THE RESPIRATORY AND CIRCULATORY SYSTEMS: THE KIDNEYS
The Mechanics of Circulation and Respiration; the Circulatory
Apparatus; the Lungs; Hygiene of the Lungs and Its Relation to
the General Health; Relation of Respiration to Body Heat; the
Respiratory Functions of the Abdominal Muscles; the Importance
of Good Chest Development; Proper Relation Between the Height,
Weight, and Chest Measurements; Chemical Properties of Air; Town
and Country Air; Dust and Its Relations to Disease; Rôle Played by
Bacteria; Ventilation; the Injurious Effects of Overheated Air; the
Proper Degree of Moisture for the Air of the House; Ventilation of
Bed-rooms.
Care of the Nose, Throat, and Ears; Impediments to Respiration;
Ventilation of the Lungs and Breathing Exercises; Cure of Chronic
Bronchitis by Deep Breathing Exercises; Relation of Colds to
Pneumonia and Tuberculosis, and Their Prevention.
The Kidneys and Their Function; the Physiology of the Female Pelvic
Organs.
It is said that diseases of the lungs are the cause of four-fifths of
all indispositions, ill health, and actual disease among civilized
people, and that, between the age of fifteen and twenty-five, almost
one-half of the mortality is due to pulmonary tuberculosis.
This almost universal weakness of the lungs, as it may be styled, is
a product of modern civilization, and is caused by our unhygienic
mode of life. Too little importance is attached to physical
development, and well-developed lungs can only be found in a
well-developed chest; too little time is spent in outdoor exercise;
and private houses, public conveyances, and public assembly rooms are
not properly ventilated.
Good development of the chest and lungs, and thorough and systematic
ventilation of the lungs, are essential to a strong heart, a vigorous
circulation, and power of the tissues to resist disease.
=The Mechanics of Circulation and Respiration.=—In order to
understand the mechanics of circulation and respiration, it is
necessary to appreciate four fundamental facts—that the thorax is a
distensible, air-tight cage; that it contains and is filled by the
heart, lungs, and great blood-vessels; that the exchange of gases
in the blood takes place in the lungs; and that, on the development
of the chest and respiratory muscles, depend the development of the
lungs and the force of the circulation.
[Illustration: Fig. 7.—The bony thorax, anterior view (Ingals).]
_The Thorax._—The chest or thorax is a cone-shaped, distensible
cage, formed of bones, elastic cartilage, and muscles. The spinal
column forms the fixed part of this living cage, and the ribs are
attached to this in such a way as to allow of their being raised in
inspiration, thus increasing the anteroposterior and the lateral
diameters of the chest.
The thorax is converted into an air-tight cavity by means of
muscles. The base is made up of one huge muscle, the diaphragm.
This is attached at its border to the ribs and posteriorly to the
backbone. It is the diaphragm which separates the cavity of the
thorax from that of the abdomen. When the diaphragm is relaxed, it
has a concavoconvex form, the convexity being directed toward the
chest, and the heart and lungs rest directly on it, while the concave
surface covers or rests on the liver.
_The Circulatory Apparatus._—This consists of a central force and
suction-pump, the heart, and a series of elastic tubes that grow
smaller the further from the heart they are situated; they divide and
subdivide, like the branches of a tree. The smallest arteries, called
capillaries, from their hair-like size, are so minute that they only
allow the passage of a single corpuscle at a time and their walls are
transparent.
The heart is a somewhat cone-shaped organ, placed between the
two lungs; it is situated more or less obliquely in the chest,
immediately back of the breast-bone. Roughly speaking, the base of
the heart corresponds to the right edge of the sternum, while the
apex lies a little below and to the right of the left nipple.
The heart is divided into a right and left side. The left side forms
the force pump, whose motive power is supplied by the contraction of
its own muscle-fibers. The bright red blood, with its fresh supply
of oxygen—hence its color—flows from the lungs into the left heart,
which then contracts automatically and forces the blood into the
arteries of the body.
The arteries consist of a series of elastic tubings; hence, the
smaller the tubing, the greater the resistance which has to be
overcome by the force of the heart’s beat, so that during violent
exercise, when the contraction of the muscles causes a pressure
on the minute arteries and capillaries situated in them, the more
forcible must be the beat of the heart to overcome this additional
resistance. Likewise, when the surface of the body is suddenly
chilled, as by a plunge into cold water, all the vessels situated
here contract, and, again, more work is thrown on the heart.
The three chief factors in the mechanics of the circulation are the
force and frequency of the heart’s beat, the peripheral resistance,
and the elasticity of the arterial walls. Any disturbance between
these relations brings about abnormal conditions.
[Illustration: Fig. 8.—Front view of heart and lungs, showing
relations to other thoracic organs (Ingals).]
The average frequency of the heart’s beat, or the pulse, is 72 times
a minute. It is increased by exercise; it is quicker in the standing
than in the sitting posture. It is quickened by meals, and, on the
whole, it is quicker in the evening than in the early morning hours.
Independent of muscular exertion, it is quickened by great altitudes.
It is said to be quicker in summer than in winter. Its rate is
profoundly influenced by mental conditions.
The whole of the blood of the body passes through the heart in 32
beats—that is, in less than half a minute. The greatest part of this
time is spent in the capillaries. There the tissues are obtaining
their fresh supplies of food and discharging their waste matter into
it.
[Illustration: Fig. 9.—Relation of heart and great vessels to the
wall of the thorax. The collapsed lungs are drawn slightly aside
(after Heath).]
The heart, great blood-vessels, and the lungs are placed in the
air-tight cavity of the thorax, and are subjected to the pumping
action of the respiratory movements. The inspiratory muscles elevate
the ribs, at the same time that the diaphragm, by its contraction,
pushes the contents of the abdomen downward. The cavity of the
chest, so enlarged, causes the pressure around the heart and the
great blood-vessels within the chest to be less than that on the
blood-vessels outside the chest; hence, during each inspiration the
venous blood is sucked back into the right side of the heart.
The tissues deprive the blood of its oxygen, so that which flows back
to the heart in the veins is blue. The right heart then sends this
blue blood to the lungs, that it may get rid of its carbonic acid,
which is not only not needed, but is actually injurious to the body,
and to receive a fresh supply of oxygen, which has been carried into
the lungs in breathing.
The _blood_ is the great medium of exchange between all parts of the
body. It is, at the same time, the nourisher and the scavenger of all
the tissues. After the food has been liquefied and converted into new
substances in the digestive system it is poured into the blood. From
the blood all the tissues draw material to renew their own worn-out
parts and other material which they store up as latent force, which,
when it unites with the oxygen of the blood, becomes active force,
such as heat and motion.
[Illustration: Fig. 10.—The diaphragm (after Kitchen).]
The blood holds in suspension a vast number of minute cells or
corpuscles; the red corpuscles give its color to the blood, and
are the oxygen carriers, while the white are the phagocytes or the
protective agents of the body against disease.
The blood constitutes about one-thirteenth of the body weight. Of
this, one-fourth is distributed to the heart, lungs, and great
blood-vessels, one-fourth to the liver, one-fourth to the skeletal
muscles, and the remainder to other organs.
In order that the blood may be a satisfactory medium of exchange
between all the tissues of the body two things are necessary—first,
there must be through all parts of the body a flow of blood of a
certain rapidity and general constancy; and, second, this flow must
be susceptible of general and local modifications.
The =lungs= are the essential organs of respiration or ventilators
of the body. They are two in number, separated from each other by
the heart, are placed in a semi-distended state in the air-tight
thorax, which we have seen they, together with the heart and great
blood-vessels, completely fill. The lungs ultimately consist of
air-cells, surrounded by dense plexuses of capillaries and nerves.
The air-cells communicate with the exterior through the bronchial
tubes, trachea, larynx, throat, and nose.
The larynx is the organ of voice. It is situated between the trachea
and the base of the tongue, at the upper and back part of the neck,
where it forms a considerable projection in the middle line, called
Adam’s apple.
The trachea is a cylindric tube, which extends from the larynx
downward about 4½ inches, when it divides into the right and left
bronchial tubes. The bronchial tubes, on entering the lungs, divide
and subdivide, until finally they terminate in a lobule which is
composed of air-cells and intercellular passages.
In inspiration the cavity of the thorax is enlarged by an active
contraction of the muscles, in consequence of which the pressure of
air within the lungs becomes less than that of the air outside of the
body, and this difference of pressure causes a rush of air through
the trachea into the lungs, until an equilibrium of pressure is
established between the outside air and that within the lungs. This
constitutes _inspiration_. Upon the relaxation of the respiratory
muscles, the elasticity of the chest-walls and lungs, aided perhaps,
to some extent, by the contraction of certain muscles, causes the
chest to return to its original size. In consequence of this, the
pressure within the lungs now becomes greater than that outside, and
the air rushes out of the trachea, until the equilibrium is once more
established—_expiration_.
