouth may continue in the stomach. The saliva also dissolves part of dry food, giving it taste, and as we shall see later, the sense of taste has a marked effect on the flow of the gastric juices. The secretion of saliva is controlled by the ner- vous system, the higher nerve centers having con- siderable effect, for it is an every-day experience that the sight, the smell, or even the thought of savory food may "make the mouth water. " On the other hand, strong emotion or fear may stop the secretions and the mouth becomes dry. When dry food is taken into the mouth, the saliva is rich in ptyalin, which comes most abundantly from the parotid glands. If the food contains much water, the secretion is meager and contains little of the starch converting ferment. This indi- cates that starchy food, such as bread, will have a better chance to be thoroughly digested if eaten dry. While the various actions in digestion support one another, still it is important that each stage be com- plete for perfect digestion. Mastication and insalivation have long been recog- nized as impotant. The Gladstone rule of twenty- Secretion of Saliva Ptyalin 54 PERSONAL HYGIENE five chews to each mouthful of food is familiar, and more recently, Fletcher and his followers have claimed that most of the ills which flesh is heir to may be corrected by long continued mastication. While " Fletcherizing " may not accomplish all that is claimed for it, yet the necessity for thorough mas- tication can hardly be over-estimated. Rapid eat- ing usually means overeating, for it has been shown conclusively that when food is eaten slowly and masticated thoroughly, a less quantity is demanded by the appetite. It is safe to say that at least one- half of the digestive disturbances common to the American people result from the "bolting" of food. The saliva also contains mucin, the constituent which gives it the ropy appearance. This helps to lubricate the food and make the act of swallowing easy. In swallowing, the food passes over the trachea, which is closed by the epiglottis. The opening to the nasal space is closed by the soft palate. The food reaches the stomach through the oesophagus. The The stomach is a muscle covered, pear-shaped sac situated under the diaphragm, with the large end towards the heart. The oesophagus entrance, called the cardia, is closed by a circular muscle, and the outlet into the small intestines is guarded in a similar manner by the pylorus. When fully distended, the stomach holds from three to five pints, but when not occupied by food it is collapsed. The herbivorous animals have two stomachs, one DIGESTION 55 chiefly for storage and the other in which more active digestion is carried on. In the same way, the human stomach is divided into a comparatively inactive and an active part. The pyloric end is the part chiefly concerned in movement and digestion, the larger end, called the fundus, serving to hold the food and make meals possible. Duodeum Pylor-us ■ Pyloric part of •Stomach- , ■Fvm-dvtS Transverse band- DIAGRAM OF THE STOMACH (After Howell.) The stomach is lined with numerous glands, which Gastric secrete the ferments, pepsin, rennin, and may be other ferments and hydrochloric acid. The pepsin glands are found in all parts of the lining, but the glands which secrete hydrochloric acid occur chiefly in the central portion of the stomach. The pepsin, in an acid medium, digests the proteids of food (the lean of meat and fish, albumen, casein of milk, gluten of wheat, legumin of beans and peas, etc.), changing Juices 56 PERSONAL HYGIENE Movements of the Stomach Control of Gastric Secretions them into peptones or peptoses, which are soluble. The connecting tissues, which hold the globules of animal fats, are dissolved, and fats, which at bodily temperature are in a liquid state, are liberated. It was formerly thought that the fats were not digested at all in the stomach, but recent experiments show that finely divided fats — emulsions, like milk and the fats in the yolk of egg, are digested to some ex- tent. Beyond the coagulation of milk, the action of rennin is not known. In the pyloric end of the stomach, wave-like con- tractions take place — in the human stomach once every 2 or 3 minutes. This mixes the food with the gastric juices, and helps to liquefy it. As the food reaches a semi-liquid condition of about the consist- ency of pea soup, the pylorus opens from time to time and small jets of the liquefied and partially di- gested food enter the small intestine. The large end of the stomach exerts a steady pressure on the food so that the active end is given a new supply. When the entire contents of the stomach becomes acid, the digestion of starch for the time being ceases. The whole process of stomach digestion occupies from three to six hours, after which time the pylorus opens and allows any insoluble substance remain- ing to pass into the intestines. The cause of the flow of the gastric juices is an important consideration. Formerly it was thought DIGESTION V that the mere presence of food in the stomach was sufficient to bring about the necessary secretions, but by means of some wonderfully ingenious experi- ments on dogs, the Russian physiologist, Pawlow (Pav-lov), has proved that this is not so. He intro- duced easily digested food, like egg albumen, into the stomach of a sleeping dog and found that it re- mained unacted on for hours, even after the dog was awakened. He stimulated the walls of the stomach mechanically in every possible way, and showed that no secretion followed. When, however, a hungry dog was even shown a piece of meat, after a waiting period of about five minutes, the gastric juices began to flow abundantly. The smell or the eating of foods by a hungry dog always produced active secretions, even though the food did not reach the stomach. The flow was in proportion to the desire; that is, greater when the dog was hungry and greater for well-liked foods. This secretion Pawlow called the "appetite juices," or the "psychic juices." Only a very few substances were found to stimu- late the secretion through their chemical composition — the most active being extracts of flesh, and to some extent water and milk, and gelatine slightly. The secretion brought about chemically was not nearly so great in amount or so long continued as that stimulated by the appetite through senses of taste and smell. These psychic juices, once started, are in quite Appetite or Psychic Juices Chemical Excitants 58 PERSONAL HYGIENE Composition of Psychic Juices Importance of Appetite large amount, increasing for an hour or so, and then diminishing. Pawlow found that after the psychic juices begin to digest the food, the substances formed caused an increased quantity of secretion, the com- position depending upon the character of the food being digested — proteid food causing an increase in the quantity of pepsin, starch being without effect, and fats decreasing the amount somewhat. Moreover, he found that on a given diet the psychic juices were always of about the same composition — a composition suitable for the food being eaten, that is, on a meat diet the secretion of pepsin was more abundant than on a bread and milk diet. On changing, say, from a meat diet to a bread and milk diet, the change in the composition of the psychic juices was a gradual one. This indicates that a radical change of diet should only be made gradually. These epoch-making discoveries emphasize the importance of appetite. Its importance has long been known from the experiences. "Now, good digestion wait on appetite, and health on both!" — Macbeth. Pawlow's work, however, proved that former ex- periments which seemed to show that the flow of the gastric juices was excited mechanically were incorrect. This error led to the practice of paying chief attention to ease of digestion in selecting foods when there was digestive disturbance. While digesti- DIGESTION 59 bility must be considered in such cases, it is not enough to take the easily digested foods, for even they might not be properly digested unless eaten with enjoyment. Food, then, should be appetizing, it should be taken slowly and tasted to the utmost, it should be eaten under agreeable conditions and the mind should not be so occupied with other matters that the food is swallowed almost unconsciously. The food leaves the stomach, a small part at a time, in a semi-fluid, partly-digested condition. The starch has been partly changed into maltose and dextrin, the proteids into peptones, the connecting tissues dissolved, the fats liquefied and finely divi- ded. The process has been mainly a preparatory one. Although there is some absorption in the stomach, it is of minor importance. Alcohol, some salts and some drugs are rather quickly absorbed there and enter the circulation. The most important part of digestion takes place in the small intestine. This is a tube from 20 to 25 feet long and about one inch in diameter. It is lined throughout with glands, and has a muscular covering, which keeps the contents constantly in motion. The movements of the small intestines are of two kinds — one which mixes the contents and the other which moves the contents forward. These move- ments may be illustrated as follows: Fill a rubber Products of Stomach Digestion Digestion in the Small Intestine 6o PERSONAL HYGIENE tube with water and tie both ends. With the fore fingers of each hand curved around the tube, press slowly and alternately, first with one hand and then with the other. This gives a backward and forward movement. Multiply this arrangement a few hun- dred times and the condition in the intestine is ex- emplified. Now run one finger slowly along the MOVEMENTS OP THE SMALL INTESTINES A, First position. B, Second position. Alternate movements give the backward and forward movement of the contents. Intestinal Ferments whole length of the tube; this gives the forward movement called peristalsis. The first portion of the small intestine leading from the stomach, is called the duodenum. Near its beginning enter the secretions of the pancreas — the most important digestive fluid of the body. This is strongly alkaline and yields at least three ferments, (i) Trypsin, which changes the proteids into peptones and these into simpler substances con- taining nitrogen, and others which do not contain nitrogen. It is much more active than the pepsin of the gastric juices, except in dissolving connecting DIGESTION 61 tissue. (2). Lipase, a fat splitting ferment which separates the fats into fatty acids and glycerine. (3) Amylopsin, much like the ptyalin of the saliva, which, like it, changes starch into maltose and dex- trin, but much more actively. Rennin is secreted, also. Very near the entrance of the pancreas is a duct, The Bile which brings a fluid secreted by the liver — the bile. This is in part a waste product from the blood. It is stored in the gall bladder until needed for digestion. The bile increases the power of the fat splitting fer- ment of the pancreas, and helps to dissolve some of the soaps formed when the fatty acids combine with the sodium carbonate in the alkaline juices. The glands in the walls of the small intestine intestinal itself give a secretion which contains a number of fer- ments, one of which Pawlow has called a "ferment of ferments." This greatly increases the activity of the proteid ferment in the pancreatic juice. An- other of the ferments converts the maltose and dex- trin formed from starch into dextrose. Two others change cane sugar into dextrose and levulose and milk sugar into dextrose and galactose. It is nec- essary for the carbohydrates to be converted into simple sugars to be useful in nutrition. Still another ferment acts on the peptones, changing them into simpler bodies. The intestinal secretions also contain a very inter- esting substance which, when acted upon by the acids Secretions 62 PERSONAL HYGIENE of the gastric juice, forms a substance which enters the blood and stimulates the secretions of the pan- creas, and possibly the bile. Thus, indirectly, the regularity of digestion and expulsion of the contents of the stomach controls the secretion of the very im- portant pancreatic juices. Absorption Active absorption takes place in the small intes- tine. The surface is very greatly increased by minute filaments called villi. Each contains blood vessels and a lacteal. The digestive products of proteids and carbohydrates are absorbed into these blood vessels and the fatty acids and soaps by the lacteals. The veins of the villi enter the portal vein, which passes to the liver, where the products of digestion undergo further changes before entering the general circulation. The liver converts a portion of the sugar into glycogen, storing it for future use and maintain- ing a constant percentage of sugar in the blood. The products of the fats — soaps and fatty acids, ab- sorbed by the lacteals, are to a large extent imme- diately made into fats in the walls of the intestine. The lacteals unite into larger vessels, which finally combine into the thoracic duct, from whence the fats pass into the general circulation near the heart. How and why absorption takes place in this man- ner is beyond present knowledge. Here, as else- where in the body, substances must pass through membranes. There are no holes. The living cells have the power of selective absorption and control DIGESTION 63 sierA Av& •Thoracic' Ductj the process, although the physical laws of diffusion and osmosis must operate to some extent. The entrance into the large intestine is guarded by a circular valve. The large intestine, or colon, is about five feet long and two inches in diameter. It is di- vided into an ascending, trans- verse and descending portion,, and joins the rectum by the sig- moid flexture. The movements of the large intestine are some- what similar to those of the small intestine, but less frequent. No enzymes are secreted here, but those already mixed with the food continue active. A mucus-like substance is secret- ed, which serves for lubrication. The food entering the large intestine is of about the same consistency as when it left the stomach, absorbtion balancing secretion in the small intestine. Absorption takes place more actively than secre- tion in the large intestine, and the contents gradually become solid and are expelled into the rectum. The nutriments absorbed take the same course as from the small intestine, the fats to the lacteals, the sugars, etc., to the portal vein and liver. Diagram of the Circulation from the Digestive Organs. Large Intestine Absorption in the Colon 64 PERSONAL HYGIENE Bacterial Action in Digestion Bacteria Unnecessary The action of bacteria in digestion remains to be considered. All foods contain bacteria — some in immense number. (See Household Bacteriology.) While solid food is being stored in the large end of the stomach, the bacteria act on the carbohydrates to some extent, but cannot affect the proteids ordin- arily present in food. If stomach digestion is unduly delayed, carbon dioxide and other gases may be formed, which cause belching and flatulence. In normal conditions, the contents of the stomach soon become acid from the hydrochloric acid, which de- stroys nearly all kinds of bacteria and renders the few that remain inactive. The contents of the small intestine are neutral, or slightly alkali, and fermentation of the sugars may take place, also putrid fermentation of the peptones, unless they are absorbed promptly. Conditions in the large intestine are favorable for the growth of bacteria and putrefaction of proteid materials goes on. Substances are formed which, if absorbed in small quantity, are disposed of in the liver and promptly secreted in the urine. If, however, there is much undigested or unabsorbed nitrogenous ma- terial, or if it remains for too long a time, toxines may be formed which, entering the blood, cause headache, and the condition conveniently termed "bilious." The statement has been made that the action of bacteria is necessary for digestion, but this is prob- DIGESTION 65 ably incorrect, for some of the animals of the arctic regions have no bacteria in the intestines. It is possible that certain bacteria may act on cellulose, which the digestive juices of man are not able to affect, and render some of it digestible. Bacteria are always present in both the small and large intes- tines, but in the conditions of health they do no harm. THE BLOOD Composition of the Blood Plasma and Corpuscles "White Corpuscles The digestion of food keeps the blood supplied with materials used by the body for heat and energy, for repair, and for building. All the substances needed by the body for this work are contained in it. In addition, nearly all the waste products, gases and solids, form a part of the blood on their way to the organs of elimination. It is apparent that the com- position of the blood must be very complex. Under the microscope the blood is seen to consist of a nearly colorless fluid called the plasma and numer- ous corpuscles, the red and white. A drop of blood contains about 500 million red corpuscles and 500 thousand of the white corpuscles. The red corpus- cles are concave discs and contain a substance — hemoglobulin — which gives the red color to the blood. With this substance oxygen forms a loose combination and the function of the red corpuscles is to carry the oxgyen absorbed in the lungs to each and every cell, to be used in combining with the nu- trients of food and yield the energy necessary for cellular activity. The red corpuscles are formed in red bone marrow. The white corpuscles are not all alike, but may be roughly classed as the leucocytes and the lympho- cytes. The leucocytes are formed chiefly in the white marrow of the bones. They, like the amoeba, have the power of independent movement, and can 66 THE BLOOD 67 even penetrate the walls of the capillaries and move between the cells. They repel or destroy bacteria or other foreign bodies, which may be introduced among the cells. The lymphocytes are formed in the lymph glands and perhaps in the spleen. Red BLOOD CORPUSCLES They are thought to aid in the absorption of fats and peptones, and help in the coagulation of the blood. The blood also contains very minute bodies called the blood plates. These are about one-tenth the size of the red corpuscles. It is thought that they aid in the coagulation of blood, beyond which their function is unknown. The blood equals about rV the weight of the body — about twelve pints in volume. The plasma con- tains 90 per cent water, 7 or 8 per cent proteid Blood Plates Gland 68 PERSONAL HYGIENE material, o.i to 0.2 per cent of sugar, a smaller quan- tity of fat, mineral salts, and a very great many other substances which, though small in proportion, are vitally necessary to the body. Ductless Among the substances present in the blood in minute quantities are the secretions of the so-called ductless glands. The thyroid glands, situated in each side of the neck, contribute a secretion neces- sary for nutrition. Their complete removal leads to mental and physical deterioration and usually to death. The adrenal bodies, found near each kidney, secrete a substance necessary to maintain muscular tone, especially of the muscles in the walls of the small arteries. Death results from their removal. There are other small glands which also produce sub- stances necessary for health. Numerous small bodies imbedded in the pancreas add to the blood an inter- nal secretion absolutely necessary for the oxydation of sugar in the cells of the muscles and glands. THE CIRCULATION The blood is the connecting medium between all the organs of the body. The circulatory apparatus consists of the heart, arteries, capillaries, veins and lymphatics. The large arteries from the heart divide and subdivide until they become capillaries in the tissues. These are so numerous that a needle can- not be inserted anywhere in the flesh without pierc- ing some. The capillaries unite into the veins which THE CIRCULATION 6 9 carry the greater part of the plasma and all of the red corpuscles back to the heart. Part of the plasma passes through the thin walls of the capillaries and actually surrounds the cells. Here it is called lymph. Each cell of the body is bathed in lymph. The lymph, then, con- sists of blood minus the cor- puscles and plus the products of cellular activity, which natu- rally varies with the kind of cells. The lymph between the cells drains back towards the heart through small vessels which orig- inate blindly in the tissues. These lymphatics unite into larger vessels and finally empty into the right lymphatic and the thoracic duct, which pour their contents into the larger vein near the heart. Thus the blood leaves the heart through the arteries, passes through the capillaries and returns to the heart through the veins and lymphatics. The heart is a double muscular force pump, which keeps the life-giving stream of the blood in motion. Each contraction of the heart forces a jet of blood from one side through the arteries leading to all the DIAGRAM OF THE CIR- CULATION. A. Capillaries of the di- gestive organs. B. Of the liver. C. Type of various systems of capillaries as in the leg, kidneys, brain, etc. L. The lungs. Dot- ted lines represent the lymphatics. Lymph The Heart 70 PERSONAL HYGIENE Rate of Flow Nervous Control of Heart Beats organs, and from the other side to the lungs. This throb or "pulse" can be most conveniently felt at at the thumb side of the wrist. The course of the circulation is from the right side of the heart through the capillaries of the lungs, back to the heart, and from the heart through the arteries to the capillaries of all the other organs of the body, and back to the heart by various paths through the veins and lymphatics. The walls of the arteries are strong and elastic. The pressure of the heart -beat dilates them and their contraction continues to force the blood forward be- tween heart pulsations. The flow of the blood is very rapid — about twenty feet a second in the arteries and large veins, but slow in the capillaries. The time required for a particle of blood to make the complete circuit of the body is about twenty-three seconds, on the average. It naturally takes longer for the blood to make the cir- cuit through the foot than through organs near the heart. The whole volume of the blood passes through the organs of the body, the kidneys for instance, a number of thousand times a day, thus bringing a constant supply of nutriment and rapidly carrying away wastes. The heart is an automatic organ, and continues to beat when supplied with blood even when all nerve connection with other parts of the body is severed. THE CIRCULATION 71 DIAGRAM OP THE HEART, LARGE ARTERIES AND VEINS, SHOWING KIDNEYS. 72 PERSONAL HYGIENE Distribution of the Blood Supply Some of the salts in the blood keep up the action, probably by stimulating nerves in the heart itself. It also has two sets of nerves coming from the cord and from the back of the brain. One set of nerves called augmentor nerves or accelerator nerves, in- creases the rapidity and power of the heart-beats; the other set produces the opposite effect, decreas- ing the rapidity of the heart-beats. These are inhib- itory nerves and their action is called "inhibition. " The proportionate supply of blood which each organ of the body receives is regulated by the con- striction and dilation of the small arteries. The muscular walls of the arteries are supplied with two sets of nerves — the vasco-constrictors and the vasco- dilators. When an organ is active, the arteries dilate, giving it a larger supply of blood. As the total quan- tity of blood is not sufficient to give all the organs the maximum quantity, the blood supply to other organs is diminished. This fact has many practical applications. When the digestive apparatus is active, some of the blood is drawn from other organs. If a heavy meal is taken, the blood supply to the brain may be lessened, and drowsiness result. In hot weather much blood flows to the skin, and mental work is more difficult. Active muscular exercise draws blood away from the internal organs, so vio- lent exercise should not be taken directly after a heavy meal, for the stomach will not receive a suffi- cient blood supply for active secretion. If the sur- THE CIRCULATION 73 face of the body is cold, the blood vessels supplying the skin contract, forcing an abundant flow of blood through the brain, under which condition it is diffi- cult to go to sleep. While the heart is the chief means of moving the blood, that in the veins and especially in the lym- phatics is impelled towards the heart by two other Accessory Means of Circulation A B C SECTIONS OF VEINS a. Split open showing Pocket Valves. 