Because the childish body quickly shows _Civics and Health

in adults would be called moderate smoking, the proper physical

examination of school children will reveal injuries which in turn will

show where and to what extent the cigarette evil exists among the

children of a community. Even the scientists who claim that "in some

cases tobacco aids digestion," or that "tobacco may be used without bad

effects when used moderately by people who are in condition to use it,"

declare emphatically that tobacco "must not be used in any form by

growing children or youths." Prohibitive laws can be rigidly enforced

if a small amount of attention is given to organizing the strong

public sentiment that exists against demoralizing children by tobacco.

Thus children and youths will not need to make a decision regarding

their own use of tobacco until after other arguments than physiological

fear have been used for many years by parent, teacher, and society.

One effective weapon is the sign on a ferryboat or street car: "No

smoking allowed on this side," or "Smoking allowed on three rear seats

only." Public halls and vehicles in increasing numbers either prohibit

smoking altogether or put smokers to some considerable inconvenience.

The trouble involved in going to places where smoking is permitted

tends gradually to irritate the nerves beyond the power of tobacco to

soothe. Again, many men would rather not soothe their excited nerves

after five, than have their nerves excited all day waiting for freedom

to smoke. Restrictions as to time or place make possible and expedite

still further restrictions. Thus gradually the army of occasional

smokers or nonsmokers is being recruited from the army of regular

smokers.

The anti-nuisance motive follows closely upon the drawing of sharp

lines of time and place for the use of tobacco. Like treason, smoking

in the presence of nonsmokers can be considered respectable only when

the numbers who profess and practice it are numerous. If the two

first-mentioned weapons are effectively used, there will be an

increasing proportion of nonsmokers and not-yet-smokers who will give

attentive ear to proof that nicotinism is a nuisance. The physical

evidences of the cigarette habit can easily be made distasteful to all

nonsmokers if frankly pointed out,--the yellow fingers, the yellow

teeth, the nasty breath, the offensive excretions from the pores that

saturate the garments of all who cannot afford a daily change of

underwear. The anti-nuisance argument is always insidious and abiding.

In the presence of nonsmokers accustomed to regard tobacco using as a

nuisance, smokers become self-conscious and sensitive. Men and women

alike would prefer a reputation for cleanliness to the pleasures of

tobacco. The educational possibility of fighting tobacco with the name

"nuisance" was recognized the other day by an editorial that protested

against a law to prevent women from using cigarettes in restaurants.

"The way for any man who has the desire to reform some woman addicted

to the cigarette habit is insidiously and gently to point out the

injurious effects on her appearance. Cigarette smoking stains a woman's

fingers and discolors her teeth. It also tends to make her complexion

sallow and to detract from the rubiness of her lips. It bedims the

sparkle of her eyes. It makes her less attractive mornings." Chewing

has practically disappeared, not because it ceased to soothe excited

nerves but because it was seen to be a nasty nuisance.

Finally, the selfishness of the smoker is a nuisance that continues

only because it has not been called by its right name. "Do you mind if

I smoke?" was a polite question two hundred years ago when tobacco was

rare enough to make smoking a distinction, or fifty years ago when

everybody smoked at home and in public. But it is effrontery to-day

when people do mind, when smoking pollutes the air of drawing room and

office, and while soothing the excited nerves of the smoker lowers the

vitality of nonsmokers compelled to breathe smoke-laden air. It is

selfish to intrude upon others a personal weakness or a personal

appetite. It is selfish to divert from family purposes to "soothing

excited nerves" even the small amounts necessary to maintain the cigar

or cigarette habit. It is selfish to run the risk of shortening one's

life, of reducing one's earning capacity. Because the tobacco habit is

selfish it is anti-social and a nuisance, and should be fought by

social as well as personal weapons, as are other recognized nuisances,

such as spitting in public or offensive manners.

The economic motive for avoiding and for eliminating tobacco is gaining

in strength. The soothing qualities of all drugs are found to be

expensive to physical and business energy if enjoyed during business

hours. Strangely enough, employers who smoke are quite as apt as are

nonsmokers, to forbid the use of tobacco by employees at work. Some of

this seeming inconsistency is due to a dislike for cheaper tobacco or

for mixed brands in one atmosphere; some of it is due to the smoker's

knowledge that "soothing nerves" and sustained attention do not go hand

in hand, while "pipe dreams" and unproductive meditation are fast

companions; finally no little of the opposition to tobacco in business

is due to fear of fire. These various motives, combining with the

anti-nuisance motive among nonsmokers, have led many business

enterprises to prohibit the use of tobacco in any form on their

premises or during business hours, even when on the premises of others.

Notable examples are railroads that permit no passenger trainman to use

tobacco while on duty. (Freight trainmen are restricted more tardily

because the risk of damages is less and the anti-nuisance objection is

wanting.)

From penalizing excessive use and prohibiting moderate use in business

hours, it is a short cut to choosing men who never use tobacco and thus

never suffer any of its effects and never exhibit any of its offensive

evidences. No young man expects to obtain a favorable hearing if he

offers himself for employment while smoking or chewing tobacco.

Business men dislike to receive tobacco-scented messengers. Cars and

elevators contain signs prohibiting lighted cigars or cigarettes.

Insurance companies reject men who show signs of excessive use of

tobacco. Why? Because they are apt to die before their time. The

Interborough Rapid Transit Company of New York City rejects applicants

for motormen and conductors "for excessive or long-continued use of

tobacco." Why? Because, other things being equal, such men are more

apt to lose their nerve in an emergency and to fail to read signals or

instructions correctly.

Armed with these weapons against tobacco, parents and teachers can

effectively introduce physiological arguments against excessive use,

against use by those who suffer from nervous or heart trouble, and

against any use whatever by those who have not reached physical

maturity. By avoiding physiological arguments that children will

not--cannot--believe contrary to their own eyes, parents and teachers

are able to speak dogmatically of that which children will

believe,--injuries to children, evils of excess, restrictions as to

time and place, and offensiveness to nonsmokers. But even here it is

wrong, as it is inexpedient, to leave the physical strength of the next

generation to the persuasive power of parents and teachers or to the

faith and knowledge of minors. Society should protect all minors

against their own ignorance, their own desires, the ignorance of

parents and associates, and against the economic motive of tobacco

sellers by machinery that enforces the law.

CHAPTER XXXVII

THE PATENT-MEDICINE EVIL

"Dhrugs," says Dock O'Leary, "are a little iv a pizen that a

little more iv wud kill ye. Ye can't stop people fr'm takin'

dhrugs, an' ye might as well give thim somethin' that will look

important enough to be inthrojuced to their important and fatal

cold in th' head. If ye don't, they'll leap f'r th' patent

medicines. Mind ye, I haven't got annything to say agin' patent

medicines. If a man wud rather take them thin dhrink at a bar or

go down to Hop Lung's f'r a long dhraw, he's within his rights.

Manny a man have I known who was a victim iv th' tortures iv a

cigareet cough who is now livin' comfortable an' happy as an opeem

fiend be takin' Dr. Wheezo's Consumption Cure." The Dock says th'

more he practices medicine th' more he becomes a janitor with a

knowledge iv cookin'. He says if people wud on'y call him in

befure they got sick he'd abolish ivry disease in th' ward except

old age and pollyticks.

Thus Mr. Dooley with his usual wit and insight tells the American

people why they spend over two hundred million dollars annually on

patent medicines. Americans consume more drugs and use more patent

medicines than the people of any other country on the civilized globe.

Self-medication has grown to tremendous proportions. Everywhere--in

cars, on transfers, on billboards, in magazines, in newspapers, in the

mails--are advertised medicines to cure disease and devices to promote

health. When we consider that electric cars contain from thirty-two to

fifty-two advertisements each, three fourths of which are directly or

indirectly concerned with health; when we multiply these by the number

of cars actually in use in American cities; when we consider the number

of advertisements in magazines and daily papers, and the enormous

circulation of these papers and magazines; when we consider that an

increasingly large proportion of advertising space is devoted to

health,--we begin to realize the cumulative power for good or for evil

that health advertisements must have.