During quiet respiration all parts of the lungs are not equally
expanded; it is chiefly the apices of the lungs, reaching up into the
region of the neck, and the central parts of the lungs, which undergo
the least change of volume. This lack of a thorough distention and
aëration of every part of the lungs is a cause of weakness of the
lungs as well as of the entire body, for it is precisely those parts
of the lungs which are the least active that are most prone to become
the seat of tuberculosis.
In forced inspiration the cavity of the thorax is increased from 2
to 3 inches, partly by the elevation of the ribs and partly by the
descent of the diaphragm, due to the contraction of its muscular
fibers. In contracting, the diaphragm presses upon the abdominal
viscera, pushing them downward about 3 inches, so that a projection
of the flaccid abdominal walls occurs. The movements of the diaphragm
are less extensive in women than in men, which is believed to be due
to the corsets and general manner of dress. A perfectly free mobility
is necessary for change in the size of the chest and lungs, in which
the respiratory movements take place from sixteen to twenty times a
minute.
The amount of air entering and leaving the lungs varies greatly in
ordinary and forced respiration, being often three times as much
in the latter. The volume of air is determined by the spirometer.
Mr. Hutchinson, who invented the spirometer, has defined the vital
capacity of the lungs as that amount of air which can be expelled by
the most forcible expiration, and so the measure of the individual’s
respiratory power. The vital capacity varies according to a number of
conditions, as age, sex, weight, but, most important of all, is the
height. It has been found that between five and six feet the vital
capacity increases eight cubic inches for each inch in height.
The vital importance of the rôle which oxygen plays in the health and
life of the individual may be better understood from the facts that
about 10,000 liters of air are breathed daily, which makes the amount
of food and drink consumed daily seem almost infinitesimal, and,
important as the quality of the food is, the quality of the air is
much more so, and, finally, that one can live for some days without
either food or drink, but dies in a few minutes if the supply of air
is cut off.
_Secretion of the Lungs._—Like the lips and mouth, the lungs are
invested on their free inner surface by a delicate mucous membrane,
which constantly secretes a clear viscous fluid, the mucus. The
lungs, therefore, like the nose, are always moist, and just as the
nose is cleared by blowing it, so the lungs are cleared by hawking
or coughing. A sense of discomfort or a feeling of irritation of
the windpipe induces a deep inspiration, followed by an explosive
expiration, which quickly brings up the mucus, so that it can be
expectorated. The only difference between the mucus of the lungs and
that of other organs is that the former is mixed with air and has,
therefore, a frothy appearance.
The secretion of the lungs naturally flows down and accumulates,
until it is voluntarily brought up and expelled. Any one with a
cold on the chest, or who is subject to catarrh, will notice that,
on moving about in the morning in making the toilet, especially
on raising the arms to dress the hair, expectoration is greatly
facilitated, and that this is followed by a feeling of clearing out
of the throat and lungs.
Because of the great aid given to the lungs in clearing them of
mucus, moderate exercise in the open air is a much better treatment
of an ordinary cold than a prolonged stay in bed. And for the same
reason, in the treatment of lung troubles, so soon as the temperature
of the patient is down to normal, and her strength makes it safe to
allow her to move about, the recovery of the patient is hastened by
getting up and moving about the house.
=Hygiene of the Lungs and Its Relation to the General Health.=—Two
conditions are essential for the preservation of the health and
prevention of diseases of the lungs—good chest and lung development,
and a continuous supply of fresh air for the proper ventilation of
the lungs.
Fully one-third of the whole volume of blood is always circulating
in the lungs, and each corpuscle passes through them 8000 times in
the twenty-four hours. In other words, the lungs are the vitualizing
stations of the corpuscles which unceasingly go hurrying by. If these
carbonic-acid-laden corpuscles arrive in the lungs, and do not find
the requisite amount of oxygen awaiting them, they return to the
tissues, carrying part of their carbonic acid back to them instead
of a fresh supply of oxygen, and so the tissues are weakened instead
of being nourished, while the corpuscles themselves suffer from lack
of proper nourishment and deteriorate in form and color. Imperfect
ventilation of the lungs is the most frequent cause of anemia or
thinness of the blood.
It must not be overlooked that the air may be fresh and pure, and yet
not able to penetrate all parts of the lungs because of superficial
and improper breathing.
=Relation of Respiration to Body Heat.=—The heat of the body is
generated by the oxidation of the tissues. The chilliness experienced
by persons engaged in sedentary occupations is by no means always
caused by the low temperature of the room, as will be proved by
the thermometer, but by the close air of the room and superficial
respiration, which causes internal overheating with imperfect
combustion. The correctness of this statement may be proved if the
woman will throw the windows wide open and take deep breathing
exercises for five minutes. She will then go back to her work
thoroughly comfortable. In other words, she has breathed herself warm.
=The Respiratory Function of the Abdominal Muscles.=—Well-developed
abdominal muscles play an important part in expiration, hence, in
emptying the lungs of their impurities. Under normal conditions
the pressure in the abdominal cavity is greater than that of the
atmosphere; hence in the elastic recoil following inspiration, the
abdominal viscera constitute a buffer, so to speak, and drive the
diaphragm upward.
The chief causes of flabby abdominal muscles, with its consequent
low intra-abdominal pressure, are a sedentary life, the wearing of
corsets which prevent the free play of the abdominal muscles, and the
overdistention of the abdominal walls by repeated pregnancies and by
the accumulations of fat.
As a result of lax abdominal walls, there is very frequently an
enteroptosis or a falling of the abdominal contents far below their
normal position; this includes the liver, spleen, pancreas, the
intestines and stomach, and is the most frequent cause of floating
kidney.
Further, the accelerating influence of the diaphragmatic movements on
the circulation is seriously interfered with.
=The Importance of Good Chest Development.=—The least chest
development of the adult woman—that is, the underarm girth around the
chest—consistent with good health is 28 inches, and this girth must
be enlarged 3 inches on forced inspiration. In ordinary respiration
the waist expansion should be from ½ to 1 inch, while during muscular
activity it should be from 1½ to 3 or 4 inches.
In women the movements of the upper part of the chest are very
conspicuous, the breast rising and falling with every respiration;
whereas, in children and in men the movements are almost
wholly confined to the lower part of the chest, and are called
diaphragmatic, in contradistinction to those seen in women, which
are called thoracic. It is now the opinion of many observers in this
country and in Europe that the habit of thoracic breathing in women
has been brought about by constricting the waist and the lower ribs.
Observations made among the Indians and Chinese women show that the
abdominal is there the type of breathing, _and_ civilized women who
wore no corset had relatively good abdominal breathing. Further, that
a thoracic type of breathing can be produced in man by putting him in
a corset.
Vital capacity is, as we have seen, the term employed to denote
the amount of air that can be expired after the fullest possible
inspiration. The amount for persons 5 feet in height has been
estimated as 174 cubic inches, with an increase of 8 cubic inches
for every inch in height above this. The relation between height
and vital capacity is rather remarkable, since height is chiefly
determined by the length of the legs, and not by the size of the
trunk and thorax. This is due to the fact that mobility of the chest
increases with stature.
The capacity of the chest is determined by the spirometer. A person
who can only blow, say from 180 to 250 cubic inches, has a good pair
of lungs, while, on the other hand, an ability to blow only 100, even
where percussion and auscultation had revealed nothing, is suspicious.
One test by the spirometer is not sufficient to judge of the
condition of the lungs, since the woman may be nervous or may not
understand how to breathe into it, so that a number of tests should
be made on different days, which may give a much better result,
though no change has occurred in the lungs.
=Proper relation between the height, weight, and chest measurement=:
Height. Average weight. Average chest measurement.
Feet. Inches. Pounds. Inches.
5 120 29.80
5 1 122 30.60
5 2 125 35.00
5 3 128 35.75
5 4 131 36.25
5 5 135 37.00
5 6 139 37.50
5 7 143 38.00
5 8 147 38.50
5 9 151 39.00
_The Chemical Properties of Air._—It is of more vital importance
that the air which we breathe should be pure than the food which we
eat should be, although the latter is universally conceded to be a
matter of prime importance. The reason is that the poisons in the
air, inspired by the lungs, pass directly into the blood, whereas,
taken into the stomach, the action is much slower, and there is at
least the possibility of their passing through the digestive tract
unassimilated.
The olfactory nerves are the normal guides as to the purity of the
air, and, if they have not been dulled by long usage in breathing
impure air, they are extremely sensitive to impurities in the
atmosphere.
_Country Air._—In the open air there is a constant, even though
insensible, movement of the currents of air; the result is a constant
renewal or ventilation of the air. There is, in addition, the
evaporation from brooks, rivers, lakes, the dew and rain, which aid
in cleansing the air from dust; the peculiar freshness of the air in
the country after a heavy fall of rain is familiar to all.
The “bouquet” of the air, most noticeable and delightful in the
early morning, especially in the spring of the year, is due to the
fragrance given off from the flowers, plants, and trees, and imparts
a feeling of exhilaration and a sense of the joy of living.
Sunshine increases the respiratory movements.
