AMERICAN RED CROSS TEXT-BOOK
ON
HOME CARE OF THE SICK
***
DELANO
AMERICAN RED CROSS
TEXT-BOOK
ON
HOME HYGIENE
AND
CARE OF THE SICK
BY
JANE A. DELANO, R. N.
Chairman of the National Committee, Red Cross Nursing Service; Director,
Department of Nursing, American Red Cross; Late Superintendent
of the Nurse Corps, U. S. A.; of the Training Schools
for Nurses, Bellevue Hospital, New York City; and of the
Training School for Nurses, Hospital of the University
of Pennsylvania, Philadelphia
REVISED AND REWRITTEN
BY
ANNE HERVEY STRONG, R. N.
Professor of Public Health Nursing, Simmons College, Boston
_This is the Second Edition of the American Red Cross
Text-book in Elementary Hygiene and Home Care of
the Sick by Jane A. Delano and Isabel McIsaac._
PREPARED FOR AND ENDORSED BY
THE AMERICAN RED CROSS
PHILADELPHIA
P. BLAKISTON'S SON & CO.
1012 WALNUT STREET
COPYRIGHT, 1918, BY AMERICAN RED CROSS
THE MAPLE PRESS YORK PA
PREFACE
To the woman who wishes to protect her family from preventable diseases
and is anxious to fit herself in the absence of a trained nurse to give
intelligent care to those who are sick, this revision of the Red Cross
text-book on Elementary Hygiene and Home Care of the Sick is
particularly directed. It should appeal to men and to women who are
interested in maintaining the health of their neighborhoods and
communities and in affording effective coöperation to the public health
authorities. To teachers wishing to impart protective health information
to high school pupils, the book also should be useful as a class text as
well as a guide.
The war, which has caused the withdrawal from private practice of
thousands of physicians and graduate nurses, makes it peculiarly
important to the nation for every adult to have sound knowledge as to
how to prevent contagion and epidemics, especially by precautionary
attention to home and local sanitation. With nurses becoming more
difficult to secure, the safety of the family demands that some member
in each household know enough about elementary nursing to make a patient
comfortable and to carry out accurately the instructions of the
physician.
The work of revision, based upon the latest knowledge of hygiene,
sanitation and methods of home-nursing has been done by Miss Anne Hervey
Strong, Professor of Public Health Nursing, Simmons College, under the
personal direction of the author and the National Committee on Red Cross
Nursing Service. The material has been painstakingly read by Dr. H. W.
Rucker and Dr. Taliaferro Clarke of the United States Public Health
Service, and Lieutenant Colonel Clarence H. Connor, Medical Corps,
United States Army. Indebtedness to Dr. H. M. McCracken, President of
Vassar College and Director of the Red Cross Junior Membership, for his
valuable suggestion as to adapting the book for high school use as well
as for the assistance rendered by his Department, also is gladly
acknowledged.
J. A. D.
ACKNOWLEDGMENT
I wish to express my gratitude to those who have so kindly helped in the
work of preparing the present edition. Thanks are especially due to
Professor Isabel Stewart, Miss Anna C. Jamme, Professor Curtis M.
Hilliard, Professor Maurice Bigelow, Miss Katharine Lord, Miss Josephine
Goldmark, and Miss Evelyn Walker.
A. H. S.
CONTENTS
PREFACE v
INTRODUCTION xi
CHAPTER I
PAGE
CAUSES AND PREVENTION OF SICKNESS 1
Communicable diseases, 1. Micro-organisms and bacteria,
1. Parasites, 3. Structure and development of parasites,
4. Bacteria, 4. Shape, 4. Size, 5. Motion, 5.
Multiplication, 5. Spores, 7. Distribution, 8. Protozoa,
8. Visible parasites, 8. Transmission of pathogenic
organisms, 9. Defenses of the body, 12. Immunity, 13.
Vaccination and inoculation, 15. Carriers, 17.
Non-communicable diseases, 20. Physical examinations, 22.
CHAPTER II
HEALTH AND THE HOME 27
Heredity, 27. Hygiene of environment and person, 28.
Ventilation, 29. Lighting, 32. Cleanliness of houses, 33.
Garbage, 37. Insects, 38. Sewage, 39. Personal
cleanliness, 41. Oral hygiene, 44. Treatment of teeth,
46. Clothing, 47. Food, 48. Elimination, 52. Rest and
fatigue, 53. Sleep, 55. Recreation, 55.
CHAPTER III
BABIES AND THEIR CARE 60
Growth and development, 64. Average size, 64. Muscular
development, 65. Development of special senses, of
speech, of teeth, 66. Normal excretions, 67. Clothing,
68. Sleep, 70. Fresh air, 72. Diet, 72. Intervals of
feeding, 73. Water, 75. Weaning, 75. Nursing bottles and
nipples, 75. Tables of diet, 78. Bathing, 78. Eyes, 80.
Mouth, 81. Nostrils, 81. Genital organs, 81. Development
of habits, 82. Exercise, 83. Play and toys, 85.
CHAPTER IV
INDICATIONS OF SICKNESS 88
Objective symptoms, 92. Temperature, 92. Pulse, 96.