6. Valve open. c. Valve closed. means, the most important being respiration. At each inspiration, when the air is drawn into the lungs, there is at the same time a suction produced in the blood vessels and lymphatics of the chest. The alternate expansion and contraction of the chest and abdomen would simply make a backward and for- ward movement in the veins, if their walls were per- fectly free, but the veins and lymphatics contain valves which allow the blood to flow towards the heart, but prevent its return. In the same way 74 PERSONAL HYGIENE The Blood and Illness Anaemia periodic contraction and hardening of the muscles forces the blood out of the veins towards the heart, and the valves prevent its return; thus deep breath- ing and muscular exercise are important aids to a good circulation of the blood and lymph. The very intimate relation between the blood and every part of the body gives it a large share in all matters of health and sickness. For this reason it was believed for a long time that disorders of the blood were the cause of disease. When a person be- came sick, it was thought that an evil spirit or some impurities had found access to the blood, and that a cure could only be effected by removing them, hence the custom of blood letting, practiced for many years. Of course, this treatment served only to weaken the patient, and those who recovered were cured in spite of, rather than because of, blood let- ting. The blood itself is never the cause of illness, but in many forms of disease, particularly the chronic and protracted forms, and in all cases of general de- bility, it is reduced in quantity and altered in quality. The most common example of this condition is anaemia, in which the red corpuscles are reduced in number and their ability to carry oxygen is im- paired. The cause of anaemia is generally lack of muscular activity and fresh air. If moderate out-of-door ex- ercise is taken every day, with plenty of sleep, the appetite is increased, more food is eaten and digested, RESPIRA TION 75 and the blood is gradually restored to its normal condition, and all symptoms of weakness disappear. The old idea of impurities in the blood still sur- vives, and is the foundation for the belief that the blood needs to be purified in the spring by taking purgatives and all sorts of "spring medicines." The real cause of lowered vitality, weakness and "that tired feeling" is found in confinement to over- heated rooms, late hours, too much food, and lack of out-of-door exercise during the winter months. RESPIRATION In the "running of the machine" we have con- use of sidered how the blood is supplied with nutriment Nutrition and how it is transported to the cells, but for cellu- lar activity oxygen is as necessary as nutriment. A fire cannot be kept up without oxygen any more than without fuel. Because the oxygen of the air is everywhere present and invisible, this is not so appar- ent. The nutriments are useless to the cells with- out the oxygen to combine with them, and through the chemical union set free the energy necessary for all life processes. Oxygen is the most impera- tive requirement of the body. Food may be with- held for a week or more and drink for days, but if we are deprived of oxgyen for but a brief interval, life is extinguished. It it then the cells which use the oxygen, the lungs serving only to absorb, and the blood to transport it. Respiratory Organs 76 PERSONAL HYGIENE The two openings of the nose unite above the back of the mouth in the space behind the soft palate, called the nasopharynx. The nasal space is a high arched dome, having the roof of the mouth as a base. The passages are divided and subdivided into a AIR CELLS OP THE LUNGS Redrawn from The Human Mechanism. labyrinth, all lined with mucous membrane. In going through these passages the air inhaled is warmed to the body temperature, and for the most part, freed from dust and accompanying bacteria. The fine hairs in the nostrils strain out much of the dust, and the remainder is caught on the moist surfaces. Cer- tain ciliated cells propel the dust towards the open- ings of the nose. Through the larynx the air passes to the trachea, which divides into two branches called RESPIRA TION 77 bronchi, one going to each lung. The bronchi di- vide and subdivide, terminating ultimately in small air sacs, having exceedingly thin walls and many cap- X 4~ V IM- POSITION OF THE HEART AND LUNGS illaries. Through these thin walls takes place the absorption of oxygen by the plasma and red corpus- cles and the elimination of carbon dioxide from the plasma to the air. 78 PERSONAL HYGIENE The Lungs The lungs contain normally about 200 cubic inches of air. In ordinary quiet breathing we take in about 30 cubic inches and by forced inspiration we may take in an additional 100 cubic inches. We can expel by forced expiration about half the contents of the lungs. If we never use but a part of our lung capacity, the more distant air sacs lose tone and may become closed. This is one of the reasons why deep breathing is necessary. Breathing Inspiration is accomplished by the muscles of the chest and the diaphragm. The chest muscles in- crease the depth and breadth of the chest by lifting the breast bone and the ribs. The diaphragm, which is a thin dome-shaped muscle forming a partition between the chest and abdomen, flattens out to some extent and increases the length of the chest. This pro- duces a partial vacuum, which the air rushes in to fill. The proper method of breathing is of great im- portance. With men whose clothing often restricts the chest movements, abdominal or diaphragmatic breathing predominates. With women upper chest breathing is usually made necessary by the restric- tion of the waist from corsets. The natural method of breathing is both abdominal and intercostal. Adenoids Growths in the nose, as adenoids, may restrict the free passage of air to the lungs and thus make mouth breathing necessary. Nature intended that air should be taken in through the nose and any inter- ference of the nasal passages should be remedied. RESPIRA TION 79 It is a common expression that " oxygen purines the blood." It is true that the carbon dioxide, water and a small amount of other waste matter are eliminated during expiration, but oxygen in uniting with the nutriments of food in reality vitiates the blood. The plasma is made up chiefly of water which has little capacity for dissolving oxygen so the red cor- puscles, with their hemoglobulen, are the chief trans- porters of oxygen. The hemoglobulen in the presence of oxygen forms a combination, oxy-hemoglobulen. This, when it reaches the cells which have used up the oxygen dissolved in the lymph surrounding them, gives up a portion of its oxygen to the surrounding plasma and lymph, whence it is absorbed by the cells. On the other hand, the lymph and plasma have a considerable capacity for dissolving carbon dioxide and quickly absorb that product formed when the oxygen combines with the carbon of nutri- ments during cellular activity. On reaching the lungs, the plasma loses a portion, but not all, of its carbon dioxide. Arterial blood still contains some carbon dioxide and the red corpuscles and venous blood still contain some oxygen. Under all ordinary conditions the blood has a suffi- cient supply of oxygen. Deep breathing, or muscular exercise, or even increasing the proportion of oxygen in the air does not cause the blood to absorb more. The value of deep breathing and exercise is not in giving the blood more oxygen, but in making the. Oxygen Carriers So PERSONAL HYGIENE Effect of Impure Air circulation more rapid by increase of the number and power of the heart beats. Exercise is about the only- natural way of increasing the rapidity of the blood stream, thus making the removal of all waste matter more effectual. Deep breathing, as we have seen, is important in keeping the lungs in good condition and in helping the return of the blood from the veins and lymphatics to the heart. The carbon dioxide in expired breath is not in itself poisonous, and recent researches have seemed to show that the organic matters in expired air are not so poisonous as formerly supposed; however, the evil effects of breathing vitiated air are painfully apparent. The harmful effects are probably in the depressing effect on the nervous system rather than in actually poisoning the tissues. Every one knows the effect of fresh, out-of-doors air. We need to get out of doors every day, rain or shine, for as long a time as possible. Man was intended for an out-of-doors animal. Certain burrowing animals, like the woodchuck, may be able to thrive on impure air, but not man at his best. Consumption and pneumonia are essentially house diseases. The necessity of providing by ventilation a constant supply of fresh air in our houses and especially in sleeping rooms is treated in Household Hygiene, and need not be spoken of further. In the winter, good ventilation adds to the fuel bill, but we would not knowingly buy food containing even a small amount NUTRITION 81 of harmful substances to save ten or even twenty per cent of the cost. Why, then, begrudge the money spent for the more important necessity of the body — pure air? We are very dainty about many things, but why breathe "second-hand air " without a qualm ? NUTRITION We now come to the question of how the cells of the body make use of the nutrients of food and oxygen brought to them by the blood. Much is known as to the results of the life processes, but a great deal yet remains to be found out about the exact process itself. Digestion, absorption, assimilation — the building- up process is called anabolism, the destruction of nutrients and breaking down of tissues, katabolism, and both processes taken together, metabolism. Of the five nutrients — water, salts, proteids, car- bohydrates and fats — water and salts yield little or no energy to the body. After use they are ex- creted in much the same form as they were absorbed. They are, however, an essential part of all living cells. Without the bones, the body is made up of over three-fourths water, the fat free muscles and glands 87 per cent, the blood nine-tenths. Water is neces- sary in all life processes for dissolving substances, in the digestive juices, and for carrying away wastes. Water is lost from the lungs, and skin, but more through the kidneys — a total of about three pints Metabolism Nutrients ■Water in Nutrition 82 PERSONAL HYGIENE daily in ordinary weather and double the amount in hot weather. The loss is made good in part by the oxydation of the hydrogen, contained in all foods, to water. This may supply about a pint a day. The remainder must be made up by the water in food and by the drinking of water. Water is especially neces- sary if the diet is high in proteids as some of the products of proteid disintegration are not very soluble. Except in rare disease conditions, there is no danger of drinking too much water, but there is grave danger in drinking too little, salts in Salts form a part of all living matter, vegetable Nutrition . , . ....... and animal. The chief salts present m the body are chlorides, phosphates, sulphates and carbonates of sodium, calcium, magnesium, and iron with some others. Common salt — sodium chloride — is the only one purposely added to food, chiefly to bring out flavor. There seems to be an especial craving for it if the diet is largely made up of vegetables. We habitually use more salt than is needed by the body. The excess is secreted in the urine for the most part but the sweat and tears contain a little. The hydrochloric acid of the gastric juices is made chiefly from sodium chloride, the sodium part of the salt serving to form the carbonate of soda of the pancreatic and intestinal secretions. In addition to bone formation, the calcium salts are necessary for the coagulation of the blood and the clotting of milk, and with common salt and potas- NUTRITION 83 sium chloride in the blood, they keep up the regular beat of the heart. Iron is a necessary part of the hemoglobulen of the red corpuscles. Nearly all vegetables contain iron, but spinach has an especially large proportion of it. Meats and the yolk of egg contain a considerable amount. In any ordinary diet the body receives a sufficient supply of the salts. Some of them must be present in organic compounds to be of use. The three remaining nutrients, proteids, carbohy- drates and fats, all contain carbon, hydrogen and oxygen, but the proteids also always contain nitrogen and sulphur and sometimes phosphorus and iron. The fats have a much smaller proportion of oxygen so they can combine with a larger amount. For this reason they yield over twice as much heat and energy when oxydized as the carbohydrates or proteids. As the living cells are composed almost entirely of proteid material, except for water and a small amount of salts, it is apparent that the body must have food containing nitrogen and sulphur for making good the loss of cell substance which is constantly taking place during activity, and the young require proteid material for the growing tissues. It has been proved many times that without proteid food all animals starve, even if there is an abundance of the other food principles. Moreover, the nitrogen must Composition of the Nutrients Use of Proteid Foods 8 4 PERSONAL HYGIENE Liebig's Theory be in the form of true proteids — the gelatinoids (often called albuminoids) of which gelatine is a type, and the extractives, although they contain nitrogen and sulphur, cannot take their place. On the other hand, life may be maintained without serious trouble on proteid foods alone, showing that they may furnish heat and energy as well as repair wastes. As the muscles contain such a large proportion of proteid, Liebig set forth the theory about fifty years ago that proteids were the only source of muscular energy. It has since been conclusively proved by Voit and many others that this was a wrong suppo- sition, and that heat and energy may be supplied by carbohydrates and fats as well as by proteids. A marked difference between the proteids and non- nitrogenous foods is the fact that the nitrogenous part of proteids, at least, is eliminated by the body as fast as it is consumed; that is, if three ounces of proteid is consumed daily, nitrogen equal to that in three ounces of proteid is eliminated. If the proteid feed be increased to four ounces a day, the nitrogen excreted corresponds to four ounces. It has been found that the body will maintain this "nitrogen equilibrium" on widely varying amounts of proteid in the diet, provided the other constituents are in sufficient amount; and in general that the nitrogen excreted is irrespective of muscular exercise being taken. This does not hold in very severe exercise long continued, during which some of the body NUTRITION 85 nitrogen is used, more being eliminated than con- sumed. In going from a low proteid diet to a high proteid diet there is at first a small apparent storage of nitro- gen material. This is lost, however, when the diet is changed back to one lower in proteid. The body seems to have little power of storing proteids. If the supply is deficient, it uses its own body proteids. In starvation and in certain diseases the larger muscles waste away, some of their proteid being used to repair cells more necessary for life, as the cells of the heart muscles and nerve cells, and som^ for supplying heat and energy. If the consumption of carbohydrates and fats be increased, on the other hand, there is no proportionate increase of their waste products, but an increase of muscular exercise markedly increases the excretion of carbon dioxide coming from the carbon of food prod- ucts. See page 49. When more food is eaten and absorbed than is needed to supply energy and heat, the excess is stored as glycogen and fat. As we have seen, the starches, sugars, and gums are changed by digestion into dextrose, or other simple sugars, and as such abscrbed by the intestine, passing first through the portal vein to the liver before reaching the general circu- lation. The liver, with the help of an enzime, changes a portion of the dextrose into glycogen — animal starch. This is changed back again into sugar as it Elimination of Carbon and Hydogen Storage of Food Materials 86 PERSONAL HYGIENE Use of the Fats Oxidization in the Body How the Cells Use Nutrients is needed in the body, a constant proportion of sugar in the blood of the general circulation being main- tained. Glycogen is also stored in the muscles and some of the other tissues of the body. Experiments have proved beyond a doubt that carbohydrates in excess of bodily needs may be transformed into fat and stored as reserve food supply. The fats absorbed by the lymphatics are used at once if needed. If the food digested and absorbed is in excess of bodily requirements, fats and the car- bohydrates transformed into fat are stored, sometimes between the cells themselves but usually in the con- necting tissue, especially that surrounding the abdom- inal organs and that directly beneath the skin. The transformation of glycogen into sugar is a very simple one, so this serves as an immediate reserve food supply. It is not known just how the fats are used, but they are taken up by the blood, wherever they are stored, and transported to the part of the body needing fuel. The oxidation of the sugar by the cells is by no means a simple union of oxygen with the carbon and hydrogen, forming directly carbon dioxide and water. The process is in several stages governed by differ- ent enzimes. It is stated that sugar is first changed to lactic acid and this to alcohol, which is finally oxidized to carbon dioxide and water. One theory is that the nutriments of food are first built into the cells before being oxidized, but most NUTRITION 87 authorities now agree that it is more probable that the cells make use of the nutriments constantlys urround- ing them in the lymph in the same way as the yeast cells use a solution of sugar surrounding them when they oxidize it in their life process. The muscles and glands are not entirely dependent on the immediate supply of nutrients and oxygen brought by the blood. For example, the leg muscles of a frog, removed entirely from the body and its blood extracted, may be made to contract a number of times if the nerves are stimulated by an electric current. The contractions gradually grow weaker with successive applications of the current until they cease. Carbon dioxide and other waste products are given off. It is not known in what form this energy is stored, but the substance must be in chemical nature some- thing like the explosives in which the oxygen is held in some loose way so that it is able to unite with the carbon and hydrogen of the substance, when a spark or heavy blow starts the action. In the muscles of the body it is the nervous impulse which starts the chemical process. We are not accustomed to think of the oxidation of carbon at a low temperature as we are so familiar with common forms of rapid combustion at a high temperature where light is produced. We are also accustomed to think of heat as being the only form of energy produced by oxidation, but in the electric Reserve Energy Use of the Energy of Oxidization 88 PERSONAL HYGIENE battery we have an instance of the energy of chemical union being changed in part into heat and in part into electricity. The body cells use the energy of chemical union of nutrients and oxygen in many ways. In the muscles it is apparent in movement. In the glands the energy is used to transform some of the contents of the blood into its peculiar secretion. In the nerves the energy is transformed into a nervous impulse, and so on. Just how this happens is one of the many mysteries of life processes. The use of the carbohydrates and fats by the body cells is fairly well understood. They contain only carbon, hydrogen and oxygen,~ and their ultimate waste products are known to be carbon dioxide and water. Volt's The proteids are much more complex chemical of the use bodies. The exact way in which the atoms are com- bined in the molecule is not known of any of them. The way the proteids are used by the body has been a subject of a great deal of study and controversy. One theory is that they are all built into the living cells before being used, but, as we have already said, this seems improbable, because of the very rapid excretion of waste products of proteid soon after they are absorbed. The theory of Voit is that they are used from the blood for heat and energy by the cells in much the same way as the sugar, and that the cells use proteids in preference to sugar and fats. This has led to the common teaching that other nutri- of Proteids NUTRITION ents — the gelatinoids, carbohydrates and fats — are "proteid sparers," in the order named. Recent experiments and analyses made by the physiological chemist, Dr. Folin, at the McLean Hos- pital, Waverly, Mass., and other workers have led to the bringing forth of a new theory as to the role played by the proteids in nutrition.* The cells must have a certain amount of proteid to make good their substance lost during activity. In digestion the proteids are changed into soluble pep- tones and simpler bodies, but no peptones are found in the blood. It is thought that the proteids of the blood are built up in the walls of the intestines dur- ing absorption. The blood and lymph are richly sup- plied with proteid material from which, without doubt, the cells make good their loss and new cells are formed. Dr. Folin's experiments seem to show that only a small proportion of the nitrogen of the proteids taken in the food reaches the general circulation as pro- teid, but that most of the nitrogen and sulphur por- tion is split off during digestion and elsewhere, the nitrogen products changed chiefly to urea in the liver, and the urea and sulphur compounds eliminated from the blood by the kidneys soon after. Urea contains nitrogen, carbon, oxygen and hydro- gen. It is a substance somewhat similar to ammon- ium carbonate, to which it is easily changed outside the body. * See article in Food and Dietetics, page 196. Folin's Theory Formation of the Proteid in the Blood Nitrogen and Sulphur Split Off go PERSONAL HYGIENE The remaining part of the proteid substance — the carbon, hydrogen and oxygen — is changed, per- haps, to sugar and used like sugar. At least, it is known that proteids may yield glycogen. According to Forin's theory, then, the body uses little or no pro- teids, as such, for heat and energy, but their nitrogen and sulphur part is at once split off. The remaining part only — the carbon, hydrogen and oxygen — being of use to the body, except for a comparatively small part of that in an ordinary diet which makes good the proteid of the blood used for cellular repair and growth, cellular On a diet of starch and cream, containing practically Destroyed no proteid, he found that the daily excretion of nitro- gen products for an average size man conesponds to about 20 grams of proteid. From this and further experiments he is led to believe that the 20 grams of proteid — about ^4 °f an ounce — represents the daily proteid waste of the living cells. If Folin's theory is correct, and it seems to have been accepted by recent writers, the proteid required for the needs of the adult body to repair wastes is much less than was formerly supposed. Experiments by Professor Chittenden lead to some- what the same conclusion. While Voit and others taught that about 118 grams of dried proteid are needed daily by an adult man weighing about 150 pounds, Chittenden's experiments have shown that health may be maintained, for months at least, on from 30 to 50 grams of proteid daily. NUTRITION 91 Whether or not it is desirable to maintain the body- on low proteid diet is another question. The experi- ence of past ages cannot be lightly cast aside. The amount of proteid food recommended by Voit, At- water and others in standard dietaries is taken from the quantity consumed, on the average, by people free to choose. In some diseases, like consumption, experience has proved that high proteid feeding is very beneficial. On the other hand, the products of proteid destruction are more harmful to the body if they accumulate, and their removal involves more labor on the part of the excretory organs than the elimination of the carbon dioxide and water produced when fats and carbohydrates are used. The consumption of meat increases the amount of uric acid and other "purin bodies" formed, and this is undesirable in diseased conditions like rheuma- tism and gout. There is no evidence that such diseases are caused by uric acid. The proteids of eggs, milk, grains, nuts, peas and beans, do not increase the formation of uric acid. Uric acid is a normal waste product of cellular disintegration. It varies in different individuals. In birds it is the chief excretory product of nitrogen. There is no conclusive evidence at present that proteids may be converted into fat. It is known that they may be changed to some extent into glycogen, but the body can store only about seven ounces of glycogen, consequently if the body has the maximum Low Proteid Diet Uric Acid Formation Proteids Cannot be Stored Must be Destroyed Q2 PERSONAL HYGIENE Proteids Increase Total Oxidization quantity of glycogen, it must use up — oxidize — the proteids eaten and digested in excess of the com- paratively small amount necessary to repair cellular waste. It has been found that increasing the pro- portion of proteid, if the diet is liberal, does increase the amount of oxygen consumed, carbon dioxide elimi- nated, and consequently the output of heat of the body, even if there is no increase in muscular work. In other words, with the body at rest more heat will be produced and given out on a liberal diet made up largely of meat and other proteid foods than on a* liberal diet composed chiefly of starch, sugar, and fat. It might be stated here that the splitting off of the nitrogen and sulphur from the proteid probably involves the production of a little heat, and that to form sugar or glycogen from the residue some oxida- tion is necessary ; this would account for some of the increased heat production on a diet made up largely of proteids. Not only is the carbon and hydrogen of proteid oxidized nearly as fast as it is assimilated, but there is apparently greater total oxidation in the body. That is, assimilation of proteids stimulates oxidation of the carbohydrates and fats. Just how much this stimulation amounts to cannot be said now. It is probably greater if the external temperature is high. The United States Department of Agricul- ture, in its nutrition investigations with the respira- tion calorimeter, is working on this problem, and NUTRITION 93 the results of the experiments will be available shortly. There is, then, a marked difference in the way the carbohydrates and fats on the one hand and proteids on the other react in the body. The consumption of carbohydrates and fats is somewhat like the consump- tion of coal in a hard coal fire. Adding more coal (fats and carbohydrates) does not increase the amount of combustion to any great extent. Oxidation is increased only by increasing the draft (increasing mus- cular exercise) . The proteids are more like some easily combustible stuff, like shavings. When put on the fire (absorbed) they are immediately consumed even if the draft is not changed, and in burning, they cause more of the coal (carbohydrates and fats) to be consumed. To sum up, the present theories as to the use made of the proteids in the body are about as follows: (i) The amount of proteid required for cellular Summary repair is much less than formerly supposed. Moder- of Proteids ate muscular activity does not seem to increase perceptibly the cellular proteid destroyed. (2) Under ordinary conditions, the body has little ability to store the proteids taken in food as proteid, nor the residue after splitting off the nitrogen and sulphur as fat. (3) The body must use up the proteid digested about as fast as it is absorbed, excreting the nitrogen chiefly as urea and oxidizing the carbon and hydro- gen to carbon dioxide and to water. 94 PERSONAL HYGIENE (4) Increasing the proportion of proteid in a liberal diet increases the heat output of the body and, especially if the external temperature is high, stimu- lates the oxidation of all the food materials. TEMPERATURE REGULATION Man with the higher animals is able to maintain approximately constant temperature through a wide range of external temperature. In the hottest day of summer or the coldest day of winter, the blood registers between 97.5° and 99.5^. (See Home Care of the Sick, page 43.) Cow The so-called cold blooded animals — frogs, turtles Animals reptiles, fishes — do not have this power of tempera- ture regulation. Their blood is the temperature of their surroundings or only a few degrees higher. In the cold winter months such animals and some of the fishes "hibernate." Some animals, like the bear and woodchuck, that maintain an even temperature in summer, hibernate during the winter months. They retire to some sheltered place and sink into a deep sleep. Life processes gradually sink and the temperature of the blood lowers to about that of the surroundings. They take no food, but live on their accumulated fat. Through our ability to keep the body usually at a higher temperature than the surroundings we are able to maintain activity throughout the year, even in the coldest climate, when otherwise we would have to TEMPERATURE REGULATION 95 remain in a half-alive condition through the cold season, like the bear. The question arises, how is the heat of the body obtained, and second, how is it regulated? The activity of all the cells produces heat in addition to their peculiar functions. Heat is always one of the products of life. The muscles cannot transform all the energy of the chemical union of oxygen and the food materials into the power of contraction. Only 25 or 35 per cent of digested and assimilated food can be so used, the remainder being changed into heat. The actively working glands produce much heat; the liver during activity may reach io7°F, but the rapidly circulating blood distributes the heat fairly uniformly, although that coming from the lungs to the heart is about one degree cooler than that from the general circulation. The skin rarely has a tem- perature over 93°F, and may of course become frost bitten if exposed to severe cold. The work of the internal organs and the friction in the circulation of the blood gives considerable heat, but not enough to maintain the vital temperature of the body at rest. This is supplied by a slight uncon- scious contraction in all the skeletal muscles and the muscles which contract the small arteries. They are under slight tension or "tone" brought about by successive nervous impulses. During cold weather this unconscious muscular tension or tone is greater, giving a greater production of heat. This accounts for Production of Heat Muscular Tone 9 6 personal hygiene the stimulating effect of cold. As the external tem- perature is lowered, the muscular tension increases and it finally becomes apparent in shivering. The heat of the body is lost on the average as follows : i. By urine and feces 1.8 per cent 2. By expired air : Warming of air. .. . 