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HYGIENE:
_A MANUAL_
OF
Personal and Public Health
BY
ARTHUR NEWSHOLME, M.D., F.R.C.P., LOND.,
UNIVERSITY SCHOLAR IN MEDICINE; DIPLOMATE IN PUBLIC HEALTH, UNIV. LOND.;
MEDICAL OFFICER OF HEALTH OF BRIGHTON; MEMBER OF THE COUNCIL AND
EXAMINER TO THE SANITARY INSTITUTE; EXAMINER IN STATE MEDICINE
TO THE UNIVERSITY OF LONDON; LATE EXAMINER IN PREVENTIVE
MEDICINE TO THE UNIVERSITY OF OXFORD, AND PRESIDENT
OF THE INCORPORATED SOCIETY OF MEDICAL OFFICERS
OF HEALTH.
NEW EDITION, 1902. ILLUSTRATED.
LONDON:
GEO. GILL & SONS, LD., MINERVA HOUSE, WARWICK LANE.
PREFACE.
The writing of a preface is perhaps superfluous for a book which
has had a large and steady sale for nearly twenty years, and which
has evidently met with the approval of a large constituency. A few
words of introduction appear, however, desirable in view of the facts
that the present edition has been almost entirely re-written; that a
large amount of new matter has been introduced; and that, so far as
is known, the comments on each subject represent the most recent and
authoritative knowledge upon it.
An attempt has been made to meet the requirements of medical students,
as well as of science students and general readers, for whom former
editions were chiefly intended. A large class of medical students and
practitioners do not require the detailed statement of the subject
contained in the larger text-books. For them, and, it is hoped, also
for a large number of candidates for diplomas in public health and
in sanitary science, the present edition will prove to be useful. At
the same time, the subject has been treated as non-technically as
is consistent with accuracy, in order to retain its suitability for
non-medical readers. A large number of new illustrations have been
introduced.
The new chapters dealing with Dietetics, Trade Nuisances,
Meteorological Observations, Tuberculosis, Disinfection, and Vital
Statistics will, it is believed, enhance the value of the book.
Attention is also drawn to the solutions of mathematical problems in
the different branches of hygiene, of which a table of contents is
given on page viii.
In its new form, it is hoped that this work will be found to have
retained its value as a plain and straightforward account of its
subject for the general public and for science students; and to
have become a practical guide to sanitary inspectors and to medical
students, whether preparing for a diploma in public health, or studying
hygiene as an important branch of medicine. The use of smaller type for
specially technical matter of less general interest will facilitate
discriminative reading.
ARTHUR NEWSHOLME.
BRIGHTON,
_February 28th, 1902_.
TABLE OF CONTENTS.
CHAPTER. PAGE
I.—INTRODUCTORY 1
II.—FOOD 4
III.—THE VARIETIES OF FOOD 9
IV.—DISEASES DUE TO FOOD 23
V.—DIET 29
VI.—THE PREPARATION AND PRESERVATION OF FOOD 38
VII.—CONDIMENTS AND BEVERAGES 45
VIII.—FERMENTED DRINKS 55
IX.—WATER 65
X.—THE STORAGE AND DELIVERY OF WATER 74
XI.—IMPURITIES OF WATER 78
XII.—ORIGIN AND EFFECTS OF THE IMPURITIES OF WATER 89
XIII.—THE PURIFICATION OF WATER 94
XIV.—COMPOSITION AND PROPERTIES OF AIR 100
XV.—SUSPENDED IMPURITIES OF AIR 105
XVI.—GASEOUS AND OTHER IMPURITIES OF AIR 111
XVII.—TRADE NUISANCES 120
XVIII.—THE EXAMINATION OF AIR 125
XIX.—THE PURIFICATION OF AIR 129
XX.—GENERAL PRINCIPLES OF VENTILATION 132
XXI.—PROBLEMS AS TO VENTILATION 137
XXII.—METHODS OF VENTILATION 146
XXIII.—VENTILATION BY THE INTRODUCTION OF WARMED AIR 155
XXIV.—THE WARMING OF HOUSES 158
XXV.—HOUSE DRAINAGE 165
XXVI.—CESSPOOLS AND MAIN SEWERS 183
XXVII.—PROBLEMS AS TO FLOW IN SEWERS 187
XXVIII.—THE DISPOSAL OF SEWAGE 190
XXIX.—CONSERVANCY METHODS 194
XXX.—POSITION OF THE HOUSE 201
XXXI.—THE MATERIALS USED IN THE CONSTRUCTION OF A HOUSE 205
XXXII.—CONSTRUCTION OF THE HOUSE 209
XXXIII.—THE SOIL 219
XXXIV.—CLIMATE AND WEATHER 227
XXXV.—METEOROLOGICAL OBSERVATIONS 237
XXXVI.—PERSONAL HYGIENE 245
XXXVII.—PERSONAL HYGIENE—EXERCISE 249
XXXVIII.—PERSONAL HYGIENE—REST AND SLEEP 257
XXXIX.—PERSONAL HYGIENE—CLEANLINESS 260
XL.—CLOTHING 265
XLI.—PARASITES 273
XLII.—THE RÔLE OF INSECTS IN SPREADING DISEASE 281
XLIII.—INFECTIVE DISEASES 284
XLIV.—ACUTE INFECTIVE DISEASES 291
XLV.—TUBERCULOSIS 309
XLVI.—NOTIFICATION AND ISOLATION 317
XLVII.—DISINFECTION 324
XLVIII.—VITAL STATISTICS 335
_SPECIAL TABLE OF CONTENTS FOR ARITHMETICAL PROBLEMS IN HYGIENE._
PAGE
PROBLEMS IN MILK ANALYSIS 12
„ „ DIETETICS 35
„ „ WATER ANALYSIS 86
„ „ AIR ANALYSIS 126
„ AS TO VENTILATION 137
„ „ FLOW IN SEWERS 187
„ IN METEOROLOGY 242
„ AS TO WORK 254
„ IN VITAL STATISTICS 336
HYGIENE.