Respiration, 99. General appearance, 100. Special senses,
101. Voice, tongue, throat, gums, 102. Cough, 103.
Appetite, 103. Excretions, 103. Loss of weight, 104.
Sleep, 104. Mental conditions, 104. Subjective symptoms,
105. Pain, 105. Records, 107. Tuberculosis, cancer and
mental illness, 107. Tuberculosis, 109. Cancer, 111.
Mental illness, 112.
CHAPTER V
EQUIPMENT AND CARE OF THE SICK ROOM 117
Choice of a sick room, 118. Furnishing, 120. Ventilation,
123. Heating, 124. Lighting, 124. Cleaning, 126. The
attendant, 127.
CHAPTER VI
BEDS AND BEDMAKING 132
Bedsteads, 133. Mattresses, 135. Care of the mattress,
136. Pillows, 136. Protection of the mattress and
pillows, 137. Rubber sheets and pillow-cases, 138.
Sheets, 139. Draw sheets, 139. Pillow covers, 140.
Blankets, 140. Comforters and quilts, 141. Counterpanes,
141. Bedmaking, 141. To make an unoccupied bed, 143. To
change a patient's pillows, 146. Lifting a patient in
bed, 146. To turn a patient in bed, 147. To change sheets
while patient is in bed, 147. To move patient from one
bed to another, 150.
CHAPTER VII
BATHS AND BATHING 154
Cleansing baths, 154. Bed bath, 156. Care of the mouth
and teeth, 160. Care of the hair, 163. To wash the hair
of a bed patient, 164. Hot foot-baths, 165. Cool sponge
bath, 166.
CHAPTER VIII
APPLIANCES AND METHODS FOR THE SICK-ROOM 169
Devices to give support, 172. Bedpans, 176. Daily routine
in the sick-room, 179. Time for visitors, 182.
CHAPTER IX
FEEDING THE SICK 187
The digestive process, 188. Feeding the sick, 191. Liquid
diet, 192. Semi-solid diet, 192. Light or convalescent
diet, 193. Full diet, 193. Serving food for the sick,
195. To feed a helpless patient, 197.
CHAPTER X
MEDICINES AND OTHER REMEDIES 200
Action of drugs, 200. Amateur dosing, 202. Patent
remedies, 205. Administration of medicine, 206.
Suppositories, 209. Enemata, 210. Sprays and gargles,
213. Inhalation, 213. Inunction, 214. Household medicine
cupboard, 215.
CHAPTER XI
APPLICATION OF HEAT, COLD AND COUNTER-IRRITANTS 220
Inflammation, 220. Hot applications, 225. Dry heat, 225.
Moist heat, 227. Stupes or hot fomentations, 229. Cold
applications, 231. Dry cold, 231. Moist cold, 232. Cold
compresses for the eyes, 232. Counter-irritants, 233.
Mustard paste, 233. Mustard leaves, 234.
CHAPTER XII
CARE OF PATIENTS WITH COMMUNICABLE DISEASES 236
Incubation period, 238. Care of patients with colds or
other slight infections, 238. Care during more serious
infections, 242. Children's diseases, 246. Rules for
isolation and exclusion from school, 247. Disinfection,
248. Care of nose and throat discharges, 249. Care of
discharges from the bowels and bladder, 249. Bath water,
250. Care of the hands, 250. Care of utensils, 251. Care
of linen, 251. Disinfection of the person, 252.
Termination of quarantine, 252. Terminal disinfection,
253. Fumigation, 254.
CHAPTER XIII
COMMON AILMENTS AND EMERGENCIES 257
Conditions in which the nervous system is involved, 257.
Headache, 257. Sleeplessness, 258. Fainting, 259.
Convulsions, 260. Shock, 261. Stimulants, 263. Sunstroke
and heat exhaustion, 264. Conditions in which the
digestive tract is affected, 265. Nausea and vomiting,
265. Hiccough, 265. Diarrhœa, 266. Constipation, 266.
Colic, 266. Conditions in which the eyes or ears are
affected, 267. Styes, 267. Foreign bodies in the eye,
267. Disorders affecting the ears, 268. Conditions in
which the skin is affected, 269. Prickly heat, 269.
Insect bites and stings, 270. Ivy poisoning, 270. Other
emergencies, 270. Chills, 270. Croup, 271. Bleeding, 272.
Treatment of slight wounds, 272. Nose bleed, 274. Profuse
menstruation, 275. Other injuries, 275. Sprains, 275.
Bruises, 276. Burns and scalds, 277. Brush burn, 278.
CHAPTER XIV
SPECIAL POINTS IN THE CARE OF CHILDREN, CONVALESCENTS,
CHRONICS, AND THE AGED 280
Children, 281. Physical defects, 283. Eye-strain, 284.
Enlarged tonsils and adenoids, 284. Defective hearing,
285. Defective teeth, 286. Posture, 286. Predisposition
to nervousness, 292. Convalescent patients, 294. Chronic
patients, 299. Care of the aged, 303.
CHAPTER XV
QUESTIONS FOR REVIEW 312
APPENDIX 319
Circulars of information issued by Division of Child
Hygiene, New York Department of Health.