3.5 " " Vaporization of water from lungs 7.2 " " 3. By evaporating from skin 14.5 " " 4. By radiation and conduction from skin 73.0 " " We regulate the heat losses to some extent by wear- ing thicker or thinner clothing, according to the weather, but the chief means of getting rid of a superabundance of heat is through perspiration and the regulation of the flow of the blood to the skin. When active muscular exercise is taken or during hot weather an excess of heat is produced ; then the capillaries of the skin dilate, more blood flows near the surface and some of its heat is lost through conduction and radiation. If this is not sufficient, perspiration becomes much more active. The eva- poration of liquids, especially water, absorbs and carries away in the vapor a very large quantity of heat. Perspiration only becomes visible when it is secreted faster than it is evaporated. On a warm day with the temperature, say at g-o F, even when sitting still, the secretion of the perspira- tion is active and the blood vessels of the skin are dilated to their . fullest extent. As the temperature TEMPERATURE REGULATION 97 falls, perspiration becomes less abundant and at about 7o°F. almost ceases. Below 7o°F. the blood vessels begin to contract, forcing the blood to the interior of the body. At about 6o° they have con- tracted as much as possible and the body has done its utmost to prevent the loss of heat. To keep up the temperature of the body more heat must be supplied through muscular activity or warmer clothing must be put on. Moving air carries away heat rapidly, both by convection and by increasing evaporation. The amount of moisture in the atmosphere makes a great difference in the heat loss from the body. Moist air is a much better conductor of heat than dry air. On a winter's day when we say the air is cold and "raw", we mean that it contains a large propor- tion of moisture, and so conducts the heat away from the body rapidly. On a summer day, the air is "sultry" or "muggy" because it holds nearly all the moisture which it is capable of taking up, the per- spiration cannot evaporate from the skin rapidly and the body is more liable to become over-heated In our houses a temperature between 68°and 7o°F. is the ideal; then, with ordinary clothing, the blood is evenly distributed between the skin and the internal organs, and there is comparatively little perspiration. The dangerous temperature is between 65 and 6o°F.* If while sitting quietly in a room the tem- * The Human Mechanism, page 201. Effect of Humidity Ideal Temperature 9 8 PERSONAL HYGIENE perature gradually falls below 65°, the blood vessels of the skin are contracted more and more and the blood is forced into the internal organs and membranes, and the congestion may result in colds or other trou- bles. If the drop in temperature is gradual it may be unnoticed, whereas a sudden drop would be at once apparent and one would immediately proceed to increase the temperature or put on more clothing. It is equally dangerous to go from a room tempera- ture of 75 to 80 ° into the cold. (See Chemistry of the Household, page 19.) ELIMINATION The waste products of the human machine are its most dangerous enemies. Elimination is fully as important as alimentation and respiration. Food We have seen that the undigested part of food, and the waste portion of some of the digestive secre- tions, accumulate in the lower part of the colon. Here putrefaction goes on actively. The longer the wastes remain in the colon the more active becomes the decomposition by the bacteria. Some of the products, especially of proteid decomposition, are poisonous. As we have seen, the chief function of the large intestine is absorption. Food, even, is sometimes administered through rectal enema. It is apparent, then, that the accumulated wastes should be eliminated promptly. For most persons unloading of the rectum should take place daily. ELIMINA TION 99 Neglect of this internal cleaning is much more disas- trous than failure to clean the skin, for the skin is practically non-absorbent, while in the colon absorp- tion takes place constantly. A pasty complexion indicates defective internal cleansing more often than lack of care of the skin. It is surprising how many people, especially women, neglect this function. The vice of constipation is very prevalent among people whose occupation is sedentary. In addition to rectal troubles, such as piles and hemorrhoids, neglect leads to headache and various minor disorders. The remedy for constipation is not by drugging, but by the removal of the underlying cause, and es- pecially in establishing good habits. Regularity is as important here as regularity of meals. Defeca- tion should take place daily and preferably at ike same hour, so that the habit may become established. Food eaten should be such as will leave considerable bulk to be eliminated, that is, the diet should con- tain an abundance of vegetables and fruits, and grains which have not had all of their outer covering removed, such as oatmeal and whole wheat. Fats and oils help in some cases. Plenty of water should be taken; exercise, especially such as work the ab- dominal muscles and sometimes massage is helpful. The organs chiefly concerned in eliminating the wastes from the blood are the lungs and kidneys. Carbon dioxide, and incidentally some water, is dis- Constipation Wastes in the Blood IOO PERSONAL HYGIENE Proteid Waste Products charged by the lungs, also a small amount of carbon dioxide passes through the skin by diffusion from the blood in the skin capillaries. The nitrogen and sulphur products of proteid decomposition with water, salts, and many substances in small quantity are eliminated as urine by the kidneys. The oxidation of carbohydrates and fats yields only carbon dioxide and water. The proteids, gela- tinoids and extractives, in addition to carbon dioxide and water, give urea, kreatinine, uric acid, sulphur compounds and other substances in small quantities. The kidneys are two bean- shaped bodies situated on either side of the spinal column in the small of the back. A large artery and a large vein pass between them, both of which send off branches to each kidney. The blood flows from the artery through the kidneys to the vein. The kidney cells have the power of selective absorption and take out harm- ful and waste products from the blood. They are constantly secreting urine, which passes through the two ureters to the bladder from which it is dis- charged from time to time. Kidneys and Bladder. ELIMINA TION 101 In general, the secretion of the kidneys — the salts and other waste products, but not necessarily the water — is determined by the blood supply. Thus it is increased by active exercise, during which all the blood is circulating more rapidly. Cold weather increases the secretion to some ex- tent because the constriction of the blood vessels in the skin throws a greater quantity of the blood to the interior of the body. The amount of water in the blood is kept nearly Elimination constant by the activity of the kidneys and sweat glands. If more water is taken than is required, the excess is promptly eliminated. The kidneys must have sufficient water to dissolve the urea and other products, but especially uric acid. This is not a very soluble substance, and is the probable cause of a number of disorders, for which reason and others, it is desirable to have an excess supply of water. During active perspiration, the skin secretes con- siderable water and a small amount of urea and other waste products found in the blood. If a large amount of water is secreted by the sweat glands less is eliminated by the kidneys. In certain diseases of the kidneys, the excretion of the urea in the per- spiration is increased, but the more important func- tion of the sweat glands is their work in temperature regulation, and not in their elimination. TEST QUESTIONS The following questions constitute the "written reci- tation" which the regular members of the A. S. H. E. answer in writing and send in for the correction and comment of the instructor. They are intended to emphasize and fix in the memory the most important points in the lesson. PERSONAL HYGIENE Read Carefully. Answer each question fully. Do not be afraid of writing too fully. Use your own words, so that the instructor may be sure that you understand every point. You are expected to ask questions freely. Leave space be- tween your answers for comments and write on one side of the sheet only. i. How is energy of the human machine obtained? In what ways is this energy used ? 2. What are enzimes and how are they of use in the body? 3. Trace the digestion and absorption into the gen- eral circulation of (a) starch, (b) the fats, (c) the proteids. 4. What brings about the secretion (a) of the saliva, (b) the gastric juices, (c) the pancreatic juice? 5. To what extent have we voluntary control over digestion ? 6. What can you say of the composition of the blood ? (b) How is its proportion of sugar maintained ? (c) How is the blood circulated ? (d) What would be the effect of a sluggish circulation and what might bring it about ? 7. How is oxygen used in the body ? Does it purify the blood ? 8. Explain fully how oxygen is brought to the cells and how carbon dioxide is eliminated, (b) How is the process made more effective ? 103 104 PERSONAL HYGIENE ^ 9. How is water used by the body ? (b) For what are the mineral matters necessary ? (c) How are the salts and water eliminated ? _^ 10. Why must the body have proteid food ? ^1 1 . How are the carbohydrates used by the body cells ? The fats ? s». Give the various theories as to the way in which proteids are used. ^13. Contrast the manner in which the body acts towards proteids and non-nitrogenous foods. --14. In what forms is the body fuel stored ? What happens in starvation? ^15. How is the temperature of the body kept up and how is it regulated ? 16. What are the products of proteid disintegration? 17. Why should the waste matters of digestion be eliminated promptly ? (b) By what nat- ural means may a tendency to constipation be overcome ? 18. What new facts have you learned in this lesson applicable to the care of your own health? 19. Have you read any other books in connection with this lesson ? 20. What questions have you to ask ? Note. After completing the answers, sign your full name PERSONAL HYGIENE PART III Care of the Machine DOUBTLESS because our instincts guard us in many ways and because it is only the applica- tion of physiology, the subject of Personal Hygiene has not yet reached the stage of a science or even a well- defined art. The application is often hard to make. Medical schools teach the science of the relief of ill- ness, but the care necessary to keep the body in health is usually considered only in brief series of lectures. There are numerous technical books on anatomy, physiology, medicine, sanitation, but at present none on Personal Hygiene. The progressive physicians are true practitioners of hygiene instead of merely prescribers of drugs. " Preventive medi- cine" has a greatfuture. So far we have considered the human body as a living machine, and learned how it is operated. A little has been said in passing on the care of the ma- chine, but what has gone before, while more or less interesting, is important only in relation to the care of the machine. It is, of course, necessary to under- stand a mechanism to know how it should be cared for. Mere general rules of health are of little value. We seldom follow such unless we understand the reasons for them, or realize the sure penalty, near or remote, 105 Personal Hygiene Not Yet a Science Reasons Not Rules 106 PERSONAL HYGIENE of their infringement. Happily the day is past when poor health was a distinction; still the majority feel that illness is a grievance and not direct retribution for our physical sins of omission and commission, as it usually is. Here, it is true, "the sins of the fathers are visited on the children unto the third and fourth generation." The adult body is rarely a per- fect machine; through inheritance, accident, or lack of proper care in youth some function -or organ may become impaired. We all have our physical limita- tions, but how few of us live up to such limitations! When will physical ills be as much of a reproach as moral ills, and when shall we regard as nearly equal the "Physical health scorning disease and mental health scorning sin." HYGIENE OF THE NERVOUS SYSTEM Nervous Modern life has undoubtedly greatly increased the of Modern demands made on the nervous system. The intro- duction of rapid transportation, newspapers, tele- phone, keener competition in social and business life, many and varied interests, all have increased nerv- ous wear and tear. The majority live more rapidly than two generations ago. All this calls for a strong nervous system, but a strong nervous system is built up only by education and use and maintained only by use and a. healthy body. The brain can accom- plish an immense amount of work if it is supplied with good blood and given sufficient rest and relaxa- Life HYGIENE OF THE NERVOUS SYSTEM 107 tion. It is worry, poor nutrition and lack of rest that most often cause nervous breakdown — not brain work. As the nervous system controls every function of the human machine, its care is of the greatest impor- tance. When damaged, repair is always a long and difficult process, for its impairment throws out all the functions of the body. All the organs are sub- ject to fatigue, and require a period of rest. The muscles cannot contract continuously, the stomach cannot always be engaged in digestion — there is even a period of rest for the heart between beats. Be- cause of its great complexity, rest is absolutely ne- cessary for the nervous system, especially the higher nerve centers making up the brain. This rest the brain obtains only in sleep, — perfectly only in deep, dreamless sleep. Change of occupation gives rest to a part of the nervous system, as for example changing from mental work to physical activity; but each muscular con- traction calls for nervous impulses and so adds to general fatigue. Most often this is desirable, for gen- eral fatigue brings about sound sleep. We must sleep periodically probably because the wastes of the body accumulate faster than they are eliminated. During sleep nearly all the organs are less active and the wastes are eliminated faster than they are made. The muscles store up oxygen and nutriment, the glands build up substances out of Importance of the Nervous System Sleep io8 PERSONAL HYGIENE Conditions in Sleep Amount of Sleep Soundness and Effect of Sleep which they make their peculiar secretions, the nerve centers store up energy and all the cells are repaired. During sleep respiration is slowed down and deep- ened, the breathing is more intercostal; the heart beats somewhat more slowly; the muscles are re- laxed; less blood flows through the brain and more through the skin. "It is sometimes stated that the digestive secretions are diminished during sleep, but the statement does not seem to rest on satisfactory observation, and may be doubted." * * * "On the whole, however, the physiological activities of the body go on much as in waking conditions. " (Howell.) It is chiefly the brain which sleeps. Most people require eight hours of sleep, others nine, although for some seven hours seems to be suffi- cient. It is said that women need an hour longer sleep than men, but that probably depends upon the individual and habit. The depth of unconsciousness increases to between the first and second hour of sleep, and then gradually diminishes, although towards morning it increases slightly again. Sleep is more sound in a darkened room, and when there is quiet. Sleep is not nearly so deep during restlessness. To have the greatest effect, sleep should all be taken at one time ; several periods equaling eight hours do not give nearly as much recuperative effect as the same period at one time. If one is constantly disturbed during the night more sleep is required. HYGIENE OF THE NERVOUS SYSTEM 109 The question of naps depends upon the general Naps health and conditions. Those subjected to great nervous strain, or those who are weak are much bene- fited by a brief nap, but people in robust health should have a nervous system sufficiently strong to make naps unnecessary. The nervous system is strengthened through use, just as the muscles are trained by exercise and the stomach by eating food (in moderation) that requires strong digestive power. If one is under special strain, a brief nap gives re- freshment all out of proportion to its length. Naps cannot, however, replace the long sleep at night, and they should not interfere with it. Momentary re- laxation also gives a recuperative effect out of propor- tion to its length. The necessity of good ventilation at night has already been spoken of. An increasing number of people are making a practice of sleeping out of doors under sheltered porches, especially in summer time. What is good for the upbuilding of consumptives should prove of equal value in helping minor troubles or in maintaining health. The temperature of the sleeping room should be brought down to what it can be maintained through- out the night; then the bedding can be arranged to suit the temperature. Heavy bedding is undesirable. Woolen blankets The Bed give the greatest warmth for their weight and " down Bedding puffs" are much superior to the heavy cotton quilts no PERSONAL HYGIENE or "comforters." The typical white bed-spread is heavy and gives very little warmth. It is best removed or turned back at night. The spring should keep the mattress level. As about a third of life is spent in bed, it pays to get a good mattress. It should be comfortable, but not too soft. For most people, a low pillow is desirable, as high pillows keep the body from lying flat. insomnia Sleeplessness has many causes, but it is lack of muscular activity that is most often at the bottom of the trouble. The day laborer, the farmer, fisher- men, lumbermen — all who live an active, outdoor life, are not troubled with insomnia. Anything which over-excites the brain is liable to cause sleep- lessness. If there is trouble anywhere in the system, the nerves are unduly excited, and as there is intimate connection between all parts of the nervous system, the brain is affected. Indigestion is a fre- quent cause. The use of tea, coffee and even cocoa at night often causes sleeplessness. Those who go over in the mind the activities of the day — lie in bed and think and think, are troubled with sleepless- ness. Sleep depends much on habit. Those who have acquired the habit of not going to sleep easily, find it hard to break themselves of the habit. Regularity as to the time of going to bed is a great . help in establishing good habits of sleep. If one goes to bed at all hours, it is increasing the difficulty to drop off to sleep immediately. Sometimes the HYGIENE OF THE NERVOUS SYSTEM m trouble comes from the inability to relax the muscles completely. This power needs to be cultivated. The only means of overcoming the vice of sleep- To lessness is the removal of the cause. The imme- sleep diate cause of sleeplessness is most frequently an excess of blood in the circulation of the brain. Any- thing which will draw the blood away from the brain will prove helpful. The blood supply of the brain is most intimately connected with that of the skin. It is almost impossible to go to sleep if the surface of the skin is cold. Bed clothes should be sufficiently warm, but not too warm or too heavy. Any action which will cause the blood vessels of the skin to di- late will diminish the flow of blood to the brain. Thus, warm baths are apt to be helpful or a hot foot bath with a cold cloth at the back of the neck; light physical exercise will draw the blood to the muscles and skin. Taking a little easily-digested food, if the stomach is in good order, will often draw some of the blood from the brain. If indigestion is the cause of sleeplessness, effort should, of course, be directed to improving that. A light meal should be taken at night in such cases. If study or other mental work must continue until bed time, light exercise for ten or fifteen minutes such as a walk of half a mile out of doors, will be conducive to a good night's sleep. Preparation for bed should be a leisurely process, so that the mind may get into the proper condition ii2 PERSONAL HYGIENE for sleep. The cares of the day must be banished. It is well to avoid lying awake in bed, and thus estab- lishing the habit. If sleep does not come after ten of fifteen minutes, it is better to get up again, take a few gymnastic exercises, or in some way get the mind in a condition for rest, care being taken not to become chilled. Sometimes the repetition of num- bers, monotonous phrases, counting the respira- tions while breathing deeply, and the like, may induce sleep. The whole question of habit depends on the ner- vous system, and this plays a large part in the daily life of every one. A habit is a more or less automatic act which is repeated frequently, requiring each time less effort from the will to accomplish it easily. The process of acquiring a habit may be likened to the making of a path through a heavy fall of snow. The first person to walk through the deep snow does so slowly, and with great difficulty. The second per- son finds it easier to follow the tracks already made, than to make new ones. All who come after, find the path smoother and easier to travel, and would not think of going into the deep snow on either side. In the same way, the acts performed by the body develop an easiest path along certain routes of the nerve tissue and the act is performed automatically. This is true of the mental as well as the physical habits. The ease with which a habit is formed de- pends upon the softness and the plasticity of the HYGIENE OF THE NERVOUS SYSTEM 113 nerve tissue ; the younger the person, the easier are the habits formed. Nearly all personal habits are formed before the age of twenty or twenty-five. It is in- creasingly difficult to form new habits after the age of thirty, and it is, therefore, essential that we form right habits of eating, breathing, sitting, standing, sleep, and so on, as early as possible. Considerable strength of mind and long persistence are required to break oneself of an evil habit. HYGIENE OF FEEDING We have already considered the digestion and use of food. There remains to be spoken of the how, what, when, how much to eat, and the care of the organs of digestion. Digestion may be said to commence with the gath- ering and refining of food stuffs, and to be continued by the art of cookery, which helps to make food soluble and appetizing, but the first necessary part of digestion in the body is mastication. CARE OF THE TEETH The art of preparation of foods and the art of cookery in removing hard substances and softening foods has diminished the necessity for powerful mastication, so that the teeth of civilized people are softer and more liable to decay than those of primitive people and animals. It is a law of nature that organs or functions not used tend to degenerate, hence spe- cial care of the teeth is necessary to preserve them. A tooth consists of the crown, projecting in the mouth, the root in the gum and the narrow portion between, called the neck. The greater part of the tooth is made up of a hard, bony substance, called dentine. On the top and sides the dentine is covered with the very hard polished enamel, which serves for protection. The root is covered with a grayish substance called cement. In the center the cavity 114 CARE OF THE TEETH "5 is filled with blood vessels and a nerve, which enter through a small opening in the end of the tooth. The thirty-two teeth of the adult begin to replace the first set of "milk teeth" at the sixth to eighth year. The four innermost permanent teeth — the wisdom teeth — do not appear until some time between the fifteenth and twenty-fifth year; in some cases they do not come at all. They usually are very soft, and decay easily. Irregularity in the teeth is usually due to lack of development of the jaw or to extra large teeth coming early. The teeth of a child should be watched, and if they tend to form an irregular line, the dentist should be consulted at f^f's,' Jaw once. He may find it advisable to extract m °nt.' ' one tooth and thus allow those remaining to come in evenly. Especially while the teeth of the child are developing, the diet should contain some foods, like crusty bread and hard crackers, that will tend to develop strong teeth. In a grown person, even, much may be done to strengthen naturally soft teeth by providing food which requires vigorous mastication. Although the miller and the cook give us soft bread instead of the hard, coarse, ash-cake of primi- tive people, and the art of stock raising and of the butcher give us tender meat, instead of the tough A TOOTH .4, Enamel; B, Dentine; C, Permanent Teeth n6 PERSONAL HYGIENE Grinding Power flesh of the wild animals, the food must be insalivated and finely divided to make digestion in the stomach quick and thorough. The chief work of grinding comes on the molars, of which there are twelve, HALF SET OF UPPER AND LOWER TEETH 1, First Incisors; 2, Second Incisors; 3, Cuspids or Canines: 4, First Bi- cuspids or Stomach, 5, Second Bicuspids; 6. First Molars; 7, Second Molars; 8, Third Molars. Indigestion and Poor Teeth counting the wisdom teeth. These are very often lost early, leaving only eight. The loss of only one of these diminishes the grinding capacity one-fourth, for the opposing tooth is of little use. The loss of two molars may lessen the grinding power by one- half. The triumphs of American dentistry are such that the loss of a few teeth or even an entire set is not regarded as a serious matter by most people, yet poor teeth are responsible for a much greater pro- portion of digestive troubles than is often supposed. A good dentist can accomplish wonders, but he can- CARE OE THE TEETH "7 not equal nature's providing, any more than a false foot is equal to the natural member. Many theories have been advanced to explain the cause of caries or decay, but it is now well established Causes of Decay COMPLETE SET OF UPPER TEETH that the main cause is in some way connected with the growth of the various micro-organisms lodged be- tween the teeth. As long as the enamel is intact and the neck not exposed, decay does not begin readily, but if the bacteria find lodgment and food, the fermentation and decomposition caused by their growth tend to injure even the enamel. Once the enamel is broken, the decay of the dentine goes on rapidly. n 8 PERSONAL HYGIENE Preserving the Teeth Tooth Brushes Use of Tooth Powder It is safe to say that if the growth of bacteria on the teeth could be prevented entirely, even the weakest natural set could be preserved. Absolute cleanliness is the most important preventive to decay; next comes maintaining a high degree of polish so that the bacteria will find no place of lodgment. The practice of picking the teeth with pins or other metal instruments tends to crack the enamel, and thus expose the dentine to the action of bacteria. Biting of hard substances, as in cracking nuts with the teeth, or the constant biting off of threads may have the same effect. Decay is favored by the exposure of the neck of the tooth when the gums are loosened or pushed back by the injudicious use of the tooth pick or a stiff bristle brush. A good brush is the most effective instrument for cleaning the teeth. The bristles should be stiff, but not too stiff, set not too close, and the tufts on the end should be a little longer to facilitate brushing between the teeth. The brush should be discarded when the bristles become spread and so apt to irritate the gums. Precipitated chalk is one of the best powders to use, because it is sufficiently coarse to produce some scouring action and cleanse thoroughly, yet not hard enough to injure the enamel. Powdered soap, orris root, and flavoring may be added if desired. The brushing should be forward and back, and up and down between the teeth. The inside of the teeth CARE OF THE TEETH n 9 should be brushed as carefully as the outside. The brush should be used, if possible, after every meal, and especially before going to bed at night. The night cleansing is most important, for during the hours of sleep the bacteria have a long period of unin- terrupted activity. The mouth provides the most favorable condition for bacterial growths — moisture, warmth and darkness, and if there is food present, they multiply enormously. When it is known that with some kinds of bacteria a new generation may be formed every twenty minutes, it is not surprising to learn that by morning the uncleaned mouth may contain literally millions of bacteria. No wonder that many are reminded by the condition of the mouth to use the brush in the morning. At night, then, the teeth should receive their most thorough toilet. The use of the brush and pow- der alone will seldom remove all the food between the teeth and a fine silk thread, or better, the so-called "dental floss," should be pulled back and forth between close-set teeth, care being taken