Wind clears the air of impurities, and is only harmful when it
carries dust with it, or when it is so strong that it impedes the
respiration or bodily movements. Very weak persons get out of breath
easily when battling against the wind.
_Town Air._—Even the outdoor air of towns has its full quota of
oxygen,—21 per cent.,—and so is healthier than indoor air. The
carbonic acid in the air varies from 0.2 to 0.6 per cent. Among the
impurities of the air are smoke, fog, and dust.
=Dust and Its Relation to Disease.=—Dust, consisting of particles of
all kinds of organic and inorganic matter, is a nuisance of indoor
as well as outdoor life. That the dust in cities is the intolerable
nuisance and menace to public health that it is, is due to the filthy
condition of the streets.
The specific cause of tuberculosis is the tubercle bacillus.
Considering the prevalence of the custom of spitting on the
pavements, streets, floors of public conveyances, and public halls,
that the dust from the streets is carried into the houses on the
shoes and the trailing skirts of women, it is self-evident that
anything which stirs up the dust, as sweeping, stamping on the floor
with the feet, dancing, and on the streets strong currents of air and
high winds are a most serious menace to the health and lives of the
community.
In addition to the fact that dust is the great carrier of the
tubercle bacillus, the particles of dust cause a direct irritation of
the mucous membranes lining the nose, throat, larynx, and bronchial
tubes.
That dust is an important factor in the causation of colds may be
inferred from the facts that they are more common in the city than
in the country, and that in the city they are more frequent in the
spring and fall, when the streets are not watered.
=The Rôle Played by Bacteria.=—Bacteria are distributed nearly
everywhere and in larger quantities than is generally believed. The
air in open spaces in cities contains from 100 to 1000 bacteria per
cubic meter, while the air of an inhabited room contains from 6000 to
10,000.
It can now be definitely stated that microörganisms are the immediate
or exciting cause of bronchitis observed in diphtheria, in influenza,
measles, whooping-cough, pneumonia, etc. These microörganisms are
conveyed both directly from the sick to the well, and from the
inhalations of the germs floating in the atmosphere. Whenever dust is
raised, we breathe in a great number of microörganisms.
In influenza the bacilli are found in the secretions of the nose,
throat, and in the expectorations from the lungs.
The bacilli are not only the cause of the acute infections, but also
of chronic bronchitis.
The bacterial flora usually present in the throat and the respiratory
passages is rich and varied. So long as the mucous membrane lining
these passages remains in a healthy condition, an unfavorable
condition is offered for their growth and development and these
microörganisms are harmless. But just so soon as the general vitality
is lowered, or there is an impairment of the normal condition of
the epithelium lining the respiratory tract, a culture-medium is
provided in which these germs flourish and grow. Anything which will
cause an irritation or congestion of the mucous membrane of the
throat and bronchial tubes furnishes the necessary conditions for
the infection to take place. The germs themselves excite an acute
inflammation, and the inflammation extends from the head or throat to
the bronchial tubes, through the spread of the infective agent along
the respiratory tract.
=Ventilation.=—Very few people in cities spend more than one hour
a day in the open air, which means that they are housed up for the
other twenty-three hours, so that no pains should be spared to bring
up the quality of the indoor air to approximate as nearly as possible
that of the outdoor air. The air of houses contains many more
microbes than that of the street.
For dwelling-houses 3000 cubic feet of fresh air is needed every
hour. It is said that in the country the only bad air is in farmers’
houses, whence it has no chance to escape.
Direct sunlight kills the tubercle bacillus in thin layers of sputum
in five or six hours, and diffused sunlight in several days, and
proper ventilation greatly facilitates this bactericidal action.
A large cubic space is of little avail if the ventilation is
inadequate. The windows should be at least one-seventh of the floor
space.
The air of the house must be fresh, pure, and cool, to allow proper
ventilation of the lungs and skin. Colds are prevalent in winter,
because that is the season when people are housed up and breathe
impure air.
The commonest causes of impurities of the air in houses are the
expired air and the transudation of the skin; the production of the
combustion of lights or unconsumed gas may come from the burner when
lit, if the pressure is very strong, or the rubber fittings may
retain the gas; tobacco smoke; the effluvia of simple uncleanliness
of rooms and persons; and the products of the fluid or solid excreta
retained in the room. In addition, there may be special conditions
which allow the impure air to flow into the room, as from the
basement or cellar of a house, from imperfectly trapped soil and
waste-pipes, or from other impurities outside of the house.
In respiration the air is vitiated by a decrease in the amount of
oxygen and an increase in the amount of carbonic acid; the expired
air contains about 4 or 5 per cent. less oxygen and about that amount
more of carbonic acid than the inspired air. It has been estimated
that an individual takes into her lungs about 500 cubic inches of air
per minute and exhales the same amount of vitiated air. The expired
air is of a higher temperature, and is loaded with aqueous vapor.
The organic substances present in expired air are in part the causes
of the odor of the breath; it is probable that many of them are of a
poisonous nature. The air is still further vitiated by the products
of decomposition of persons having decayed teeth, nasal catarrh, and
disorders of the digestive systems, as well as by personal emanations.
When the sensibilities of the sense of smell become dulled, they give
no warning of the sense of danger, and the individual may not feel
conscious of the harm, although the nervous centers may be greatly
depressed, and, because discomfort has not been experienced in a
vitiated atmosphere, it does not follow that harm has not been done.
The effects are slowly and imperceptibly cumulative, but are on this
account none the less injurious, and are now recognized as being
among the most potent and wide-spread of all the predisposing causes
of disease.
The physiologic effects of breathing vitiated air are that, owing
to the impurities of the air, the respirations become quicker and
shallower, the heart’s action more rapid and feeble; there is a more
or less irritation of the mucous membranes lining the nose, throat,
and larynx. In extreme cases, where many people are crowded together
and the ventilation is totally inadequate, the air often becomes so
impure as to cause headache, lassitude, nausea, and fainting.
The long-continued action of such impurities on the olfactory
nerves may ultimately induce, through the central nervous system,
alterations in the respiration, circulation, and nutrition. When
moderately vitiated air is breathed more or less continuously, the
individual becomes pale and loses her appetite; after a time there is
a decline in the muscular strength and animal spirits. The aëration
and nutrition of the blood is interfered with, and the general tone
of the system falls below par.
It has further been maintained that metabolism is hindered by
much-breathed atmosphere. In addition to the ordinary symptoms of
discomfort, the long occupancy of so-called stuffy rooms so lowers
the resistance as to be conducive to the contraction of colds and
even to more serious infections.
People in this lowered condition of health, which is very common
among those who spend the greater part of the day indoors, in
offices, houses, schools, factories, and workrooms, offer much less
resistance to attacks of acute diseases than do people who lead an
outdoor life.
In considering the ventilation of a house, the purity of the air, the
temperature, and the dryness of the air must all be considered.
The test now generally accepted as the standard of purity of the air
is not the chemical one of the estimation of the amount of carbonic
acid contained in the air of a closed space, but that, on entering a
room or closed space from the outside fresh air, no sense of impurity
or closeness should be noticeable.
The so-called natural ventilation of houses, which takes place
through the porosity of the walls, the cracks around the doors and
windows, is generally too inconsiderable to be taken into account.
Where houses are heated by furnaces, a certain amount of ventilation
is furnished by this means, but the air is by no means so pure as the
air of a house heated by hot air or steam pipes. In the latter case,
the greatest drawback is the dryness of the air.
As the air contained in an inhabited room cannot be kept as pure as
the outside air, the object of ventilation is, by the admission of
the pure external air, so to minimize the impurities that the air
respired may not be detrimental to health.
The most effective means for the ventilation of houses and apartments
is the throwing wide open all doors and windows; the windows must
be opened at both top and bottom, as the hot impure air rises and
the cold air falls to the floor. The length of time which the house
should be left open will depend on the outside temperature and the
velocity of the winds. This ventilation of the entire house should
be carried out three times a day—in the early morning, at noon, and
again in the evening.
In addition to this, provision should be made for a constant access
of fresh air to the room. A simple and rather primitive method is by
raising the lower sash by a strip of wood several inches in height
and the exact width of the window. The air will then enter the space
between the upper and lower sashes. Some such or any better method of
ventilation should be in continuous use, day and night, when the room
is occupied. So soon as the weather is sufficiently mild, some of the
windows should be left open all the time.
When the air of a room is fresh and pure, the human system is
furnished with all the oxygen it can consume, and heat is thus
introduced into the body, so that a lower external temperature is
necessary for comfort. Hence, supplying a sufficient quantity of
fresh air minimizes the amount of coal consumed, besides increasing
the vigor of the body.
The temperature of the house will depend on the occupation, age, and
health of the inhabitants. With a sedentary occupation, a temperature
of from 64° to 70° F. is the most suitable. The temperature of the
bedroom at night should not be allowed to fall below 50° F. Every
room in the house should be furnished with a thermometer.
