_PERSONAL HYGIENE_
Whatever the conditions under which one lives, or whatever his abstract
knowledge of foods and sanitation, the health of the individual resolves
itself at last into a question of his personal habits; and some of these
personal questions must be considered in a book of this character.
_Exercise._
One of the commonly accepted facts of hygiene is that, for the best
development and for the perfect health of the human body, a certain
amount of exercise should be taken by each part of the body. This is
true not only for the larger muscles, such as those of the arms and
legs, but also for the muscles of those internal organs less frequently
considered. Experiments have been made by tying up some part of the
body, such as the forearm, with the result that, in the course of a few
weeks, its functions have been so lessened that its usefulness is
temporarily at an end. But the general effect of exercise on the body,
aside from the beneficial results on the particular muscles engaged, is
to promote the building up of new lung tissue. Oxygen is received from
the lungs through the blood and is carried to the different parts of the
body, where it serves the useful purpose of carrying off the waste
products of the different organs. If the lung action is inadequate, if
deep breathing in fresh air is not practiced, or if, through laziness,
no exercise is taken, then the amount of oxygen supplied will be
deficient and the body will be loaded up with the toxic products
resulting from decomposition. The exact effect of exercise upon the lung
action may be seen from the fact that under ordinary circumstances a man
breathes about 480 cubic inches of air per minute. If he is walking at
the rate of 4 miles an hour, he inhales air at 5 times this rate, and if
he is walking at the rate of 6 miles an hour, inspiration increases to
seven times this rate, or 3360 cubic inches of air passes through his
lungs per minute instead of 480, as when at rest.
Of course, it is assumed that in the country a person has no lack of
exercise, and that of all men the farmer is in least need of exercise.
But, as a matter of fact, the exercise which he gets is irregular and
confined to certain sets of muscles, rather than to the development of
the whole body. Agility, for instance, quickness of action and immediate
control of the muscles, is far less common in the country than is
supposed, although there is probably no lack in the actual power of the
muscles. It is common observation that among farmers an erect carriage
is less frequently seen than an awkward, shuffling gait. The fact is,
that exercise, to be beneficial, should affect not one set of muscles,
but all the muscles of the body, because the continuous exercise of one
set, while leading first to growth, results later in demolition and
waste. When, however all the muscles of the body are exercised, there is
no demolition or waste, but a healthy growth throughout. Regular
exercise is beneficial, not merely to the muscles involved, but also to
the other organs of the body. Exercise sharpens the appetite, makes
digestion more perfect, and increases the absorptive power of the
intestinal membranes; conversely, lack of exercise, which is found in
the country in the winter, lessens both the digestive power and the
appetite.
_Clothing._
Little need be said on this subject, since the amount of clothing needed
varies so greatly with the vitality of the individual. It has already
been pointed out that in rural communities the death-rate from
pneumonia, bronchitis, and similar respiratory troubles is much higher
than in urban communities, and it is quite possible that deficient or
unsuitable clothing is practically responsible for this.
The object of clothing is twofold: to protect the body against the
weather, particularly against changes in the weather, and secondly, to
protect the body against injury. Included in the former are the defenses
against the elements of cold, wet, and heat; while the protection
against injury is chiefly a matter of shoes. As has been pointed out, a
large part of the food consumed by the body is utilized in the
production of heat, whereby the body temperature is maintained at about
98 degrees Fahrenheit. A large part of this heat is continually being
lost from and through the skin by radiation and evaporation, and
evidently some regulating influence must be provided so that the amount
of heat given off may be adjusted to variations of the external
temperature. To be sure, the skin itself acts as a regulator, since a
rise in temperature causes the blood vessels on the surface to distend
so that a larger quantity of blood is distributed over the surface and
thereby more freely evaporated. Fall of temperature, on the contrary,
causes a contraction of the blood vessels and therefore a reduction in
the evaporation. But this is not sufficient where external temperature
undergoes wide variations, as in the northern and central parts of the
United States, and a modification of the clothing is a necessary
supplement. The main object of clothing, then, is not to keep out cold
or heat, but to preserve and make uniform the evaporation from the body.
It is an agent of the same sort as food in so far as the body
temperature is concerned, and without doubt light clothing requires a
greater amount of food; while, on the other hand, warm clothing will
make possible a lighter diet.