To illustrate advertisements devoted to health to-day, I have kept

clippings for one week of news items, editorials, and advertisements in

a penny and a three-cent paper, and had them classified according to

the subjects treated:

===================+=========================+========================

| PENNY PAPER | THREE-CENT PAPER

+------+---------+--------+-----+---------+--------

-------------------+------+---------+--------+-----+---------+--------

Milk | 3 | -- | 2 | 3 | -- | 2

Teeth | -- | 1 | 2 | -- | -- | 1

Shoes | -- | -- | 4 | -- | -- | 1

Food | 1 | -- | -- | 1 | -- | 4

Alcohol | 1 | -- | 5 | 3 | -- | 7

Tuberculosis | -- | -- | 1 | 1 | -- | --

Patent medicine | -- | -- | 17 | -- | -- | --

Constipation cures | -- | -- | 4 | -- | -- | 5

Eyes | 3 | -- | 5 | 1 | -- | --

Beauty | 2 | 5 | 8 | -- | -- | 6

General | 8 | 3 | 3 | 5 | -- | --

-------------------+------+---------+--------+-----+---------+--------

Total | 18 | 9 | 51 | 14 | -- | 26

===================+======+=========+========+=====+=========+========

The following list of health topics was treated in the advertisements,

editorials, and articles of a popular monthly periodical devoted to

women:

=========================+=========+===========+===============

| ARTICLE | EDITORIAL | ADVERTISEMENT

-------------------------+---------+-----------+---------------

Babies | 1 | -- | 11

Soaps and powders | -- | -- | 5

Beauty | 3 | -- | 6

Quack cures | -- | 2 | --

Tooth powders | -- | -- | 4

Household | 1 | -- | 5

Food and cooking | 1 | -- | 14

Clothes | 13 | -- | 5

Teaching sex laws | 1 | 2 | --

Medicine | 4 | 1 | --

-------------------------+---------+-----------+---------------

Total | 24 | 5 | 50

=========================+=========+===========+===============

Besides the classic patent medicines, such as Lydia Pinkham's Vegetable

Compound, Castoria, Cod Liver Oil, etc., there are "Colds Cured in One

Day," "Appendixine," health foods, massage vibrators, violet rays,

Porosknit underwear, sanitary tooth washes, soaps, vitopathic,

naturopathic, and faith cures. New ones appear every day,--enough to

make a really sick person dizzy, let alone a person suffering from

imaginary ailments. All seem to outline my particular symptoms. After

they have flamed at me in red letters in the surface cars, pursued me

in the elevated and underground, accompanied me out into the country

and back again to the city, greeted me each morning in the daily paper

and in my daily mail, each week or each month in the periodical, the

coincidence of a familiar package on a drug-store counter seems to be

providential and therefore irresistible. I know that I ought to be

examined by a physician, but I am busy and not unwilling to gamble for

my health; it cannot kill me and there is a chance that it will cure

me. If there is nothing the matter with us, we may be cured by our

faith. If we are taking a cure for consumption, the morphine in it may

lull us into thinking we feel better. If we are taking a tonic for

spring fever, the cheap alcohol may excite us into thinking our

vitality has been heightened. Soothing sirup soothes the baby, often

doping its spirit for life, or soothing it into a sleep from which it

never wakes.

In spite of the fact that the "Great American Fraud" has been exposed

repeatedly in newspapers and magazines of wide circulation, the appeal

of the quack still catches men and women of intelligence. The other

night a friend went out to a dinner and conference with a lawyer in the

employ of the national government. Annoyed by a nagging headache, he

made for the nearest drug store and ordered a "headache powder." He

admitted that it was an awful dose, but he had been told that it always

"did the business." He knew the principle was bad, confessed to a

scorn for friends of his whom he knew to be bromo-seltzer fiends, but

he had the headache and the work to do--a sure cure and a quick one

seemed imperative. The headache was due to overwork, indigestion,

constipation. Plain food and quiet sleep was what he needed most. But

the dinner conference plus the headache was the unanswerable argument

for a dose with an immediate result.

Last winter an Irish maid slowly lost her rosy cheeks and grew

hollow-eyed and thin. She was taken to a specialist who discovered a

rapidly advancing case of consumption. He said that owing to the girl's

ignorance, stupidity, and homesickness, her only chance of recovery was

to return to the "auld countrie" at once. The girl agreed to go, but

insisted on a few days "to talk it over with her cousins in New York."

After two weeks had elapsed she was found in a stuffy, overcrowded New

York tenement. She had found a doctor who had given her a little bottle

of medicine for two dollars, which would cure her in the city. It was

futile to protest. Days in the unventilated tenement and nights in a

"dark room" meant that she would never live to finish the bottle.

For a year Miss H. took a patent preparation for chronic catarrh. It

seemed to "set her up"; but it so undermined her strength, through its

artificial nerve spur, that chronic catarrh was followed by

consumption. It later transpired that the cure's chief ingredient was

whisky, and cheap whisky. A good grandmother, herself a vigorous

temperance agitator and teetotaler, offered to pay for it as long as my

friend would take it faithfully. The irony of it makes one wonder how

many earnest advocates of total abstinence are in reality addicted to

the liquor habit.

Last summer a district nurse of the summer corps who visited city

babies under two years of age encountered in the hallway of a tenement

a bevy of frenzied women. A baby lay on the bed gasping and "rolling

its eyes up into the top of its head." The nurse asked the frightened

mother what she had been giving it. "Nothing at all," said the woman.

But a telltale bottle of soothing sirup showed that the child was dying

from morphine poisoning. Happily the nurse came in time to save it.

Is it not pitiful, this grasping for a poison in an extremity; this

seizing of a defective rope to escape the fire?

[Illustration: LEARNING HOW TO KEEP BABY WELL WITHOUT PATENT

MEDICINES

Recreation Pier, New York City, Summer, 1908]

The patent-medicine evil cannot be cured by occasional exposure or by

overexposure. Nor can it be cured by legislation, legislation,

legislation, unless laws are rigidly enforced.

Occasional exposure is no better than occasional advertising of good

things. The patent-medicine business thrives on constant, not

occasional, advertising. Leading advertisers expect so little from the

first notice that they would not take the trouble to write out a single

advertisement. That is the reason merchants charge advertising in the

programmes of church, festival, and glee-club concert to charity, not

to business. Warning people once does no more lasting good than sending

a child to school once a month. The exposure of patent-medicine evils

must be as constant as efforts to sell the medicines.

Overexposure is ineffective. It is the evils of patent medicines that

do harm, not their name and not their patents. The medical profession

has in vain protested against proprietary medicines. Ethical barriers

cannot be erected by resolution. Calling things unethical does not make

them unethical. The mere patenting of medicines for profit does not

make the medicine injurious any more than the mere mixing of unpatented

drugs makes a physician safe. Physicians who would not themselves

patent a drug will use certain patented drugs whose ingredients are

known to be safe and uniform. True exposure of patent-medicine evils

will enable the average physician and the average layman to distinguish

the dangerous from the safe, the fraud from the genuine, lies from

truths.

Legislation is needed to crystallize modern knowledge and to establish

in courts the right to protection against the evils of patent

medicines. The national Pure Food Law, passed January 1, 1907, and now

in force throughout the country, requires on the "labels of all

proprietary medicines entering into interstate commerce, a statement of

the quantity or proportion of any alcohol, morphine, opium, heroin,

chloroform, cannabis indica, chloral hydrate, or acetanilid, or any

derivative or preparation of any such substance contained therein; this

information must be in type not smaller than eight-point capital

letters; also _the label shall embody no statement which shall be false

or misleading in any particular_." This law does not forbid patent

medicines nor the use of alcohol and narcotics in patent medicines; it

merely says, "Let the label tell, that all who _buy_ may read." It does

not require that all who _run_ may read, for _it does not say that

advertisements of a patent medicine shall tell the truth about its

ingredients or its action on the human body_; only that the label on

the bottle shall tell. The object of this law is to explain to the

consumer the exact nature of the medicine. But to the majority of

people the word "acetphenitidin" on the label of a headache medicine

does not explain. The new order that requires manufacturers to

substitute acetanilid for acetphenitidin does no more than replace fog

with mist. Protection requires legislation that cannot be evaded by

technical terms. The present law requires that packages must be

properly labeled _on entering the state_. To carry out the national

law, state laws should make it an offense for dealers to have in their

possession proprietary medicines without explanatory labels that

explain. Where state laws to this effect do not exist, the packages

once in the state may be deprived of their labels and sold as secret

remedies, thus nullifying the whole effect of the national law.

Enforcement must be insured. Impure drugs may do as much harm as patent

medicines containing harmful drugs. In New York a vigorous campaign was

recently inaugurated by the department of health to drive out impure

drugs. Drugs are dangerous enough at their best. When they are not what

they pretend to be, whether patented or not, they may take life. One

extreme case where a patient's heart was weakened when it ought to have

been strengthened, led to the discovery that practically all of one

particular drug offered for sale in New York City was unfit to use and

calculated to kill in the emergency where alone it would be used.

Yesterday four lives and several million dollars were lost in a New

York fire because the hose was rotten or weak. As inspection and

testing were needed to insure hose equal to emergency pressure, so

inspection and testing of patent medicines and drugs are needed to make

legislation effectual.

Legislation and enforcement should reach the newspaper, magazine,

billboard, street car, that advertises a falsehood or less than the

essential truth regarding drugs, foods, and patent medicines. Public

sentiment condemns the advertising of many opportunities to commit

crime or to be disorderly or indecent or to injure one's neighbor. The

facts about hundreds of nostrums can be absolutely determined. The

advertising agency, whether secular or religious, that carries

misrepresentation of drugs and foods should be forbidden circulation

through the mails. The existence of such advertisements should be made

evidence of complicity in a public offense and punished accordingly.

Treat them as we treated the Louisiana lottery. Boards of health,

instead of furnishing names to druggists and manufacturers who want to

sell patent foods and medicines, should print circulars exposing

frauds, and punish so far as the law permits.

While trying to secure adequate legislation and efficient

administration of the above-mentioned standards, there is much that can

be done by individuals and clubs. We can give preference to those

journals that refuse drug and food advertisements unless evidence is

produced that the truth is told and that the goods are not harmful. We

can refuse to have in the house a paper or journal which prints notices

that lie or that conceal the truth. If this drastic measure would cut

us off entirely from daily papers, we could choose the least offensive

and petition it to exclude specific lying methods. When it preaches

health, honesty, and philanthropy, we can cut out of one issue the

noble editorial and the exploiting advertisements and send them to the

editor with our protest. Knowledge of the ingredients and dangers of

patent medicines should be a prerequisite for the practice of medicine

or pharmacy. We can help bring about such conditions, and we can

patronize physicians who send patients to drug stores that cater to

intelligence rather than to ignorance.