=The Injurious Effects of Overheated Air.=—A rise of temperature in
the surrounding air diminishes the amount of oxygen consumed and the
amount of carbon dioxid discharged; a fall of temperature has the
opposite effect. In addition, this overheated air forms a hot jacket
about the body, which prevents the radiation of heat necessary to
keep the body in a healthy condition.
For the same reason, when out-of-doors, furs should not be worn
close up around the neck, and fur coats should only be worn in
the extremely cold weather. Paper and rubber worn about the body
act in the same way, by preventing the radiation of heat and
moisture—practically steam jackets are formed; the skin is rendered
very sensitive and susceptible of chilling on the slightest fall of
temperature.
=The Proper Degree of Moisture of the Air of the House.=—The air
below the freezing-point is deprived of much of its moisture; brought
into the house, and raised from 70° to 80° F., or drawn into the
nostrils and raised to 98° F., it must take up its quota of moisture.
This moisture must, therefore, be provided in the air of the house.
In the case of houses heated by furnaces, some moisture is furnished
by the water-pans of the furnace; but in the case of heating by hot
air and steam pipes, there is less circulation of air, the air is
very much drier, and generally of a very much higher temperature. A
satisfactory method of furnishing these houses with the proper degree
of moisture has not yet been invented.
One is only comfortable in a dry air when it is of a low temperature.
When the dry air becomes heated, there is more moisture given off
by the mucous membranes, which causes a feeling of dryness and
irritation in the nose, throat, and larynx; there may also be a
sensation of uneasiness of the chest, and, at the same time, the
individual feels chilly.
Persons constantly breathing abnormally dry air lower the resisting
power of the respiratory mucous membranes and become very susceptible
of taking cold.
Since the degree of moisture of the air of a house is equally
important as its temperature, every room should be furnished with a
hygrometer, which should register from 65 to 70 per cent. of moisture.
=The Ventilation of Bed-rooms.=—The importance of the proper
ventilation of the sleeping-room will be seen from the fact that
two-thirds of the oxygen absorbed in the twenty-four hours is
absorbed between 6 o’clock in the evening and 6 o’clock in the
morning; and on the state of the air of the bed-room will depend
greatly the vitality of the individual. During sleep inspiration
occupies ten-twelfths of the respiratory period, while at other times
it occupies only five-twelfths of that period. In a closed room the
oxygen would eventually be consumed, the air become filled with
impurities, and the body languish for want of oxygen and incapacity
to throw off its impurities.
The air of the room should be perfectly fresh on retiring; where it
has been used as a sitting-room, it should be thrown wide open and
thoroughly ventilated just before going to bed. The temperature of
the room should not be above 65° F. In the bed-room at night all the
air coming into the room should come from the same side of the room,
and the doors opposite should be closed. If the room is small, and
the window is at the head or foot of the bed, some provision must
be made to screen the bed, and to allow the air to enter the room
without falling directly on the sleeper.
In the intense heat of summer, especially if the air is saturated
with moisture, one sleeps much more comfortably on the side, with
the face almost at the edge of the bed; in this way the formation of
a stagnant pool of exhaled air about the face is prevented, which
would otherwise be rebreathed, and greatly increase the feeling of
discomfort and malaise.
On retiring at night the clothes worn during the day should be spread
out over chairs to become thoroughly ventilated, instead of being
hung up in a closed press or closet. From a sanitary point of view,
it is essential that every article of clothing worn during the day
should be removed at night. Both clothes and body need ventilation.
In the morning the clothes should all be taken off the bed, and they,
as well as the night-clothes, should be spread out to be aired during
the ventilation of the room. The windows are thrown wide open when
one goes to breakfast.
=The Care of the Nose, Throat, and Ears.=—It will be most profitable
to consider the care of the nose, throat, and ears together, since
the mucous membrane lining these cavities is continuous, and so there
is always great danger of an inflammation of one extending to the
others.
It has been calculated that about one-third of our adult population
are notably deaf in one or both ears. In the majority of cases
deafness is the result of colds and throat troubles, and much can be
done to prevent its occurrence.
The nose communicates through the nasal fossæ with the nasopharynx,
and the mucous membrane lining the nose is continuous with that
lining the throat.
The nose performs four important functions—it serves as a passageway
for the air in breathing, and it warms, moistens, and filters the
inspired air; it is the organ of smell; it aids in phonation; and
it affords ventilation to the ears and accessory sinuses. But by
far its most important function is the rôle which the nose plays in
respiration. To supply the large amount of water necessary to moisten
the inspired air, it has been calculated that about one pint of
water must be secreted by the nose daily; part of this amount of
moisture is furnished by the tears. Mouth-breathing always causes
dryness of the throat.
The filtration of the air is accomplished first through the action
of the hairs at the external margin of the nose, which hinder the
entrance of large particles, and, second, by the adherence of small
particles to the moist surface of the intricate passages of the nose
and nasopharynx. The microbes are expelled with the dust; in addition
to this, the nose probably has the power of destroying any bacteria
through the action of its germicidal mucus.
_Obstruction of the Nasal Passages._—In adults the commonest modes
of obstruction are the bending of the nasal septum to one side, or
by a thickening of the septum by which one nostril may be completely
closed up. The occlusion may also be due to the swelling of the
mucous membrane or the presence of polypi.
In children the most common form of obstruction of the nose is by the
adenoids and the enlargement of the tonsils; this enlargement may be
so great as to prevent nasal breathing and interfere with the normal
ventilation of the ears.
_The Throat or Pharynx._—The throat or pharynx is the upper and
funnel-like portion of the alimentary canal, which is seen at the
back part of the mouth. It extends up back of the nose. The cavity
of the throat is somewhat separated from that of the mouth by the
soft palate. This is a membranous curtain, which is attached to the
posterior part of the hard palate. The pendulous part of the soft
palate is known as the uvula. The uvula sometimes becomes so greatly
relaxed that it rests on the base of the tongue, which causes a
constant irritation and slight cough, a condition which is easily
relieved by a few astringent applications.
On looking into a mirror there will be seen, on either side of the
throat, two arches, formed by folds of mucous membrane; these are
known as the pillars of the throat. Between these pillars, on either
side, is an almond-shaped body called the tonsil. In health the
tonsil should not protrude beyond the anterior pillar.
_Causes of Diseases of the Nose and Throat._—Exposure to wet and
cold, when insufficiently clad, or, even worse, sitting still with
damp skirts or shoes on. A still more potent factor than exposure
to cold is the relative degree of humidity of the atmosphere; great
humidity is frequently accompanied by epidemics of influenza.
Exposure to very high winds; sudden changes of temperature; the
very dry air and the overheating of houses; insufficient covering
at night; the inhalation of irritating vapors and finely divided
mechanical irritants. Also, gastro-intestinal affections and uric
acid.
Chronic enlargement of the tonsils predisposes to tonsillitis and
to all the infective and contagious throat diseases. In addition,
the breath is apt to be fetid, and swallowing the mucus, germs, and
toxins has a deleterious effect on the stomach and general health.
Mouth-breathing and anemia often follow, and there is an increased
liability to inflammation of the eyes.
_The Importance of a Healthy Condition of the Throat and Nose._—The
nose and throat are the portals of entrance to the bronchial tubes
and lungs, and it depends on the condition of their mucous membranes
whether the germs of disease will find lodgment here and be carried
down into the bronchial tubes and lungs, or whether they will be
expelled with the mucus.
Any irritant which destroys the vitality of the epithelium covering
the mucosa, or a local congestion which interferes with the
nutrition, circulation, and secretions of the part, offers favorable
conditions for the culture of bacteria normally present. Also,
anything which will cause a lowering of the general health, and
thereby lessen tissue resistance, acts as a predisposing cause to
local inflammation, while the germs themselves excite inflammation by
their active growth _in loco_.
From these facts will also be seen the importance of having cut
short, as rapidly as possible, any congestion or inflammatory
troubles of the nose and throat.
_Prevention of Nasal Catarrh and Sore Throat._—First in importance
comes attention to the general health. Under this must be considered
the clothing, food, ventilation, and exercise.
The clothing should be light, yet sufficiently warm to be a
protection against the cold and winds. Heavy shoes with thick soles
are necessary to protect the feet, and it is not so much the matter
of getting wet as it is of sitting down with damp clothing on.
An atmosphere filled with dust in sweeping should not be tolerated in
any well-kept house.
_Local Treatment for the Prevention and Cure of Mild Cases of Nasal
Catarrh and Sore Throat._—The treatment is practically the same.
The toilet of the nose and throat should be made at least as often,
and at the same time, as that of the teeth; certainly, the first
thing on getting up in the morning and again before dressing for
dinner. In our seaboard cities and towns, at least, there is a very
general predisposition to some degree of congestion of the mucous
membrane of the nose and throat. This means an abnormal amount of
mucus which collects in the parts during sleep. Again, on coming in
from out-of-doors on a windy day a large amount of dust, which means
microbes as well, has become lodged in the mucous membranes of the
nose and throat.