The best non-conductor of heat is still air, and if one could always
remain in quiet air, no clothing of any sort would be necessary, even in
the most severe weather, because the air itself would serve as a garment
and would prevent radiation from the body. Therefore, loose, porous
garments containing air in their folds and pores are much warmer than a
single, tightly woven garment, and the same material made up in three or
four thicknesses will give the body far more warmth than an equal weight
of texture made up in a single thickness. Similarly, a tight garment is
much less warm than a loose one. A practical demonstration of this fact
is found in the comparative lack of warmth in an old, much-washed,
quilted, bed blanket which is very heavy but quite lacking in warmth
compared with a light fluffy woolen blanket, newly purchased.
Much has been written on the advantages of woolen underwear, on the
ground that since clothing is intended to retain the body heat and
since wool acts as a more effective non-conductor of heat than either
cotton or linen, therefore the woolen undergarment is of the greatest
value. Another argument urged in favor of woolen undergarments is that
they check the chill resulting from excessive perspiration, since the
non-conducting power of wool prevents any rapid evaporation of
perspiration responsible for the lower temperatures. For this reason,
woolen undergarments are always recommended for those climbing mountains
or in occupations where violent exercise is likely to be followed by
rest or quiet in cold air. The objection to woolen undergarments at all
times is that with sensitive skins irritation may take place, and the
odd saying of Josh Billings becomes pertinent, namely, that "the only
thing that a wool shirt is good for is to make a man scratch and forget
his other troubles." Underwear woolen only in part may take the place of
all-wool garments and have the further advantage of being less
expensive. The amount of clothing worn in winter depends, or should
depend, on the character of the occupation of the wearer.
Formerly, heavy woolen underclothes were almost universally worn
throughout the winter without regard to the employment of the
individual. When an out-of-door occupation was pursued a large part of
the time or when the temperature indoors was hardly above freezing, then
heavy clothing was essential; but now that much time is spent in a
well-heated house or office, heavy clothing is as objectionable as
overheated rooms, and the comfort and health of the body will be much
better preserved by not increasing the weight of clothing except when
exposed to the outer air. It must be remembered, however, that old
persons, whose circulation is impaired and who are forced to lead
sedentary lives, will always have difficulty in maintaining the body
heat unless the outer temperature is high, and for such, woolen
undergarments are very useful. The outer garments in winter, to be
efficient, must have two qualities, namely, an impervious surface so
that winds may not penetrate and a loose open weave in which air may be
held so that warmth may be secured.
Rubber boots, although very common in the country, are not desirable as
a foot covering, because they do not allow the perspiration to
evaporate, but rather hold the foot in a moist condition very
detrimental to it. Rubber-cloth overshoes or arctics are much better
than rubber boots, and felt overshoes are equally satisfactory.
Chilblains are fostered by the use of rubber boots, and cloth shoes are
a great relief when the feet are thus affected.
_Ventilation of bedroom._
Since the agitation for fresh air has become so extensive and the
knowledge of the dangers of tuberculosis so widespread, much more
attention has been given to the ventilation of bedrooms, and whereas
formerly the night air was religiously excluded from a sleeping room, it
is not at all uncommon now for a window to be kept wide open, even
through the coldest nights of winter. From what has already been said on
the subject of ventilation, it is plain that to breathe over and over
one's expired air is not healthy, and while it is possible that a
bedroom may be so large that the concentration of the organic matter in
the air may not affect an individual sleeping in the room, yet in most
cases it must be admitted that the bedroom is so small or the number of
people in the bedroom so large that this possibility does not exist. It
is, again, possible that the structure of the house may be so poor that
it is not necessary to open a window to get plenty of fresh air; the
writer remembers sleeping in rooms where, with the windows shut, paths
of snow across the floor in the morning showed the intimate connection
between the inside and the outside of the room.
But the tendency nowadays is to build better houses, to cover the walls
with paper, to put on double windows, and even to paste up the cracks to
make the room as air-tight as possible. To sleep in such a room without
a window open may not be committing suicide, but it is a deliberate
method of reducing the vitality, of insuring a headache or a numbed and
stupid mental condition, and of loading up the system with poisons which
ought to be eliminated by the oxygen which fresh air supplies. It would
add many years to the lives of the people of this country if, from
childhood up, the habit was formed of sleeping with the window open. Nor
need one fear that a cold would result from such exposure. A cheesecloth
screen in the window prevents any draft and yet allows perfect
ventilation. The face is trained to all kinds of exposure without any
danger of catching cold, and there is no reason why, if the bed clothing
be sufficient, the night air should not be thoroughly enjoyed without
danger. Of course, the bed clothing must be sufficient; two lightly
woven blankets are always better than one heavy one. Wool is better than
cotton; if a cotton quilt is used, it should be loose and not tied
tightly.