Fighting patent-medicine evils is a civic duty to be accomplished by

civic coöperation, not private effort. It is impossible to organize

unofficial educational agencies that can offset the cumulative, lying

advertisement. Personal opposition is but the beginning. Official

machinery must be set running and kept running so as to protect the

public health against the commercial motive that preys upon ignorance

and easily inspired faith.

CHAPTER XXXVIII

HEALTH ADVERTISEMENTS THAT PROMOTE HEALTH

It is usually considered futile to attempt to defeat the devil with his

own methods, because he knows so much better how to use them. But abuse

does not do away with use, and the success of quacks in reaching the

people demands our respect. There is no reason why their methods, based

on a knowledge of human nature and human psychology, should not be

employed to appeal to needs rather than to weaknesses. A good thing may

lie unused because of lack of advertisement. Vitality is coming to be

the passion of the American people. It is on this sincere passion that

fakirs have so long traded.

There can be no doubt that advertisements of health-promoting goods are

quite as profitable as health advertisements that injure health, when

equally effective methods are used to make them reach the public. The

tradition has been repeatedly mentioned in this book that the better

the doctor, the less he advertises himself, except in medical and

scientific journals that notoriously fail to reach the people. The same

is too often true of reputable remedies and goods. The theory that

these things stand or fall on their merits is not borne out by

practical experience,--conspicuously in the case of "fake" remedies.

Purely philanthropic undertakings for the advancement of health fail,

if not placed before the people whom they aim to help in an attractive,

convincing form. Failure to advertise a worthy cause limits its

usefulness, and is therefore unjustifiable, whether we speak of

medicine, legal aid, or dental clinics.

An intensive study of the methods used to advertise patent medicines

will suggest means of extending the usefulness of health-promoting

goods. Aside from clever methods of suggestion that lead many people to

take medicine for imaginary ailments, especially seasonal ailments,

patent-remedy advertisers have employed (as an argument for the

efficiency of their cures) scientific theory, bacterial origin of

diseases, recent medical or physiological discoveries, and state and

national movements for promoting health. In fact, they have turned to

their own uses the very law that seeks to control them and the

exposures that seek to exterminate them. Whatever may be the merits of

Castoria, the "Don't Poison Baby" advertisement on the following page,

printed just after the accompanying "Babies Killed by Patent

Medicines," which appeared in a home journal, was surely a clever bit

of advertising. Upon an editorial in a daily paper on the relation of

eyeglasses to headache and indigestion, an optician based a promise of

immediate relief for these ailments if he himself were patronized. The

recent investigations of the Department of Agriculture, and of

Professors Chittenden and Fisher, in regard to foodstuffs, are proving

helpful to food quacks and advertisers of pills for constipation and

indigestion. Since the passage of the Pure Food Law one health food is

advertised in a column headed "Pure Food."

When the season for pneumonia comes around numerous medicines are "sure

cures" for grippe and pneumonia. "Rosy teachers look better in the

schoolroom than the sallow sort," is surely a good introduction to a

new food. Woman's vanity sells many a remedy advertised to counteract

the "vandal hand of disease, which robs her of her beauty, yellows and

muddies her complexion, lines her face, pales cheek and lip, dulls the

brilliancy of her eye, which it disfigures with dark circles, aging her

before her time." Who in your town is as good a friend to "owners of

bad breath" as the advertiser who tells them that they "whiff out odor

which makes those standing near them turn their heads away in

disgust"? The climax of effective educational advertising as well as of

consummate presumption and villainy is reached in the notice of an

alcoholic concoction that uses the headline, "Medical Supervision

Needed to Prevent the Spread of Consumption in the Schools." Thus

grafting itself on the successful results of the medical examination in

the Massachusetts schools, it enlists the aid of teachers, trades on

the fear of tuberculosis, even indorses the fresh-air treatment. So

convincing was this appeal that it was reprinted in the news columns

of a daily paper in New York as official advice to school children.

[Illustration: Don't Poison Baby.]

So clever are these methods of advertising and so successful are they

in reaching great numbers of people, that if reputable physicians would

take lessons of them, they might conduct a health crusade that would

exterminate tuberculosis, diminish the use of alcohol and tobacco, and

save thousands of babies that die unnecessarily. The theory of

patent-medicine advertising is sound. It emphasizes the joys of health,

the beauty of health, the earning power of health. It adapts its

message to season, event, and need. It offers testimonials of real

persons cured. It is all-appealing, promising, convincing,--a fearful

menace to health when the remedies offered are dishonest, a universal

opportunity for promoting health if the cure is genuine.

A classic example of health advertising that promotes health is

Sapolio. The various hygiene lessons that have promoted Sapolio have

done much to raise the standard of living in the United States. Few

eminent physicians have done so much for public health as the "Poor

M.D. of Spotless Town who scoured the country for miles around, but the

only case he could find was a case of Sapolio."

Recent press discussions about furnishing free eyeglasses to the

children in the public schools have so enlightened people as to the

need for expert examination of their eyes that opticians will be forced

to employ competent oculists to make the preliminary examination and to

see that the glasses are properly adjusted. In spite of the long

mis-education by makers of corsets, the persistent advertising of "good

health" and "common-sense" waists has gained an increasing number of

recruits from the ranks of the self-persecuting. It is only a matter of

time when the term "stylish" will be transferred to the advocates of

health, because advertisers who tell the truth will, if persistent,

gain a larger patronage than advertisers of falsehoods; there is

profit in retaining old customers. The advertisement of a window device

for "Fresh air while you sleep" will make prevention of tuberculosis

more profitable than "sure cures" that lie and kill.

A man deserves profit who sends this message to millions of readers:

There are three kinds of cleanliness:

First, the ordinary soap-and-water cleanliness.

Second, the so-called "beauty" cleanliness.

Third, prophylactic cleanliness, or the cleanliness that "guards

against disease."

But the man who sells soap ought to be the one to use this

advertisement, not a man who sells toothwash that, when pure, is little

better than water, that is seldom pure, and that always hurts the

teeth. Many children and adults are being cured of flat foot by men who

make money by selling shoes designed to strengthen the arch of the

foot. Millions would never know how to discover the evil effects upon

themselves of coffee and alcohol except for money-making

advertisements. Little Jo's Smile taught a nation that the majority of

crippled children are victims of neglect on the part of adult

consumptives.

Certain it is that advertising is an art promoted by the severest

competition of the cleverest brains. It is a force which we cannot

afford to ignore. If we can harness it to the promotion of aids to

health, it will do more good than all the hygiene books ever written.

To this end we must educate ourselves to distinguish between goods

which do what they profess to do and those which do not. A good eye

opener would be to keep for a week clippings from a high-priced daily

paper, a penny daily paper, and one or two representative magazines,

including a religious paper. Teachers and parents can very easily

interest children in such clippings. Moreover, they can use the

bulletin method, the stereopticon exhibit, the _cumulative

illustration_ of a fact, which is the essence of successful

advertising. Boards of health can use all the typographical aids to

clear understanding,--cuts, diagrams, interesting anecdotes. In New

York both the health board and the school board have issued circulars

and given illustrated lectures, some of them being in school and some

on public squares. Medical and sanitary societies and other educators

can be induced to follow what a successful business man has called the

three cardinal rules of advertising:

First, put your advertisement where it will be seen. (Tell your

story where it will be heard.)

Second, write it so that people will read it. (Tell it so that

people will understand it.)

Third, tell the truth, so that people will believe it.

CHAPTER XXXIX

IS CLASS INSTRUCTION IN SEX HYGIENE PRACTICABLE?

Among remedies for preventable disease and preventable poverty, the

following was urged at a national conference for the betterment of

social conditions: "We have been too prudish. Because we have been

unwilling to teach school children the evils of violating sex hygiene,

we have been unsuccessful in combating evils justly attributable to

ignorance on the part of girls as to the duties and dangers of

motherhood." This point of view is shared by so many men and women that

a national body was organized in 1905 to promote the teaching of sex

hygiene,--the Society for Sanitary and Moral Prophylaxis. This society

has its headquarters in New York, and distributes at cost lectures and

essays. The second of its educational pamphlets is addressed to

teachers, and is entitled "Instruction in the Physiology and Hygiene of

Sex." The introduction asks eleven questions of the teachers as

follows:

1. Do you wish a pamphlet on sex subjects to hand to your pupils?

Why?

2. Do you wish separate pamphlets for boys and girls?

3. For what age limits and social conditions do you wish them?

4. What topics do you wish the pamphlets for boys to "handle"?

5. What topic do you wish the pamphlet for girls to "handle"?

6. If you think one pamphlet sufficient for both sexes, what

should it consider?

7. How far do you go in teaching sexual hygiene or reproduction?

By what method?

8. What special difficulties do you find in teaching it?

9. What special need of teaching it have you found?

10. What special benefits (or otherwise) have you noticed from

teaching it?