This toilet of the nose and throat is best carried out by means of
a nasal spray. The spray apparatus consists of a bottle holding
some two ounces, a hard-rubber spray piece, and a bulb with tubing
to force the liquid through the spray piece. The tip of the spray
should have the form of a cone; this should be introduced into each
nostril, the bulb squeezed several times, until the amount of fluid
is sufficient to be hawked out, and this process is facilitated by
holding the mouth open during the spraying of the nostrils. After the
nostrils have been thoroughly cleansed, the throat should be sprayed
directly.
The liquids used must be bland and unirritating, and only enough
should be used at one time to cleanse the parts. There are on the
market excellent alkaline and antiseptic tablets; one tablet should
be dissolved in a spray-bottle not quite full of water. This solution
keeps in perfect condition, and is always ready for use.
A solution of boric acid, in the proportion of two teaspoonfuls of
boric acid to one pint of water, may also be used.
If the nose and throat are inflamed, this so-called water spray
should be followed by an oil spray, which will be found to be
most soothing and healing. A separate apparatus for this will be
necessary, as an oily solution would clog an ordinary water-spray,
but the principle of the spray is the same, and it is used in the
same way. The following is an excellent formula: Take of menthol
and carbolic acid each two grains; of eucalyptol, six drops; and of
albolene, two ounces. Mix well, and fill the spray-bottle one-third
full; it is to be used in the full strength. Use only enough of this
spray to moisten the nose and throat; by inhaling simultaneously with
squeezing the bulb, the very fine spray is carried into the larynx,
and so is very useful when there is an irritation of that organ, as
shown by hoarseness. If there is only a slight irritation of the
parts, the use of the spray twice daily will be sufficient; the last
time should be just before retiring. On windy days it will be a
great protection to the mucous membrane of the throat to use it just
before going out-of-doors, on the throat only. If the inflammation
is severe, the spray may be used as often as every two hours. This
prescription should be put up by a good druggist.
Ear specialists condemn all nasal _douches_ as dangerous, on account
of the possibility of the water being forced into the Eustachian
tubes.
_General Treatment._—First of all, the system must be toned up by
the systematic use of cold baths, adapted to each particular case,
tonics, iron, and cod-liver oil. It is a grave mistake to allow these
cases to become chronic, as they may be the forerunners of influenza
and even general tuberculosis. They need prompt and scientific
treatment, which the physician alone is capable of giving.
=The Ear.=—The ear is divided into three parts—the external ear,
the middle ear or tympanum, and the internal ear or labyrinth.
The internal ear is the essential part of the organ of hearing in
which the auditory nerve ends. Its structure is very complicated.
The external ear is separated from the middle ear by the tympanic
membrane or drumhead. This is a thin, small, membranous sheet, which
is stretched tautly across the junction of these two cavities, and
vibrates inward and outward between them. The external ear collects
and conducts the waves of sound to the tympanum.
The middle ear, or tympanum, is an irregular cavity, situated within
the bone. It is traversed by a chain of movable bones, which connect
the drumhead with the internal ear, and serves to convey vibrations
of sound to it. The middle ear, or drum cavity, is filled with air,
and communicates with the pharynx by means of the Eustachian tube.
The middle ear is lined throughout with mucous membrane, which is
continuous with that of the throat and nose.
The Eustachian tube is continuous with the middle ear, and extends
downward and forward about an inch to connect it with the pharynx,
where it opens by a trumpet-like expansion, just above the soft
palate, at the junction of the throat and nose. It serves to carry
off the excess of fluid from the middle ear and to preserve the
equilibrium of the pressure between the gaseous contents of this
cavity and the atmosphere. The walls of the Eustachian tube are in
close contact, but they are normally opened during every act of
swallowing, yawning, etc., when the air finds its way into the middle
ear. A stoppage of the nose reverses the process, and when the tubes
are not likewise stopped up, every swallowing motion draws air out
of the tubes. If the openings of the tubes become closed, deafness,
dizziness, and subjective noises will result.
The middle ear is the seat of about two-thirds of all aural troubles,
and, since much of this could be prevented, this becomes a matter of
great practical importance.
_Causes of Impairment of Hearing._—The majority of the affections of
the middle ear originate from extensions of catarrhal inflammations,
from the nose and throat, through the Eustachian tubes. In children
adenoids are the most frequent cause of deafness. The so-called
hereditary deafness is probably due to an inherited configuration of
the septum of the nose, a bending of the septum to one side, or a
tendency to catarrhal affections of its mucous membranes.
Every cold in the head tends to mechanically involve the ears,
and, while recovery may seem complete, there is likely to be some
unrelieved trouble which insidiously but steadily increases—first one
ear, and then the other, shows signs of defective hearing. If only
one ear is involved, the condition may progress seriously before the
patient is aware of the trouble.
_Preventive Measures Against Deafness._—From what has been said,
it naturally follows that the preventive measures must be chiefly
those already given against taking cold. If one does take cold,
instead of leaving it to run its course, as is too often done, proper
therapeutic measures should be at once adopted to bring as speedy a
cure as possible.
_Impacted Ear-wax and its Removal._—A healthy ear should never
show more than enough wax to render the hairs within soft, and the
individual should be unconscious of the wax coming away. Wax does not
collect in a healthy ear. When it does occur, there is a stopped-up
feeling in the ears, due to the occlusion of the meatus by wax.
The only procedure that is safe to follow in order to remove the
wax from the ear is to gently douche the ear with warm water, at
a temperature from 105° to 110° F. If this does not suffice, a
physician must be consulted, as all efforts to remove the wax after
it has become impacted are dangerous and futile except in skilled
hands.
_Earache._—The best thing for the relief of earache is the external
application of heat by means of a hot-water bag. If this does not
give relief, the ear may be douched with warm water. Earache can
often be prevented, by those subject to it, by placing a very small
piece of absorbent cotton in the ear before going out in very high
winds or in automobiling.
=Impediments to Normal Respiration.=—These are, for the most part,
acquired through improper habits of posture, dress, lack of muscular
and chest development. Other impediments to respiration are a
deviation of the septum of the nose to one side, marked curvature of
the spine, and deformities of the chest which may be the results of
rickets.
Curvature of the spine is frequently the result of muscular weakness,
combined with faulty position at the desk.
The clothing must be sufficiently loose to admit of the fullest
possible chest expansion; the measurements for the clothing, and most
especially for corsets, must be taken during full chest expansion.
Heavy clothing suspended from the shoulders is also hurtful, because
it renders impossible the expansion of the apices of the lungs.
Obviously, all tight bands around the neck interfere with the
respiratory movements.
_Bodily position_ plays a very important part in maintaining the
symmetric development of the chest and in the proper ventilation
of the lungs; and this is a matter of the greatest importance to
students, clerks, and writers who spend a great part of every day at
the desk.
The faulty attitude, together with the weak muscles and the poor
muscular development, are fruitful sources of spinal curvatures and
flat chests; and free respiration is interfered with. Writing with a
pen is most apt to be accompanied by a peculiarly cramped position of
the body, rendering normal respiration impossible.
_The Correct Attitude at the Desk._—The chair should be of such a
height that the woman may rest her feet firmly and easily on the
floor or upon a foot-rest, the seat being deep enough from before
backward to accommodate about three-fourths of the length of the
thighs, while the back of the chair should be so curved as to support
the spine easily in its natural curves, both at the waist and at the
level of the shoulder-blades.
The chair and desk should be sufficiently close together so that the
student may sit erect to read from books, since leaning forward at
the desk causes round shoulders, flat chest, and short-sightedness.
When the desk and chair are properly arranged, two-thirds of the
forearm can be rested upon the desk without raising the shoulders.
In reading, the distance of the book from the eyes should be twelve
inches, and the book-rest should be inclined, sloping downward toward
the reader, at about an angle of 85 degrees.
If the woman has any great amount of writing to do, she should learn
to use a typewriter. In using this machine she not only writes very
much more rapidly and easily, but the position of the body is much
more erect than that assumed when using the pen, and it is not nearly
so fatiguing to the muscles of the hands and arms.
All closely confining sedentary occupations, as writing, sewing,
etc., should be frequently interrupted to move about for a few
minutes, rest the eyes, and take a few deep breathing exercises
before an open window; this is necessary for the eyes as well as for
the ventilation of the lungs.
=Ventilation of the Lungs and Breathing Exercises.=—Forced
respiration is essential to completely change the air in the lungs,
to maintain the elasticity of the lung tissue, and to expand the
chest in every direction. Only in this way can a thorough ventilation
of the lungs take place; a full supply of oxygen is taken in, which
stirs up, disinfects, and cools the stagnant residual air, and
forced expiration expels the respiratory excretions. One of the
frequent causes of foul breath is lack of ventilation of the lungs,
so that the expired air becomes laden with impurities.
In normal breathing the current of air which passes in and out of the
lungs travels through the nose, not the mouth. The ingoing air, by
exposure to the vascular mucous membrane of the narrow and winding
nasal passages, is warmed and moistened, and at the same time the
mouth is protected from the desiccating effects of the continual
inroad of comparatively dry air.