_Bathing._
An important function of the skin is to expel objectionable elements
coming from the breaking down of the cells and from digestive processes;
the skin is quite as important a factor in getting rid of this waste
matter as those other processes more commonly considered in this
connection. This action goes on most energetically when the secretion of
perspiration is abundant and when the temperature of the surrounding air
is so high that perspiration does not evaporate as rapidly as
discharged. All these secretions contain more or less solid material
which, unless removed, accumulates on the surface of the skin to clog up
the glands and, in some cases, to putrefy and decay. It is this decay of
organic matter on the surface of the skin which causes the odors plainly
noticeable in a crowd, particularly in the winter time. This
accumulation can be prevented only by frequent bathing and by wearing
clean clothes, and there is no surer indication of a proper self-respect
than the habit of cleanliness, both as to one's person and one's
clothes. There is also the very practical feature that cleanliness is an
effective method of discouraging infection and disease, partly by the
removal of scurf and partly by the greater healthfulness of the skin
thereby induced.
Baths have always served as therapeutic agents, and evidences of their
use may be found in Roman paintings and in Egyptian sculpture to-day.
But from our standpoint it is their hygienic importance that is insisted
upon. Ordinarily, the temperature of the bath should be between 90 and
100 degrees, and enough soap should be used to counteract the oily
nature of the deposits on the skin.
Unfortunately, facilities for bathing, except in summer, have not been
generally supplied to detached houses in the country. Plumbing in most
houses has been lacking, but in these days bath-rooms are being
installed with surprising rapidity, and the conveniences resulting are
enjoyed as soon as they are understood. Only a few days ago, the writer
was told of a small village of perhaps two or three hundred persons
where this last summer one house, the first in the village, was provided
with a bath-room, to the great interest of all the villagers. The
convenience and comfort involved were immediately appreciated, and the
plumber, who came in from a neighboring city twenty miles away, secured
contracts for and installed twelve bath-rooms in twelve houses before he
was allowed to leave the village. This same interest is everywhere
noticeable, and the lack of bathing throughout the winter, formerly,
alas, so common, is now giving way to a greater cleanliness, thereby
improving the health and character of the inhabitants.
A great deal has been written about the value of a cold bath,
particularly in the morning, and many people, from a sense of duty,
suffer what is almost torture taking a shower bath or a cold plunge bath
on rising. When a cold bath (which should not last more than a few
seconds) is followed by a good reaction, that is, when after drying, a
distinct glow is felt, there is no objection to its use, and undoubtedly
it has a tonic effect for those whose vitality is able to endure the
shock. But cold baths for their tonic effect are desirable only when the
individual is assured of their lasting benefits. Nor must one judge of
the effects by the immediate results, inasmuch as the splendid feeling
which follows may be succeeded by a period of depression lasting the
rest of the day; in which case, the total effect of the cold bath is bad
rather than good. Baths for cleanliness are everywhere desirable, and
their frequency should depend upon the individual, his constitution,
habits, and work; upon the season and temperature; and on the
conveniences for bathing in the house. Baths for tonic effect are not
necessary, and if not a pleasure, may very properly be omitted.
One other point to be noted is that no practice is of more value in
reducing the ravages of contagious diseases than a frequent and
conscientious washing of one's hands. For germs are most certainly
transmitted from one person to another, and it is accomplished more
frequently by the hands than by any other part of the body.
The invitation, therefore, to a guest to wash his hands before dinner is
really an invitation for him to disinfect himself or to get rid of the
germs which he is carrying, in order that the host and his family may
not be infected during the meal. The guest owes it to his host always to
accept the invitation, whether he thinks he needs it or not. Doctors
recognize the necessity, and it is surprising to observe how many times
during the day a doctor washes his hands, even though he may not come in
contact with any particularly infectious disease. An ordinary man, on
the other hand, washes his hands only when he thinks they are dirty,
although his daily occupation may expose the skin of his hands to
infection many times worse than that which the doctor experiences.