GLOSSARY 326
INDEX 331
INTRODUCTION
Health and sickness, at all times momentous factors in the welfare of
our nation, now as never before are matters of vital importance. To win
its victories both in peace and in war, the nation needs all its
citizens with all their powers, and it is a matter of more than passing
interest that, as conservative estimates show, at least three persons
out of every hundred living in the United States are constantly
incapacitated by serious sickness. In 1910 these seriously sick persons
numbered more than 3,000,000. Even more significant, perhaps, is the
fact that at least half of our national sickness could be prevented if
knowledge and resources that we now possess were fully utilized.
The problem of sickness is by no means peculiar to our own day and
generation. It has been a medical, a religious, and a social problem in
every age. From the time of Job its meaning has baffled philosophers;
from his day to ours thoughtful men have devoted their lives to
searching for causes and cures. Yet before the middle of the last
century little progress was made, either in scientific treatment or in
prevention of disease.
The invention of the microscope first made possible a real
understanding of sickness. Through the microscope a new world was
revealed,--a world of the infinitely small, swarming with tiny forms of
animal and vegetable life. No one, however, appreciated the significance
of these hitherto invisible plants and animals until the latter part of
the 19th century, when the great French savant, Pasteur, proved that
little vegetable forms, now called bacteria, cause putrefaction and
fermentation, and also certain diseases of animals and man. Pasteur's
discoveries were carried still further by other scientists, with the
result that bacteriology has revolutionized medicine, agriculture, and
many industries, and has made possible the brilliant achievements of
modern sanitary science. For the first time in history the prevention of
epidemics has become possible, and sickness is no longer regarded as a
punishment for sin.
Actual care of the sick, both in homes and in hospitals, has always been
one of the responsibilities of women. The first general public hospital
was built in Rome in the 4th century after Christ by Fabiola, a
patrician lady. There she nursed the sick with her own hands, and from
her day to ours extends an unbroken line of devoted women, handing down
through the centuries their tradition of compassionate nursing service.
It remained for Florence Nightingale, however, to give to the training
its technical and scientific foundation, and thus to found the
profession of nursing. As a result of her work, effectiveness was added
to the spirit of service, that spirit which inspires the modern nurse no
less than in an earlier day it inspired the Sisters of Charity who died
nursing the wounded on the battlefields of Poland.
But different generations have different needs, and to meet them the
spirit of service must manifest itself in widely varying ways. The sick
need care today no less than they did when St. Elizabeth bathed the feet
of the lepers; but such limited service, however beautiful, is no longer
enough. Today we serve best by preventing sickness. Cure of sickness and
alleviation of suffering must never be neglected; not in cure, however,
but in prevention lies the hope of modern sanitary science, of modern
medicine, and of modern nursing.
Nearly every woman at some time in her life is called upon to assist in
caring for the sick. Indeed, approximately 90% of all sick persons in
the United States are cared for at home, even in cities where hospital
facilities are good. Moreover, every woman is largely responsible for
maintaining her own health, and few escape responsibility at some time
for maintaining the health of others. For such responsibility most women
are poorly prepared. Every year in our own country thousands of persons,
many of them babies and children, die merely because someone, in many
cases a woman, is fatally ignorant of the laws governing sickness and
health.
Only prolonged and careful training, such as good hospital
training-schools afford, can furnish the skill and judgment required in
nursing persons who are seriously ill. Upon the trained nurse the modern
practice of medicine makes great and ever-increasing demands: a nurse
must perform complicated duties, meet critical situations, and carry out
a wide variety of measures based on scientific principles which she must
understand. Good will and sympathy are no longer enough; amateur
nursing, even when performed with the best intentions, may involve grave
dangers for those who are seriously ill.
On the other hand, although it is true that a little knowledge is a
dangerous thing, it is no less true that total ignorance may be more
dangerous still. For instance, in cases of incipient, slight, or chronic
illness, and in certain emergencies a little knowledge may be safer far
than no knowledge at all; and no one, surely, should be ignorant of the
principles of hygiene.
The American Red Cross, recognizing the part that women can and should
play in preventing sickness and in building up the health and vigor of
the nation, has added to its larger patriotic services this elementary
course of instruction in hygiene and home care of the sick. The lessons
are not intended to take the place of a nurse's training, and procedures
requiring technical skill are necessarily omitted. The object of the
book is to supply a little knowledge of sickness, which though limited
may yet be safe. The book is also designed to set forth some general
laws of health; to make possible earlier recognition of symptoms; to
teach greater care in guarding against communicable disease; and to
describe some elementary methods of caring for the sick, which, however
simple, are essential to comfort, and sometimes indeed to ultimate
recovery.
FOR FURTHER READING
A History of Nursing--Dock and Nutting, Volume I.
The Life of Florence Nightingale--Cook.
The Life of Pasteur--Vallery-Radot.
The House on Henry Street--Wald.
Public Health Nursing--Gardner, Part I, Chapters I-III.
Origin and Growth of the Healing Art--Berdoe.
Medical History from the Earliest Times--Withington.
Under the Red Cross Flag--Boardman.
Report on National Vitality--Fisher, (Bulletin 30 of the Committee of
One Hundred on National Health. Government Printing Office, Washington).