By means of respiratory exercises the mobility of the chest may be
greatly augmented; there is an increased flexibility of the ribs and
sternum, as well as loosening of the thoracic joints, which may have
become stiff, and these exercises also lead to a development of the
respiratory muscles.
In this manner only can the frame work of the chest become thoroughly
inflated from within, and thus all parts of the lungs, which run the
risk of becoming incapacitated from lack of use, be brought into play.
It is highly important that this thorough ventilation of the lungs
should take place at least three times a day—the first thing in the
morning, while making the toilet, again about the middle of the day,
and at night just before retiring.
To obtain the greatest benefit from these exercises they must be
taken without corsets, the clothing must be light and loose, and
the body lightly clad. The air in the room must be fresh, and after
they have been learned, they can, as a rule, be taken before an open
window. In the morning they are best taken just after the cold bath,
when, by removing the impurities and filling the lungs with fresh
air, and at the same time starting up a good vigorous circulation,
they cause one to begin the day with energy and zest.
The respiratory movements are diminished during sleep, and at the
same time there is a large accumulation of blood in the splanchnic
veins, so that, particularly when there is any tendency to difficulty
with the breathing at night, the trouble is greatly lessened by
filling the lungs with pure air just before retiring.
It is necessary, first of all, to learn the art of breathing, to be
able to dissociate the clavicular, the costal, and the diaphragmatic.
By clavicular breathing is meant the raising of the collar-bone
and shoulders as high as possible by means of a slow but deep
inspiration—this expands the apices of the lungs; costal breathing
is the throwing out and expanding the chest to its utmost capacity,
and so enlarging the chest in its transverse and anteroposterior
diameters; diaphragmatic breathing is the depression of the diaphragm
and the protrusion of the abdomen without raising the lower ribs.
The last is the most readily learned in the supine position; the
bed supports the weight of the body, so that the individual is able
to concentrate her entire attention on fixing the bony thorax,
depressing the diaphragm, and protruding the abdomen at every
inspiration and retracting it to the utmost with every expiration.
This, of course, develops and gives tone to the abdominal muscles.
When the woman has conquered these first principles of respiration,
she is ready to put them into practice in the standing posture. They
should be learned before a mirror, and after that taken before an
open window. The hands should be placed on the hips; first elevating
the collar-bones and the shoulders to the utmost, while still holding
the breath, she expands the chest, always breathing in from above
downward, and, lastly, the diaphragm is depressed. With the lungs
thus expanded to their utmost capacity, the breath is held as long
as possible, then the lungs are emptied by an abrupt and forced
expiration.
These exercises should be repeated at first ten times, gradually
increasing to thirty times. It is well to take one or two ordinary
respirations between the forced ones.
It will be found that, as these exercises proceed and the lungs are
filled with purer air, the breath can be held for a longer period of
time, and that with practice the length of time that the breath can
be held is greatly increased; it should be held for half a minute.
Public speakers, singers, and divers are all skilful in this respect.
When these simple breathing exercises have been mastered, breathing
exercises can be combined with other exercises, which have as their
aim the development of the muscles of the chest.
Reading aloud, singing, talking, laughing, are all good exercises for
developing the capacity of the lungs.
=The Cure of Chronic Bronchitis by Deep-breathing Exercises.=—The
upper part of the body must be nude and the exercises taken before
a mirror, so that the woman can watch the movements of the chest
and abdomen, see that all the hollows of the chest are filled out
during forced inspiration, and that the muscles of the abdomen are
properly retracted. For the average woman this last will be the
most difficult; in beginning these exercises she will find that it
will require all her concentrated energy and will power to cause a
retraction of these disused muscles.
Patients with chronic bronchitis do not have the ability to perform
forced respiration properly. The respirations are too superficial,
and the respiratory movements are not properly performed.
As respiration is ordinarily performed, the partial expansion of
the upper part of the chest is accompanied by a contraction of the
abdominal muscles, whereby the diaphragm is forced upward, with
the result that the lower part of the lungs remains very slightly
expanded, whereby the circulation as well as the removal of mucus is
imperfectly performed. This lack of forced respiration is a frequent
cause of acute bronchitis running into a chronic form.
In chronic bronchitis it is especially in the lower part of the lungs
that stagnation of the secretions takes place, and they can only be
dislodged from the mucous membrane by forced abdominal expiration
and the ascent of the diaphragm. This causes a cough which expels
the mucus, and forcible abdominal expiration and cough are the only
means of drainage of the lower and deep-seated parts of the lungs.
Further, in forced respiration the muscle tissue of the bronchial
tubes contracts, which certainly does not take place in ordinary
respiration, but, on the contrary, this tissue atrophies.
Other beneficial results from forced respiration are increased
oxygenation, improved nutrition, changes of a mechanical nature,
ventilation, and disinfection of the lungs, massage of the lungs and
pleura, and drainage.
No other method of treatment is so successful in the cure of chronic
bronchitis not dependent on disease of the nose and throat. In from
two to six weeks of treatment, in which there is a profuse discharge
of mucus, it will be found that the bronchial tubes have cleared up,
provided that the patient is supplied with an abundant supply of
fresh air day and night. Methodically practised, deep breathing is
not only the surest cure, but also the safest stimulating expectorant.
=Relation of Colds and Influenza to Pneumonia and Tuberculosis and
their Prevention.=—We have already seen that bacilli are not only
the cause of acute infections, but also of chronic bronchitis, and
that this was especially true of the bacillus of influenza and the
pneumococcus of pneumonia.
It is well known that influenza is an infectious disease, which
rapidly spreads through the family and the community, but it is
not so well known that the so-called “common colds,” ordinary sore
throat, and tonsillitis are also highly contagious. The infection
is carried from one person to another by direct contagion; the air
is being constantly sprayed with the germs of disease in talking,
laughing, sneezing, and coughing. In coughing and sneezing it is not
sufficient to hold the hand before the mouth—a handkerchief must be
used for this purpose.
_Colds_ are among the most frequent of the so-called minor ailments
in this country. The causes are the overheating of the houses, the
great dryness of the air, badly ventilated houses and public assembly
rooms, which render people very susceptible to the great variations
in temperature.
_Prophylaxis_, or _the prevention of colds_, combine all those
measures which promote the general tone of the system, and may be
said to embrace all the elements of personal hygiene. Good digestion
and proper nourishment of the body with suitable food; the proper
ventilation of houses, all public buildings and conveyances, for in
these latter the public are brought into very close contact with
their fellow-men.
Local prophylaxis would consist in the toilet of the nose and
throat—the removing of adenoids and enlarged tonsils.
The individual must remember that she can reinfect herself; for this
reason, an abundant supply of handkerchiefs must be used; they should
be placed in a handkerchief bag and washed separately. Packs of cards
should be thrown away before they become soiled. Sprays and atomizers
must be individual property, and be kept thoroughly cleansed.
With the exception of deep-seated chest colds, in the early stages a
cold may often be nipped in the bud by a few hours of hard sudorific
work in the open air. In half a day the nasal ducts and respiratory
system will throw off irritating matter that would take much longer
time if the patient remained indoors and relied on the action of
drugs alone.
_Treatment._—Other methods of treatment are a hot tub-bath on
retiring, an active but not too severe cathartic, as two grains of
calomel, taken just before going to bed, and, if the individual
is chilly, a hot lemonade should be taken at the same time. Both
the cathartic and the free perspiration will aid in relieving the
internal congestion and thus aid in its abortion. A cold sponge
should be taken the following morning to tone up the system. Turkish
baths are also useful in breaking up colds; again, the precaution
must be taken to avoid chilling on leaving the bath.
The following tablet is a very simple and very efficacious remedy
for breaking up a cold in the early stages: Take of powdered camphor
¼ gr.; of the sulphate of quinin ¼ gr.; and of the fluidextract of
belladonna root ⅛ minim. This should be well mixed, and made up into
one tablet or a capsule. One tablet is taken every half-hour, until
four doses have been taken; after that one tablet every three hours,
until the running of the nose has ceased, which generally occurs
within twenty-four hours. If there is not marked improvement at the
end of this time, or if there is any fever, a physician should be
consulted at once.
Quinin, when given alone to abort colds, must be given in
sufficiently large doses to produce cinchonism, the subjective
symptom of which is a slight deafness or ringing of the ears. The
natural tendency of cold is to cause inflammation of the middle ear,
and since the use of quinin in large doses causes a congestion, and
so predisposes to inflammation of the middle ear, its use should be
avoided.
The great amount of illness and mortality from pneumonia during and
following epidemics of influenza is too familiar to the public to
need more than mentioning. The patient is so rapidly and extremely
prostrated by the attack of influenza as to be susceptible to
the ready action of the pneumococcus, which, as we have seen, is
ever present, and the extension of the inflammation from the fine
bronchial tubes to the air-cells of the lungs rapidly takes place. In
the exhausted condition of the patient she is not able to resist this
invasion, the heart is already weakened, and death frequently rapidly
ensues as the immediate result of heart failure.