_Mouth breathing._
Children have sometimes wondered why they were made with both mouths and
noses, since they could breathe equally with either, and many years
have gone by before they realized that breathing through the mouth was
not intended, but that the exclusive province of the nose was to furnish
air to the lungs. The reason for nose breathing rather than mouth
breathing is twofold. In the first place, no provision for removing or
filtering out germs from the air is made in the mouth, whereas in the
nose the crooked passages, the moist surfaces, and the hairlike growths
all tend to strain out any germs normally in the inspired air.
Further, breathing through the mouth has a tendency to induce
inflammation in the tonsils and in the air passage connecting with the
ear. This inflammation develops into those growths known as adenoids,
which, when enlarged sufficiently, close the nostril entirely and
prevent its normal use. A recent examination made by the New York Board
of Health of 150 school children, all in some way abnormal, showed that
137 had either adenoids or enlarged tonsils. Example after example could
be given of school boys and girls whose mental and moral development has
been markedly retarded because of mouth breathing. One need only look at
a child or adult who constantly keeps his or her mouth open to be
impressed by the listless, vacant, inert appearance of the face thus
disfigured. Figure 74 shows a photograph of a schoolgirl just before an
operation and the characteristic expression due to adenoids is plainly
marked. Earache is largely due to adenoids or to inflammation that
rapidly leads to adenoids, and Mr. William H. Allen, Secretary of the
Bureau of the New York Municipal Research, reports that in 415 villages
of New York State, 12 per cent of the children living there were found
to be mouth breathers. Whenever a child is unable to breathe through his
nose, is slow in talking, and then speaks with a stuffy accent, calls
"nose" "dose," has a narrow upper jaw, and is either deaf or has
inflamed eyes, it is practically certain that enlarged tonsils and a
well-developed growth of adenoids are present and should be removed. Not
merely do these growths interfere with the mental and physical
development of the child, but they also make him more susceptible to
contagious diseases, particularly those of the lungs and bronchial
tubes.
[Illustration: FIG. 74.--Schoolgirl with adenoids.]
The removal of adenoids is a simple operation, lasting not over a
minute, and the result of the operation is in some cases almost
miraculous. The medical inspectors of the New York City schools consider
the removal of adenoids as a most important part of their work, and
groups of children are regularly taken from the schools by the principal
to the clinic at the hospital, where one after another tonsils are cut
off or adenoids are removed, all fright and commotion being avoided by
the gift of five cents as a reward.
_Eyes._
Another evidence of advancing knowledge in matters pertaining to
sanitary hygiene is shown in the greater attention given to the eyes,
particularly of children. Such incidental troubles as headache,
sleeplessness, or biliousness are frequently due to weak or strained
eyes, and in the case of school children a great deal of the alleged
insubordination, backwardness, and truancy of the children is caused by
their being unable to see written instructions or explanations.
It is not likely that this increased difficulty with the eyes is a new
thing, but rather that both physicians and laymen are more careful as
well as more expert in diagnosing the trouble. The New York State Board
of Health in the fall of 1907 sent out cards for testing the eyes of
school children to 446 incorporated towns. The results of using these
cards in 415 schools were returned and showed clearly that nearly half
the children of school age in the state had optical defects. A similar
test in Massachusetts recently discovered 22 per cent of the school
children with defective vision, and this knowledge in itself is an
advance inasmuch as it suggests to each individual or to all parents
that deficient vision is common and that good eyesight is not a thing to
be assumed.
In the country it is more difficult, perhaps, to realize these
deficiencies, because the constant outdoor life acts as an offset to
the strain during the time when close work is required, and perhaps the
distance from a competent oculist serves to postpone the time of
consultation, but no greater folly can be indulged in than to suffer
inflamed eyes, persistent headache, and imperfect vision, if it is
possible in any way to secure the services of an oculist.
Never is it worth while to buy from a jeweler, a grocer, or a hardware
store a pair of spectacles, much less to buy them from an itinerant
peddler, since an oculist, with his particular apparatus, can measure
the seeing ability of each eye and fit each eye with the necessary lens
to restore normal vision. It is better to have no glasses than to have
glasses that are wrong.
_Teeth._
A curious result of the recent studies among school children with
defective eyes and ears has been the discovery that bad teeth were quite
as important in their relation to general health as either bad eyes or
ears. One eye specialist went so far as to say that the teeth of school
children should be attended to first, because thus many of the eye
troubles would disappear.