not to in- jure the gums. To preserve the polish of the teeth and to prevent the accumulation of sordies — tartar — an orange wood stick, cut in the shape of a chisel, should be rubbed up and down between the teeth, with a little powdered pumice stone, several times a month. After cleansing the teeth thoroughly the mouth may be rinsed with an antiseptic solution. This Cleaning the Teeth Use of an Antiseptic 120 PERSONAL HYGIENE Visiting the Dentist Fillings checks the growth of the bacteria somewhat, but is ineffective if food is left between the teeth. Any of the common mouth washes, such as listerine diluted with an equal quantity of water, may be used ; Seider's antiseptic tablets are convenient. While thus clean- ing the mouth, it is well to gargle the throat, as this tends to prevent throat troubles. It is economy of money, time and pain, to say nothing of the appearance of the teeth, to visit the dentist frequently. He should examine and clean the teeth at least once every six months. If the teeth are subject to decay, it is best to go once in three or four months. The thorough cleaning which only a dentist can give is important, for small cavities easily filled, are frequently discovered which would otherwise pass unnoticed and become very much larger. Properly done, the cleaning can do no harm, and the high polish will lessen the chances of food and accompanying bacteria finding lodgment. Some- times slight defects in the enamel can be treated with nitrate of silver or otherwise without filling. Of fillings gold is the most permanent, the amalgam or silver filling darkens the teeth and can be used only where it will not be seen. The ideal filling would be cement if a substance could be found which would be permanent. With other kinds of fillings, the cavity must be "under cut" to hold the filling in. Cement has sufficient adhesion so that the undercut is not so necessary, and not nearly as deep an excavation need HYGIENE OF FEEDING 121 be made. When the teeth are very soft, cement may prove the most economical filling even if it has to be renewed every year or two. WHEN, HOW MUCH AND WHAT TO EAT The composition, nutritive value and digestibilty of food have been treated in the lessons on Food and Dietetics, but it will be well to look at the subject from a different standpoint here. By providing us with a stomach, nature evidently Meals intended that we should take our food in meals. Some of the working people of the European nations partake of food five times daily, and those who attend the theater and late entertainments often may add an extra meal at midnight, but for most of us three meals a day seems to be the best plan. The stomach usually empties itself in about four hours, so that breakfast between 7 and 8, lunch between 12 and 1 and dinner between 6 and 7 gives it some rest between periods of activity. It needs this rest, for the stomach is not a continuous performance organ, like the heart. Moreover, stomach digestion goes on in stages. As the "psychic" or appetite juices decrease, the secre- tion brought about by the products of digestion con- tinue, and the juice secreted is adapted to the food being digested. Eating between meals may upset the balance. If one is really hungry, there is no objection to Eating taking a little simple food once between meals, pro- M^anf 6 " 122 PERSONAL HYGIENE vided it does not interfere with the appetite at the regular meal time. It is the constant eating of candy, etc., to gratify the sense of taste that is disastrous to appetite an d digestion. Young children usually need a lunch between meals. When a child is willing to eat bread and butter, it is probable that he needs food. Those of weak digestive power usually manage the same amount of food in four or five meals better than in three. Regularity as to meal time is important. If for any reason one goes much over the regular meal time, the appetite may be too keen and there is an inclina- tion to overeat and eat too rapidly, with resulting digestive disturbance. Unless there is a regular lunch to prepare, the housekeeper is very apt to be- come careless and eat at any time or wait until there is a "sinking feeling" in the stomach. Time for For the secretion of the digestive juices a liberal supply of blood is needed, so that very active exercise which calls blood to the muscles should not follow directly after the taking of a full meal. Moderate activity, like slow walking after a meal, is without much effect, and may be favorable. In the same way, bathing should not immediately precede or follow eating a full meal, but a short cleansing bath has less marked effect on the distribution of the blood than severe exercise and is. usually attended with no unfavorable results. We should not take a full meal directly after the loss of considerable water Eating HYGIENE OF FEEDING 123 through perspiration. At such times the proportion of water in the blood is lessened and the secretion of gastric juice is apt to be scanty. We naturally drink water at such times, from the call of thirst, and in fifteen or twenty minutes the blood has regained its normal composition. We should not partake of a full meal when ws are very tired, either physically or mentally. A rest of half an hour before eating will put the system in more favorable condition. This is one argument in favor of having the principal meal at night when the active work of the day is over. Then there is time to take the meal slowly with full enjoyment. As to how much to eat, the appetite is the best how Much guide we have. Indeed, an intelligently directed appetite is a very good guide. Pawlow's researches show very clearly how necessary it is that food should be eaten with appetite. If the appetite does not call for food, little food should be eaten. As Pawlow points out, however, the appetite may be disarranged because of some disorder or mental condition when the body really needs food. After a few mouthfuls the appetite develops, or as the saying goes, "appetite comes with eating." If there is a continued impair- ment of the appetite, the warning should be heeded, its cause should be found and conditions changed. Meanwhile, little food need be eaten. The body usually has sufficient stored food material to supply deficiencies for a day or longer if necessary. 124 PERSONAL HYGIENE Food and Exercise Standard Diets From the physical standpoint alone, the question of the total amount of food required is determined solely by the heat and energy output of the body. This the United States Department of Agriculture has found very accurately in the respiration calorimeter under different conditions. The outgo beyond a certain minimum depends upon the muscular exer- cise taken. See table, page 49. The amount of heat lost is dependent chiefly on the skin surface, for most of the heat of the body escapes through the skin. The weight or contents of bodies increases faster proportionately than the surface area. That is, a small orange has more peel in pro- portion to its contents than a large orange. The body of a child has a larger surface area than that of an adult in proportion to the weight. A tall thin person has a greater skin surface in proportion to weight than a short, fat person. Taking into consideration all these factors, it would be easy from the table on page 49 to calculate to a nicety the number of calories of food required to keep the body in condition, as the fuel and energy value of all foods has been determined. Such cal- culations, however, would be only of general value, for although rules may be laid down for averages, individuals differ so greatly in the amount of food required that standard dietaries and the like are of little value except for comparison. It is a matter of every-day experience that two persons of about the HYGIENE OF FEEDING 125 same weight and height and taking about the same amount of muscular exercise need very different quantities of food to keep them in the condition of health. One person may put on fat on a diet which would be insufficient to keep up the body weight of another. Inheritance is a large factor. One person may be able to digest and assimilate a much larger proportion of food eaten than another. It is the amount of food digested and assimilated which is of use to the body. However, people are much more alike than they are different and it is important to know the com- position and the nutritive value of foods. The following table gives the food value (fuel and energy value) of a number of common foods as eaten : that is cooked, if they are cooked, and without refuse or the inedible part. The figures only represent averages for the composition varies greatly, a large propor- tion of water decreasing the food value and fat greatly increasing it. The value is given in calories per ounce. The volume of a pint equals about 16 ounces and a measuring cup 8 ounces and two level tablespoonfuls about an ounce of many foods. A cubic inch of butter or meat and a slice of bread half an inch thick weighs about one ounce. Personal Peculiarities Nutritive Value of Food 126 PERSONAL HYGIENE FUEL AND ENERGY VALUE OF FOODS AS EATEN Calories Calories Food Per Ounce Food Per Ounce Lard, salad oil, etc 250 Indian Pudding 52 Butter 225 Eggs (boiled) 48 Nuts (almonds, peanuts, pecans, walnuts) .avg. . 185 Chocolate (bitter) 179 Chocolate nut candy (about) 140 Cheese (cream) 123 Crackers and cookies 119 Sugar 116 Plain candy 112 Cake 105 Lamb (broiled chops) .... 104 Dates and raisins 10 1 Beef (roast) 10 1 Mutton (roast leg) 89 Olives (green pickled ) . . . 87 Mince Pie 85 Ham (boiled) 83 Broiled Tenderloin of Beef 8 1 Apple Pie .« . 79 Bread (white) 76 Bread (whole wheat) 72 Sweet Potatoes 58 Cream 57 Pudding, rice, tapioca. ... 52 Note. Fish (baked blue) 42 Baked Beans 35 Bananas 29 Grapes 28 Potatoes (boiled) 28 Macaroni (cooked) 26 Hash 24 Milk (whole) 20 Apples 19 Oat Meal Mush 19 Chicken Soup(home made) 1 8 Peas (green canned). ... 16 Spinach (cooked) . 16 Oysters 15 Oranges 15 Soup Stock 12 String Beans, Onions Beets, Squash 12 Musk melon 12 Strawberries 11 Milk (skimmed) 10 Tomatoes and Lettuce. . . 6 Celery and Cucumber. ... 5 Cereal Coffee (infusion) . . 2 From the above table, in connection with that on page 49, it will be easy to get a general idea of the quantity of food required. For example, with eight hours of sleep, six hours of rest, and ten hours of light exercise, a man of a body weight of 154 pounds would require about 2,800 calories. (See page 49.) A woman weighing a little over 100 pounds would need 1,900 calories. This would be supplied by 14 ounces of chocolate candy, or about a pound loaf of bread and three ounces of butter, and so on. HYGIENE OF FEEDING 127 There are many people "blessed with a good appe- tite;" such are apt to eat too much. Indeed, with abundant food supply, which the art of the cook has made most tempting, and because of rapid eating, very many people eat too muck, especially those of sedentary habits. We must eat only to satisfy the demands of the appetite, not to gratify the sense of taste. It is only one who has much manual labor to perform that needs "three square meals a day." A light breakfast, a light lunch, and a moderate dinner will keep others in a better condition. If overeating does not ruin the digestion, the per- son is apt to grow fat, especially after middle life. Although heredity makes a great difference, accum- ulation of much fat is always a proof that too much food has been eaten or that there has been to little physical activity — usually both. Fat is so much stored food material — lifeless mat- ter. The only way it can be reduced is by oxidizing it in the body — burning it up. This can be done only by lessening the food supply and by taking very active physical exercise. Exercise which produces active perspiration is most effective. Putting on of fat gives a disinclination for active exertion and so the tendency is for the fat to accumulate. Although there is no evidence that fat may be made from the proteid of food eaten, and if the food could be made up entirely of proteids (which is impossible), the amount of fat would not increase, but it cannot be Over Eating Reducing Fat 128 PERSONAL HYGIENE diminished unless the physical activity calls for more fuel and energy than is contained in the food eaten. The diet in obesity, then, would consist of such foods as have low fuel and energy value. A concentrated food means a food that contains little water. Fats have nearly 2X times as much fuel and energy value as proteids and carbohydrates. Foods that contain a large amount of water are vegetables and fruits, except dried fruits. A certain bulk has to be taken to satisfy the calls of the stomach and to prevent con- stipation. It is usually recommended that the diet consist largely of proteid foods, especially lean meat. As we have seen, the proteids are quickly burned up. However, if the diet, even made up chiefly of pro- teids, is liberal, sufficient energy will be furnished to the body and none of the body fat will be consumed ; consequently the total fuel value of the food is the chief consideration, so far as diet is concerned, if fat is to be decreased. Less clothing should be worn, as low external tem- perature increases the heat output of the body, and so body fat is consumed if the diet is light. Less sleep should be taken, for during sleep the body uses less than a fourth the energy used in active exercise. increasing The conditions for increasing fat are just the re- verse. The diet should be liberal and consist of easily-digested food, with abundance of fats and carbohydrates. Long hours of sleep and rest should be taken; there should be freedom from worry and Fat HYGIENE OF FEEDING 129 nervous wear and tear; clothing and surroundings should be warm ; sufficient out-of-door exercise should be taken, to give a keen appetite. It is often more difficult to put on fat than to lessen the amount, as heredity has such great influence. A complete change of life may be required to make any difference in body weight. Somewhat more food is required in winter than in summer, because of the greater heat output of the body, but if thicker clothing is worn and one is not exposed to any great extent to out-of-door tempera- ture, no more food is needed than in spring or fall. During very hot weather the quantity of food should be considerably diminished, especially pro- teids, and more liquids should be taken so that per- spiration may be active and not diminish the pro- portion of water in the blood. It has been found, strangely enough, that when the external temperature is very high, the body furnishes more heat than at ordinary temperature. In other words, oxidation is more active, the bodily fires burn more fiercely. This increase is brought on by the proteids, carbohydrates and fats in the ratio of 20 to 10 to 7. The increased heat production may raise the temperature of the body to such an extent as to cause a "heat stroke" if it is not lost suffi- ciently rapidly. During hot weather the appetite calls for less food, for much water and succulent vegetables, as salad plants and fruits. It is recom- Winter Diet Hot ■Weather Diet Heat Stroke to Eat 130 PERSONAL HYGIENE mended that the total amount of food eaten should be less in fuel value than the heat output of the body. Under these conditions, some of the body fat is used, which accounts for the fact that most people lose weight during a long period of hot weather. Here is the probable reason that exercise inducing perspiration is found to be most effective in the reduction of weight in obesity. what As to what to eat, again the educated appetite is a trustworthy guide. We should eat the things which we find palatable, for these will have a better chance for thorough digestion. This is not saying, how- ever, that all food eaten with enjoyment will be per- fectly digested. When the digestive organs are in good condition, a reasonable amount of all foods that have been found by experience to be wholesome should be disposed of without trouble provided only, that the food be properly cooked and properly eaten. No human stomach can be expected to digest pies and doughnuts as they are sometimes made, but they may be so cooked that any one in health should be able to eat small quantities without discomfort. The stomach needs some exercise, like all the other organs of the body. The constant eating of easily digested and predigested foods will weaken the digestive organs, just as lack of exercise will weaken the muscles. While the digestive organs should be capable of taking care of small quantities of difficultly digested food, the whole diet should not HYGIENE OF FEEDING 131 consist of foods known to be digested with difficulty. A little fried food occasionally, skillfully cooked, should cause no trouble, but a constant diet of the product of the frying pan may be expected to ruin any digestion. Many people find that certain foods disagree with them at times, such as lobster, sausages, strawberries apples, cucumbers. Such personal peculiarities must, of course, be heeded, but the list of forbidden foods ought to be a small one. Those who will take little or no exercise find their list of indigestible food con- stantly increasing. It is far better to take sufficient exercise to keep the digestive powers up to a reason- able level. What we like depends upon our education; we usually prefer throughout life the foods which we learned to like in youth. It is desirable that we develop omnivorous tastes while young, for the appetite calls for variety. Children are very apt to acquire unreasonable tastes in food, and while they should not be forced to eat food that is distasteful, still with a little tact, good food habits can be formed. A child will usually consent to eat a little of a new food without undue family disturbance if favorite foods are withheld until the mouthful or two is disposed of. After a few times, he will often call for more than a little of formerly despised foods. As we have seen, it makes little difference whether the energy of the body is supplied by fats or by car- 132 PERSONAL HYGIENE Amount of Proteid Meat Eating bohydrates or by proteids. If the composition of foods is known, we can safely leave the appetite and experience to the subconscious selection of the pro- portion needed for the body in health. Recent experiments have shown that in any diet which we would select, if free to choose, we would obtain sufficient proteid to furnish that required for cellular repair, so we need have little fear that the diet will be deficient in proteid. We may, however, easily take too much. Although eggs, milk, cheese, beans, and peas contain a considerable proportion of proteid, there is not much likelihood that we shall eat in excess of any of them. The proportion of proteid in meat is much greater, and very many people, espe- cially those of sedentary habits, undoubtedly eat too much meat. This comes about because most people like meat, and because it is somewhat difficult to make a good roast or steak unpalatable by poor cooking. As we have seen, the proteid foods have a decid- edly stimulating effect on the organism. In case of general debility, anaemia, and in wasting diseases such as consumption, this stimulus is just what the body requires, but for those leading inactive lives, there may be too much stimulation. It is only oxidation that is stimulated ; elimination may not keep pace, and the accumulation of wastes brings about unfavorable conditions. Headaches and other nerve troubles are favored by too much meat eating more often than commonly known. HYGIENE OF FEEDING 133 The diet of the growing child and youth needs to be high in proteid. Vegetarianism has been advocated as a cure-all, and for those who eat too much or whose diet con- sists too largely of proteids, it is undeniably helpful, but there seems to be no reason (except the ethical argument that man should not take animal life for his maintainance) that all use of meat should be abandoned. To quote from Professor Chittenden, whose work gives a strong argument for less meat eating: "I am inclined to emphasize the desirability of using com- mon sense in the application of dietetic rules, remem- bering that man is an omnivorous animal, and that Nature evidently never intended him to subsist solely on a 'cereal diet,' or on any specific form of food to the exclusion of all others. On matters of diet every man should be a law unto himself, using judgment and knowledge to the best of his ability, reinforced by his own personal experiences. Vege- tarianism may have its virtues, as too great an indul- gence in flesh foods may have its serious side, but there would seem to be no sound physiological reason for the complete exclusion of one class of food-stuffs, under ordinary conditions of life." Vegetarianism Common Sense in Diet 134 PERSONAL HYGIENE DRINK water As to drink, pure water is the best drink we have, but impure water is very dangerous as it may pass through the stomach without becoming mingled with the hydrochloric acid, which destroys nearly all disease germs. The living tissue contains nearly nine-tenths water, i. e., the muscles 87 per cent, the glands, like the liver, 86 per cent, the blood 90 per cent. Many people, especially women, do not drink sufficient water. There is a feeling that water taken at meal times will dilute the gastric juices, and so interfere with digestion. Pawlow found that water is one of the few substances that stimulates the secretion of the gastric juices, and it has been proved that any quan- tity less than three pints (an impossible amount) helps rather than hinders digestion. It is well to take a glass or two of water in the morning before breakfast, one or two glasses with each meal and between meals, if desired. The water passes rather quickly out of the stomach and is absorbed into the blood in the intestines, and soon after is secreted by the kidneys. Experiments have shown that an imperceptible amount of energy is required for the absorption and elimination of water, and it has been found that increasing the quantity of water increases the amount of urea and other waste products eliminated. Drinking water with meals is favorable to digestion, but this is by no means the same thing as taking water with food. As we have seen (page 53), dry DRINK 135 foods should be chewed until the saliva has moistened them sufficiently to make swallowing easy, for in addition to the digestive action of the saliva, the taste of foods increases the flow of the "psychic juices." If the food is washed down with water or other liquids, it will not have nearly as good a chance of being easily digested. The temperature of the water does not seem to make very much difference. Ice water is not harm- ful, provided it is sipped slowly, and so becomes warm before entering the stomach. Hot water is sometimes recommended in cases of indigestion, but in reality the heat has very little effect. It does not cause an increased flow of gastric juice but may increase the movements of the stomach somewhat. Of the beverages, tea, coffee, and cocoa, tea and Tea coffee contain the alkaloid caffein and the cocoa a cocoa substance very similar, called theobromin. These are substances something like uric acid in chemical composition, and so undesirable in certain disease conditions. For most people a cup of coffee with the breakfast adds to the enjoyment of the meal and for that reason may help digestion. While one cup of coffee may be favorable, two cups may be decidedly harmful. Here, as in all else, temperance should be the rule. Tea, coffee, and to some extent cocoa have a stimulating effect on the nerves. Some people can take coffee and not tea, others the reverse. We 136 PERSONAL HYGIENE usually know whether tea or coffee is harmful or not, and we certainly should have the strength of mind to refrain from one or the other if we cannot take it with impunity. Few people leading sedentary lives can take either tea or coffee three times a day without harmful results. Alcohol Alcohol is commonly regarded as a stimulant. At first it increases the flow of blood to the skin and brain and gives a feeling of warmth and of general well- being. According to the latest experiments, alcohol brings about the increase of the flow of blood to the skin and brain by inhibiting, paralyzing, the action' of the vasco-constrictor nerves. In the brain it loosens up or gives freedom from restraint. In small quan- tities alcohol can without doubt be taken without harm, but it is a powerful drug, and as the system adapts itself to abnormal conditions, larger amounts are required to produce its effect and the appetite demands more and more. Large quantities are disas- trous to every function of the body. The evils of alcoholic intemperance do not have to be enlarged upon ; without doubt the world would be far better off if there were not such a substance as alcohol, even though physicians may sometimes use it to advantage. HYGIENE OF THE SKIN AND ITS MODIFICATIONS The skin is the protecting covering of the body, and the hair and nails come from modifications of its structure. The mucous membrane is similar to the skin in structure, but without its outer horny layer. (See page 42.) Although the outer skin contains many "pores, " sweat glands and sebaceous glands — it is not porous. On the contrary, the skin is practi- cally water tight from the outside inwards. Aside from certain mercury preparations, the skin cannot be made to absorb a material amount of any substance, although the outer covering takes up oils and other matters to some extent. The mucous membrane, however, in some parts is "porous." The outer skin is constantly shedding its outer layer of horny cells; the salts dissolved in the per- spiration are deposited on the surface and in the mouths of the sweat glands, the oily material secreted by the sebaceous glands accumulates, and may stop up the opening, causing pimples; and the secretions contain odorous substances ; so for health and decency bathing is required. BATHS The chief use of the bath is for cleanliness, but it may also have other hygienic effects. The frequency of bathing from the standpoint of cleanliness depends on the occupation and environment. Some people require a daily cleansing bath, while with others one or two 137 The Skin "Water Tight Cleansing Bath Baths 138 PERSONAL HYGIENE a week is sufficient. Too frequent bathing with soap and warm water may have unfavorable effects, as it is not well to carry away all the oil of the skin which is needed to keep it soft and pliable. Effect of The stimulating effects of bathing depend on (1) Kinds 6 of the temperature of the water used, (2) kind of bath, (3) the time of day, and (4) the duration of the bath. (1) Very cold water produces a shock and either depresses or overstimulates, according to the strength of the individual. Hot water always produces a sedative and depressing effect. Cool water produces a tonic effect, and from a hygienic standpoint, is the only temperature that should be used for bathing. The degree of coolness which will produce the great- est benefit varies with different individuals and in different seasons. (2) The kind of bath used depends on the vol- ume and the force of the water, which comes in con- tact with the body. Great force and large volume produce a shock, and thus tend to overstimulate. The douche, large shower with high pressure, and the plunge, represent baths with great force and large volume of water. Applying water to a small surface at a time, as in a sponge or hand bath, pro- duces only local effects, because the volume and the force are not sufficient to stimulate ^the whole body. A needle spray, mild shower, or a sponge bath with a very large sponge tend to produce general tonic effect. (3) A bath taken just after rising, when the func- BATHS 139 tions of the body are greatly reduced in activity, will produce far greater effects than later in the day after some vigorous muscular exercise. (4) A cold shower bath of two minutes' duration would ordinarily have a tonic effect on a healthy individual after exercise, but the same bath continued for eight or ten minutes would have a decidedly de- pressing effect. A warm bath of five minutes' dura- tion would have a soothing effect, but if continued for ten or fifteen minutes it would prove depressing. We have, then, four important principles govern- stimulating ing the question of bathing. These principles are closely related and overlap each other. For example, a plunge in luke-warm water in the early morning would not stimulate any more than a cold sponge bath at the same hour, and a cool sponge bath in the early morning would produce as much effect as a cold shower or plunge bath in the late afternoon. Knowing the general effects of temperature, pressure, and volume of water, time of day, and duration of bath, we can arrange the conditions with a view to securing a tonic effect. It is impossible to lay down rules for everybody, but, fortunately, every one can find out for himself what is the temperature, kind of bath, and duration of bath which will be most beneficial for him. This is shown by the after-effects of the bath. If the bath has produced a tonic effect, the individual will feel warm, wide awake, comfort- able, and ready for work, and there will not be a 140 PERSONAL HYGIENE The Morning Bath Salt 'Water Bathing Sun Baths reaction of depression one or two hours later. On general principles, the most favorable conditions for a daily hygienic bath would be a cool or cold shower bath, following some vigorous muscular exercise about five o'clock in the afternoon. If the bath is taken immediately after rising, the temperature, volume, and force of water should be moderate. Most people are benefited by a cool bath every morn- ing. While it takes considerable courage to indulge in a tub bath of very cold water, it is not necessary that the water be of the same temperature as it comes from the tap. Although a tub or shower bath is not available for every one, all having a bowl of water may indulge in a sponge or hand bath, and the brisk rub afterwards. The stimulus of the reaction sends the blood coursing through the system, the respiration is deepened, and the active exercise of rubbing gives one a good start for the work of the day. Salt water bathing is supposed by most people to be more beneficial than fresh water bathing, because of the presence of salt in the water. It is true that sea bathing is more exhilarating than lake or river bathing, but the exhilaration comes from the sea breeze, the greater coolness of the water, and the movement of the waves; the presence of salt in the water has no effect. The use of rock salt in the bath tub at home is a waste of time and money. Another most valuable tonic for the skin is the sun bath. The effect of the sun's rays on the skin CARE OF THE HAIR 141 is appreciated only by those who have tried it. The skin should be exposed for a short time at first, in order to avoid burning. Gradually the time may be increased, until the skin is of a rich brown color. The good effect of sun baths is not limited to the skin, but the whole body, and the nervous system in par- ticular, is greatly benefited. CARE OF THE HAIR The hair and hair sheath are both modifications of the outer skin. Each hair root has a small net- work of blood vessels supplying it with nourishment. The skin form- ing the scalp is very thick, owing to its large number of hair roots and blood vessels. The amount and quality of the hair, like nearly all the physical characteristics, is largely a matter of inheritance. Its condition depends indirectly on the general health and directly on the circulation in the scalp. When the scalp is thin and tightly drawn, the circulation of the scalp is apt to be poor, the nourishment of the hair roots inadequate, and the hair suffers. Sometimes the amount of the hair diminishes rapidly in a few weeks because of acute illness or a general low condition. A, Hair; B, Sneath; G, Polical; Z>, Hair Root: E, Sebaceous Gland; F, Muscle. 