CHAPTER I
CAUSES AND PREVENTION OF SICKNESS
Diseases of two kinds have long been recognized: first, those
transmitted directly or indirectly from person to person, like smallpox,
measles, and typhoid fever; and second, diseases like heart disease and
apoplexy, which are not so transmitted. These two classes are popularly
called "catching" and "not catching;" the former are the infectious or
communicable diseases, and the latter the non-infectious or
non-communicable. The term contagious, formerly applied to diseases
supposed to be spread only by direct contact, is no longer an accurate
or useful term.
THE COMMUNICABLE DISEASES
The invention of the microscope, as we have seen, revealed the existence
of innumerable little plants and animals, so small that even many
millions crowded together are invisible to the naked eye. These tiny
living creatures are called micro-organisms or germs. The plant forms
are called bacteria (singular, bacterium), and the animal forms
protozoa (singular, protozoön). The common belief that all or even most
bacteria are harmful is quite unfounded. As a matter of fact, while not
less than 1500 different kinds of micro-organisms or germs are known,
only about 75 varieties are known to produce disease.
Most bacteria belong to the class of micro-organisms called saprophytes,
which find their food in dead organic matter, both animal and vegetable,
and cannot flourish in living tissues. These saprophytes act upon the
tissues of dead animals and vegetables, and resolve them into simpler
substances, which are then ready to serve as nourishment for plants
higher in the vegetable kingdom. Thus the processes which we know as
fermentation and putrefaction are due to the action of saprophytes.
Higher plants in turn furnish food for men and animals, and so the food
supply is used over and over in different forms, making what is known as
the _food cycle_. If it were not for bacterial activities vegetation
would be robbed of its supply of nourishment, and plant life would
speedily end; destruction of plant life would deprive the animal kingdom
of food and thus all life would become extinct. The saprophytes are
consequently essential to the existence of both animals and vegetables.
There are, however, other organisms called _parasites_, which can exist
in living tissues of animals or vegetables. The organisms at whose
expense the parasites live are called their _hosts_. Parasites not only
contribute nothing to their hosts, but generally harm them by producing
poisonous substances or depriving them of food. Some parasites are able
to lead a saprophytic existence also, but as a rule they live at the
expense of animal or plant life. Pathogenic, or disease-producing, germs
belong to the group of parasites. The pathogenic germs which find
favorable soil in the body produce poisons called toxins. These poisons
or toxins interfere with the bodily functions, and thus cause what we
know as communicable disease. Communicable diseases are caused by
specific germs only: that is, a certain disease cannot develop unless
its particular germs are present; the germs of typhoid for instance, can
cause typhoid fever only, and not tuberculosis or other disease.
A number of diseases are caused by micro-organisms that are now well
known. Chief among these diseases are colds, septicæmia (blood
poisoning), influenza, pneumonia, diphtheria, typhoid fever,
tuberculosis, whooping cough, Asiatic cholera, bubonic plague,
meningitis, tetanus ("lock jaw"), leprosy, gonorrhœa, syphilis,
relapsing fever, typhus fever, glanders, and anthrax. Micro-organisms
not yet identified probably cause the communicable diseases whose origin
is not known with certainty. These include infantile paralysis,
smallpox, scarlet fever, measles, mumps, chicken-pox, Rocky Mountain
spotted fever, yellow fever, hydrophobia (rabies), foot-and-mouth
disease. We can hardly doubt that the intensive laboratory research now
in progress will reveal in the near future the specific germs of these
diseases also.
STRUCTURE AND DEVELOPMENT OF PARASITES
The group of parasites consists of two general classes, the vegetable,
and the animal. In the former class belong the bacteria, and in the
latter the protozoa. The two classes are not sharply differentiated, but
in general the vegetable parasites are less highly organized than the
animal.
BACTERIA
SHAPE.--Bacteria are composed of single cells and are consequently
called unicellular organisms. Under the microscope individual cells are
seen to differ in size, shape, and structure. In shape bacteria show
three different types; the rod-shaped (bacillus), the spherical
(coccus), and the spiral (spirillum). The organisms causing typhoid
fever for example are a variety of bacilli, those causing pneumonia are
cocci, while those causing Asiatic cholera are spirilla.
[Illustration: FIG. 1.--BACILLI OF VARIOUS FORMS. (_Williams._)]
SIZE.--Bacteria vary greatly in size. Average rod-shaped bacteria are
about 1/25000 of an inch long, but there are undoubtedly organisms so
small that they cannot be seen, even by means of the strongest
microscopes we now possess.
[Illustration: STAPHYLOCOCCI. STREPTOCOCCI. DIPLOCOCCI. TETRADS.
SARCINÆ. FIG. 2.--(_Williams._)]
MOTION.--The power of motion in certain species of bacteria is due to
hair-like appendages called flagella. These flagella by a lashing
movement somewhat resembling the action of oars enable the organisms to
move through fluids.