11. What criticisms (favorable or otherwise) do you encounter?

The difficulty of introducing formal instruction in sex hygiene, even

in the upper grades of public and private schools, is hinted at in the

pamphlet. The purpose of the publishing society as given in its

constitution is "to eliminate the spread of diseases which have their

origin in the social evil." Although sex hygiene does not begin with

sex immorality, almost every text-book on sex hygiene, and almost every

pamphlet urging class instruction in sex hygiene, begins with sex

immorality. Yet only the exceptional school child is in danger of

violating sex morals, while every school child needs instruction in sex

hygiene.

Instruction in sex hygiene, whether at school or at home, should deal

with sex normality, sex health, sex temperance. Instruction in sex

immorality is objectionable, not merely because it offends prudists,

not because it is difficult, but because it can be shown by experience

to be less efficacious than training in sex health.

To expect fear to prompt sex hygiene is to make a mistake that has

retarded the development of sound measures in the treatment of

offenders against criminal law. For centuries man failed in attempts to

fit the punishment to the crime. To deter men from committing crime by

holding up a threat of prolonged and dreadful punishment has been found

futile. Individuals take the risk because they think they will escape

detection. It is an axiom of criminal procedure that a would-be

offender is deterred by the certainty, not by the severity, of

punishment. The modern theory of probation is, that children and adults

may be best led away from evil practices by crowding out old influences

with newer and stronger interests. Occupations that are wholesome are

made to rival diversions or occupations that are harmful and criminal.

[Illustration: OBJECT LESSONS FOR INSTRUCTION IN SEX HEALTH

Note the uncomfortable, unhealthy overdressing]

Abnormal conditions of mind and body in regard to sex can almost always

be traced to general physical ill health or to an unhealthy moral

environment. Cure and prevention require two kinds of treatment within

reach of parents and teachers: (1) build up the child's physical

condition; and (2) give him other interests. Proper physical care, and

work adjusted to body and mind, may be relied upon to do infinitely

more to promote sex hygiene than instruction, either at home or at

school, in immoral sex diseases. That sex morality is weak and

untrustworthy which is based upon fear of sex diseases. Like alcoholism

and nicotinism, the saddest results of sex diseases are social and

economic. The strongest reasons against such diseases are economic and

social, not physiological.

[Illustration: THE STUDY OF INFANT HEALTH IS CONDUCIVE TO

PURE-MINDEDNESS

Note the simple, comfortable, hygienic dress]

Once having made up our minds to concentrate the teaching of sex

hygiene upon sex health rather than upon sex immorality, upon sex

functions rather than upon sex diseases, the chief objection to school

instruction and to instruction in class will disappear. Our school

text-books in history, literature, and biology abound in references to

sex distinctions, sex functions, and sex health. In enumerating the

daily routine of health habits I mentioned daily bathing of the armpits

and crotch. There is nothing in this injunction to offend or injure a

boy or girl. If studies and physical training are to be adapted to

physiological age, and if children are to know why they are graded

according to physiological age as well as mental brightness, we shall

soon be talking of mature, maturing and not-yet-maturing girls and

boys, so that everybody will be instructed in sex hygiene without

offense. Any teacher who can explain the family troubles of King Henry

VIII without becoming self-conscious can easily learn to look a class

of girls and boys in the face and explain how a mother's health will

injure her baby before its birth, why breast-fed babies are more apt to

live than bottle-fed babies, why it is as important for the mother to

keep a nursing breast absolutely clean as to clean the nipple of a

nursing bottle. Words whispered by children, or marked in dictionaries,

to be stealthily and repeatedly looked upon and talked over with other

children, lose all their glamour when pronounced by a teacher.

In these days of state subsidy of school libraries the child is hard to

find who has not free access to books of fiction full of voluptuous

allusions that make undesirable impressions which only blunt, candid

discussion of sex facts can make harmless. Children now learn, whether

in fashionable private schools or crowded slums, practically all that

is lascivious and unwholesome about sex. For teachers to explain that

which is wholesome and pure will disinfect the minds of most children

and protect them against miseducation.

Class instruction in hygiene is practicable for all matters pertaining

to normal sex health. Girls of thirteen should be taught in classes the

fact and meaning of menstruation, and its grave importance to the

health, in order that they may care for themselves not only before,

during, and immediately after the menstrual period, but throughout the

month, in order that menstruation itself shall not be unnecessarily

painful, enervating, and harmful to efficiency. It is not yet advisable

to discuss dangers peculiar to girls or dangers peculiar to boys in

mixed classes. Generally speaking, it is undesirable that men teachers

discuss girls' troubles with girl pupils. But why should it not become

possible for women teachers to explain health dangers peculiar to girls

to classes of boys?

Individual instruction in sex matters should be reserved for the

diseased mind, for the boy or girl who has already been morbidly

instructed. Discussion of immoral sex diseases should be confined to

individual talk. This field teachers have already entered. Repeated

physical examination of children will detect symptoms of sex

abnormality. When detected, the fact and the meaning should be

explained to the individual by school physician, school nurse, or

school-teacher. While much can be done through mothers' meetings and

through individual instruction of parents, the most effective means of

improving the general attitude towards sex health is to give the simple

truth to the millions of children who have not yet left school. Armed

with the A B C's of sex hygiene at school, boys and girls will be

prepared to select employment, associates, and newspapers that will

permit normal, healthy sex development. Men and women who are leading

normal lives, who have plenty of work, sleep, fresh air, nourishing

food, amusement, and exercise are unlikely to be sexually abnormal.

After all, the question of instruction in sex hygiene will quickly

settle itself when it is made a condition of a teacher's certificate

that the applicant shall himself or herself know the personal and

social reasons for sex health. The woman who does not know how to take

care of her own sex health, the man who is ignorant of a woman's

special needs, cannot do justice to the requirements of arithmetic,

language, and discipline. Whether men and women teachers are mentally,

physically, and morally equipped to be sexually normal and to teach the

law of sex health will be disclosed as soon as trustees and

superintendent dare to ask the necessary questions. Whether an

instructor's personality will enable him to fill the minds of children

with interests more wholesome, more absorbing than obscene stories or

morbid sex curiosity can also be learned. When school-teachers are

prepared to teach the social and economic aspects of general health

they will quickly solve the problem of instruction in sex health.

Just one word about country morality. It is customary to deplore the

influence of large cities on the young. Of late, however, there has

been a tendency to question whether, after all, sex morality is apt to

be higher in the country than in the city. Parents and teachers in

small towns and in rural districts will do well to take an inventory of

the influences surrounding their children. It will always be impossible

to give country children city diversions. One great disadvantage of

country children frequently counter-acts the beneficial influence of

out-of-door living; namely, isolation. The city child is practically

always in or about to be in the sight of, if not in the presence of,

other people. Numbers and close contact with people, though they be

strangers, mean restraint and pervading social conscience. City

children find it difficult to have good times in pairs. No amount of

instruction of rural pupils in sex hygiene will take the place of

amusements and entertainments for groups of children, forming thus a

special antidote for "two's company, three's a crowd." Liberating and

standardizing normal intersex relations and discouraging cramped social

intersex relations are more urgent needs than instruction in sex

diseases. A working environment that permits pure-mindedness will do

more to inculcate a reverence for sex cleanliness and for parenthood

than lectures and essays on moral prophylaxis.

CHAPTER XL

THE ELEMENT OF TRUTH IN QUACKERY; HYGIENE OF THE MIND

Patent medicines and other forms of quackery could not pay such

enormous dividends unless there was some truth in their claims; unless

their victim found some beneficial return for his money. They win

confidence because they raise hopes and combat fear. They do cure

thousands of people of fear and of "ingrowing thoughts." In so doing

they remove the sole cause of much disability.[17] In so doing they are

merely applying by wholesale principles of mental hygiene that are

legitimately used by physicians, tradesmen, teachers, and parents who

deal successfully with nervousness.

Quackery makes cures and makes money because of the undoubted influence

of mind in causing and in removing those ailments that originate in

fear, imagination, or morbid introspection. A few years ago a little

out-of-the-way town in southern Minnesota was visited by train loads of

the sick and crippled from miles around. Miraculous cures were heralded

broadcast. Life-long cripples left wagon loads of crutches and braces

to decorate the little church with the enchanted transom. People who

had not walked for years returned to their homes cured. The marvels of

famous shrines were fast being duplicated when the church authorities

at St. Paul issued an explanation of the alleged miraculous appearance

of biblical figures in the transom of the new church. The outlines of a

mother carrying a baby had been vaguely impressed in the transom glass

when molten. When the mystery was explained the excursions and the

cures stopped.

Nearly every physician and practically every medical charlatan can

count scores of cures of ailments that had previously defied the skill

of eminent physicians. A child's bumps actually stop aching after the

mother or nurse kisses the abused spot. Invalids forget their

limitations under stress of some great excitement or some intense

desire for pleasures incompatible with invalidism. Many a physician of

reputation owes his success in great part to the discriminating use of

the _placebo_,--a bread pill designed to supplant the patient's fear

with confidence. Hypnotism and "suggestion" have been successfully used

to cure alcoholism and to fill patients' minds with conviction stronger

than the fear that produced the sickness. A well-known writer and

preacher cures insomnia by auto-suggestion, telling himself he is

sleepy, is very sleepy, is going to sleep, is almost asleep, is fast

asleep. Treatment by osteopathy has been followed by disappearance of

diseases that cannot possibly be cured by osteopathy. Christian Science

has restored to health and happy usefulness hundreds of thousands of

chronic invalids. Verily is hygiene of the mind an important factor in

the civics of health.