142 PERSONAL HYGIENE With the return of general bodily health, the hair roots secure sufficient nourishment, and the hair resumes its normal growth. Dandruff The presence of dandruff is perhaps the most com- mon accompanying condition in the falling of the hair. Cleanliness is absolutely essential to the health of the scalp, and dandruff is an indication of poor condition. The best way to keep the head free from dandruff is by the use of a stiff brush night and morning, and by washing the scalp with soap and water two or three times a month, or as often as ne- cessary. A stiff brush should be used for brushing the hair, with the bristles far enough apart to allow of the brush being easily cleaned. Three to five minutes, vigorous brushing night and morning will prevent dandruff from accumulating, and will stim- ulate the circulation of the blood in the scalp. If the scalp is very tender, a softer brush should be used. The comb should have long, blunt teeth, set not too close together; sharp, rough teeth tend to scratch the scalp and injure the hair. Some people hesitate to comb or brush the hair, any more than is absolutely necessary to dress it, because by so doing some of the hair comes out. If the right kind of a brush is used with gentleness, the hair which falls in brushing and combing is prac- tically all dead hair which ought to be removed. Shampooing The frequency of shampooing depends on the in- dividual. With some, once a month is often enough, Brushing the Hair CARE OF THE HAIR 143 and others require a thorough washing once a week. Any good toilet soap will serve the purpose. The scalp should be rubbed thoroughly with the ends of the fingers, care being taken not to scratch with the nails, or a stiff brush like a nail brush may be used. The soap should be washed out completely with warm water, and the head rinsed with cold water, to avoid taking cold. The hair must be dried thoroughly with towels and finally held near a register, or pre- ferably in the sun. A certain amount of oil is necessary to keep the hair soft and in good condition. The oil glands in the scalp usually secrete a sufficient amount for this purpose. It is sometimes thought that frequent washing of the scalp will remove all the oil and make the hair too dry. This is not usually the case, be- cause the rubbing and cleansing stimulate the oil glands to greater activity. The application of oil or vaseline is advisable only when the hair is very dry. Aside from cleanliness, massage is about the only Massage effective method of stimulating the growth of the hair. For the best results, massage should be ap- plied for about five minutes every day. A long ap- plication at infrequent intervals has very little effect. The ends of the fingers of both hands should be ap- plied to the scalp as closely as possible and rubbed gently backward and forward, alternating with a cir- cular movement, care being taken not to pull too of the Scalp 144 PERSONAL HYGIENE Hair Tonics Cutting »nd Singeing Gray Hair hard on the hair. At times the scalp itself should be moved over the bones beneath. Electricity has been recommended as a stimulant to the scalp. If used judiciously it may increase the circulation to some extent, but the results ob- tained are no better than massage, and hardly war- rant the inconvenience and expense. The same may be said of vacuum caps. Innumerable hair tonics are advertised in super- lative terms, but the only benefit to be derived from them is the little massage involved in the applica- tion of the so-called tonic. No drug can be absorbed by the skin in sufficient quantity to produce much effect. Cutting and singeing have been recommended to increase the growth of the hair, but there is no evi- dence that this has the slightest effect. Split ends' of long hair should, however, be trimmed off. Curling the hair may injure its quality and appear- ance by pulling too hard on the roots, or in using the curling iron too hot. If the hair is not pulled or burnt, curling does not seem to injure it. Superfluous hair on the face can only be removed permanently by means of electricity. If done prop- erly, this method is painless, the root is destroyed, and the hair never grows again. The time when the hair grows gray depends largely on inherited tendency, but this change is hastened by mental strain, worry, overwork and unhygienic CARE OF THE COMPLEXION H5 living. Occasionally some great sorrow or nervous shock will cause the hair to turn gray in a short time. In rare cases its color may return with im- provement of the general health. There is no drug or remedy applied externally or taken internally which has the slightest effect in preventing the hair from turning gray. CARE OF THE COMPLEXION A clear, healthy complexion is an indication of good digestion, good circulation and good elimina- tion, and is to be obtained and kept only through attention to the general health. The skin of the face is both delicate and much exposed, so its care calls for special attention. Here as elsewhere clean- liness is essential to the health of the skin. As to how often to use soap and water depends upon con- ditions. In a soft coal city and in dusty places soap must be used. There i-s some danger of removing too much of the oil of the skin if the face is washed to© frequently with soap and warm water. Soap may be used on an oily skin with advantage more often than on one which has a tendency to be dry. It is probable that moderately cold water is best for general use. The cold stimulates the muscles of the face and the blood vessels of the skin, and keeps them in good tone. Only clean, soft water should be used, and the wash cloth must be abso- lutely sweet and clean. Whenever soap is applied Complexion and Health ■Washing the Face 146 PERSONAL HYGIENE Steaming the Face Massage of the Face it should be thoroughly rinsed off with cold water. If the skin is apt to be dry, an application of an oil substance, such as cold cream, will prove helpful. The best time for thorough cleansing with soap and warm water is probably at night before going to bed. Then the skin will not be exposed to cold, and by morning the protecting oil secretion will have been restored. Any good toilet soap may be used; medicated soaps are of little value. The price is a fairly good indication of the care with which the soap has been made. Transparent soaps usually contain glycerine. For a thorough cleansing, a thick cloth like a Turkish towel may be wet in hot water and laid over the face. This, in addition to softening the tissues, induces perspiration, which tends to clear out the sweat glands. This may be followed by an appli- cation of cold cream, well rubbed in. On wiping off the cold cream with a soft cloth the amount of dirt removed will often be surprising. This treatment should be followed by an application of cold water to contract the blood vessels of the skin. In addition to the stimulating effect on the mus- cles of the face of cold water, massage with cold cream is very helpful in improving the circulation. The tips of the fingers should be used with a rotary, up- ward and outward movement, the lines and wrinkles being always rubbed across. The touch should be firm, but gentle. To have much of any effect, CARE OF THE COMPLEXION M7 massage must be practiced for a few minutes every day. Cold cream is a mixture of white wax or sper- maceti and some oil, as almond oil or castor oil, to which some fragrant substance is usually added. Lotions and creams usually contain glycerine and a great variety of substances, some of which are harm- ful. Face powders are made of talc, starch, bismuth, zinc oxide, chalk and magnesia, and as a rule are harmless if applied in moderate quantity for a short time and thoroughly washed off. Powder is white dirt instead of black dirt; it has the same effect as the application of so much graphite — the principal ingredient of stove blacking — which has about the same physical properties as talc. Pimples are most often caused by some micro- organisms, usually bacteria, finding access to the skin in dirt through some small break or through some gland. The pus which they contain is made up, among other things, of the dead bodies of white corpuscles which have perished in their endeavor to rid the skin of the intruders. A boil is an enlarged pimple. Their discharges are somewhat infectious. In general, pimples and boils do not represent the efforts of the blood to free itself from the impurities, but if the blood is in poor condition, by reason of faulty elimination or indigestion, its protecting power is lessened and skin troubles are more apt to manifest Cold Cream Face Powders Pimples and the Blood 148 PERSONAL HYGIENE themselves. Skin diseases are many and complex, and they should be treated by specialists. Blackheads are the hardened secretions of seba- ceous glands. They may be softened by the applica- tion of cloths wet in hot water and removed by press- ing the skin gently between the balls of the thumbs. care of Some care is required to keep the hands in good condition, especially if much housework is done. Stains and dirt should be removed as soon as possible, so that they may not become deeply imbedded and require rough treatment for their removal. Crude soaps contain free alkali, and when used in hot water remove all the protecting oil, making the skin hard, dry, and apt to crack open or chap. Only a good grade of white soap should be used in dish-washing and the like, if the appearance of the hands is to be considered. The hands must be kept out of hot water and soap and soda when possible, and should be dried thoroughly at once after being wet. When it is necessary to use strong soaps and alkali, rubbing vaseline or oil into the hands previously will help. Thin rubber gloves may be used, but they are very uncomfortable and clumsy. The nails should be kept clean not only for appear- ance sake, but because the dirt may harbor dangerous infection. The nail brush, orange-wood stick and nail file are better to use than sharp instruments. If the nails are brittle and so-called hang-nails form, nightly treatment with cold cream for a few weeks should bring about improvement. COLDS . 149 CARE OF THE MUCOUS MEMBRANE —COLDS Inflammation of the lining of the upper portion cause of Colds of the respiratory tract, given loosely the general name of a cold is, perhaps, the most common ailment with which people, healthy otherwise, have to deal. It is well established that the real cause of colds is bacterial activity. Explorers, while in the arctic regions, where there is no bacterial life, are not afflicted with colds, although they are exposed to greatest extremes of temperature. On their return to civiliza- tion, 'an epidemic of colds usually comes on. A mother with a family of small children does not need to be told that colds are infectious, for if one child catches cold the rest usually have it, although some members of the family, by reason of better resistance, may escape. The means by which a cold is usually brought on Bringing on is through some disturbance of the circulation, most frequently by chilling of the surface of the body. Chilling continued for some time throws a greater volume of blood to the internal organs, and the vessels of the mucous membrane become overcharged. This condition in some way enables the bacteria to gain a foothold and multiply. This, in turn, leads to a further accumulation of blood, especially of the white corpuscles, to repel the invaders. The continued excess of blood results in the inflammation. In this condition some of the capillaries may become stopped up from white corpuscles adhering to the minute a Cold ijo PERSONAL HYGIENE Prevention of Colds Hardening the System veins, and this makes a congestion. As the bacteria are driven out, the inflammation subsides and the blood vessels are gradually cleared. The prevention of colds, then, involves keeping the mucous membrane as clear as possible from foreign matters, in accustoming the system to change in ex- ternal temperature, and in reasonable care that the surface of the body does not become unduly chilled. The first involves the care of the nasal passages and the throat. The most convenient and effective means of doing this is the oil atomizer. A light mineral oil called alboline is generally used. This may be used plain or some medication may be added, such as eucalyptus, menthol, with a very little car- bolic acid. A physician will give the proper prescrip- tion which should be adapted to the condition of the individual. This oil spray used night and morning, together with gargling the throat with an antiseptic solution, will help to keep the mucous membrane in good condition and to remove the source of infection. More important, perhaps, is the training of the heat-regulating mechanism to become less sensitive to change in external temperature — in hardening the system. Cold baths are most effective here. The clothing should not be too warm and the rooms not kept at too high a temperature, for this keeps the skin in continual tropical surroundings, so that any slight change of external temperature has marked effect. Reasonable care should be exercised towards COLDS 151 chilling the body. The greatest danger conies in sitting still in a room below 65 or remaining inactive for a considerable time in a strong draught or wind. While one is taking active exercise, there is little danger of taking cold. Wet clothing conducts the heat away from the body much more rapidly than when it is dry, so that it is dangerous to remain quiet if the clothing is damp. This is especially true in regard to the shoes and stockings. The body is much more susceptible to colds at one time than at another. Naturally, susceptibility is greater when the other functions of the body are not in good condition. Indigestion may make one especially liable to take cold, and we are always more susceptible when we are tired. If the bedding is too warm, the body may get into a perspiration, and if it is then thrown off unconsciously, a chill is liable to follow before one is awakened. "No cold is trivial." Although a slight cold may not occasion serious inconvenience, it should be cared for. Even a slight disturbance of the system by a cold, with the attending inflammation, makes the body less resistant to communicable diseases, and a slight cold may become a serious matter if added to. Frequent colds tend to produce chronic inflammation of the mucous membrane or catarrh which is a condi- tion difficult to cure. Much may be done when a cold is felt coming on to lessen its effect. Any means which will draw the Catching Cold Susceptibility to Colds Care of Colds 152 PERSONAL HYGIENE blood away from the congested area is helpful. Hot baths, or mustard foot baths are recognized as a means of bringing about the desired results; the taking of hot drinks, as hot lemonade, throws the blood to the skin and away from the mucous mem- brane. After the cold has once gained foothold in the body, not very much can be done except to protect the body from further chilling. Cold baths, if taken, should be discontinued ; in going out of doors in cold weather the clothing should be warm and come up well around the neck and throat. Very active exer- cise which produces rapid circulation is not favorable at the height of a cold, but may help to clean out the stopped-up blood vessels at the end of a cold. The Drugs taking of drugs, unless the whole system is involved, is worse than useless. Many of the so-called cold cures throw out the digestive system, which needs to be kept in good condition at this time. Local applications, however, may help somewhat. Medi- cated oil spray will give some relief and "adrenolin" ointment is recommended for a cold in the head. This contains a very small amount of the extract of the adrenal gland of some animal, and has the prop- erty of constricting the capillaries locally. If there is a hard cough, which tends to irritate the inflamed area simple cough drops or mixtures, which will pre- vent the coughing, are useful. HYGIENE OF CLOTHING Clothing is worn to help the body maintain an even temperature, also for personal adornment and modesty. Heat is transmitted from the skin by conduction and convection, and leaves the clothing in both these ways, and by radiation. There is only a very slight difference in the con- ducting power of the substances of which textile fibers themselves are made. The chief difference in the heat-conducting power of fabrics comes from the structural nature of the fiber and the weave. As dry air has less than i-ioo of the conductivity of the fiber substance, clothing is a poor conductor of heat in proportion as it contains air between the meshes and fibers. A number of layers of cloth give more warmth than one of the same weight. The fibers of wool are very much curled and twisted, and have considerable elasticity or spring, so that they are not easily spun into compact thread or matted. Cotton fiber is flat and twisted, without much elasticity; linen and silk are nearly straight and cylindrical, the fiber of silk being very fine and that of linen much coarser than any of the other tex- tile fibers. Wool fabrics, because of the character of the fiber and the way in which it is woven, enclose the greatest amount of air between the fibers, and so make the warmest clothing. Cotton may be so woven as to be almost equal to wool in this respect, 153 Conductivity of Cloth Character of the Textile Fibers i54 PERSONAL HYGIENE Relation of Clothing to Perspiration Warm Weather Clothing but it mats much more readily. If meshes are too large, the heat is carried away rapidly by convection — especially by moving air. Although clothing should prevent undue loss of heat, it should not prevent the escape of perspiration. It is only by evaporating that the perspiration carries away heat. If the vapor cannot escape, the skin is apt to become too warm, more perspiration is given off, and the underclothing becomes saturated ; water replaces the air and the underclothing then becomes a very good conductor of heat. If there is any movement of the air, the heat is taken away rapidly, both by convection and increased evapora- tion, so the body may become chilled. A leather jacket or newspaper worn under the coat may be desirable out of doors to keep cold winds from pene- trating the clothing, but any covering which prevents the evaporation of the perspiration as fast as it is formed, is very undesirable. Rubber waterproof garments are for this reason very uncomfortable during warm weather. Fabric called "cravenette," which is treated so. as to be waterproof, yet still retain its porous character, is more desirable. Clothing for the hot days in summer should impede the escape of superfluous heat and the perspiration as little as possible. For underclothing the open mesh or net knit goods seems most suitable. While this permits the free circulation of air, and so ready cooling, it makes an extra layer of air between the HYGIENE OF CLOTHING 155 skin and outer clothing when additional wraps are added, and so gives considerable warmth. The amount of clothing to be worn in winter de- pends upon conditions. People living in a city in houses more apt to be overheated than underheated, and riding in heated street cars, require clothing but little heavier in winter than in spring or fall. In- creased warmth when going out of doors is better obtained by putting on extra warm outside wraps, which are removed when in the house. For robust people, only medium weight clothing, especially underclothing, ought to b^ worn, for when the temperature of the rooms is kept at 68 degrees F., with heavy underclothing perspiration becomes active, and the skin is made very sensitive to the changes in temperature and the liability of taking cold in- creased. Old people leading inactive lives and those who are not strong may require thicker underclothing. Those who live in the country where houses may not be well or uniformly heated, or people who are much out of doors and inactive, as when riding in carriages, may well protect themselves by thicker underclothing, as well as with warm outside garments. Color has some effect on the radiation and reflection of heat by clothing. White reflects heat, as it does light, much more completely than black or dark colors which absorb it, so we wear white in the hot sunshine of the summer. Dark colors which absorb heat radiate it better than white or light colors. For Winter Clothing Effect of Color of Clothing 1 5 6 PERSONAL HYGIENE Uniform Warmth Freedom from Restriction The Corset this reason, white is warmer in winter, except in the sunshine, as well as cooler in summer. It is stated that a white rabbit loses only three-fourths as much heat as one whose coat is gray or black. White or light colored underclothing and bedding, then, is somewhat warmer than that of dark color. Clothing should be of uniform thickness all over the body, as there seems to be no logical reason why one part of the body needs greater protection than another in health — although it may be desirable to protect certain parts in special cases. Clothing should allow unrestricted movement of all parts of the body. Constriction at any place disturbs the circulation of the blood and interferes with proper nutrition. Cir- cular garters for holding up the stockings have no excuse for being. Nothing will so quickly ruin the graceful curves of the neck as a tight collar. It would be impossible to write of the hygiene of clothing without adding a word to the already sufficiently great protest against the corset. // the corset is not worn until full growth is attained, and if it is the proper shape and not too stiff, and if it is not worn too tight (but no woman will admit that she wears her corset tight), then they do little or no harm. It is hardly less than criminal to put a young growing girl into a tight waist or corset. The abdom- inal organs need the support of the abdominal muscles to keep them in a proper position and the muscles can only be developed by use. Natural breathing HYGIENE OF CLOTHING 157 is prevented, the natural figure is distorted by the constriction, grace of movement is interfered with be- cause of the cramping and under-development of the muscles of the waist. Boys might be put into corsets and men wear them with comparatively little harm. The corset and the high heeled shoe are, according to all physi- cians, responsible for the greater part of the ills peculiar to women. Undoubtedly to the corset may be attributed more suffering in America yearly than was ever caused by the Spanish Inquisition. A waist too small is as much of a deformity as too small a neck. Compare a fashion plate to a Greek statue! In time education may lead to reform, but there seems to be no hope at present that the corset will be banished, at least for dress-up occasions. However, there seems to be no good reason why a woman's clothing, while working about the house, should not be so constructed as to make a corset unnecessary. As made at present, skirts which fasten with a draw-string or narrow band at the waist are uncomfortable without a corset, but they may be made with a wide fitted band so as to be supported by the hips and waist, or made on a waist and sup- ported by the shoulders. Union suits and combina- tion garments are a step in the right direction. Equestrain tights are warmer and not so heavy as thick underskirts. Deformed ■Waists Working Dresses i 5 8 PERSONAL HYGIENE Foot Troubles Preserving the Arch of the Instep SHOES Because the feet have such heavy duty to perform and are so important in connection with physical exercise, shoes deserve considerable attention from the hygienic standpoint. American shoes are now constructed more in accordance with the natural shape of the foot than formerly, but it is rather rare that the adult foot is not mis-shapen by wearing im- proper shoes, and corns, bunions, ingrowing nails are still very common. The foot is made up of twenty-six small bones, which are held in place by ligaments, cords and muscles. To preserve the arch of the instep, all of these must be strong and well developed. The im- portant cords running under the instep to the toes form the bow-string action necessary to maintain the truss which the arch of the instep really is. They may be easily felt by placing a hand under thi instep. To make these tendons strong, the toes must have full play, and this they cannot have in the typical pointed shoe. In order to act as a perfect lever, the great toe should be nearly straight in the line of the foot and hence the inside line of the shoes should be nearly straight. The toes should be sufficiently wide; the soles should be flexible, so that the toes may be able to push in walking. A large stiff box prevents this. Now-a-days it is possible to obtain ready-made shoes that