MULTIPLICATION.--After bacteria have fully developed, each cell divides
into two equal parts; the process of division is called fission. Each
of these two parts rapidly grows into a full-sized organism. Then
fission again takes place, so that four bacteria replace the original
one. In each of the four, fission occurs again, and so the process of
multiplication continues. As bacteria develop they group themselves in
characteristic ways. Some, like the streptococci, arrange themselves in
chains; the diplococci, in pairs; the tetrads, in groups of four; others
in packets called sarcinæ, and still others, the staphylococci, form
masses supposed to resemble bunches of grapes.
[Illustration: FIG. 3.--SPIRILLA OF VARIOUS FORMS. (_Williams._)]
[Illustration: FIG. 4.--BACTERIA SHOWING FLAGELLA. (_Williams._)]
Under favorable conditions fission occurs rapidly; in some types a new
generation may appear as often as every 15 minutes. Enormous
multiplication would result if nothing occurred to check the process.
But in nature such increase never continues unhindered, and bacteria,
acting upon their food substances, produce acids and other materials
injurious to themselves. Furthermore, lack of proper food, moisture, or
favorable temperature, and competition with other organisms tend to
prevent their unrestricted growth and multiplication.
[Illustration: FIG. 5.--BACTERIA WITH SPORES. (_Williams._)]
SPORES.--Most bacteria die if conditions become unfavorable to their
growth, but some enter into a resting stage. This stage is characterized
by the development of round or oval glistening bodies called spores,
which are of dense structure and possess an extraordinary power to
withstand heat, chemicals, and unfavorable surroundings. Except in rare
instances a single cell produces but one spore. As soon as favorable
conditions of temperature, moisture, and food supply are restored, the
spore develops into the active form of the germ; it may, however, remain
dormant for months or years. Spore formation, however, occurs in only a
very few varieties of pathogenic bacteria.
DISTRIBUTION.--Bacteria are very widely distributed in nature; they are
in fact found practically everywhere on the surface of the earth. They
are present in plants and water and food; on fabrics and furniture,
walls and floors; and they are found in great numbers on the skin, hair,
many mucous surfaces, and other tissues of the body.
PROTOZOA
The protozoa are the lowest group of the animal kingdom. Like bacteria
they are composed of single cells so small as to be visible only under
the microscope. They play an important part in causing certain diseases
of man, especially in the tropics. Among the well-known human diseases
of protozoan origin are malaria, amoebic dysentery, and
sleeping-sickness. Protozoa also cause several wide-spread and serious
plagues of domestic animals.
VISIBLE PARASITES
A few diseases are caused by parasites large enough to be seen with the
naked eye. One of the most important is hookworm disease. This disease
is caused by a tiny worm which penetrates the victim's skin and
ultimately finds its way into the intestine. Other diseases also are
caused by parasitic worms, such as tapeworms, pinworms, and trichinæ.
The latter are acquired as a result of eating infected meat,
particularly infected pork that has not been thoroughly cooked.
TRANSMISSION OF PATHOGENIC ORGANISMS
Pathogenic or disease producing organisms need for their development
food, moisture, darkness, and warmth, conditions that exist within the
human body. When one or more of these factors is unfavorable,
development of germs is checked; if unfavorable conditions are extreme
or long continued, the organisms begin to die. It is difficult to say at
exactly what moment they will die if deprived of moisture or exposed to
extremes of temperature or other unfavorable conditions, just as it
would be impossible to state at exactly what moment a collection of
house plants would all be dead if water were withheld, or if the room
temperature were greatly reduced.
Most pathogenic organisms, however, do not flourish long outside the
body, and owe their continued existence to a fairly direct transfer
from person to person. They gain access to the body through mucous
surfaces such as the respiratory and digestive tracts, and through
breaks in the skin, such as cuts, abrasions, and the bites of certain
insects. They leave the body chiefly in the nasal and mouth discharges,
as in coughing, sneezing, and spitting, in the urine and bowel
discharges, and in pus or "matter."
[Illustration: FIG. 6. (_L. H. Wilder._)]
The problem of controlling communicable diseases, consequently, lies in
preventing the bodily discharges of one person from travelling directly
into the body of another. If a person is not expelling pathogenic germs,
it is clear that he cannot pass diseases on to others. But both
pathogenic and harmless germs follow the same routes from person to
person, so that safety as well as decency lies in preventing so far as
possible all exchanges of bodily discharges.
There are five routes by which the bodily discharges most frequently
travel from one person to another. Four of these routes of infection are
called public, because in most cases efforts of individuals alone are
not sufficient to control them. The public routes are water, milk, food,
and insects. The fifth, or private route, includes all means by which
fresh discharges of one person are passed to another, as when nose and
mouth discharges are carried in coughing, sneezing, and kissing, or when
bowel and bladder discharges are carried by the hands. These five routes
in a given case differ greatly in relative importance, but the fifth, or
direct route plays an immense part, although its importance in causing
sickness has only lately been recognized. It cannot be too strongly
emphasized that the chief agent in the spread of human diseases is man
himself, and the human hand is the great carrier of disease germs both
to and from the body. If unclean hands could be kept away from the
orifices of the body, particularly the mouth, many diseases would soon
cease to exist.
Defenses of the Body
In view of all the dangers from disease-producing germs it may seem
surprising that the human race has not long ago succumbed to its
invisible enemies. But the body has various defenses by means of which
it may prevent invasion, or successfully combat its enemies in case they
do gain access.