Fear can originate with mind. Fear produces fear. Fear disarranges

circulation of the blood and the nourishment of muscle and nerve. Fear

can produce many bodily disorders which in turn feed fear. Fear cannot

last unless bodily symptoms exist or arise to justify and feed it. Fear

can be cured and removed in two ways: (1) by driving away fear and

releasing bodily disorders from its thraldom; (2) by removing the

disorders and making fear impossible to the logical mind. An enforced

sea voyage begins with the disorder; a clever, buoyant physician begins

with the fear. Patent-medicine proprietors, quacks, and fakes of every

kind begin by displacing the fear with hope or cheer; the physical

disorders frequently vanish by the same window as fear. For _fear_

write _self-pity_, _morbid self-consciousness_, _hypertrophied

submission_; to _hope_ and _cheer_ add _smile_, _relaxation_, and

_zest_; and we have the chief elements of mental hygiene and the reason

why intelligent as well as unintelligent men like to be swindled by

medical or other quacks.

The social aspects of mental hygiene are particularly important. Once

admitting the power of the mind to decrease vitality, we recognize the

duty of seeming happy, buoyant, cheerful, vital, at least when with

others, for the sake of others' minds and bodies. Secondly, we find the

duty to refrain from commenting on others' appearance in a way that

will start "ingrowing thoughts." A "grouchy" foreman can give blues and

indigestion to a roomful of factory girls. A self-pitying teacher can

check the heart beats of her class, cause arteries and lungs to

contract, and deprive the brain of fresh blood. An oversympathetic

neighbor can put a strong man to bed by discovering signs of nervous

disintegration. Shall we gradually work out a code of mental hygiene

rights and nuisances that will require compulsory notification of the

"blues" and compulsory segregation of every person unable to "smile

dull care away"? Is the time coming when boards of health will

accompany infection leaflets with messages such as this from James

Whitcomb Riley:

Talk health. The dreary, never-changing tale

Of mortal maladies is worn and stale.

You cannot charm or interest or please

By harping on that minor chord, disease.

"Whatever the weather may be," says he,

"Whatever the weather may be,

It's the songs ye sing, and the smiles ye wear,

That's a-making the sun shine everywhere."

Mental hygiene has hitherto enjoyed an evil reputation and has been

condemned to generally evil associations, because the rank and file

have been ignorant of hygiene of every kind. Medical science has so

long enveloped itself in mystery that it is in danger now of becoming

discredited and of falling heir to the mantle of quackery.

Quacks often get social and economic results more agreeable to the

patient and more helpful to society than orthodox medicine. "When

traitors become numerous enough treason becomes respectable." So when

mental hygiene succeeds, it becomes science for the case in question,

and for that case orthodox medicine loses its respectability. For the

layman there is no safety except in having intelligence enough to know

whether his trouble has defied the sincere application of mental

treatment, auto-suggestion, and loyalty to the health ideal.

Mental hygiene admits the existence of dental cavities, scarlet fever

germs, adenoids, cross-eyes, uncleanliness, broken legs, inflamed eyes,

overeating. The organic, structural defects which are to be sought by

physical examination are all admitted by mental hygienists. They work

for an orderly, daily routine and affirm the penalties of its

violation. They would even favor going periodically to a physician,

provided that we never go to him except when organic or structural

disorders may safely be assumed from the fact that cheer and relaxation

treatment does not give relief. Unhygienic living and mind cure cannot

go together. The mind that tries to deceive itself cannot cure either

mind or body. The man who violates the habits of health cannot patch

his injuries or conceal the ravages of dissipation by mental hygiene.

Here is the great advantage of knowing how to live hygienically, of

observing habits of health, and then concerning ourselves not with

ourselves, but with conditions of living for all those whose health can

be affected by our health, or can affect our health and efficiency.

The most recent practical application of mental hygiene for moral and

physical uplifting is the "moral clinic" or "psychotherapeutic" clinic

established by Emmanuel Church in Boston. This clinic represents the

union of three forces,--religion, medical diagnosis, mental hygiene. As

a result of this alliance it is anticipated that both religion and

medicine will be humanized, socialized, vitalized, made to express more

accurately and more consistently that community consciousness and that

yearning for equal opportunity and equal happiness which constitute the

profoundest religious impulse. No person is treated at this moral

clinic whose trouble is organic or structural. In determining whether

the case belongs to this clinic, expert medical diagnosis is relied

upon rather than the credulity of the patient or the zeal of the

clergyman. Medical scientists of highest repute can consistently

coöperate, because they recognize two scientific facts: first, that

many troubles are due primarily to mental disorder; and, second, the

greatest asset of the human mind is that something called religion,

which is no less real and potent because peculiar to each individual.

Whatever may be that deepest current of thought and feeling, whatever

that synthetic philosophy, that explanation of being, which guides my

life, it can be of inestimable aid if enlisted in an effort to secure

normal vitality of mind and body.

The controlling motive of the moral clinic has proved infectious. There

is reason to believe that the alliance of medicine and religion has

come to stay, and that the present excitement over psychotherapeutics

will settle down into a scientific utilization of religious motive and

medical knowledge to prevent mental and moral disease. Unwholesome,

morbid, self-centered thought is driven out. A recognition of others'

claims takes its place. Hypnotism, suggestion, and group enthusiasm are

used to their utmost possibilities. The success of the Boston moral

clinic is due to establishing in the mind of the neurasthenic, the

alcoholic, the world-weary, and the purposeless a truer conception of

the pleasures that result from vitality and from altruistic effort.

It is too early to classify by kind of functional disorder the patients

treated. Results from one patient have been described in newspapers as

follows:

A school-teacher, as a result of nervous collapse, had lost

control, began to fear the children under her care, and thought of

relinquishing her profession. She was instructed in the art of

self-control and the control of others; the notion of fear was

dislodged and a sentiment of love for her little charges took its

place. In the course of a few weeks this conscientious and

experienced teacher regained her poise and found herself

performing her duties better than ever before.

Many alcoholics have for months given evidences of complete cure.

Stories almost incredible are quickening pastor and physician alike

throughout the country. After individual treatments are given, after

religious motive is appealed to, and the soul stirred to heed the

lessons of religion, medicine, and sociology, patients are given the

work cure. Thus a branch of social service is established, where

after-treatment is given to the patient whose thoughts have been turned

from himself to others. All of a sudden the church finds itself in need

of definite knowledge as to opportunities for altruistic work, as to

definite community needs not met, as to people in distress who can be

relieved by volunteers, as to agencies which can be called upon to

coöperate both in treating the individual and in utilizing his energies

for others' benefits.

Because a relatively small percentage of men and women are

neurasthenic, melancholy, morbid, alcoholic, the lesson of the moral

clinic is most serviceable when extended for the benefit of the "not

yet alcoholic" and the "not quite neurasthenic." In other words,

individuals in thinking of themselves must learn the health value and

soul value of purpose that centers in others' happiness. That thing

which we have called tact in personality, and which in the past was

discovered by induction, namely, the law of mental hygiene and the

control it gives over others' health, must be taught in schools to

children by wholesale, must be taught in medical and theological

schools, to all physicians and all pastors. This alliance of medicine

and religion, which is at present confined to one or two moral clinics,

should be incorporated into education, into social work, into church

work, becoming thus a part of civilization's normal point of view.

Mental hygiene cannot survive conscious violation of the fundamental

laws of medicine and religion. The alliance of medicine and religion

will prove utterly futile unless habits of living and of thinking are

inculcated that conform to nature's law of self-preservation and to

God's law of brotherly love. Self-centered religion, like self-centered

medicine, destroys both body and soul.

FOOTNOTES:

[17] The alliance of mental hygiene, medicine, and religion is discussed

in the Emmanuel Church book, _Religion and Medicine; the Moral Control

of Nervous Disorders_; also in its bulletins, _Religion and Medicine_.

CHAPTER XLI

"A NATURAL LAW IS AS SACRED AS A MORAL PRINCIPLE"

When a grammar-school boy I learned from the game "Quotations" that

Louis Agassiz, scientist, had written the sentence with which I

introduce a final appeal for living that will permit physical and civic

efficiency. Agassiz has been called "America's greatest educator," and

again "the finest specimen yet discovered of the genus _homo_, of the

species _intelligens_." The story of his long life as teacher of

teachers reads like a romance. But among his gifts to education and

citizenship none can be made to mean more than the simple proposition

that natural law is as sacred as a moral principle. All who remember

this "beatitude" will be helped to solve many perplexing problems of

dress, diet, play, education, philanthropy, morals, and civics.

Reverence for the natural carries with it a distaste for the unnatural.

Those who obey natural law soon come to regard its violation as a

nuisance when not immoral. On the other hand, compromise with the

unnatural, like compromise with vice, quickly leads first to toleration

and thence to interest and practice. Therefore the importance of giving

children Agassiz's conception of the sacredness of the laws that govern

the human body. A passion for the natural is a strong foundation for

habits of health and a priceless possession for one who wishes to know

morality in its highest sense.