fulfill these requirements which are still not clumsy in appearance. The shoe SHOES 159 should fit snugly around the instep and heel, but allow sufficient room at the ball of the foot and toes. People who have worn shoes that have deformed the feet and have prevented the development of strong cords and tendons, are apt to have the arch give way some time during middle life. The bones of the instep sag, giving the condition called "flat foot." This, in addition to being very painful, prevents enjoyment of the very good and most available form of physical exercise — walking. Those afflicted with flat foot find some relief in using a metal innersole made for the condition, or in especially constructed shoes, which support the instep. Corns are a malignant growth of a papilla caused by irritation of an ill-fitting shoe, usually by shoes that are too small — sometimes by too large a shoe. They may be cured by the attention of a chiropodist, the wearing of shoes which prevent the irritation, and thorough cleanliness. A bunion is a much more serious affair, being a disease of the joint of the great toe, and caused from a turning out of the toe by pointed shoes, and by pressure. Since the improve- ment of the art of shoe-making, they are much less common than formerly. While leather is somewhat porous, it is not suffi- ciently so in many cases to permit the perspiration to escape as fast as it is formed. This leads to an accumulation of perspiration, the stockings be- come damp and then the feet grow cold easily. If Flat Foot Corns and Bunions Perspiring Feet 160 PERSONAL HYGIENE the sweat glands of the feet are especially active, shoes of thin leather should be worn and thin stockings. If the feet are especially tender, a nightly bathing in warm water and then in cold, with the application of a little oil, will prove beneficial. Low shoes Low shoes, because they give good ventilation, are a hygienic form of footwear, especially for the summer months. If gaiters are put on when out of doors they may be worn the year round. Tan shoes reflect heat, and so are cooler for summer wear. Patent leather shoes are practically non-porous because of the coating of varnish, and are not suitable for con- stant wear. Rubbers Rubbers seem to be a necessary evil, and undoubt- edly prevent many colds. The sandal variety which protects the soles sufficiently do not cause the feet to perspire so much as those that cover the entire foot. A liberal application of oil to the soles of shoes makes them much more water-proof. It is said that the vegetable and animal oils, such as salad oil and lard oil, are better for the leather than mineral oils. PHYSICAL EXERCISE The hygiene of physical exercise has been left until now because it is so inclusive. We all know of people who take little muscular exercise, yet seem to main- tain a fair degree of health. Is muscular exercise abso- lutely necessary for health, and if so, why ? We must remember that those who seem to get along comfor- tably with hardly any physical activity, are the exceptions. Many, very many more leading inac- tive lives are continually in a half -well condition. The mere act of sitting, standing and walking involves some muscular activity, and undoubtedly is the physical salvation of many who lead sedentary lives. As to why muscular activity is so essential to Necessity of health, it is only necessary to point out that about Activity half the weight of the adult body is made up of the skeletal muscles (those attached to bones). Fur- ther, the fat of the body is so much lifeless food material, the bones, except the outer layer, are prac- tically lifeless, the connecting tissues, cords and ten- dons have comparatively few living cells, and the blood, aside from the corpuscles, consists of nutrients, wastes and water. There remain the glands, nerve tissue, and muscles, which constitute the active, living cells of the body. Of these the muscles comprise over three-fourths by weight. The really living part of the body, then, is made up largely of the muscles. They are the dominant tissues; for them the organs 161 l62 PERSONAL HYGIENE Developed Through Muscular Activity Reserve Power Effects of Physical Culture of digestion, respiration, circulation, • and elimina- tion do most of their work. In the child, muscular activity trains and develops the nervous system, the heat regulating mechan- ism, the heart, the lungs, the digestive organs, and the muscles themselves. The development of the bones, even, is largely dependent on muscular exer- cise. It is easy to see, then, why nature has made the life of the young one of constant muscular activity. As no organ except, perhaps, a part of the brain, can be properly developed without muscular activ- ity, so the full strength and activity of no organ or function can be maintained except through muscular exercise. An automobile with a half-horse power engine is able to run along without trouble so long as the road is smooth and level. Rough going, or a hill, however, would cause something to break or bring the engine to a dead stop. Reserve power is needed. In the same way we all need reserve power to weather the storms and overcome the rough places in life. We need to be able to "speed up " for a time, if necessary. The good effects given by physical activity are (i) the training of the heart — muscular exercise is the only natural way of increasing the number and power of the heart-beats, and so in maintaining a strong heart. (2) Respiration is increased and deepened during muscular activity, the capacity of PHYSICAL EXERCISE 163 the chest increased by movement of the ribs, the lungs ventilated, and all of the remote air sacs distended. (3) The circulation is made more rapid by exercise and rhythmic contraction and relaxing of the muscles, combined with deep breathing, are powerful aids to a good circulation, preventing stagna- tion in the blood vessels, and especially in the lymph vessels. This leads to better elimination. (4) The heat regulating mechanism is trained, for muscu- lar exercise sets free much heat. (5) Moderate exercise has a favorable effect on digestion, and the movements of the abdominal muscles help peri- stalsis; exercise gives a keen appetite, and so helps digestion. (6) General exercise gives the body gen- eral fatigue and thus makes sleep natural and profound. The life of our ancestors involved considerable Human muscular activity, and the human machine is adapted Bum for to do a large amount of muscular work. Conditions of living have changed faster than the physical body could possibly change. We have essentially the same sort of a body as that of our prehistoric ancestors. It is a question whether the race will ever develop into one with weak muscles, small bones, and degener- ate organs. Certainly the type of man would not be so high. Two generations or so ago few people were troubled because of lack of physical activity. Nearly all received a sufficient amount in the course of their daily living. It is estimated that the amount of mus- Work 164 PERSONAL HYGIENE cular work performed by the people of the United States has decreased about 75 per cent during the last twenty-five years. This great change is due to the introduction of all sorts of labor-saving machines. A generation ago wage earners did a great deal of laborious muscular work ; now they accomplish more by sitting down and tending a machine which does the mechanical part and simply requires close watch- ing. A corresponding change, although to a less extent, has taken place in housework. Running water, coal and gas stoves, sewerage have lessened greatly the amount of laborious work necessary. increase There are certainly many advantages in this Activity decreased amount of muscular work needed ■ at present, but there are also disadvantages. With the decrease in manual labor, there has been an accom- panying great increase in the nervous energy re- quired in the life of to-day. Investigations have revealed the fact that city families on an average do not last more than three generations, and rarely more than two, without the addition of country stock. It is undeniably true that average conditions of life in a city are not so favorable to health as the condi- tions which exist in the country. This comes about through less muscular activity, less out-door life and more mental work, excitement and nervous stimula- tion. There is no principle in hygiene better estab- lished than that considerable muscular activity is nec- essary to counteract the evil effects of sedentary life. PHYSICAL EXERCISE 165 The objection is often made that "there is no time," but time must be found. The necessary physical activity takes no more time than that lost through illness. The diminished efficiency in work counts for more than time actually spent in muscular activity needed for health, to say nothing of the increased pleasure of living and joy that comes with abundant vitality. The amount of neglect and abuse that the human machine will stand is surprising, but physical sins have their punishment soon or late. Physical self-sacrifice which may perhaps lead to invalidism or death is never justifiable. It is better for the children to receive less of the mother's time and still have a mother ; better for the family to have less money than no provider. There are certain essential principles governing the value of various forms of muscular activity. Exer- cise taken for its hygienic effect should involve a maximum amount of muscular work and a mininum of nervous energy. This is accomplished by exer- cising the large group muscles of the legs and trunk rather than the small muscles of the arm. A con- siderable amount of muscular work is done in playing the piano, but the amount of nervous energy expended is so great that the activity does not serve the purpose of hygienic exercise. Brisk walking, swimming, bicycle riding, golf, and the like, call for a consider- able amount of work by the larger muscles, and for this reason are valuable hygienic exercises. The exercise Economy of Time Principles of Hyiegnic Exercises 166 PERSONAL HYGIENE should be sufficiently vigorous to increase the activity of the heart and lungs. It should be rhythmic rather than sustained, because such exercises are more pleasurable and less apt to cause strain. It should be enjoyable, if possible, and so rest the mind. Undoubtedly the best kind of physical exercise is that involved unconsciously in one's daily occupa- tion. A long walk taken to one's place of business or to do marketing is better than the same amount of walking done simply for the exercise. A situation "only a two minutes walk" from the markets, station, or street car is not always desirable for one's homes. A mother with three or four small children, doing most of the housework, gets sufficient physical activity, perhaps more than enough. What she needs is a lessening of nervous strain through social relaxa- tion and moderate out-door activity. Housework If the clothing be loose, the shoulders kept back, the chin in, housework is a very good form of physi- cal exercise (except that it is indoors) , but if the work is not well organized, or if there is a wrong attitude of mind towards the work, the nervous strain and mental disquietude counteract the good physical effects. But there are many women able to keep two or three servants, whose physical (and mental) health would be far better if they were not so fortunate ( ? ) and found it necessary to do more of the housework. For those leading a sedentary life, then, some mus- cular activity outside the daily routine is necessary PHYSICAL EXERCISE 167 for health. No argument is necessary to prove that when possible exercise should be taken in the open air. The simplest, most universally available and a very desirable out-of-door exercise, is walking. It is esti- mated that a brisk walk of two or three miles a day, or its equivalent, is needed on the average to keep a man or woman in good physical condition. The walk must be rapid — between three and four miles an hour. The saunter of the typical "constitutional" requires little more muscular activity than standing. Walk- ing on level city pavements produces weariness long before an adequate amount of muscular exercise has been done. The feeling of monotony and weariness does not come so soon if the walk is taken in good company. A cross-country walk up and down hill is usually delightful and most beneficial exercise. It is always better to walk with some object in view. Any physical exercise, taken simply for the exercise, although it may have some favorable effect, cannot begin to compare with that through which pleasure is obtained. Out-of-door fads involving considerable walking contribute greatly to physical well-being. Among such are botanizing, the study of birds, of butterflies, and all of the many forms of nature study, microscopy, geology, amateur photo- graphy, and the like. For the summer vacation there is mountain climbing. There is no way equal to walking of coming close to nature and getting at her wonderful secrets. Often exploration of one's own ■Walking Out-of-Door Recreation i68 PERSONAL HYGIENE city or town will yield much of interest in history and sociology. We are apt to neglect the things within walking distance. Bicycling Bicycling has some advantages over walking, as it involves a greater distribution of muscular effort and so a greater total amount of work may be done with- out fatigue. It gives one a much larger radius and a wider range of interests. It is a pity that bicycling has now lost the vogue it formerly held, but it is just as enjoyable as ever, and machines are much less expensive. Automobiling and carriage riding give very little exercise. Taking the air is desirable, but not a substitute for physical activity. The rapid motion and fresh air may whet the appetite, and so tempt one to over-eat. Horseback riding is an excellent form of exercise, although not suitable for delicate women. It is ex- pensive in the city, but not so in the country. Rowing and paddling are exceedingly valuable. They are easily learned, pleasurable, and are usually associated with beautiful scenery and delightful sur- roundings. The movements involved in handling the oars and paddles are particularly adapted to the exercise and strengthening of the arms, back, chest and waist. Swimming Swimming is a most fascinating and exhilarating exercise, especially when practiced in the ocean. It involves the activity of nearly all the muscles in the body, and tends to give a symmetrical figure and Horseback Riding Rowing PHYSICAL EXERCISE i6g erect carriage. Because swimming is so enjoyable there is danger of remaining too long in the water, if the water is cold. If the body becomes chilled and the lips blue, much more harm than good comes from sea bathing. Swimming has the disadvantage of being difficult to learn after youth. Of the out-of-door sports, golf seems to be the most Golf generally valuable. It is not difficult for adults to acquire some proficiency, it is suitable for all ages ; nearly all get the "enthusiasm;" it can be played nearly all the year round. In addition to the mus- cles involved in walking, there is moderate exercise for the arms, shoulders, back, waist and abdominal muscles. It occupies the mind completely, and most people find they can cover a distance in following the ball that would be impossible in a straight-away walk. Much or little exercise can be taken, as desired. Lawn tennis, also, has many advantages. It is Tennis interesting, adapts itself to mild, moderate, or vig- orous exercise, and the movement involved in lifting the arms overhead, the frequent bendings and twist- ings of the waist, the running and jumping, make it a splendid all-around exercise. The disadvantages are that the game is difficult to learn after youth, and like golf it is not available for every one. Croquet, archery, and the like, are mild forms of exercise, and although better than nothing, do not give robust people sufficient muscular activity for the time taken. 170 PERSONAL HYGIENE ■Winter Sports Gymnasium Games Dancing Gymnastics It is more difficult to get sufficient out-of-door ex- ercise in winter. Skating, snowshoeing, toboggan- ing are excellent, but they are usually possible only at irregular intervals and cannot be depended upon for regular exercise. Walking is always available, but somewhat less interesting. In winter we must resort to indoor games which afford valuable exer- cise, combined with recreation. Bowling is easily learned, and combines activity, with considerable enjoyment. Even though only one hand is used, there is little danger of one-sided development in bowling two or three times a week. Fencing has many advantages as an indoor exer- cise. It gives grace of movement, an erect carriage, agility and precision. The combative element makes fencing fascinating, and develops judgment, coolness and self-control. Basket ball is an excellent indoor game, but it is apt to become somewhat violent. Hand ball is a very good gymnasium game. Were it not for poor ventilation and late hours, dancing would be an admirable form of exercise, but in a- close, dusty hall it is of doubtlul value. How ever, it is possible to have good ventilation and to stop at a reasonable hour. In addition to the indoor games there is an end- less variety of systematic gymnastic movements which, if practiced regularly and judiciously under a trained instructor, bring about the very best re- sults in the correction of faulty carriage and in de- FUNDAMENTAL POSITION 172 PERSONAL HYGIENE. veloping the muscles, as well as in the maintaining of good physical condition. We are not concerned here with the large subject of physical education, but are more interested in gymnastics from the hy- gienic standpoint. While the best results are ob- tained in gymnasium classes under a trained instructor, it is possible to receive much good by practicing free movements, without apparatus, at home. For this purpose a few selected typical movements are described and illustrated here for the benefit of those who are willing to give ten or fifteen minutes every day to maintaining and improving their physical condition.* . Home There are two series of exercises. Those in the Exercise . first series are simple and not very vigorous; those in the second series — in brackets — are more vigor- ous, and should not be tried until those in the first series have been practiced for several weeks. All the exercises in the two series may be taken by vig- orous women after a few weeks' practice. The figures indicate the counts that correspond to the movements in each exercise. It is well to count while doing the movements. Try to imitate the positions in the illustrations as accurately as possible. Practice each exercise about 8 counts at first and increase gradually to 32 *Exercises designed and photographs furnished by Pro- fessor G L. Meylan, Director "Gymnasium Department, Columbia University. EXERCISE 1. One. — liend head backward. Two. — Return to position. EXERCISE 2. One.— Bend arms. Raise heels. Two.— Return to position. 174 PERSONAL HYGIENE counts in five or six weeks. The rhythm should be rather slow at first, and increased gradually up to moderate rapidity. The total amount of work is increased by doing the exercises rapidly. Avoid doing the exercises in a jerky manner. It is well to stand before a mirror while learning them, to make sure that all the positions are taken accur- ately. Dress and Have the windows wide open, dress loosely, take three or four deep breaths and begin the exercises, being careful to take them in the order given. The breathing should be deep and regular while doing the movements. Follow the exercise by a cool sponge bath and a vigorous rub with a coarse towel. EXERCISE i One — Bend head backward, with chin in, hands on hips, and shoulders low (inhale as head goes back). Two — Return to position. EXERCISE 2 One — Arm bending and heel raising. Two — Return to position. One — Raise heels. Two — Lower heels and raise toes (rest hands on back of chair if necessary to maintain balance). EXERCISE 3. One.— Raise arms sideways and bend the knees. 176 PERSONAL HYGIENE EXERCISE 3 One — Raise arms sideways and bend knees. Two — Return to position. One — Raise arms sideways (and bend knees as far down as possible). Two— Return to position. EXERCISE 4 One — With hands on hips and feet apart, bend side- ways to right. Two — Straighten up. Three — Bend sideways to left. Four — Straighten up. (Same as preceding exercise, only with hands back of neck.) EXERCISE 5 One — With arms bent and feet apart, bend forward with back straight. Two — Stretch arms overhead. Three — Bend the arms. Fourth — Straighten up. EXERCISE 6 One — Lift right knee high. Two — Replace right leg on floor and lift left knee immediately (stationary walking in moderately quick rhythm) . One — (Same as previous exercise, only with knees straight, supporting the hands on back of chair if necessary.) EXERCISE 4. One.— Bend sideways, hands on the hips. EXERCISE 5. Two. — Stretch arms over head after bending EXERCISE 6. One.— Lift knee high. i So PERSOXAL HYGIEXE EXERCISE 7 One — Bend arms. Two — Stretch arms overhead as high as possible. Three — Bend the arms. Four — Stretch the arms horizontally sideways. Five — Bend the arms. Six — Stretch the arms down to sides. EXERCISE 8 One — With "hands on neck, twist to right (try not to move below the waist). Tivo — Return to position. Three — Twist to left. Four — Return to position. EXERCISE 9 (a). One — AYith arms bent and feet apart, bend down and try to touch the floor (knees straight"). Two — Straighten up. Three — Stretch arms overhead. Four — Bend the arms. (b). One — From fundamental position, bend the arms. Two — Jump to position feet apart, and at the same time bend down and try to touch the floor. Three — Straighten up, with arms overhead. Four — Jump to position. EXERCISE 7. Two.— Stretch arms over head. EXERCISE 8. Owe.— Twist to the right. 1 82 PERSONAL HYGIENE EXERCISE 10 (a) Place hands on a chair. One — Reach back with right foot as far as possible. Two 1 — Place left foot beside right foot and maintain body straight. Three — Return right foot. Four — Return left foot. (Same as preceding exercise only move both feet back at the same time.) (b) Lie on the floor with hands back of neck. One — Raise right leg as high as possible with knee straight. Two — Lower right leg to floor. Three — Raise left leg. Four — Lower left leg. EXERCISE ii With hands on hips and heels raised, jump up and down with feet together. (Same as preceding exercise, only jump with feet apart and together alternately.) EXERCISE 12 Run in place, lifting the heels high up behind. (Same as preceding exercise, only lift knees high in front at each step.) EXERCISE 10. Two.— Place left foot beside the right, keeping the body straight. EXERCISE 14. One.— Raise arms sideways, palms down. EXERCISE 14, One continued.— Turn hands over, bend head hack, take deep breath. 1 86 PERSONAL HYGIENE EXERCISE 13 One — Raise the arms forward — upward as high as possible while taking a deep breath. Two — Bring arms down sideways while breathing, breathe out. EXERCISE 14 One — Raise arms sideways' to horizontal, palms down, turn hands over with backward bending of head and taking a deep breath. Two — lower the arms, return head to position and out. Exercise Not All Monotony Although the practice of the foregoing or other home gymnastics will bring about a great improve- ment in health, attention must, of course, be given to correct carriage of the body, standing or sitting, proper method of breathing, wholesome food, and so on. Fifteen minutes gymnastic work will not counter- act the effect of the infringement of all other rules of hygiene through the rest of the twenty-four hours. The great drawback to home gymnastics is that the work grows monotonous after a week or two, and some strength of mind is required to keep up the daily practice. However, the exercises may be varied, often by out-of-doors exercise, or light appar- atus may be used. From the hygienic standpoint it does not matter much how the physical activity is obtained so long as it is obtained daily. Even if it does become monotonous at times, the results justify PHYSICAL EXERCISE 187 the effort. Care of the body in general is not particularly interesting, but habit makes it a matter of course. Practicing scales on the piano is irk- some, but it is the only means to a desired end; so physical activity is the only means of acquiring and maintaining a high degree of personal health. PERSONAL HYGIENE Part III Read Carefully. A number of personal questions are asked in connection with this lesson, not for the information of the instructor, but to bring the matter home to you, and to enable you to clarify your thoughts by writing them out. Answer fully and leave space between answers. i. Give a brief account of your own health history with the probable reason for any periods of lack of health. 2. (a) Why is the care of the nervous system so important? (b) How are strong nerves de- veloped, and how maintained? (c) Why is sleep necessary ? How much do you find that you need ? 3. Why is it important that good personal habits and habits of work be formed early? (b) What is laziness ? 4. What are the important points in the care of the teeth ? How should your own teeth be cared for? 5. (a) What determines the amount of food re- quired ? (b) Which do you consider the most important (1) the chemical composition of food, (2) the manner of eating, or (3) the way the food is cooked and why ? (c) What are your own food problems ? 188 PERSONAL HYGIENE 189 6. Why is it desirable to drink a considerable amount of water? About what quantity of water or other liquids do you take daily ? 7. What factors determine the effects of baths? Do you find a daily cool bath of any kind beneficial ? 8. Give the principles governing (a) health of the hair, (b) health of the complexion. 9. What are "colds?" How are they brought on, and how prevented ? How should a cold be cared for ? 10. What can you say of the hygiene of clothing? (b) To what extent does the question of health govern the selection of your own cloth- ing? 11. Why is the care of the feet and the selection of shoes of importance ? 12. What reasons are there for believing that a cer- tain amount of physical activity is necessary for health? Answer fully. 13. Give the principles governing the good hygienic effects of exercise. 14. What forms of physical activity are available for you at the present time ? 15. In the care of your own health what tendency or weakness calls for special attention ? What can you do to overcome such fault? i go PERSONAL HYGIENE 1 6. Make out an hourly schedule for yourself, giving hours for work, recreation, eating, and sleep, and allowing some time for the care of health — a schedule which you could easily follow, say for 350 days in the year. 17. Give your opinion of the duty of health. 18. What is your feeling in regard to the taking of medicine (meaning drugs) for minor ailments and without a physician's orders ? 19. Which would you say was greater, the influence of health of mind on health of the body, or the influence of the health of body on health of mind ? 20. Draw up a set of good resolutions relating to your personal health. (A certain place is said to be paved with good intentions, but "heaven is vaulted with them.") 21. Have you read any of the books recommended or others in connection with this lesson ? 