The unbroken skin is usually impassable to bacteria. Virulent organisms
are often found upon the skin of perfectly healthy persons, where they
appear to be harmless unless an abrasion occurs which affords entrance
into the deeper tissues. Most bacteria breathed in with the air cling to
the moist surfaces of the air-passages and never reach the lungs.
Mucous membranes lining the mouth and other cavities of the body would
prove favorable sites for the growth of bacteria if the mucus secreted
by them were not frequently removed. The mouth of a healthy person may
contain bacteria of many kinds, but the saliva has a slight disinfectant
power and serves as a constant wash to the membranes. The normal gastric
(stomach) juice is decidedly unfavorable to the growth of bacteria,
although it does not always kill them; they often pass through the
stomach and are found in large numbers in the intestines. Other bodily
secretions, such as the tears and perspiration, tend to discourage
bacterial growth.
Tissues of the body vary greatly in their power to resist invading
germs, so that the route by which germs enter influences the severity of
their effects. Typhoid bacilli and the spirilla of Asiatic cholera when
taken with food or water produce far more serious disturbances than when
injected under the skin; infections from pus germs through an abrasion
of the skin may result in a slight local disturbance, while the same
amount introduced into a deeper wound might cause a fatal infection.
Certain germs nourish in certain tissues only; even tuberculosis, which
attacks practically all tissues, has its favorite locations.
IMMUNITY.--In addition to its mechanical defenses against disease, the
body shows a varying degree of _immunity_, or the power possessed by
living organisms to resist infections. Immunity or resistance is the
opposite of susceptibility. It is exceedingly variable, being greater or
less in different people and under different conditions, but the exact
ways in which it is brought about are still in many cases far from
clear.
Immunity may be _natural_ or _acquired_. By natural immunity is meant
an inherited characteristic by which all individuals of a species are
immune to a certain disease. The natural immunity of certain species of
animals to the diseases of other animals is well known. Man is immune to
many diseases of lower animals, and they in turn are immune to many
diseases of man. Cattle, for instance, are immune to typhoid and yellow
fever, while man shows high resistance to rinderpest and Texas fever;
both, however, are susceptible to tuberculosis, to which goats are
immune. There are all gradations of immunity within the same species.
Moreover, certain individuals have a personal immunity against diseases
to which others of the same race or species are susceptible.
Immunity may be _acquired_ in several ways. It is commonly known that
one attack of certain communicable diseases renders the individual
immune for a varying length of time, and sometimes for life. Among these
diseases are smallpox, measles, whooping-cough, scarlet fever, infantile
paralysis, typhoid fever, chicken-pox, and mumps; erysipelas and
pneumonia on the other hand appear to diminish resistance and to leave a
person more susceptible to later attacks.
Again, in some cases immunity may be artificially acquired by
introducing certain substances into the body to increase its
resistance. Examples of this method include the use of antitoxin as a
protection against diphtheria, of sera in pneumonia and other
infections, and vaccination against smallpox and typhoid fever whereby a
slight form of the disease is artificially induced. Laboratory research
goes on constantly, and doubtless many more substances will eventually
be discovered that will reduce human misery as vaccines and antitoxin
have already reduced it.
Vaccination and inoculation have saved thousands of lives. Smallpox,
once more prevalent than measles, was the scourge of Europe until
vaccination was introduced. During the 18th century it was estimated
that 60,000,000 people died of it, and at the beginning of the 19th
century one-fifth of all children born died of smallpox before they were
10 years old. In countries where vaccination is not practised the
disease is as serious as ever; in Russia during the five years from
1893-97, 275,502 persons died of smallpox, while in Germany where
vaccination is compulsory, only 8 people died of it during the year
1897. Death rates from diphtheria and typhoid fever have been greatly
reduced by the use of antitoxin and antityphoid vaccine. Thus in New
York State in 1894, before antitoxin was generally used, 99 out of every
100,000 of the population died of diphtheria, while only 20 out of
100,000 died of it in 1914. In 1911 a United States Army Division of
more than 12,000 men camped at San Antonio, Texas, for four months. All
of these men were vaccinated against typhoid fever and only a single
case occurred during the summer, although conditions of camp life always
tend to spread the disease.
While many and various factors tend to lower resistance rather than to
increase it, the idea that these factors act equally in all kinds of
infection is erroneous.
"The principal causes which diminish resistance to
infection are: wet and cold, fatigue, insufficient or
unsuitable food, vitiated atmosphere, insufficient sleep
and rest, worry, and excesses of all kinds. The mechanism
by which these varying conditions lower our immunity must
receive our attention, for they are of the greatest
importance in preventive medicine. It is a matter of common
observation that exposure to wet and cold or sudden changes
of temperature, overwork, worry, stale air, poor food,
etc., make us more liable to contract certain diseases. The
tuberculosis propaganda that has been spread broadcast with
such energy and good effect has taught the value of fresh
air and sunshine, good food, and rest in increasing our
resistance to this infection.