=The Prevention of Tuberculosis.=—The tubercle bacillus is
practically ubiquitous, and the prevalence of tuberculosis is
universal. Hence it is imperative to raise the resistance of the
individual in every way possible, as well as to limit the spread of
the infection. This means the employment of all the resources of
public and personal hygiene, public and private sanitation, and the
education of the public in how the disease is disseminated, and how
its spread may be prevented; also the teaching of the individual, her
duty to the family and society, as well as to herself, in order not
to spread the contagion.
Tuberculosis attacks the crippled and poorly developed lung just as
surely as it shuns the one which is fully expanded and in constant
and active service. Numerous observations have established the
existence of a constant ratio between tuberculosis of the lungs and
deficient chest expansion.
_Diet._—The doctrine has been growing among the laity that the
child’s likes and dislikes should determine what food it should eat.
Thus a finical taste is cultivated and a lack of proper nourishment
follows, and it is this finical diet class of people which forms a
large percentage of tuberculous invalids. It has long been recognized
that a proper diet and the tolerance of it is of the utmost
importance in the treatment of tuberculous patients, but from the
foregoing it would appear that a proper diet throughout life is also
of the utmost importance in the prevention of disease; a sufficiency,
not only as to quantity, but also as regards variety.
It is the patient who can eat everything who stands a good chance of
getting well. So, too, it is the individual whose diet for years has
been perverse, who could not eat meat, to whom eggs were distasteful,
who could not stand milk, who was infected with the vegetarian fad,
or the two-meal-a-day fad, who stands a fair chance of falling
a victim to tuberculosis, through a lowered tone of the system,
because it offers but a feeble resistance to a powerful and insidious
enemy. And the mode of the preparation of the food is an equally
important factor. It has been shown that the poor cooking among the
lower classes is a powerful predisposing cause to intemperance and
tuberculosis.
Influenza is a frequent and important agent in bringing to light
latent tuberculosis, and must be classed as an important exciting
if not predisposing cause. Low, damp climates predispose to the
infection by lowering the vitality. Tuberculosis is more prevalent in
cities than in rural communities, due to the manner of housing and
the character of the occupation.
_Summary of the Present Views of Infection._—The doctrine of
inherited and acquired susceptibility still holds sway; next, that
all infants are susceptible, and that susceptibility lessens with
increase in age; that adults are comparatively insusceptible when
free from general and local lowered resistance and repeated and
prolonged exposure.
As to the source of infection, the consensus of opinion and
ascertained facts point to the sputum as of overwhelming importance;
cow’s milk is an important factor; the food may be infected directly
by coughing, or the dirt and dust from the floor and hands; the
fingers and many other objects that find their way into the child’s
mouth are sources of danger. To adults, both dust and moist droplets
are more often the source of infection than infected food.
_Expectoration._—Careless expectoration is the chief source of
infection. Laws should be passed and enforced prohibiting the
expectoration on pavements, stairways, in all public conveyances, and
all public places.
The danger of infection from tuberculous house servants has not been
sufficiently appreciated. A chronic cough in the case of a servant
should be at once investigated by the family physician. Servants
should be taught the necessity for washing the hands before touching
the food or cooking utensils. The condition of their rooms, clothing,
bathing, and other personal habits should be closely investigated,
and personal cleanliness should be demanded as a _sine qua non_ for
obtaining or keeping a situation.
Since it is a well-known fact that tuberculosis can be acquired from
the occupation of houses and rooms formerly occupied by tuberculosis
patients, it has been suggested that a clean bill of health should
be demanded of the owner of the house before renting it; that is, a
certificate from the Board of Health, that no case of infection has
existed in the house, or that it has been properly disinfected since
that time. If such a movement became popular, landlords would be
obliged to furnish these bills of health in self-defense. Since the
Boards of Health demand the reporting of all cases of tuberculosis,
this scheme is by no means impracticable or Utopian.
The tubercle bacillus is not destroyed by any degree of cold, but
both light and sunlight are distinctly injurious to these bacteria.
The lowest fatal temperature to the tubercle bacillus is 131° F. of
moist heat, acting for a period of six hours. The thermal death-point
of tubercle bacilli in milk is of great practical importance,
and many experiments have been made which have determined that a
temperature of from 140° to 167° F., was sufficient if continued
for one hour. If it is desired to pasteurize the milk, it should be
placed in a closed bottle or stirred and heated for at least twenty
minutes at a temperature of 149° F.
_Disinfection._—The use of formaldehyd gas has practically displaced
the use of sulphur for the fumigation of rooms, as well as for the
disinfection of furniture and clothing. For this purpose a moist
vapor used in a sealed room is essential.
At least 8 ounces of the commercial 40 per cent. formalin should be
used for each 1000 cubic feet of air content. The most efficient
method is that used by Biggs, of New York, which is as follows: For
an ordinary room, 1000 cubic feet, 1 pound of lime, 8 fluidounces of
formalin, and from 2½ to 3 fluidounces of commercial sulphuric acid
are required. All openings but the door are sealed. The formalin is
poured into an empty water-pitcher, 4 ounces of water are added, and
then the sulphuric acid is poured slowly in. The lime is placed in
a china or earthenware wash-basin on the floor upon newspapers; all
water is removed from the room. All drawers and cupboards opened;
the mattresses stood on end; and the mixture poured quickly upon the
lime, when the door is sealed. The sulphuric acid may be packed in a
tin bucket containing the lime, and, with the formalin in a separate
bottle, may be used by any person of ordinary intelligence. The room
should remain closed from twelve to eighteen hours. It must not be
lost sight of that after disinfection by means of formalin a thorough
cleansing is imperative. A room which has been thoroughly cleaned
and carbolized is safer than a room which has been disinfected with
formalin and not properly cleaned.
After death or removal the entire place should be renovated. Besides
disinfection and scrubbing the painted woodwork with a solution of
hot soda water, the walls should be repainted or repapered, and the
woodwork repainted.
Rugs, bedding, pillows, and clothing should be disinfected by hanging
up in the room while it is undergoing disinfection. Books and all
articles of small value should be burned. All soiled linen should be
boiled.
=The Kidneys and their Function.=—The kidneys are the secretory
organs of the urine; they are two in number, and are the largest
tubular glands in the body. They are deeply seated in the lumbar
region, lying one on each side of the vertebral column; the kidneys
extend from the eleventh rib nearly to the crest of the pelvis. They
are usually embedded in a considerable quantity of fat, which is the
chief factor in holding them in position, aided to some extent by
the large blood-vessels with which they are connected. The kidneys
are oblong bodies and measure about 4 inches in length, 2½ inches
in breadth, and over 1 inch in thickness. Their weight is about 4½
ounces.
As an excretory organ the kidney probably stands second to the
alimentary canal; it surpasses in importance the skin, whose total
excretion of water it equals. The abnormal substances appearing in
the urine are often not the products of disease of the kidneys, but
of some other organ or system.
The kidneys excrete and put the finishing touches upon the urinary
fluid; they act at the end of the metabolic course, both as active
and as passive agents. While to some extent the kidneys are
mechanical contrivances, mere filters, so to speak, they are to a
far greater degree active, specific glands. The renal epithelium has
the power of synthesis, and builds up complex substances that are
not apparent as such in the blood or lymph, as well as the power
of analysis or breaking down of substances. These changes are due
to the formation in the tubular cell of an enzyme, which we call
histozyme. The kidney is the end link in the vascular chain, and the
daily performance of healthy kidneys is no doubt a combination of the
mechanical and the vital processes.
_The Secretion of the Urine._—In a perfectly normal being the
problems of waste and repair are balanced to a nicety. As we know,
the tissues of the body are bathed in lymph containing in solution
the compounds that are necessary for their nourishment—proteids,
carbohydrates, fats, salts, and gases. Waste follows in direct
proportion to the activity of the tissues. The worn-out, effete
material first finds its way into the lymph, and from it into
the blood-stream, to be later eliminated from the economy, else
deleterious results will follow their retention in the body. It is
by the selective action of the cells of the various glands of the
body that these useless substances are removed from the blood, and
converted into such forms as can be readily excreted. In the main,
the products to be removed are urea and the allied nitrogenous
bodies—carbon dioxid, salts, and water. These organs are of vital
importance, since nearly all of the waste-products containing
nitrogen are eliminated in the urine.
The most easily understood function of the kidneys is the excretion
of the urinary water; this varies in amount with the rapidity of flow
through the renal vessels and to some extent on the blood-pressure.
[Illustration: Fig. 11.—Relation of kidneys to heart and great
blood-vessels: A, Heart; B, B, kidneys; C, bladder (after Quain).]
The separation of the solid substances of the urine form the
next function of the kidneys, and these substances fall into two
groups—inherently useful materials, which are in excess or which have
served their purpose, and substances which are inherently harmful.
The latter class embrace many end-products of metabolism, which we
are accustomed to consider as normal constituents of the urine.
The analytic study of the urine is of great value to the physician
and surgeon, because of the knowledge which it gives concerning the
processes of metabolism occurring within the body. The nature and
amounts of the various end-products of metabolism are carefully
investigated as they occur in the urine, whether they be normal or
pathologic.