As has already been pointed out, the first, step in digestion is taken
in the mouth, and careful chewing is not less important than the other
parts of the digestive process. If one's teeth are not adapted to
chewing, if they are bunched, crowded, loose, or isolated, the
appearance of the teeth is the least objectionable feature. The real
importance comes from the fact that with such teeth perfect mastication
is impossible. The teeth themselves harbor germs which actually infect
the food and favor its putrefaction. With decayed teeth, infectious
diseases find a ready entrance to the lungs, nostrils, stomach, glands,
ears, nose, and membranes. At every act of swallowing, germs are carried
into the stomach. Mouth breathers cannot get one breath of
uncontaminated air, and dental clinics, organized and conducted in the
interests of the health of school children, have been altogether too
little inaugurated. The use of a toothbrush should be encouraged in
children as soon as they are four years old, and its habitual use twice
a day is most desirable for every one.
Only regular examination by the dentist can keep the teeth in good
condition, and periodic visits at least once a year to a dentist's
office, not to the kind advertised by Indians where they are willing to
extract teeth without pain, free, but where a regularly qualified
dentist practices, should be the habit. Armenian children, who prize and
covet beautiful teeth, are taught to clean their teeth always after
eating, if only an apple or a piece of bread between meals, and while
probably our American customs would hardly make this possible, there is
no question but that a persistent and frequent use of the toothbrush
will help much in reducing dentist bills.
_Sleep._
From many standpoints sleep is the most wonderful attribute of the human
body. Our familiarity, from our earliest years, with sleep, closes our
eyes to its strange, its awful power. We know that every human being,
once in twenty-four hours, will normally close his eyes and for a
certain length of time be as oblivious to things present as if already
in the sleep of death. It is a common belief that sleep is nature's
provision for restoring tired muscles and jaded nerves, and for building
up new tissue in cell and corpuscle. Excessive exertion produces a
numbness and exhaustion so that the body becomes "dead tired," and sleep
brings back life and elasticity. And yet some parts of the body, some
muscles and some organs, do not stop work during sleep, and apparently
feel no bad results for their continuous lifelong exertion. Thus, the
lungs, whose muscular action is estimated at the rate of one thirtieth
of a horse power, have no rest day or night, seemingly without
weariness. Similarly, the heart is continually forcing blood under a
pressure of about three pounds through the arteries without cessation
from birth to death.
Why do the muscles of the arm and leg tire and need sleep as a restorer,
while those of the heart and lungs are independent of sleep? Dr. W. H.
Thomson, in his book on "Brain and Personality," finds an answer to this
question in the fact that the latter do their work independently of the
human consciousness, while the former are stimulated and directed by the
will. He points out that fatigue comes in proportion to the intensity of
the mental effort expended. A baby, to whom everything is strange, whose
consciousness is absolutely zero at birth, however well developed his
body, sleeps five sixths of the time because of the mental efforts
needed in his simplest bodily acts. Brain work, the most absorbing task
of consciousness, is always the most compelling in the matter of sleep.
Not the muscles themselves but the attention, the skill, the mental
effort required to direct those muscles, Dr. Thomson says, constitute
the reason for sleep, a reason which, to those who labor only with their
hands, must seem unutterably sad. He says that while muscle work is the
commonest and the simplest, so it is also the most poorly paid and the
most degrading, and that while brain work is ennobling and the highest
type of labor, it is so difficult of attainment and produced only by
such grievous toil that most of us shirk it, even while reproaching
ourselves at our lack of capacity and purpose. The pathetic burden of
unfulfilled possibilities, he says, is the curse of labor, and only in
sleep does man have temporary oblivion through which, for a time, he
forgets his work and, as it were, uses sleep as an anaesthetic for the
pain of labor, to rise therefrom each morning ready to carry his burdens
for another day.
Lack of sleep, to those whose brains are active, speedily brings nervous
disaster, and the consciousness, from being the active superintendent of
the body, becomes inert, and the body drifts like a boat without a
pilot. Lack of sleep to those whose work is muscular means a numbness in
the nerve cells which guide those muscles, so that they disobey the will
or act unreasonably and without direction. But too much sleep, like
over-indulgence in any anaesthetic, is only shirking that duty and
avoiding that effort to which the higher life calls us, and the sluggard
who sleeps more than the tired nerves need is allowing himself to sink
deeper and deeper into a slough of despond. He forgets his toil in
sleep, but it is only by active, conscious effort when awake that his
work may be lifted to the higher plane where the brain is active, where
work ceases to be mechanical and a burden, and where that greatest
reward of personal satisfaction can be obtained.