"There is, however, a wrong impression abroad that because
a lowering of the general vitality favors certain diseases,
such as tuberculosis, common colds, pneumonia, septic and
other infections, it plays a similar rôle in all
communicable diseases. Many infections, such as smallpox,
measles, yellow fever, tetanus, whooping-cough, typhoid
fever, cholera, plague, scarlet fever, and other diseases,
have no particular relation whatever to bodily vigor. These
diseases often strike down the young and vigorous in the
prime of life. The most robust will succumb quickly to
tuberculosis if he receives a sufficient dose of the
virulent micro-organisms. A good physical condition does
not always temper the virulence of the disease; on the
contrary, many infections run a particularly severe course
in strong and healthy subjects, and, contrariwise, may be
mild and benign in the feeble. Physical weakness,
therefore, is not necessarily synonymous with increased
susceptibility to all infections, although true for some of
them. In other words, 'general debility' lowers resistance
in a specific, rather than in a general, sense."--(Rosenau:
Preventive Medicine and Hygiene, pp. 403 and 404.)
CARRIERS
Well persons who carry in their bodies pathogenic germs but who
themselves have no symptoms of disease are called carriers. Thus typhoid
carriers have typhoid bacilli in the intestinal tract, while they
themselves show no symptoms of typhoid fever; diphtheria carriers have
bacilli of diphtheria in the throat or nose, but have themselves no
symptoms of diphtheria, and so on. It has now been proved that many
patients harbor bacteria for weeks, months, or even years following an
infection, and are dangerous distributors of disease; also, some
healthy individuals without a history of illness harbor living bacteria
which may infect susceptible persons in the usual ways. Transmission by
healthy carriers goes far to explain the occurrence of diseases among
persons who have apparently not been exposed. This explanation has
greatly clarified the whole problem of the spread of communicable
diseases. Carriers, unfortunately, exist in large numbers, and render
the ultimate control of disease exceedingly difficult. They can usually
be identified by bacteriological tests. To some extent they can be
supervised; food handlers at least should be legally obliged to submit
to physical examinations, and should be licensed only when proved free
from communicable disease.
Diseases are also spread by persons suffering from them in a form so
mild or so unusual that they pass unrecognized. These persons are known
as "missed" cases. Carriers of disease and "missed" cases go freely
about the community, handling food, using common drinking cups,
travelling in crowded street cars, standing in crowded shops; in various
ways coming into close contact with other people, coughing and sneezing
and kissing their friends no less often than normal individuals. It is
consequently clear that the bodily discharges of supposedly normal
persons may be hardly less a menace than those of persons known to be
infected.
Diseases that depend for transmission upon milk, water, food, and
insects may be controlled by public action, that is, by specific
measures taken by a large group of people in order to protect the
individual. Such action constitutes _public sanitation_. There is,
however, a large group of diseases, chiefly sputum-borne, that cannot be
controlled except by individual action. Such individual action
constitutes a large part of _personal hygiene_.
The whole problem of controlling infections sounds simple, depending as
it does for the most part upon unpolluted water, milk, and food,
extermination of certain insects, and cleanliness in personal behaviour.
In practice the problem is not so easy. Public sanitation has performed
miracles in the past, and will do much in the future; behaviour,
however, will continue to be influenced by many factors, social and
economic as well as personal. Ignorance of the laws of health is an
obstacle to progress, but in modern conditions even the instructed may
be unable to control their ways of living and working. Indeed, such
control is at present limited to the privileged few. On the ignorant and
the poor, those least able to bear it, society loads the heaviest burden
of sickness. Only when ignorance and poverty are abolished, as one day
they will be, can the final stage be reached in the fight for public
health.
THE NON-COMMUNICABLE DISEASES
In this group is included a great variety of maladies. Of some the
causes are known, while in the case of others, origin, prevention, and
remedy are still obscure. Here belong defects in structure of the body,
both hereditary and acquired; insanity and other nervous diseases; new
growths, like tumors and cancer; disturbances of bodily processes, as
malnutrition and gout; and the important class of degenerative diseases,
like arteriosclerosis, in which tissues become hardened and fibrous and
hence less able to perform their normal functions.
The degenerative diseases are playing a menacing part in national
health. The average length of life in the United States has shown a
marked increase it is true, during the last 40 years. But this gain
represents chiefly the saving of life through prevention of communicable
diseases, especially among babies and children; among people who have
passed the 30th year on the other hand, death rates are actually
increasing. This increase is most marked after the age of 45, and is
caused chiefly by the increase of cancer, and of degenerative diseases
of the heart, blood vessels, and kidneys. Degeneration of tissues is
normally a condition typical of old age, and in aged persons it may
occur in any tissue. There is no elixir of youth, and for old age there
is no cure. But the important facts in this connection are that
degenerative changes now occur prematurely, and that among a vast number
of people, in various classes of society and various occupations, the
vital organs show a marked tendency to break down after the age of 45.
This condition is not inevitable. Before the beginning of the present
war, death rates at all ages were decreasing in England, Sweden, and
other European countries. In America also degenerative diseases can be
checked or prevented to a large extent, and it is highly important that
their causes should be generally understood.
The two groups following include some of the probable causes:
1. Conditions of life which result in continued overwork, and mental
overwork in particular; worry, excitement, insufficient recreation and
exercise, and other kinds of nervous strain typical of modern life,
especially in cities.