"Natural" is less attractive to us than it would be had Agassiz first

interpreted it for us rather than Rousseau or present-day exponents of

"the simple life," "back to nature," and "back to the land." It is too

often forgotten that no one sins against natural law more grievously

than the primitive man or the isolated man in daily contact with

non-human nature. Communing with nature seems not only to require

communing with man but to give joys in proportion as the nature lover

is concerned for the human society of which he is a part. Natural law

does not become a moral principle until man is benefited or injured by

man's use of nature's resources within and about him. Natural living

according to natural law must be something sounder, more beautiful, and

more progressive than can be read into or out of mountains, trees,

brooks, and sky, or primitive society.

Natural law points to a Nature Fore as well as a Nature Back, to a

Nature Up and Beyond as well as a Nature Down and Behind. The Nature

that was yesterday will not do for to-morrow, any more than a man is

willing to give up his nature aspirations for the careless, animal ways

of romping childhood. Civilization is constantly urged at each step to

repeat the prayer of Holmes's old man who dreams for the Autocrat of

the Breakfast Table:

Oh for one hour of youthful joy!

Give back my twentieth spring!

I'd rather laugh a bright-haired boy

Than reign a gray-beard king!

Off with the wrinkled spoils of age!

Away with learning's crown!

Tear out life's wisdom-written page,

And dash its trophies down!

One moment let my life blood stream

From boyhood's fount of flame!

Give me one giddy, reeling dream

Of life all love and fame!

But every experiment in turning back exalts the present and the future.

Gifts as well as problems are seen to come with complexity, and

civilization flatly refuses to relinquish these gifts. Sound maturity

is better than youth or age:

The smiling angel dropped his pen,--

"Why, this will never do;

The man would be a boy again,

And be a father too!"

Problems of health and of civics can never be solved by appealing to

Nature Back, when only the few could be healthy, when one baby in three

died in infancy, when old age was toothless and childish, when

infection ravished nations, when the average life was twenty years

shorter than now, and when unspeakable filth was tolerated in air,

street, and house. They can all be solved by appeals to Nature Fore,

which holds up an ideal of mankind physically able to enjoy all the

benefits and to conquer all the dangers of civilization. It is not

looking back, but looking in and forward that reveals what natural law

promises to those who obey it.

By using numerous tests which have been suggested in preceding chapters

we can learn how far we and our communities obey natural law when

working and playing. Health for health's sake has nowhere been urged.

On the contrary, healthful living has been frankly valued for its aid

to efficient living by individual and by community; wherefore the

emphasis upon others' health and upon the civic aspects of our own

health. Tests furnish us with the technic necessary to efficient

living; civics, with the larger reason; natural law, with the "pillar

of fire by night" to help us choose our path among habits and pleasures

whose immediate results upon efficient living cannot easily be

determined.

Fashions, tastes, mannerisms, personal indulgences, have been left for

Agassiz to deal with. Generally speaking, we all know of numerous acts

committed and numerous acts omitted in our daily routine that convict

us of not living up to our knowledge of physiology and hygiene,--wearing

tight shoes or tight corsets, drinking strong coffee, smoking, reading

while reclining, failing to insure clean air and clean bodies. Then

there are other acts whose omission or commission violate no physical

law so far as we can see, but whose unnaturalness we concede,--putting

chalk on the eyebrows, wearing false hair or curious puffs, putting

perfumery in the bath or on handkerchiefs, assuming artificial poses of

body or mouth. These violations of natural law are forced upon us by

"style" or "custom" or family convenience. When we come to choose

between following fashions and disobeying them, we generally decide that

it is better to do a foolish or slightly harmful thing than to occasion

criticism, mirth, or even special notice by our dress or our

abstemiousness.

Last night I went to a dinner party at eight. I ate and ate a great

variety of palatable foods that Nature Back never knew. After two hours

of eating I imbibed for two hours the tobacco smoke of the gentlemen

who made up the party. I knew that eight o'clock was too late for me to

begin eating, that two hours was too long to eat, that the tobacco of

others was bad for my health and for to-day's efficiency. All this I

knew when I accepted the invitation to dinner. I went with no intention

of preventing others from smoking or of lecturing my host or his chef

or his guests for the unhygienic practices of our day. Yet the physical

ills were more than offset by certain definite gains to the school

children of New York that will result from last night's meeting.

Natural law was abated in part. But I declined certain dishes that

would not agree with me, helped myself sparingly of many dishes,

avoided tobacco and wines, and by a three-mile walk in the open air, a

bath, and a good long night's sleep have almost recovered my right to

talk of the sacredness of natural law.

Nature Back says I should not have gone to this dinner. But I was

compelled to go. I know I am going to others. I cannot do my work

unless I overdraw my current health account. Nature Fore tells me that

effective coöperation with others will frequently require me to eat at

the dinner hour of others, to retire at others' sleeping time, to wear

what others will approve, to violate natural law. But Nature Fore also

tells me how to build up a health reserve so that I can meet these

emergencies without endangering my health credit.

Nature Back demands "dress reform." Nature Fore tells me that I can

march in step with my contemporaries without either attracting

attention or discrediting and affronting natural law. Passion for the

natural has effected numerous reforms in dress, diet, and social

habits, until commerce provides a natural adaptation of practically

every fashion. With regard to few things is it necessary to-day for any

one who reads magazines to do violence to bodily health for fashion's

sake. We may wear what we will, eat what we prefer, decline what is

unnatural for us, without inviting censure. The debauches of those

unfortunate people who live an unnatural, purposeless existence, affect

such a small number that their laws need not be considered here.

Natural law makes obedience to itself attractive; hence commerce is

rapidly learning to cater to distaste for the unnatural. With few

exceptions, only temporary concessions to unnatural living are required

in order to dress and act conventionally.

Nature Back throws little light upon conditions necessary for modern

labor. It can do nothing but demand the abolition of the factory, the

big store, the tenement, the school. Nature Fore says we cannot abolish

the means of working out the highest forms of coöperation. But we can

make them compatible with natural living. We can modify conditions so

that earning a livelihood will not compel workers to violate natural

law at any or all times. The greatest need of factory and tenement

reform is for parents and teachers to make a religion of Nature Fore

and to instill its principles in the minds of children. Parents and

teachers must live the natural before they can make children love the

natural. Parents and teachers cannot possibly be natural in this day,

cannot live or love natural law unless they know the machinery by which

their communities are combating conditions prejudicial to health,

morals, and civic efficiency.

INDEX

Adenoids. See _Mouth breathing_

Administration, health:

steps in evolution, 11-22;

knowledge of needs, 220;

machinery, 302-309;

in combating alcoholism, 362;

departments of health:

(1) New York City, 26, 27, 47, 48, 61, 71, 84, 296-298, 302;

(2) general, 265, 281

Advertisements:

motives for, 8;

for dental parlors, 100;

for consumptives, 234;

by physicians, 281;

educational, in newspapers and magazines, 323;

"no smoking" signs, 365;

of patent medicines, 369;

that promote health, 378-383

Agassiz, Louis, 398, 400

Air, night, 216.

See _Fresh air_

Alcoholism, 343-362;

compulsory instruction in, 3;

insurance companies against, 7;

disqualifies for railroad service, 193;

depletes vitality, 201;

results, 209;

Hartley's fight against, 253;

injures the tuberculous, 274;

ineffective ways of combating, 343;

incited by bad living conditions, 348;

injury to negroes, 350;

so-called moderate use, 358;

labor unions blacklist drunkards, 361;

social dangers, 386;

mental hygiene, 392, 396

Animal sanitation, 252, 260, 307

Association for Improving the Condition of the Poor, New York, 177,

236, 253

Babies. See _Milk_

Bathing:

motives for, 8, 13;

a social requirement, 14;

cold-water, 214

Beauty, reason for health, 15

Bibliography:

A Bureau of Child Hygiene (Bureau of Municipal Research), 298;

Annals of a Quiet Neighborhood (MacDonald), 110;

Aristocracy of Health (Henderson), 208;

Bitter Cry of the Children (Spargo), 33, 167;

Bulletins of Emmanuel Church, 391;

Bureau of Municipal Research, publications, 298;

Care of Dependent, Defective, and Delinquent Children (Folks), 174;

Charities and the Commons, 325;

Child Growth (Newsholme), 120;

Children of the Nation (Gorst), 33;

Children's Diseases, 326;

Clean Milk for New York City, 255;

clippings, 370, 382;

white-plague scrapbook, 250;

Committee on Physical Welfare of School Children, programme, 166,

three studies, 168;

Crusade against Tuberculosis (Flick), 229;

Dangerous Trades (Oliver), 203;

Dental Catechism, 94;

Dentistry, lectures and treatises, 274;

Deterioration, Physical, report on, 339;

Development of the Child (Oppenheimer), 110;

Dietetic and Hygienic Gazette, 326;

Efficient Life (Gulick), 208;

Environment of Child at School (North), 142;

Pure Food (U.S. Department of Agriculture), 379;

Good Health, 326;

Health of the School Child (Mackenzie), 132;

Heredity (Thompson), 336;

How to Give Wisely, 355;

International Congress, Tuberculosis, programme, 246-249;

Journal of Nursing, 326;

Making a Municipal Budget (Bureau of Municipal Research), 306;

Milk Industry, 252;