2 2 . What questions have you ? Note. — After completing the answers, sign your full name. ETHICS OF HEALTH; OR HEALTH A DUTY By Thomas D. Wood, M. D. Professor of Physical Education, Columbia University . UNITY OF THE BODY, MIND, AND SOUL The attempt to classify man under the headings of the physical, mental, and moral is misleading. No clear distinction exists or can be made between these three conditions or attributes. The complete unity of man is one ot the most striking and significant facts in nature. The interdependence between different organs, functions, and faculties is so close and vital that what affects a part of the organism affects all of it, and the indirect influences frequently are so subtle and far-reaching as to confuse the best of physicians, physiologists, and psychologists. The nervous system is as genuinely physical as bones and muscle. The brain is a physical structure — a part of the nervous system — and mind is a func- tion of the brain ; so that mental activity is essentially as physical a process as digestion, muscular action, or the circulation of the blood. Mental activity is hidden away within the brain in the skull, but the only way in which mental action can be expressed to others is through muscular action in speech, or writing, or the expression of the face, or the rest of the body. 191 192 PERSONAL HYGIENE Moral qualities have to be expressed in a similar way. In fact, "moral" refers to the attitude of the person in relation to others in purpose and conduct. Moreover, the moral tone and quality of the individual depends vitally upon physical structure, functional health, and bodily vigor. The person who has dyspepsia or other physiologic disorders is apt to be depressed mentally ; lacking in energy to do things, and frequently morbid in conscience. The vicious, criminally minded, and im- moral have often been found to be deformed or diseased, and incapable, therefore, of meeting human responsibilities. "Weakness is often akin to wicked- ness." In many cases no clear distinction can be made between weakness of body, mind, or soul. Some real and other apparent exceptions to this statement do not dfcjprove the fact, or lessen the importance of the genera*!) rinciple. The importance of the so-called physicaMjhen, is to be estimated in its relation to the highest arfd best faculties of the human being which depend upon and express themselves through the human organism. INHERITED CHARACTERISTICS More extraordinary than the unity of the individual human being is the continuity of human life. Hered- ity is a vague and comprehensive term referring to all the influences affecting the child up to the time he is ETHICS OF HEALTH i 93 born, coming from parents, grandparents, and all the ancestors back to the beginning of living things, from which the child is descended. The number of bones and organs ; the shape of the body ; the relation of its parts ; similarity in color of hair ; expression of face ; even in gesture and gait, are all inherited in various degrees by child from parent. More subtle characteristics in temperament, mental and moral qualities seem to be handed down in fam- ilies. Individual deformities due to accident or in- jury are not inherited, and many of the popular beliefs regarding prenatal influences are without foundation in fact. TENDENCY IN HEREDITY Different from the inherited characteristics already briefly alluded to are the organic influences trans- mitted directly from parent to child, and of much hygienic importance. Children are rarely stronger and healthier than their parents, unless special atten- tion is given to physical education. Much more fre- quently where there is a real difference, the children are less robust and more inclined to disease. Ten- dencies to degeneration and disease are much more apt to be transmitted than the tendency to improve- ment of any kind. The diseases due to immorality and vicious living are most apt to be transmitted to children. Tenden- cies to gout, rheumatism, some diseases of the heart and other vital organs, and the various nervous dis- 1 94 PERSONAL HYGIENE orders are not infrequently transmitted from parent to child. Tuberculosis — either of the lungs or of other parts of the body — is almost never transmitted directly, but the tendency or susceptibility to tuber- culosis — transmitted to the child by the tuberculous parent — is one of the most definite and serious facts in human life. The fundamental and inalienable birthright of the child is that he shall be born of parents and earlier ancestors who have lived their lives with an intelligent and conscientious sense of their responsibility to their possible descendants. RIGHT LIVING The science of healthy living is to-day well under- stood by a few (physicians and others) , but in general and in relation to its intrinsic importance, hygiene rceives less attention than any other subject. More serious yet is the fact that in the care of health, conduct falls so far short of the knowledge which people have upon this subject. Nowhere in the realm of human affairs is there a greater gap between theory and practice, between knowledge and action, than in the matter of hygiene. It is claimed, and probably is true, that human life is on the average longer to-day than it was a few generations ago. Nevertheless, the human animal is the least sound organically of all the species of living things — i. e., less free from disease, and further from the best ETHICS OF HEALTH i95 health and power possible if adequate attention and care were given to health. INSTINCT VERSUS INTELLIGENCE In nature, under the guidance of instinct, the wild animals live healthy lives and transmit to their young the capacity for the highest degree of strength and health. They strive for the best conditions of life possible to them, and in so doing work unconsciously for the best health of their offspring and the race to whicn they belong. Thus does nature insure a fine quality of life among her creatures. The first effort of the animal is for self-preservation, although at times life is sacrificed for the sake of the young. The weak and injured are left to perish, and there are lack- ing in the animal world many of the finer and nobler human attributes, but a high standard of health in the species is maintained. Human beings are not guided so surely by instinct as are the animals, nor are they usually as healthy and strong as the creatures in nature. This is due to the fact that intelligence, reason, and conscience do not impel civilized men and women to lead as healthy, wholesome lives as the animals live under the guidance of instinct in nature. Human beings are not yet wise enough to realize in practice the true value of the highest physical efficiency and their responsibility for it 1 96 PERSONAL HYGIENE DUTY TO POSTERITY Each human being has received from his ancestors life and a certain capacity for health and strength. The people of this generation must be the parents of the next, and thus each generation is the con- necting link between all the life of the past and all the life of the future. This responsibility im- posed by nature of receiving life from the past and handing it on to the future is a racial obligation; is fundamental and must receive much more intelli- gent and rational human care than has yet been given to it. The duty to be well and strong, to maintain the best possible standard of organic soundness, to im- prove one's human power and efficiency to the highest possible pitch, is owed to one's self, to one's ancestors, to one's contemporaries, and vastly more to one's children, and to the children's children in coming gen- erations. Human life and health are not simply individual possessions to be controlled solely or pri- marily for immediate ends ; to be sacrificed for personal caprice or even ambition. They may not contribute alone to individual achievements, however worthy such may be or seem. They may in justice be used for the present only so far as such immediate use does not detract from but rather enhances their value for the future offspring whose chance for life and health depends upon their present treatment and care. A clear understanding of this great continuity of life and ETHICS OF HEALTH 197 its implications will modify human thought and con- duct in manifold ways. CIVILIZATION AND HEALTH Human demands and interests to-day are much more numerous and confused than those of the ani- mals, or even those of primitive man. Civilization rapidly increases the complexity of the human envi- ronment and multiplies to confusion the demands upon time and strength. Many of these lead away from, and not a few are in direct opposition, to the laws of rational and wholesome living. Instinct guides the animal wisely in a multitude of ways, while man too often ignorantly or heedlessly stumbles through life, using haphazard, and perhaps destructively, the precious heritage of the ages. SELFISHNESS Human selfishness causes much of the irrational and unhygienic living and often prevents obedience to the laws of health which are well known. The objects for which people struggle are often superficial in value, and if attained are frequently purchased at the expense of health and perhaps of other values even more important than health in our human world. Money beyond what is needed; fashionable houses; furniture and clothing beyond that which is required for the highest living; fame in the commerical, polit- ical, social, or scholastic world beyond what is rational ; 198 PERSONAL HYGIENE all these and other motives impel many beyond what is their reasonable best at the expense of other and more important values. But worse than the penal- ties involved for the adult person through unwise action are the injuries done to the health and the future of children through the folly and ignorance of parents. It seems of slight moment comparatively to sacrifice some sleep, some rest, some healthful exercises when human affairs crowd; or to eat more than is needed, or a dish less wholesome, that the taste may be grati- fied. These errors are usually less serious for the grown person than for the child, but they are all wrong in principle, and they are often due to some degree of selfishness. PROTECTION OF HEALTH PARAMOUNT Health is not the highest or finest value in human life, nor is it the chief end of living, but health is abso- lutely essential to the best success in the life and work of the individual, and it is even more important for the welfare of human society and of the race. The child's health should be sacrificed to nothing else by the parent, the teacher, or the community; and in adult life health should be given for other things only very rarely. This protection of health should not be given in any selfish way, nor should it conflict in child or adult with the expression of human cour- age, self-sacrifice, and devotion to the needs of others. ETHICS OF HEALTH 199 The risking of health or life even, in the effort to help or save a fellow being in emergency, must always be considered higher and finer conduct than mere self- preservation or care. However, this unselfish devo- tion of life and strength to others is not a real excep- tion to the rule of health preservation, but empha- sizes the importance of considering health care a duty, in order that one may be most efficiently prepared for life emergencies. In relative value the life and health of the child is more important than that of the parent because he has more of his life ahead with its undeveloped possi- bilities, and the child of to-day will be the parent of the children of the next generation. This great racial obligation, if recognized, must give each individual a stronger reason and an inspiring motive for the best care of health which human science may show to him. "NO MAN LIVETH TO HIMSELF ALONE" The short-sighted and spasmodic attention given to health, ordinarily, leads people to guard their phy- sical welfare as if it belonged solely to them ; as if no one else, at least beyond their immediate family and children, had any claim upon it. Parents usually foster their children's health as if the world were to end with the child. This well intended but often misdirected attention frequently makes the child selfish and too self-conscious. This protection of 200 PERSONAL HYGIENE health for one's self and for the children under one's care — whether as parent or teacher — should con- stantly aim. to make the individual more capable and effective in doing for others. In this way, the care of health, instead of being a self-centred process, may become an impelling factor in higher and better living. IDEALS IN LIVING To maintain the highest standard of health possible to each individual involves an unselfish, intelligent devotion to high ideals of living and a sacrifice of present indulgences to future well-being. Instinct, feeling, and appetite are useful indications, but they must be controlled and guided by reason and judg- ment. The individual who eats at regular intervals, in suitable amounts, the portions of food intelligently adapted to his needs will in the long run, and fre- quently from the beginning, have better health and get more pleasure from eating than the person who consumes without judgment what he happens to crave. The person who takes muscular exercise rationally will enjoy movement, while the individual who neglects wholesome activity soon loses the pleas- ure of exercise. Thus does nature reward those who obey, and punish those w*ao violate, the laws of life and health Human appetites and desires bring genuine satis- faction only to those who control instinct and passion for the welfare of the family, of society, and the race. ETHICS OF HEALTH 201 Happiness here, as in other phases of life, cannot be attained simply by pursuing it for its own sake. True happiness is simply the pleasure and satisfaction accompanying wise conduct. Consistent living will bridge the gap between the knowledge and practice of hygiene, but it is important to remember that people will not live consistently simply through the knowledge of the laws of health. Too many other goals in life appeal to the mind and ambition of the individual. A rational consistent care of health is a fundamental and most important duty for each one, and the human conscience must be aroused to the importance of this duty. The duty to health must become a part of one's religion. The conscience must be touched, the heart thrilled, and the imagination fired with a com- pelling devotion to this ideal of living which will hold the individual to a care of health, which will be in accord with the more immediate and the large rela- tions and responsibilities. THE USE AND ABUSE OF DRUGS By H. M. Lufkin, M. D. Professor of Physical Diagnosis and Clinical Medicine, Uni- versity of Minnesota The teaching of medicine in the earliest periods of recorded history was associated with the offices of religious worship. The little known of medicine, confined to the priestcraft, was jealously guarded and its administration surrounded by the mystic rights and superstitious practices common to an age when the operation of natural laws was ascribed to the occult. The dawn of the Christian era witnessed a gradual decline of the priestly influence in medicine and independent philosophers and scholars, or "savants," made their names famous by their medical teaching. Through the intervening centuries prog- ress in medicine has kept pace with the other sciences. Schools and dogmas have risen, attained more or less fame; have contributed perhaps some- thing or nothing to the sum total of accepted fact, and sinking again into oblivion, have been followed by other schools and dogmas. Until the advance of the related sciences made research productive, medicine remained more an art than a science. Chemistry, physics, botany, experi- mental physiology, and biology are the handmaidens of a broad and enlightened profession. Growing out 202 USE AND ABUSE OF DRUGS 203 of the general advance, and as a result of the accumu- lated knowledge, one great and illuminating fact stands out at the present time, and that is, that the prevention of disease is easier to effect than its cure. "Health is that condition of the system in which all the organs of the body and mind act in harmony and without sensible disturbance." It is a truism that, "In the health of the people lies the strength of the nation." The public health is the sum total of that of all its individuals. Hence, the individual has the responsi- bility of considering himself as an independent unit and as a part of the body politic. Aside from the personal discomfort of ill health he must consider his influence upon the community at large. Hence, enlightened governments provide and administer laws safeguarding the public health. CLASSIFICATION OF DISEASES Diseases may be broadly classified as junctional and organic. Functional diseases are characterized by the arrest of a function of a part or all of the cells of an organ engaged in some essential duty involving the integrity of nutrition and elimination. So long as the disorder is purely functional, such cells or groups of cells do not undergo permanent structural change. When a structural change takes place in the cell or group of cells constituting an organ, just 204 PERSONAL HYGIENE so far has functional disease given way to organic disease. A healthy functionating organ is capable of resisting, by its natural powers, surprisingly long-continued and often serious attacks upon its integrity. Such attacks commonly stand for the violation of well- recognized laws of health and may be referred to ignorance, inadvertence, weak will power, or un- wholesome environment or occupation. If the disturbance has not been too acute and is recent, the proper application of the rules of hygiene which shall correct the particular fault — get at the cause — is all that is necessary to a cure. It must be remembered that the impairment of one function sets up a "vicious circle" which operates on other functions, this in turn vitiating the natural phys- iological resistance of the fluids of the body to the invasion of infection. In this way, always insidious and at first scarcely noticeable to the victim, do the cells of the body fall prey to the degenerative changes which constitute acute and chronic organic disease. The dividing line between functional and organic disease is not always to be recognized. An organ may be partially destroyed and yet carry on its function in a fairly satisfactory fashion. A part of the lung may be destroyed, and yet nearly perfect health is maintained through the capacity of the rest of the organ to perform the function of that USE AND ABUSE OF DRUGS 205 destroyed. One kidney will often do the work of both when either has been removed. Sometimes an organ may be completely removed, and yet analogous structures carry on its work, as has been proved by the total extirpation of the stomach. SYMPTOMS A disordered function or disease is made manifest through abnormal sensations or feelings, called symp- toms. Symptoms are called subjective when they are felt by the patient;' objective when they are only to be known by the observation of the patient by another person. Headache, pain, fever, are subjective symptoms and warn the patient of a disordered system. Albu- men in the urine, the character of the pulse, are objective symptoms. It is the sum total of these which enables the physician to diagnose the abnormal condition. DRUGS AS CURATIVE AGENTS From the days of mysticism in medicine, to the present time, it has been sought to relieve symptoms and so cure disease by the administration of drugs. To find the "Elixir of Life" was one of the great goals of the alchemists. The first use of drugs was purely empirical. That is, if the patient recovered by the use of a drug, it was assumed that the drug caused the cure, and was administered in similar cases. 206 PERSONAL HYGIENE Much valuable information has thus been obtained and incorporated in our materia medica. The mode of cure, the effect upon the tissues or functions as such, were not known. A notable example of the large empirical use of a drug was that of quinine upon its introduction. The curative uses of quinine are now known to be very limited. Certain other drugs, like mercury and salicylates attained to the dignity of so-called specifics, i. e., in certain affections their curative virtues were con- sidered universal. This class of drugs is very limited. HOW DRUGS ACT A second class are the drugs whose action has been studied upon animals and their power over the various functions of the body noted, and this action applied to the modification of function to meet the require- ments of disease. This class is very large, and its use constitutes the bulk of prescribing to-day. As knowledge of drug action has become more exact, empiricism has steadily given way to the modern prescription — a single drug, directed to a definite purpose. The so-called "shot-gun" prescription involved the combination of many drugs in the hope that Nature's selective power would supply the de- ficiency of the prescriber. It is now happily seldom seen outside of patent medicines. The use of drugs in the physiological sense, is the most exacting method of prescribing for the sick. It presupposes a clear USE AND ABUSE OF DRUGS 207 knowledge of the effect of the drug upon a given function and system at large HOW DRUGS ACT. (PHYSIOLOGICAL ACTION) The most commonly used drugs are anodynes — pain-relieving drugs. Opium and cocaine, antipyrine and acetanilid are examples. Opium acts through its influence upon the circulation of the brain, producing first an afflux of the blood to that organ and then a decrease of the same, through the nerve centers con- trolling the caliber of the blood vessels (vaso-motor nerves) . In the absence of undue excitability of the nerves, there is produced a condition resembling normal sleep. In large doses its action is profound, producing the following effects: Profound stupor, complete anasthesia, paralysis of the respiratory centers, paralysis of kidneys, and finally from habitual use, profound changes in nutrition and in the psychic centers, resulting in emaciation, moral perversions and imbecility. Such drugs have a far-reaching effect, and are common ingredients of patent medi- cines. Stimulants are such drugs as have for their primary action the stimulation of all the functions of the body, or exert their chief influence on some special function. Alcohol is used as a general stimulant, while strychnine, belladonna, cannabis indica, digitalis, are examples of special stimulants, each acting through one or more nerve centers, yet all are rank poisons, 208 PERSONAL HYGIENE and destructive, not only of function, but of life, in excessive doses. Hypnotics or sleep-producing drugs. In this class may be included some of the narcotic drugs, such as opium and cocaine. They operate through direct influence upon the brain. Chloral hydrate is the standard by which these drugs are judged. A pure hypnotic produces sleep, but does not relieve pain. They have secondary actions, which make their use hazardous by the unskilled. Diuretics stimulate the function of the kidneys. Diaphoretics act upon the sweat glands through their nerve supply, increasing perspiration. Cathartics promote loose evacuations of the bowels, a class of drugs widely exploited by patent medicine vendors. They act in various ways, through stimu- lating the flow of bile, by stimulating the muscular walls of the bowels, by stimulating the secretion of the intestinal glands. Cathartics are widely used, and seldom with advantage, except for brief periods of time, and then should be selected for the special condition which calls for their use. The secondary effect of most cathartics is to intensify the abnormal condition they are used to overcome. There are many other classes of drugs, and in each class are many drugs whose actions, in the main, are similar, yet whose differences render the choice a matter of knowledge and discrimination impossible for the layman to acquire. USE AND ABUSE OF DRUGS 209 There is not a function which can not be altered by drug action. There is hardly to be found a diseased function which may not be influenced for the better by the wise use of a drug. The converse is true. There is no drug, unless inert, which does not in some degree change a function, by acting upon one or more organs, either directly through its chemical activities, or its less well-understood, though more common, influence upon the tropic (nutrient) or other nerve centers. Not uncommonly drugs have a double action, and while beneficial in one direction are posi- tively harmful in another. Yet such a drug may have its evil influence neutralized or balanced by one of opposite action combined with it. A group of drugs much used of late are good pain relievers or anodynes, yet they have a powerful depressing action upon the heart. A simple heart stimulant, combined with such drugs, eliminates, when judiciously used, the evil effect, while the desired effect is not impaired. In this way many valuable combinations are brought about, greatly enlarging the field of scientific therapeutics. This seldom involves the use of more than one or two drugs. Often the happiest effects may be brought about in this way, and helpful action sustained over long periods. OTHER METHODS There are other methods of using drugs. The home- opathic method is the opposite of this physiologic. 210 PERSONAL HYGIENE If a remedy creates certain morbid manifestations in the healthy individual, it is administered for a similar morbid state when the result of disease. It is essen- tial that the dose should not be sufficient to set up its physiological action. Ipecac causes, in large doses, excessive nausea and vomiting. In small doses it relieves nausea and vomiting. Organotherapy. This branch of therapeutics, al- though in its infancy, promises large results. It is based primarily upon the theory that the secretions of certain organs of the body, by becoming deficient, take from the system an essential element which is necessary to the general well-being. The absence or disease of a small gland in the neck (thyroid), whose function was not known, was observed to be a constant accompaniment of a certain disease ending in insanity. The same gland from a healthy animal was found to supply the deficiency and cure the disease when taken in small quantities. Investigation has proved the value of such remedies in a wide variety of diseases. All use of drugs involves the wisest discrimination, based upon thorough familiarity with drug action, and with the organic structure and function of the human system, from the minute cell to the complete animal. This must be combined with knowledge of the condition and peculiarities of each patient. DRUGS MAY HELP, NATURE CURES While many drugs are capable of destroying cell life, there is yet to be known a drug which can create USE AND ABUSE OF DRUGS 211 a new cell. The power which creates the new cell, the vital force, may be favorably or unfavorably influenced by drug action. Or, the same drug may work harm or benefit, according to the dose. Some of our most useful drugs, in which small doses have an effect upon the system of great usefulness, are destructive to life in larger doses. A drug which stimulates as its primary effect either over-stimulates on continued use, and thereby may permanently weaken, or tolerance is established, and increasing doses are required to keep up its effect. The proper use of drugs, then, is to give some organ or organs of the body temporary assistance, and thus enable them to resume their normal functions Nature only can effect a lasting cure. The prescribing of drugs for diseases and their symptoms has become systematized, and through their use many lives have been lengthened, at the same time the limits of their usefulness as curative agents are becoming better established, so that useless drugging, a practice until recently almost universal, is giving place to other rational methods of cure. For example, the use of electricity, massage, baths, open air and feeding (the most successful for tuber- culosis) ; the wide scope of surgery which has invaded the field of medicine in many affections (epilepsy, ulcer of stomach). The public attitude is well illustrated by this inci- dent: A dressmaker called for relief from a long 212 PERSONAL HYGIENE train of nervous and dyspeptic symptoms. Her case was carefully reviewed, and she was advised as follows: "Join a ladies' gymnasium class. Take general exercise for an hour, in addition to the class lesson, each day. Eat only such food as your appetite demands. Take a brisk walk out of doors before each meal. Report progress in a month." There was a moment of some embarrassment, as the lady felt that the interview was ended. "But don't I get any medicine?" "No." "Well, you are the most peculiar doctor I ever heard of." She paid the fee with the remark: "Well, I hardly know what I am paying for." Yet in a month the patient returned a reformed, healthy woman, a result which probably could not be attained with the wisest use of drugs. This is the almost universal attitude at the present time, and the general public needs to be educated in the lesson taught by the incident. THE ABUSE OF DRUGS There is no greater responsibility to be assumed than that of advising the sick. It weighs heavily upon every practitioner, yet this great responsibility is shouldered with eagerness, not only by the sick, but by his neighbors. Where the trained scientist would hesitate, the worse than untrained layman is eager. This general attitude is a relic of the days when ignorance of drugs was universal. No drug which USE AND ABUSE OF DRUGS 213 has any virtue as a medicine can be taken haphazard with impunity. If not directed accurately to its appropriate purpose within the system, it is an added burden to the sick organ, or is directly destructive of function, and handicaps Nature's effort at a cure. Widespread harm arises from the misuse and abuse of drugs. That many survive such practices is true, but what of the many who are sacrificed ? The neighbor or friend recommends only such patent medicines or other drugs as have come to his limited attention. He can know nothing of the disease, or of the drug's action. The laws of most states pre- scribe the amount of knowledge a physician must have before he may practice his art. Nor will his word be accepted, but he must pass an examination on all branches of medicine. The people are thus safeguarded from incompetency. Yet there is no law which protects the sick from the gratuitous unskilled counsel of his friends. The law compels the druggist to attest full knowl- edge of the drugs he dispenses, yet permits the public to buy and use secret nostrums or patent medicines of the most vicious and demoralizing types. No law can prevent a willing victim from accepting advice, or the giver from giving advice. A proper appreciation of personal hygiene and the self-respect- ing application of the same will teach the folly of the indiscriminate use of drugs. 