2. Irritating substances in the body, including poisonous substances
resulting from infectious diseases, and from syphilis in particular;
poisons from chronic infections, alcohol, and industrial poisons such
as lead and other metals; overeating and improper eating, especially of
meat and other proteins, and rich or highly seasoned food; faulty
digestion, constipation, and imperfect elimination through the
kidneys.--(See Dr. A. E. Shipley, in bulletin of the N. Y. City Dept. of
Health, Feb., 1915.)
The importance of early recognition cannot be overemphasized. In many of
these troubles the symptoms are not pronounced, and the victims have no
knowledge of their condition until they happen to be examined for life
insurance, or until the disease is far advanced. And even when they
realize that trouble exists, as for example constipation or overwork,
most people absolutely fail to realize how serious the consequences may
be. The first step toward remedy is periodic complete physical
examination by a competent physician, in order to learn in time how to
prevent these degenerative diseases, if present, from growing worse. The
custom of undergoing an annual physical examination is becoming more
common, and "such a course, conservatively estimated, would add 5 years
to the average life of persons between 45 and 50."--(Winslow.)
"Recently, we have been making examinations of the
employees of whole institutions, large banks and other
industrial concerns in New York City, and we find almost
the same conditions there. Out of 2000 such examinations
among young men and women of an average age of 33, just in
the early prime of life, men and women supposedly picked
because of their especial fitness for work, only 3.14% were
found free of impairment or of habits of living which are
obviously leading to impairment. Of the remaining persons,
96.69% were unaware of impairment; 5.38% of the total
number examined were affected with chronic heart trouble;
13.10% with arteriosclerosis; 25.81% with high or low blood
pressure; 35.65% with sugar, casts or albumen in the urine;
12.77% with combination of both heart and kidney disease;
22.22% with decayed teeth or infected gums; 16.03% with
faulty vision uncorrected.... The fact of greatest import,
however, was that impairment, sufficiently serious to
justify the examiner in referring the examinee to his
family physician for medical treatment, was found in 59% of
the total number of cases, while 37.86% were on the road to
impairment because of the use of "too much alcohol," or
"too much tobacco," constipation, eye-strain, overweight,
diseased mouths, errors of diet, and so forth....
"And what is the cause of this appalling increase, in the
United States, of these and other degenerative diseases? I
believe it can be shown to the satisfaction of any
reasonable person that the increase is largely due to the
neglect of individual hygiene in United States....
"If a man were suddenly afflicted with smallpox or typhoid
fever or any other acute malady, he would lose no time in
getting expert advice and applying every known means to
save his life. But his life may be threatened just as
seriously, though possibly not so imminently, by
arteriosclerosis, heart disease, or Bright's disease, and
he will do nothing to prevent the encroachment of these
diseases until it is too late, but will continue to eat as
he pleases, drink as he pleases, smoke as he pleases, or
overwork, and worry himself into a premature
grave."--("Conservation of Life at Middle Age," Prof.
Irving Fisher, Am. Journal of Public Health, July, 1915.)
Periodic physical examinations are as necessary for children as for
adults, in order to detect physical defects. These defects are known to
have such an immense bearing upon health that routine examinations of
all children have become an integral part of the work of enlightened
public schools.
Prevention of degenerative disease, then, as well as of the enormous
numbers of preventable accidents and injuries, depends in large measure
upon proper living conditions and proper personal habits. The infectious
diseases, according to Dr. Hill, cost us annually at least 10 billion
dollars in addition to the loss of life, and he adds: "The infectious
diseases in general radiate from and are kept going by women."--(Hill--
New Public Health, p. 30.) Women, it is true, can prevent many of the
infections, but they can do still more, for hygienic habits to be
effective must be acquired early, and mothers and teachers, because they
have practically the entire control of children, have the power to
prevent many cases of degenerative as well as of communicable disease.
EXERCISES
1. Distinguish between communicable and non-communicable disease.
2. Describe the part played by micro-organisms in causing disease.
3. Describe the structure of bacteria and their method of
multiplication.
4. In what ways are pathogenic germs transmitted from person to person?
5. Upon what preventive measures does the control of communicable
diseases depend?
6. What is meant by immunity?
7. Against what diseases may immunity be acquired artificially? How has
the practice of immunizing affected death rates from communicable
diseases?
8. What factors tend to lower resistance? Do they act equally in the
case of all diseases?
9. Define a carrier, and explain the importance of carriers in the
spread of disease.
10. Name some of the characteristics and causes of degenerative
diseases.
11. Whom do the degenerative diseases most commonly affect?
12. Describe methods that should be employed to prevent degenerative
diseases.
FOR FURTHER READING
The New Public Health--Hill, Chapters I-IX.
Health and Disease--Roger I. Lee, Chapters XV-XXIV.
Principles of Sanitary Science and the Public Health--Sedgwick, Chapters
I, II, III.
Scientific Features of Modern Medicine--Frederic S. Lee, Chapters II,
IV-VI.
Disease and Its Causes--Councilman, Chapter I.
Preventive Medicine and Hygiene--Rosenau.
Publications of the Life Extension Institute--25 West 45th Street, New
York City.