_The Urine._—The normal human urine recently passed is a clear
liquid, of a straw color, with an average specific gravity of 1020,
the specific gravity indicating the amount of solids contained in the
urine. It is acid in reaction. The quantity for twenty-four hours
is 50 ounces, or about 3 pints, depending on the amount of water
ingested. During sleep the amount secreted is less than at other
times. The amount of urine is decreased after profuse sweating,
diarrhea, thirst, diminution in the blood-pressure, and after severe
hemorrhage. When the body temperature is considerably higher than
normal, the amount of urine is again diminished in quantity.
Urea forms nearly one-half of the solids in normal urine and nearly
one-half of the urea is nitrogen. It is the principal representative
of the waste of the nitrogenous tissues. The chief source of urea is
from the metabolism of the muscles; the ingestion of a large amount
of proteid food stimulates metabolism. The quantity of urea passed in
the twenty-four hours is about 500 grains.
The uric-acid constituent is very small, and in the human urine
scarcely reaches 0.03 per cent. of the solids. Lack of exercise
leads to an increased formation of uric acid by a lessening of the
oxidation of the tissues. In gout the amount of uric acid excreted is
abnormally small, because it accumulates in the blood and tissues.
The brick-dust deposit sometimes seen in the urine is composed
chiefly of the urate of sodium. The average daily amount of uric acid
passed in the human urine is about 7 grains. The excretion of uric
acid may be increased by drinking copious drafts of water.
_Toxicity of the Urine._—After the removal of both kidneys the
animal dies of uremia; that is, there is an accumulation of urinary
products in the blood. The removal of one kidney is not necessarily
fatal, and women have so lived very comfortably for many years. A
human being excretes enough poisonous material by the kidneys in two
days to cause death.
_The Urinary Excretory Apparatus._—After the urine has been secreted
by the kidneys it must be carried away from the body, so that the
economy may not suffer from the resorption of the contained toxic
principles. The excretory apparatus comprises the ureters, the
bladder, and the urethra.
The ureters are two cylindric tubes of the diameter of a goose-quill
and about 15 inches long. They make their exit from the inner border
of the kidney, and pass downward and inward toward the median line,
to empty into the base of the bladder by a slit-like orifice.
The bladder is the reservoir for the urine. It is a musculomembranous
sac, situated in the pelvis, and in the female it is in front of the
uterus and above the vagina. It normally contains one pint. It should
be emptied four times a day. If it is allowed to go longer than this,
it becomes overdistended, and is apt to displace the uterus backward,
and the bladder-walls themselves become weakened.
=The Physiology of the Female Generative Organs.=—The internal
and essential organs of generation are the uterus, ovaries, and
the Fallopian tubes. These organs have to do with the process of
ovulation, menstruation, and reproduction.
_The Ovaries._—These are two small bodies of an almond shape, and lie
one on either side of the uterus. The bulk of the organ consists of
connective tissue, in which lie embedded the Graafian follicles, or
ovisacs, in which the ova are contained.
During the child-bearing period, or from about the age of fifteen to
forty-five years, the development of the Graafian follicles and the
discharge of the ova are continually taking place. The liberation
of the ova usually takes place at definite times, which, in general,
coincide with the menstrual epochs, one or more ova being set free at
each period, but this is by no means invariable.
_The Uterus._—The virgin uterus is a small, hollow, muscular organ,
somewhat pear shaped, whose cavity is about 1½ inches deep. The
uterus is situated in the middle of the pelvic cavity, between the
bladder and the lower bowel. It is held in position by broad elastic
bands, which go to different sides of the pelvis; it is also in part
supported by the structures below and above it; but so loosely is the
uterus held that it is easily pushed about, as, for instance, by a
full bladder or a packed bowel, and persistently allowing the bladder
to become overful, and failure to have a daily evacuation of the
bowels, are prolific sources of displacements of the womb.
_Respiratory Movements of the Uterus._—When no constrictions are
placed about the waist, the uterus moves freely up and down with
every respiration. So distinctly, and with such regularity, do these
movements occur that an operator, by watching the movements of the
uterus, can tell the effect that the anesthetic is having on the
patient’s breathing. These so-called respiratory movements play a
very important rôle in the circulation of the uterus, and in the
return of the venous blood to the heart.
Anything which interferes with these movements, as the wearing of
corsets or of tight bands about the waist, prevents the free return
of the venous blood. The uterus becomes congested, and through the
constant abnormal weight of the organ itself, as well as by the
pressing down upon it from above of the superincumbent organs, the
uterus is pushed down below its normal position, the ligaments whose
duty it is to hold it up become relaxed, and the unhappy woman
suffers all the agonies that are attendant on the “falling of the
womb.” For this reason the disorder is frequently met with in women
who have never borne children as well as in those who have.
_The Functions of the Uterus._—The function of the uterus is to
provide a favorable place for the reception of the product of
conception, where it may be protected and nourished during the period
of its development. The purpose of menstruation is to keep the uterus
in suitable condition for the reception of this product of conception
at any time. It is now known that the menstrual flow is not the whole
of menstruation, and that the changes going on in the uterus are
almost as continuous as the process of digestion.
_Average Duration of the Menstrual Flow._—The average duration of the
menstrual flow is five days, although the variations are considerable
in healthy women. A flow lasting any place from two to six days is
perfectly consistent with health, but a flow continuing less than two
days or more than six days generally indicates a local or general
disease.
_Character of the Menstrual Flow._—For the first few hours, or
perhaps for the first day, the flow is usually slight in quantity
and light in color; on the second and third day the flow reaches
its height, and is profuse and dark in color, but it should never
be clotted; after this it generally ceases. The amount of the flow
varies from 5 to 10 ounces. If less than 5 or 6, or more than 18
napkins, are pretty well saturated through, the amount may be
considered abnormal.
_Premonitory Symptoms of the Flow._—The premonitory symptoms of the
monthly flow should not be so marked as to cause the individual any
discomfort. The first indication of the return of the period should
be the flow. There is generally a feeling of abdominal fulness, with
some lassitude and sometimes slight headache. The temperature is
lower and the pulse is slower than at other times. This lowered tone
of the system is an additional reason for increased care against
exposure in wet or cold weather.
=Hygiene of Menstruation.=—During the menstrual period all _cold_
baths must be strictly prohibited, whether tub-baths or cold sponges.
The reason for this is that the application of cold to the surface
causes a driving in of the blood from the exterior of the body to the
internal organs, and, at the time of the menstrual periods, there is
already a congested condition of the pelvic organs, and it must be
remembered that congestion is the first stage of inflammation.
Hot or warm sponge baths may be taken throughout the period, and the
vulva should be bathed with warm water twice a day throughout the
entire period of the flow, as this not only removes the clotted blood
before it decomposes and becomes the source of irritation, but also
removes other irritating matters, and prevents the nervousness that
is caused by local irritation.
Another question which is still _sub judice_ is the necessity for
and the frequency with which vaginal douches should be taken; all
physicians are agreed that a vaginal douche, taken immediately after
the menstrual period, is beneficial, as it removes all of the débris
of the flow, which is sometimes very irritating.
_Exercise._—A moderate amount of exercise should be taken every day;
this is needed now quite as much as at any other time, and only good
can result from it, and no harm comes of a woman going out in the
rain or the cold weather. As has been shown, the menstrual process
is going on for a large part of the time, and the flow is only the
external appearance, but during the time of the flow the woman must
be unusually careful not to get her feet wet or sit down with damp
clothing on. Violent exercise of all kinds is to be prohibited at
this time, as dancing, bicycling, gymnastics, and walks of over
three miles. The reason for this is very obvious: the uterus has now
reached the height of its turgescence, and is heavier than at any
other time, hence the danger that displacements or a very profuse
flow would be caused by any kind of violent exercise.
_Treatment._—If the woman has been so unfortunate as to have been
caught out in a heavy rain, so that her clothes have been wet
through, or if in the cold weather she should come into the house
thoroughly chilled, the best thing to do is to take off her wet
things as quickly as possible; be well rubbed down with hot rough
towels; drink a cup of hot tea, and go to bed at once, with a
hot-water bag placed over the abdomen or under the small of the back.
She should remain in bed until the next morning, to the end that the
circulation may regain its equilibrium as quickly as possible by the
immediate relief of the pelvic congestion.
If this exposure should have caused the sudden cessation of the flow,
a hot mustard foot-bath should be taken. One tablespoonful of ground
mustard is used to the gallon of water, as hot as it can be borne;
the pail should be made as nearly full as possible, without running
over, and a blanket wrapped about the pail and woman, so as to cause
a profuse perspiration; this should be kept up for ten minutes; as
the water cools off, hot water may be added.
Profuse menstruation, painful menstruation, and scanty, very slight,
or irregular flow are all abnormal conditions that are due to some
abnormal or pathologic causes, and a good gynecologist should be at
once consulted, so that not only suffering may be prevented, but that
serious consequences to the general health may be averted.