Municipal Sanitation in the United States (Chapin), 304;

National Hospital Record, 326;

New Basis of Civilization (Patten), 33;

New Jersey Review of Charities and Corrections, 325;

Pediatrics, 326;

Physical Culture, 326;

Poverty (Hunter), 167;

press and magazines, 322-328;

Prevention of Tuberculosis (Newsholme), 229;

Principles of Relief (Devine), 174;

Principles of Sanitary Science and the Public Health (Sedgwick), 304;

Psychological Clinic, 106, 326, 330;

Real Triumph of Japan (Seaman), 23;

Religion and Medicine (Emmanuel Church), 391;

reports of schools, 166;

reports of schools and health, 310-321;

reports of institutions and societies, 327;

reports of state and national conferences of charities and

corrections, 327;

reports of United States bureau of labor, 203;

Sanitation of Public Buildings (Gerhard), 139;

School Reports and School Efficiency (Snedden and Allen), 311;

Social Order and the Saloon (Fox), 351;

Study of Children and their School Training (Warner), 110;

Study of School Buildings in New York City, 289;

Teeth and their Care (Hyatt), 94;

Training of the Human Plant (Burbank), 120;

Typhoid Fever (Whipple), 13, 16;

Uncommercial Traveller (Dickens), 46;

Unconscious Mind (Schofield), 110;

Vital Statistics (Newsholme), 131

Biggs, Hermann M., M.D., 237, 251, 271, 274, 295

Boston, 34, 155, 161, 241, 250, 290, 395

Boston Society for the Relief and Study of Tuberculosis, 155

Boyd, Emma Garrett, 355

Brannan, John Winters, M.D., 240

Breath, bad, 360, 379

Brightness, abnormal, 104-106

Bronchitis, 67

Brookline, 34

Budget:

should provide for cleansing, 61;

and tuberculosis, 237;

annual health programme, 306;

reforms in New York City, 350

Burbank, Luther, 120

Bureau of Municipal Research, 298, 306

Butler, Nicholas Murray, LL.D., 330, 332

Cabot, Richard C., M.D., 181

Calmette's Eye Test, 238

Carnegie Foundation, 285

Caroline Rest, 70, 267

Catching diseases:

cost of, 16;

unenforced laws, 30;

steps in eradicating, 31;

germ sociology, 57, 71;

favorable soil at school, 58;

instruction concerning, 62;

mouth a breeding ground for, 63;

information for bathers, 64;

dangers of, 131;

reasons for national board of health, 135;

cost of, in New York City, 272;

remedies urged, 384

Charity Organization Society, New York, 236, 239

Chicago, 34

Chicken-pox, 64

Child Hygiene, Bureau of:

working-paper tests, 192;

established, New York City, 298;

programme, 299

Child labor:

compulsory school attendance, 140;

welfare or age test, 142;

movement's limitations, 185;

national and local committees, 33, 192;

physical-fitness tests, 194

Children's Aid Society, New York, 56, 93

Child-saving agencies:

coöperation with schools, 174-183;

do-nothingism in, 332

Chorea. See _Nervousness_

Christian Science, 276, 392

Christmas shopping, 227

Cigarettes. See _Tobacco_

Cincinnati, 118

Cleanliness:

acquired taste, 14;

beauty of, 96;

personal uncleanliness, 210;

cost of, 216;

dry cleaning dangerous, 244;

in fighting tuberculosis, 250

Cleveland, Ohio, 294

Clippings:

scrapbook, 250;

envelope method, 324;

advertisements, 382

Coffee, strong, 401

Colds, 63-69

College, physical tests, 39

Committee on Physical Welfare of School Children, New York, 39-41, 166,

168, 178, 286, 290, 311

Compulsory laws:

school hygiene, 3;

purpose of, 33;

registration of catching diseases, 57;

removal of tuberculosis cases, 237;

notification of tuberculosis, 237, 274;

hygiene, for private schools, 283;

to remove physical defects, 288;

restricting alcoholism, 343

Conference on Summer Care of Babies, New York, 260

Congestion:

evils avoided, 290;

and alcoholism, 348

Conjunctivitis, 71. See _Eyes_

Connecticut's school reports, 318

Constipation, 210, 216, 347, 357

Consumption. See _Tuberculosis_

Corsets, 381, 401

Cost:

of preventable diseases, 16;

of bad breath, 98;

of diseases to nation, 135;

of tuberculosis, 245

Crampton, C. Ward, M.D., 129, 289

Dangerous trades, 191

Darlington, Thomas, M.D., 297

Death rates:

of bronchitis, 67;

of pneumonia, 67;

how to reduce, 131

Defects, physical:

index of community needs, 33-44;

removable, of children, 22;

schools manufacture, 139;

income distribution, 169

Delinquency, and mouth breathing, 47

Dental Hygiene Council, 95

Dental sanitation, 89-103;

surface for breeding germs, 63;

dentists, 93;

state organizations, 95;

clinics needed, 171;

insurance companies treat teeth, 204;

family instruction, 245;

indigestion, 272;

early treatises, 274;

advertising parlors, 281

Devine, Professor Edward T., 174

Diet:

cooking lessons at home, 180;

overeating, 201, 347;

improper, 210;

proper and regular, 212;

adapted to need, 214, 401;

kitchens, 267;

irregular eating, 272, 347

Diet kitchens, 267

Diphtheria, 18, 65

Dispensaries and hospitals:

dental supervision, 102;

coöperate with schools, 174-183, 185;

welfare nurse, 188;

emergency, 227;

to prevent duplication, 239;

lack of, 240;

teach baby feeding, 261;

inefficient, 278;

social interest of, 292

Doing things at school, 159-165;

free meals, 44, 161, 171;

may hurt, 181;

cripple social agencies, 185, 189;

danger of malpractice, 184, 189;

analogous to model tenements, 186

Do-nothing ailments, 329-334

Ear trouble, 83-85;

periodic tests for, 201, 207

Edinburgh, 70

Ellis Island, 238

Environment:

health problem, 9;

tests, 120, 320;

injurious school, 139-150;

effect on physique, 203;

and tuberculosis, 229-251;

do-nothing ailments, 329;

within our control, 336;

in combating liquor, 362

Epidemics, 18, 38

Epilepsy, 47, 49

Ergograph, 125-127

Erysipelas, 65

Ethics, professional, 81, 101, 281

Eugenics, and heredity, 336

European remedies, 159-165

Eye trouble, 72-82;

in high school, 40;

catching diseases, 69-71;

caused by bad teeth, 89;

eyeglasses, free, 161, 164, 171, 184;

in business, 193;

examination for adults, 201;

tuberculin test, 238;

inefficient inspection of, 300;

teachers' test, 301

Examination, physical:

of school children, 33-138;

best test of health needs, 33-44;

individual record of, 35, 312;

Snellen test, 73, 77;

of teachers, 153;

for work certificates, 190-200, 237, 301;

by railroads, 193;

at West Point, 199;

periodic after school, 201-207, 218, 228;

semi-annual, 202;

tuberculin tests, 240;

stripped, at Leipsic, 289;

follow-up work, 295-300;

of teachers and sex hygiene, 389

Family:

unit of social treatment, 174;

examining parties, 237, 241;

tuberculosis histories, 241

Fear and bodily disorders, 392

Flick, Lawrence F., M.D., 229

Follow-up work, 295-301

Fox, Hugh F., 351

Fresh air:

others' standards of, 9;

fiends, 66;

outings, 176, 178;

economic value of, 195;

ventilation at school, 142;

ventilation at home, 210;

ventilation at work, 212;

ventilation at sanatoriums, 214;

ventilation at churches and theaters, 217.

See _Air_

Georgia, 350

Germany, 160, 204

Germs, disease:

in milk bottles, 14;

isolation, 31;

germ sociology, 57-71;

dental sanitation, 89-103;

locating germ factories, 238;

tuberculosis, 234

Getting things done, 166-173;

doing of highest kind, 183;

study underlying causes, 189;

by local agencies, 287

Glands, 88

Goler, George W., M.D., 196

Gorgas, William C., M.D., 59

Government. See _Administration_

Greenwich House, 287

Grenfell Association, 197

Grippe, 379

Gulick, Luther H., M.D., 123, 208

Habits of health, 208-217;

combat tobacco, 364;

mental hygiene, 394;

and Nature Fore, 400

Hartley House, 287

Hartley, Robert M., 252

Havana, 60

Hawthorne Club, 287

Headache, 210

Heredity, 335-342

High schools need physical tests, 39

Hip trouble. See _Tuberculosis_

Home conditions:

indexed by epidemics, 32;

indexed at school, 33;

among different incomes, 39;

cooking instructions, 180;

weighing parties, 241;

score card, 337;

promote alcoholism, 348

Hughes, Governor Charles E., 201

Hunter, Robert, 167

Hyatt, Thaddeus P., D.D.S., 94

Impetigo, 65

Income, 34, 38, 39

India, 108

Indigestion:

anti-social, 10;

due to teeth, 272

Individual record card, 35, 312-314

Industrial hygiene:

educates laborers, 131;

factory conditions, 221, 227;

factory reforms, 403;

employers, 3, 210, 218, 360, 367;

employees, 202, 211, 219, 228, 360

Influenza, 65-68

Ingram, Helene, 177

Insomnia, 392

Inspection:

of milk, 26, 259;

score cards, 27, 29, 337;

of school children, 43, 61, 296;

of factories, 131;

of milch cows, 260;

of transmissible diseases, 295;

of foods, 307

Instinct, motive to health, 12, 14, 94

International Congress on tuberculosis, 238, 245

Itch, 65

Japan, 23, 287, 309

Junior Sea Breeze, 267

Kansas City, 161

Kidney trouble, 217

Labrador, 197

Lavatories, public, 217

Laws:

nonenforcement demoralizing, 4;

define rights, 23;

when not enforced, 25;

should not injure health, 151;

enforcement better than character, 219;

regarding milk, 258;

licensing practitioners, 280;

need machinery, 303, 348;

to control liquor, 343, 355;

test of prohibition, 353;

on patent medicine, 373;

on pure foods, 379

Leipsic, 289

Louisiana, 350, 376

Lung trouble. See _Tuberculosis_

Machinery, health:

unsatisfactory coordination, 296;

necessary, 302-309;

five elements, 303

Mackenzie, W. Leslie, M.D., 132

Magistrates:

promote disorder, 173;

enforce health laws, 303

Malnutrition, 35;

income distribution, 39;

signs and tests, 86;

prevention of, 184;

education of family, 241

Massachusetts, 74

Maxwell, Superintendent William H., 286, 288

Measles, 64

Mental hygiene, 391-397;

blues, anti-social, 10;

hospital welfare work, 182;

moral clinics, 276, 291, 295;

and insomnia, 392

Meyer, William, M.D., 47

Milk:

unclean dairies, 10;

scalding receptacles of, 17;

carries typhoid, 18;

inspector's outfit, 24;

tests of protection, 25;

score cards, 26, 259, 337;

public should know, 219;

fight for pure, 252-267;

New York conferences, 255, 260;

breast feeding, 266

Milk committee, New York, 258, 260

Minnesota, 45, 269

Misgovernment causes sickness, 10

Mitchell, S. Weir, M.D., 73

Montclair, 265

Mosquitoes, 59, 307

Motives, seven health, 11-22, 377

Mouth breathing, 45-56;

and delinquency, 47;

adenoid parties, 55;

causes deafness, 83;

injures baby teeth, 89;

industrial disadvantage of, 195;

in Labrador, 197;

preventable defect, 272;

inefficient inspection of, 300

National Association for the Study and Prevention of Tuberculosis, 236, 246

National Board of Health, 133, 292, 308

National Bureau of Labor, 199

National Bureau of Census, 305

National Bureau of Animal Industry, 306

National Bureau of Education, 171, 292

National Playground Association, 118

National School Hygiene Association, 139

Nature Fore and Nature Back, 398-403

Negroes and alcoholism, 350

Nervousness, 85;

and school life, 108;

physical defects, 110;

preventable, 111;

causes of, 112;

habit, 111, 113;

from tobacco, 363

Neurasthenia. See _Mental Hygiene_

New Jersey, 12

Newsholme, Arthur, M.D., 120, 131, 229, 241

New York City, 16, 25, 34

New York Juvenile Asylum, 47

New York state, 12, 24

New York State Charities Aid Association, 236, 242

Nicotinism. See _Tobacco_

Normal schools, 110

North, Professor Lila V., 142

Notification of diseases, 31, 41

Nuisances, 17, 18, 23, 366

Nurses at school, 230, 286, 293, 300.

See _Milk_

Oliver, Thomas, 203

Orthopedics. See _Tuberculosis_

Ophthalmia, 65

Oppenheimer, Nathan, M.D., 110

Osteopathy, 275

Panama, 59

Parents:

and school hygiene, 3;

interested by examinations, 41;

should coöperate with physician, 279;

interested in school examinations, 297;

need health reports, 310;

heredity, 335-342;

nicotinism, 368

Parks and playgrounds, 7, 32, 118, 122, 142, 186, 290, 294

Parochial schools, 189, 198

Patent medicines:

evils of, 369-377;

advertisements, 380

Patten, Professor Simon N., 9, 14, 33, 165

Pediculosis, 69-71

Pennsylvania, 311

Philadelphia, 34

Phthisis. See _Tuberculosis_

Physical training, 115-117;

in New York City, 296;

and sex hygiene, 387

Physician:

preventive medicine, 268-282;

and eyes, 81;

semi-annual visit to, 204;

self-advertisement, 378;

school, 173, 286, 293, 315

Physiological age, 105, 289, 387

Pittsburgh, 269

Plague, 15, 57

Pneumonia, 67, 379

Preventable diseases:

those not communicable, 272.

See _Catching Diseases_

Private schools, 189, 198, 283, 291, 330

Prohibition laws, 348, 350, 355

Pro-slum motive, 19-20

Public Education Association, New York, 287, 298

Publicity, 45, 81, 99, 292, 310-321, 382

Quarantine, first, 15;

national, 308

Records:

of disease centers, 31;

defective, 32;

individual, 35, 312-314

Reform's failure, 349

Registration:

of diseases, 31

Relief, material:

sound principles of, 174;

at school, 175, 179, 184;

indiscriminate, harmful, 332

Richman, Julia, 172

Riggs disease, 92

Rights:

political, 21;

not enforced, 23-32;

of workmen at work, 190;

machinery for enforcing, 283-322

Riis, Jacob, 18

Ringworm, 65

Rochester, N.Y., 262, 266

Rome, 15

Roosevelt, Theodore, 60, 118

Rural districts:

encourage disease, 13;

compared, 32;

physical defects, 74;

schools unsanitary, 141;

hygiene in Great Britain, 308

Russia, 108

Sage Foundation, 285

St. Vitus's dance, 111

Salmon, Professor Lucy M., 355

Scabies, 65.

See _Itch_

Scarlatina, 65

Scarlet fever:

thrives in slums, 18;

signs and method of infection, 65;

"peeling," 132;

compulsory removal of cases, 240;

germ carried in milk, 264

School hygiene:

and employers, 3;

instruction compulsory, 3-10;

practice of, 5, 18;

biological engineering, 139, 203, 339;

departments of, 283-293;

in New York City, 294, 296-301

Score cards, 27, 29, 259, 337

Scranton, 269

Sea Breeze fresh-air home, 176

Sea Breeze seaside hospital, 9, 240

Seaman, L.L., M.D., 23

Seattle, 161

Sedgwick, Professor William T., 304

Sex hygiene, 384-389

Sexual deviates, 182

Shoes, tight, 401

Sickness, preventable, cost of, 278

Sleep and vitality, 201, 272

Slum, a menace, 13, 20

Smallpox:

epidemics great teachers, 6;

conquered by vaccination, 7;

neglected in rural Pennsylvania, 18;

comes rarely to cities, 31;

compulsory removal of cases, 240

Snedden, Professor David S., 33, 165, 311

Snellen eye test, 73, 77

Society for Sanitary and Moral Prophylaxis, 384

Southern states, 351

Spargo, John, 33, 167

Spitting, 223, 235

State activity, 4, 73, 121, 236, 292, 306

Statistics, object of, 131, 134, 333

Strauss, Nathan, 260

Streets, 15, 122, 217, 254, 348

Study hours, too long, 287

Sweating, 152, 211

Taxes, taxpayers. See _Budget_

Teacher's health:

tests of, 152-158

Teachers:

social work, 172;

health passport, 202;

for tuberculous pupils, 237;

excluded when tuberculous, 242;

and physicians, 279;

physical examination of, 284;

use of alcohol, 358;

cigarettes, 368;

use clippings, 382

Teeth. See _Dental Sanitation_

Temperance. See _Alcoholism_

Tenement reforms, 20, 186, 209, 304, 403

Thompson, J. Arthur, 336

Tobacco:

instruction at school, 3;

economic injuries of, 201;

forbidden to employees, 210;

evils of nicotinism, 363-368, 386

Tonsils, hypertrophied, 44

Trachoma, 69-71

Trudeau, E.L., M.D., 274

Tuberculosis:

pupils excluded from school because of, 65;

aggravated by colds, 68;

bone tuberculosis, 87, 88, 236;

and bad teeth, 90, 99;

in teachers, 153;

examination for working papers, 191;

periodical examination for, 201;

last days of, 229-251;

eye and skin tests for, 240;

tests of cows, 260;

carried in milk, 264;

out-of-door treatment, 274;

only predisposition to, inherited, 335

Typhoid:

a rural disease, 13;

carried in milk, 264

University Extension Society, 178

Vacation schools, playgrounds, 109, 296

Veiller, Lawrence, 9

Vitality tests and statistics, 124-138

Water, drinking:

reason for works, 15;

factories pollute, 17;

fountains, 217;

public responsibility for, 226;

protecting sources, 307

Welfare work, 7, 221-225

West Point, 199

Wheeler, Herbert L., D.D.S., 93

Whipple, George C., Ph. D., 13, 16

White plague. See _Tuberculosis_

Whooping cough, 64

Williams, Alida S., 72, 122

Williams, Linsly R., M.D., 241

Work:

physical examination for working papers, 190-200, 285;

healthful habits, 208-217;

unpatented medicine, 334.

See _Industrial Hygiene_

Young Men's Christian Association, 227

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Because the childish body quickly shows the injurious effects of what