214 PERSONAL HYGIENE PATENT MEDICINES The pure food law, which contains a clause on patent medicines, will perhaps ameliorate this to a limited extent. It requires a label bearing the per cent of alcohol, morphine, opium, cocaine, heroin, chloroform, cannabis indica, chloral hydrate or acetan- ilid on all sealed packages. A law which would limit a nostrum to its legitimate uses would be of service. The nostrum itself, in the vast majority of cases, is not only of little or no curative value; it is demoralizing to the patient. Even more widespread is the harm brought about by the method of the advertiser in impelling its use by the sick. First, by lying in the most unscrupulous way about the effects and cures of his nostrum. Second, by false teaching, magnifying the least im- portant and most common of morbid sensations to be the serious disease which the nostrum will cure (a backache means Bright's disease). Third, the creation of imaginary disease by suggestion, creating hopeless wrecks of their victims. Fourth, the im- moral influences upon the unformed wills and minds of the young. These are evils apart from the promiscuous effect of misused drugs. The postoffice department, by excluding from the mails such publications as lend themselves to this sort of iniquity, would soon bring about amelioration of this evil. USE AND ABUSE OF DRUGS 215 COMPOSITION OF SOME PATENT MEDICINES CONTAINING A LARGE PROPORTION OF ALCOHOL Peruna, 28%. Ayer's Sarsaparilla, 26%. Paine's Celery Compound, 21%. Hood's Sarsaparilla, 18%. Lydia E. Pinkham's Vegetable Hostetter's Stomach Bitters, Compound, 20%. 44%- Burdock Blood Bitters, 25%. CONTAINING MORPHINE (OPIUM) Mrs. Winslow's Soothing Dr. Bull's Cough Syrup. Syrup. Fenner's Cough Honey. Kopp's Baby Friend. Chamberlain's Colic Remedy. CONTAINING COCAINE Birney's Catarrhal Powder. Agnew's Catarrh Powders. Dr. Cole's Catarrh Cure. I. C. R. Instant Catarrh Cure Gray's Catarrh Cure. Prentzinger's Catarrh Balsam Crown Catarrh Powder. Compressed Voice Tablets CONTAINING ACETANILID Orangeine Cephalgine Bromo-Seltzer Dr. Davis's Headache Pow- Antikamnia ders. Royal Pain Powder. Anti-Headache. Megrinine Miniature Headache Powders. Ammonol Nerve Ease. Salacetin Klein's Kold Kapsules Phenalgin. Dr. Holbrook's Kold Powders. Note. — The above list is taken from the reports of the Mas- sachusetts State Board of Health, and the articles on "The Great American Fraud," published in Collier's Weekly on October 7, 28, November 4, 18, and December 2, 1905, and January 13, February 17, April 28, July 14, August 4, September 1 and 22, 1906. When the National Pure Food Law becomes operative, after January 1, 1907, it may be expected that the composi- tion of some of the patent medicines will be changed some- what, as the law requires that a statement be made on the label of the quantity of certain drugs. PUBLIC HEALTH IN THE UNITED STATES By Maurice LeBosquet, S. B. Paper read at the Lake Placid Conference on Home Economics, September, 1906. A few months ago, in the interest of our students, we began investigations of the work of the National and State Health Departments. If hygiene is the chief basis of home economics, the members of the Lake Placid Conference may be interested in the following report, which is by no means complete. After some little inquiry, the health department of the central government was found to be a part of the Miscellaneous Division of the Department of the Treasury, entitled Public Health and the Marine Hospital Service. Surgeon General Walter Wyman is at the head of the Department which has charge of the marine hospitals, preventing the spread of epidemics, quarantine service and the public health. In 1905 this Department spent over a million dollars. Apparently only $20,000 was spent directly for sanitary inspection in the United States, the re- mainder being spent for maintaining stations and hospitals, in quarantine work, and in Cuba, South America and foreign ports. The Board consists of 118 officers, surgeon gen- erals and assistant surgeons, which maintains a hygienic laboratory in Washington for the exami- nation of antitoxines, serums, etc. The Laboratory is also investigating various public health problems. The Yellow Fever Institute is continuing its inves- 216 PUBLIC HEALTH 217 tigations of yellow fever under the charge of the Public Health Department, and investigations in leprosy are in progress in the Hawaiian Islands. Other investigations are also in progress on cholera, the plague, hook-worm disease, prevalent in the southern states and Porto Rico. Under the law of 1902 establishing the Depart- ment, the Public Health . officers are authorized to hold an annual conference of the State and Territorial Health Boards in Washington. Four conferences have been held. PUBLICATIONS The annual report of the Department of Public Health and Marine Hospital Service — a book of about 500 pages — is made up chiefly of statistics and departmental reports, but contains a number of articles of interest. It is sent out pretty gen- erally. The Public Health Reports are published weekly and are purely statistical, containing records of death throughout the United States. The Hygienic Laboratory issues bulletins of tech- nical and scientific interest. The Yellow Fever Insti- tute has published fifteen technical bulletins relating to yellow fever. The department issues no popular bulletins for gen- eral distribution. Apparently the U. S. Department of Public Health is ably and efficiently administered. We know that it has done wonderful work in Cuba, the Philippines Porto Rico, and at the Isthmus of Panama. It stands ready to help out state authorities, as in the case of the recent epidemic of yellow fever in New 2i 8 PERSONAL HYGIENE Orleans. The United States Department of Health should be given the credit of the discovery that yellow fever is transmitted only through the bite of the female of a certain variety of mosquito, and some of the credit for proving that malaria is trans- mitted in the same way by another species of mos- quito. STATE BOARDS OF HEALTH A letter was sent out to all the prominent states asking for their last yearly report and any bulletin which they had for distribution, also that our name might be placed on the mailing list to receive future bulletins. Twelve annual and biennial reports were received, and a number of them contain interesting articles on a great varietv of subjects. In addition to the annual and biennial reports, which presumably all the State Boards of Health publish, quite a number of the state boards pub- lish monthly, bi-monthly, or quarterly bulletins. We have received the following: Maine — Bi-monthly bulletin, July, 1906, special tuber- culosis number. New Hampshire— Quarterly bulletin relating to pure food, sanitation, communicable diseases. Vermont — Quarterly bulletin, special articles, pure food reports. Massachusetts — Monthly bulletin, food and patent medicines analyses and reports of dairy inspec- tion, mortuary statistics, reports of epidemics, showing causes. New York — Monthly bulletin, chiefly statistics with brief articles. PUBLIC HEALTH 2ig Ohio — Monthly bulletin, articles and reports, yearly subscription 25 cents. Indiana — Monthly bulletin, statistics, food work, brief articles. Iowa — Monthly bulletin, news, book reviews, brief articles. Wisconsin — Quarterly bulletin, brief articles. Michigan — Quarterly bulletin, called "Public Health," rather long articles and extracts. Colorado — Monthly bulletin, entirely statistical. California — Monthly bulletin, statistics and brief extracts. Doubtless other states issue periodical bulletins but we have not received them. In addition to the monthly, bi-monthly or quar- terly bulletins, many of the state Departments of Health issue pamphlets on the various communica- ble diseases, disinfection, etc. All these bulletins and pamphlets are issued primarily for the health offices in cities, towns and villages within the state of publication, but in many cases they are sent to anyone interested outside of the state. Illinois is an exception to this. The office of the State Board of Health in all cases is located at the state capital, the secretary usually being the executive officer. Michigan has undertaken educational work on hygiene to a greater extent than any other state. A law was passed in 1895 requiring every teacher to give oral and blackboard instruction relating to dangerous communicable diseases and other health matters. A series of teachers' bulletins and pam- phlets was published. Over a quarter of a million 220 PERSONAL HYGIENE of some of these have been sent out since the law was passed. One of the teachers' bulletins contains an inter- ing estimate on the money value of public health work. The writer, from statistics compiled before and after the health crusade gives figure's that seem to show about 2,000 lives are saved annually in the state of Michigan by combating smallpox, scarlet fever, typhoid fever and consumption alone. Mod- estly reckoning the value of a life at $1,000, and that of a child at half price, considerably over a million dollars is saved yearly, or more than the total yearly state appropration. In Vermont a law was passed in 1905 requiring the teachers to examine school children for defective eyesight and hearing. Charts and directions were prepared by the State Board of Health at a cost of only $700.00. Of the pupils examined, 33 per cent or nearly 15,000., were shown to be defective, the greater proportion having defective eyesight. Surely it was worth 5 cents each to find out these defects so that they might be rectified! Many of the states have Laboratories of Hygiene and manufacture and distribute serums, anti-tox- ines, examine specimens for tuberculosis, diph- theria, etc., analyze public water supplies, and give advice for sewerage systems. Although many of the State Boards of Health are performing their work admirably, and some of their bulletins are excellent, there seems to be a great deal of duplication of effort, especially in regard to printed matter. If the national govern PUBLIC HEALTH 221 ment could be induced to issue a series of bulletins on the preventable diseases, disinfection and other sanitary matters, for free distribution, somewhat similar to the Farmers' bulletins, a tremendous edu cational work for hygiene might be inaugurated. Only a few thousand dollars would be required. A recommendation to the President or to Congress from the Lake Placid Conference might help. SUGGESTION FOR THE RESOLUTION COMMITTEE Whereas, Living men are the 'most valuable possession of the state, as health is of the individual; and, Whereas, The health of the people must depend ulti mately on the education of the individual; and, Whereas, Over 300,000 lives are lost annually in the United States, and a vast amount of illness results from contagious and infectious diseases now known to be preventable ; Resolved, That Congress be petitioned to authorize the Department of Public Health and Marine Hos- pital Service to issue a series of bulletins, popu- lar in character, for free distribution throughout the United States, on the various preventable dis- eases, such as consumption, pneumonia, diph- theria, typhoid fever, scarlet fever, whooping cough, measles, etc., on disinfection and on other health matters, and to make an appropriation for the same. YOU CAN HELP IN THIS WORK. WRITE TO YOUR SENATORS AND CONGRESSMAN, AND GET THE CLUBS AND ASSOCIATIONS TO WHICH YOU BELONG TO SEND A PETITION SOMETHING LIKE THE ABOVE, PLEA FOR A NATIONAL DEPARTMENT OF HEALTH By Professor J. Pease Norton In the next twelve months 750,000 persons will die in the United States, whose lives could be saved by proper effort. Unless the effort is made, the lives of 750,000 will be sacrificed. Such is the tenor of a bulletin sent out recently by the Yale Department of Social Science. The bulletin is a plea for the establishment of a national department of health by Prof. J. P. Norton, head of the department. He says: "There are four great wastes to-day, the more lamentable because they are unnecessary. They are, preventable death, preventable sickness, pre- ventable conditions of low physical and mental effi- ciency, and preventable ignorance. "Of the people living to-day over 8,000,000 will die of tuberculosis, and the federal government does not raise a hand to help them. "The Department of Agriculture spends $7,000 000 on plant health and animal health every year but, with the exception of the splendid work done by Drs. Wiley, Atwater and Benedict, Congress does not directly appropriate 1 cent for promoting the physical well-being of babies. Thousands have been expended in stamping out cholera among swine, but not $1 was ever voted for eradicating pneumonia among human beings. "In fact, the department of agriculture has ex- pended during the last ten years over $46,000,000 But not a wheel of the official machinery at Washing- 222 A NATIONAL DEPARTMENT OF HEALTH 223 ton was ever set in motion for the alleviation or cure of diseases of the heart or kidneys, which will carry off over 6,000,000 of our entire population. Eight millions will perish of pneumonia, and the entire event is accepted by the American people with a resignation equal to that of the Hindoo, who, in the midst of indescribable filth, calmly awaits the day of the cholera. "During the next census period more than 6,000,- 000 infants under 2 years of age will end their little spans of life, while mothers sit by and watch in utter helplessness. And yet this number could probably be decreased by as much as one-half. But nothing is done. " Prof. Norton recommends the creation of a national department of health, having as its head a secretary who shall be a member of the cabinet. Under this department there should be created fourteen bureaus, as follows: Infant hygiene, education and schools, sanitation, pure food, registration of physicians and surgeons, drugs, druggists and drug manufacturers, control of institutions of public and private reliefs, correction, detention, and residences, organic dis- eases, quarantine, health information, immigration, labor conditions, research. Such a department of health, Prof. Norton argues, might not only save 750,000 lives annually, but would add greatly to the productive wealth of the nation. Estimating wages at $1 a day, Prof. Norton shows that $1,444,000,000 are lost every year by illness. A national department of health could save $500,000,- 000 of the amount every year. 224 PERSONAL HYGIENE BIBLIOGRAPHY The Human Mechanism, Hough and Sedgwick. ($2.00, postage 1 8c.) Manual of Personal Hygiene, Walter L. Pyle. ($1.50, post- age 14c.) Personal Hygiene, Alfred H. Woodhull. ($1.00, postage 10c.) Nature and Health, Edward Curtis. ($1.25, postage, 12c.) The Art of Right Living, Ellen H. Richards. (50c, post- age 6c.) A Natural Method of Physical Training, Chickley. ($1.50, postage ioc.) How to Get Strong and How to Stay So, Blakie. ($1.00, postage 12c.) Physiology for High Schools, Macy. ($1.10, postage 12c.) Story of the Living Machine, Conn. (35c, postage 6c.) What a Young Girl Ought to Know, Mrs. Mary Wood Allen. ($1.00, postage ioc.) What a Young Woman Ought to Know, Mrs. Mary Wood Allen. ($1.00, postage ioc.) What a Young Wife Ought to Know, Mrs. Emma F. A. Drake. ($1.00, postage ioc.) Beauty Through Hygiene, Mrs. Emma Walker. ($1.00, post- age ioc.) The Four Epochs of Woman's Life, Anna Galbraith. ($1.50, postage 14c) Care of the Teeth, Samuel A. Hopkins. (75c., postage 6c.) School Hygiene, Charles Porter. ($1.25, postage ioc.) Medical Inspection of School Children, Babcock. Published by Maltine Co., Brooklyn, N. Y. Free. (Postage 8c.) TECHNICAL BOOKS. A Text of Physiology, Howell. ($4.00, postage 34c) The Work of the Digestive Glands, Pawlow. ($2.00, post- age 16c.) Recent Advance in Physiology and Bio-chemistry, Leonard Hill. ($5.00, postage 26c.) Note. — Any of the above books may be borrowed by mem- bers of the School for the cost of postage. Send stamps with request. SUPPLEMENTAL PROGRAM ARRANGED FOR CLASSES ON PERSONAL HYGIENE MEETING I • (Study pages 1-29) General Principles Personal Hygiene, Pyle. Introduction. ($1.75, postage 18c.) The Art of Right Living, Richards. ($0.50, postage 6c.) The Human Machine The Human Mechanism, Hough and Sedgwick; Chapters I-VII, XV. ($2.00; postage 18c.) Physiology for High Schools, Macy; Chapters I-VI. ($1.10, postage 1 2C.) Personal Hygiene, Pyle; Hygiene of the Brain and Nerv- ous System. ($1.75, postage 18c.) Story of the Living Machine, Conn. "The Cells." ($0.35, postage 6c.) MEETING II (Study pages 29-45) The Senses The Human Mechanism, Chapter XIV. "The Sense Organs." Text Book of Physiology, Howell. Chapter XV, "Cutane- ous and Internal Sensations;" Chapter XVI, "Taste and Smell." ($4.00, postage 34c.) The Eyes Personal Hygiene, Pyle. "Hygiene of the Eye." The Human Mechanism. Chapter XXII. Physiology for High Schools, Macy. Chapter VIII. Nature and Health, Curtis. Chapter V. ($1.25, postage 12c.) Text Book of Physiology, Howell. Chapter's XVII, XVIII, XIX. 225 226 PERSONAL HYGIENE Hearing Personal Hygiene, Pyle. "Hygiene of the Ear." Nature and Health, Curtis. Chapter VI. Text Book of Physiology, Howell. Chapter XX. Topic: Testing the Eyesight and Hearing of School Children. See "Medical Inspection of School Children," Prize Essay on Preventive Medicine, published by Maltine Company, Brooklyn, N. Y. (Free from the publishers; from the School, 8c.) Also Report of Vermont State Board of Health (4c, from the School). Sample chart for testing eyesight with directions for use, loaned for 10c postage. (Select a composite set of answers to the Test Questions on Part I and send to the School, with a report on Meet- ings I and II.) MEETING III (Study pages 45"5 6 ) Digestion of Food The Human Mechanism. Chapter VIII and pages 44-52. Text Book of Physiology, Howell. Chapter VII and "Enzimes and their Action," pages, 657-665. Work of the Digestive Glands, Pawlow. "The Psychic Juices." ($2.00, postage 16c.) Personal Hygiene, Pyle. "Hygiene of the Digestive Apparatus." Food and Dietetics, Hutcherson. Chapter XXIII. ($3.00 postage 26c.) The Blood and Circulation The Human Mechanism. Chapter IX. Text Book of Physiology. Chapters XXII, XXIV. Physiology for High Schools. Chapter XII. Personal Hygiene, Woodhull. Chapter IV. PROGRAM 227 Respiration The Human Mechanism. Chapter X. Personal Hygiene, Woodhull. Chapter III. Life and Health. Chapter I. MEETING IV (vStudy pages 54-104) Nutrition The Human Mechanism. Chapter XIII. Text Book of Physiology. Chapters XLVII, XLVIII. See article in Food and Dietetics, on "Proteid Metabolism," Folin; and article in American Journal of Physiology January 1905. (From the School, 4c.) Recent Advances in Physiology and Bio-chemistry, Hill. Chapters X, XI, XII, XIII. ($5.25, postage 28c.) Heat Product and Regulation The Human Mechanism. Chapter XII. Text Book of Physiology. Chapter LI. Elimination The Human Mechanism. Chapter XI. (Select and send answers to the Test Questions on Part II and report on Meetings III and IV.) MEETING V (Study pages 105-136) Hygiene of the Nervous System The Human Mechanism. Chapter XVIII. Personal Hygiene, Pyle. Pages 275-314. Personal Hygiene, Woodhull. Pages 47-51. 228 PERSONAL HYGIENE Hygiene of Feeding v^ee Food and Dietetics, Norton. Volume VI of the "Library." The Human Mechanism. Chapters XIX, XX. Personal Hygiene, Pyle. Pages 26-48 Nature and Health. Chapters II, III, IV. Food and Dietetics, Hutcherson. Chapters I, II, III, XXVII, XXVIII. MEETING VI (Study pages 137-187) . Hygiene of the Skin and Appendages The Human Mechanism. Chapter XXI, Colds; Chapter XXIV, Bathing. Personal Hygiene, Pyle. Pages 52-67; 82-92. Personal Hygiene, Woodhull. Pages 124-133. Nature and Health. Pages 204-210. Clothing The Human Mechanism. Chapter XXV and XXIII, Hygiene of the Feet. Personal Hygiene, Pyle. Pages 72-81. Nature and Health. Pages 191-203. Physical Exercise The Human Mechanism. Chapter XVII. Personal Hygiene, Pyle. Pages 315-348. Nature and Health. Pages 250-273. How to Get Strong and How to Stay So, Blakie. ($1.00, postage 12c.) A Natural Method of Physical Training, Checkley. ($1,50, postage 8c.) (Send answers to the Test Questions on Part III, with a report of the last two meetings.) INDEX Absorption, 59, 62, 63, g>£ Abuse of drugs, 202 Adenoids, 78 ' ^Esophagus, 54 Air, impure, 80 Alcohol, 136 Amoeba, 5 Amount of sleep, 108 Amylopsin, 61 Anabolism, 81 Anaemia, 74 Appetite, 123 gastric juices, 57 Arteries, 68 Astigmatism, 35 Auditory nerves, 40 Automatic acts, 22 Bacteria, in digestion, 64 Balanced ration, 131 Baths, 137 Bedding, no Beds, 109 Bibliography, 224 Bicycling, 168 Bile, the, 61 Bladder, 100 Blood, 66 circulation of, 68 distribution of, 72 plates, 67 rate of flow, 70 Body, structure of, 12 Boils, 147 Bones, 14 Brain, the, 20 Breathing, 78 deep, 73, 79 Brushing the hair, 142 Bunions, 159 Capillaries, 68 Carbon dioxide, 79 Care of colds, 151 of the complexion, 145 of the hair, 141 of the teeth, 114 . Caries, 117 Cartilage, 14, 28 Catalysis, 52 Cataract, 38 Catarrh, 41, 149 Cells, 7 air, 76 Children's diet, 131 Chittenden's experiments, 90 Circulation, 68 Cleaning the teeth, 118 Clothing, 153 Cocoa, 135 Coffee, 135 Cold-blooded animals, 94 Colds, 149 Colon, 63 Color blindness, 36 of clothing, 155 Complexion, 27 care of, 145 Conductivity of cloths, 153 Connective tissue, 28 Constipation, 99 Constitution, 3 Cooking, 130 Corns, 159 Corpuscles, 66 Corsets, 156 Dancing, 170 Dandruff, 142 Deafness, 43 Decay of the teeth, 117 Deep breathing, 73, 79 Dermis, 24 Diaphragm, the, 78 Diet in obesity 128 229 230 PERSONAL HYGIENE Digestion in small intestine, 60 in stomach, 59 salivary, 52 Digestive peculiarities, 131 Diseases, classes of, 203 preventable, 3 Drink, water as, 134 Drugs, action of, 206 for a cold, 152 use and abuse of, 202 Duodenum, 60 Ear, the, 39 foreign bodies in, 42 wax, 42 Earache, 42 Eating, 59, 121 Elimination, 98 of carbon, 85 of hydrogen, 85 of nitrogen, 84 of water, 10 1 Energy, 48 outgo of, 49 reserve, 87 Enzymes, 52 Epidermis, 24 Epiglottis, 54 Ethics of health, 191 Eustachian tube, 41 Evolution of the body, 9 Exercise, muscular, 161 Exercising the stomach, 130 Eyes, care of, 36 Face powders, 147 Fat, digestion of, 56, 61 increasing, 128 reducing, 127 Fats, use of, 86 Fatigue, 107 Feet, care of, 158 Ferments, 52, 55, 60 Fibres, muscle, 17 Fillings for the teeth, 120 Flat foot, 159 Fletcherizing, 54 Folin's theory, 89 Food, 85, 124 required, 124 values, 126 wastes, 98 Fried food, 130 Fundus, 55 Ganglia, 23 Gastric juices, 55 Glands, ductless, 68 salivary, 5 1 sebaceous, 26 sweat, 25 Glycogen, 62 Golf, 169 Gray hair, 144 Gymnastics, 170 Habit, physiology of 112 Hair, 141 care of, 141 tonics, 144 Hands, care of, 148 Health, 1 a duty, 191 factors in, 11 protection of, 198 Hearing, sense of, 39 Heart, the, 69 Heat losses of the body, 96 regulation, 96 stroke, 129 Hemoglobulen, 66 Heredity, tendency in, 193 Home gymnastics, 174 Hot weather, food in, 129 Housework as exercise, 166 How much to eat, 123 Humidity, effect of, 97 Hydrochloric acid, 55 Hygiene, 1, 105 of feeding, 114 of the nervous system, 106 of the skin, 137 Hygienic exercise, 165 Ideals of living, 200 INDEX 231 Inherited characteristics, 192 Insomnia, no Instinct versus reason, 195 Intemperance, 3 Intestine, large, 63 small, 59 Intestinal ferments, 60 secretions, 61 Katabolism, 81 Kidneys, secretion of, 100 Lacteals, 62 Large intestine, 63 Liebig's theory, 84 Leucocytes, 66 Life, nature of, 5 Lipase, 61 Liver, the, 62 Living, irrational, 197 Lunches, 122 Lungs, the, 78 Lymph, 69 Lymphatics, 69 Lymphocytes, 66 Massage of the face, 146 of the scalp, 143 Mastication, 51 Meals, time for, 121 Meat eating, 132 Mechanical efficiency of the body, 49 Medicines, patent, 214 Metabolism, 81 Motor nerves, 20 Mucin, 54 Mucous membrane, 24 Muscles, 15 Muscular exercise, 161 sense, 3 1 tone, 95 Xaps, 109 Nasopharynx, 76 National department of health, plea for, 222 Xerve cell, 19 centers, 20 Nerves, motor, 20 sensory, 20 Nervous system, 19 hygiene of, 106 sympathetic, 23 voluntary, 21 work of, 50 Nitrogen, elimination of, 84 Nutrients, 81 use by cells, 86 Nutrition, 81 Nutritive value of food, 125 Organs, inter-relation of, 8 Ossification, centers of, 14 Over eating, 127 Oxidation, 92 in the body, 86 Oxygen, 75, 79 use of, in nutrition, 75 Oxy-hemoglobulen, 79 Pancreas, 60 Pancreatic juice, 60 Patent medicines, 214 Pawlow's experiments, 57 Pepsin, 55 Periosteum, 14 Personal limitations, 3 Perspiration, 25, 96 and clothing, 154 Physical exercise, 161 Pigment, 27 Pimples, 147 Plasma, 66 Plexuses, 23 Portal vein,. 63 Posterity, duty to, 196 Prevention of colds, 140 Proportion of nutrients, 131 Proteid, amount of, 132 decomposition, 98 digestion of, 55, 60 formation in the blood, 89 Proteids, use of, 83, 88, 93 Psychic juices, 57 Ptyalin, 51, 53 232 PERSONAL HYGIENE Public health in the U. S., 216 Pylorus, 54 Rectum, 63 Recreation, out-of-doors, 167 Reflex acts, 22 Rennin, 55 Reserve power, 162 Respiration, 75 Rest, 109 Right living, 4, 194 Rubbers, 160 Saliva, 51 secretion of, 53 Salivary digestion, 52 Salt-water bathing, 140 Salts in nutrition, 82 Sebaceous glands, 26 Secretions, intestinal, 61 Selfishness, results of, 197 Sense organs, 29 muscular, 31 of hearing, 39 of pain, 31 of sight, 33 of smell, 31 of taste, 32 tactile, 30 temperature, 31 Shampooing, 143 Shoes, 158 Sigmoid flexture, 63 Sight, 33 Skin, the, 24 Sleep, 107 Sleeping-room, 109 Sleeplessness, no Small intestine, 59 movements of, 59 Standard diets, 124 Starch, digestion of, 51, 61 State boards of health, 218 Stimulating baths, 139 Stomach, 54 movements of, 56 Structure of the body, 1 2 Summer clothing, 155 diet, 129 Sun baths, 129 stroke, 129 Sweat, 25, 96 Swimming, 168 Sympathetic nervous system, 23 Tactile senses, 30 Taste sensations, 32 Tea, 135 Tears, 38 Teeth, care of, 114 Temperature, body, 94 ideal, 97 regulation, 25, 94 sense, 31 Tendons, 17 Tennis, 169 Trypsin, 60 Unity of body, mind and soul, 191 Urea, 10 1 Ureters, 100 Uric acid, 91, 10 1 Use of drugs, 202 Vegetarianism, 133 Veins, 68 Ventilation, 80 Villi, 62 Vision, defects of, 34 Vitality of individuals, 10 Voit's theory, 88 Voluntary nervous system, 21 Walking as exercise, 167 Wastes, food, 98 in the blood, 99 Water, elimination of, 10 1 What to eat, 130 White corpuscles, 66 Winter clothing, 155 diet, 129 sports, 170 Worry, 107 COLUMBIA UNIVERSITY LIBRARY This book is due on the date indicated below, or at the expiration of a definite period after the date of borrowing, as provided by the rules of the Library or by special ar- rangement with the Librarian in charge. DATE BORROWED DATE DUE DATE BORROWED DATE DUE C28(238)M100 - IA7?6 Le Bosquet L4G