CHAPTER I.
INTRODUCTORY.
In classical mythology, Æsculapius was worshipped as the god of
Medicine, while his daughter Hygeia had homage done to her as the sweet
and smiling goddess of Health. The temples of these two deities were
always placed in close contiguity; and statues representing Hygeia
were often placed in the temple of Æsculapius. In these statues she is
represented as a beautiful maid, holding in her hand a bowl, from which
a serpent is drinking—the serpent typifying the art of medicine, then
merely an art, now establishing its right more and more to the dignity
of a science.
That considerable attention was paid in very early times to matters
relating to health, is also shewn by the elaborate directions contained
in the Mosaic law as to extreme care in the choice of wholesome foods
and drinks, in isolation of the sick, and attention to personal and
public cleanliness. It is not surprising, therefore, to find that the
Jews, throughout the whole of their history, have apparently enjoyed a
high standard of health.
In this country great ignorance of the laws of Health has prior to
the last fifty years prevailed, and consequently preventible diseases
have been rampant, and have claimed innumerable victims. Each
century has been marked by great epidemics, which have swept through
the country, scattering disease and death in their course. In the
fourteenth century, for instance, there was the Black Death, a disease
so fatal that it left scarcely one-fourth part of the people alive;
while Europe altogether is supposed to have lost about 40 millions
of its inhabitants, and China alone 13 millions. A century and a
half later came the Sweating Sickness (though there were a score of
minor epidemics in between). This was carried by Henry the Seventh’s
army throughout the country, and so great was the mortality, that
“if half the population in any town escaped, it was thought great
favour.” Considerable light is thrown on the rapid spread of this
disease after its importation, when we remember that there were no
means of ventilation in the houses; that the floors were covered with
rushes which were constantly put on fresh without removing the old,
thus concealing a mass of filth and exhaling a noisome vapour; while
clothing was immoderately warm and seldom changed; baths were very
seldom indulged in, and soap hardly used.
In the sixteenth and seventeenth centuries there were five or six
epidemics of The Plague, and it was only eradicated from London, when
all the houses from Temple Bar to the Tower were burned down in the
Great Fire of September 2nd, 1666, which destroyed the insanitary and
necessitated the building of new and larger houses.
Scurvy, jail-fever, and small-pox, are other diseases which were
formerly frightfully prevalent. Jail-fever, the same disease as the
modern typhus-fever, has now become practically extinct in its former
habitat, owing largely to the noble work of John Howard, “whose life
was finally brought to an end by the fever, against the ravages of
which his life had been expended.” This disease was fostered by
overcrowding, ill-ventilation, and filth.
Scurvy formerly produced a very great mortality, especially among
sea-faring men. In Admiral Anson’s fleet in 1742, out of 961 men, 626
died in nine months, or nearly two out of every three, and this was no
solitary case. Captain Cook, on the other hand, conducted an expedition
round the world, consisting of 118 men; and although absent over three
years, only lost one life. He was practically the first to demonstrate
the potency of fresh vegetables in preventing scurvy.
The striking facts respecting small-pox will be found on page 293. The
general death-rate has also greatly declined. Thus while the annual
death-rate in London 200 years ago was 80 per 1,000, it only averaged
18.8 in the four years 1896-99; and the death-rate of England and Wales
has declined from 22.4 in 1841-50 to 18.7 per 1,000 in 1891-95 and 17.6
in 1896-99.
That much still remains to be done is evident on every hand. There is
little doubt that the general death-rate might be reduced to 15 per
1,000 per annum, instead of the present 18, were the laws of health
applied in every household and community. It has been estimated that
on the average at least 20 cases of sickness occur for every death;
therefore nearly half of the population is ill at least once a year.
A simple calculation will show how much loss the community annually
suffers from this vast mass of preventible sickness. It amounts to
many millions of pounds, leaving out of the reckoning the suffering
and distress which are always associated with sickness. For details
relating to special diseases, see page 297.
In the prevention of this mass of sickness, the knowledge of its
causation is half the battle; when once a disease is traced to its
source, as a rule, the agency which produces it can be avoided.
The reason why even more progress has not been made in the prevention
of disease is not far to seek. In order to prevent a disease it is
necessary to remove its causes. The causes of disease can only be
ascertained by a careful investigation of its phenomena; and it is
only within the last century that these have been studied to any
large extent scientifically. Such knowledge of morbid processes not
only results in improved measures of treatment, but in more rational
and complete measures of prevention. Thus, not only is the number of
diseases which are _curable_ becoming gradually augmented, but the
number _preventible_ is even more rapidly on the increase.
Inasmuch as the preservation of health involves the prevention
of disease, Hygiene, the science of health, is sometimes called
_Preventive Medicine_.
The subject of Hygiene naturally divides itself into two parts, the
health of the individual, and that of the community, or _Personal and
Public Health_.
The former treats of the influence of habits, cleanliness, exercise,
clothing, and food on health; while the latter is concerned with the
interests of the community at large, as affected by a pure supply of
air and water, the removal of all excreta, the condition of the soil,
and with the administrative measures required to secure the removal
of evil conditions. It is obvious, however, that these two divisions
are not mutually exclusive. What is important to the health of the
community, is equally so to each individual member of it. The purity of
air and water, for instance, is of immense importance both personally
and collectively.
It will be convenient to study first the three main factors in relation
to health—food, water, and air—subsequently considering other matters
of importance to health (see pages 4-157).