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 AMERICAN MUSEUM OF NATURAL HISTORY 
 
 HANDBOOK OF HEALTH 
 IN WAR AND PEACE 
 
 A MANUAL OF PERSONAL 
 PREPAREDNESS 
 
 / 
 
 ISSUED AT THE 
 
 OPENING OF THE HEALTH AND FOOD EXHIBITION 
 
 OF THE 
 
 AMERICAN MUSEUM OF NATURAL HISTORY 
 MAY 23, 1917 
 
 PRICE 25 CENTS 
 
 HANDBOOK SERIES, NO. 6 
 
AMERICAN MUSEUM OF NATURAL HISTORY 
 
 HANDBOOK OF HEALTH 
 IN WAR AND PEACE 
 
 A MANUAL OF PERSONAL 
 PREPAREDNESS 
 
 BY 
 
 C-E. A. WINSLOW 
 
 WITH FOREWORD BT 
 
 HENRY FAIRFIELD OSBORN 
 
 PREPARED AND ISSUED BT 
 
 DEPARTMENTS OF PUBLIC HEALTH AND PUBLIC 
 EDUCATION OF THE AMERICAN MUSEUM 
 
 OF Natural History 
 NEW YORK, 1917 
 
PUBUO 
 
 HEALTH 
 LIBRARY 
 
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 C(i^ 
 
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 FOREWORD 
 
 There has never been a period in American history when 
 diffusion of knowledge of the laws of nature was a more im- 
 mediate and a more imperative duty than at the present 
 time. Hundreds of thousands of young men and young 
 women are ready to offer their services and, if need be, 
 their lives for their country and for the great principles of 
 loyalty, truth, justice, humanity and liberty for which our 
 President has enlisted us in this world war. But let not a 
 single life be lost needlessly. Let no constitution be broken 
 by disease through ignorance. The patriotic opportunity of 
 all men of science is to spread the truth, and to spread it as 
 quickly as possible. Let us speak plainly of all the dangers 
 and enemies which surround the soldier and the sailor, of 
 those that kill the soul as well as those which destroy the 
 body. The loss to the world of the finest strains of manhood 
 is the most awful curse of the many curses attending this 
 war. Every young man, if single, must think of his future 
 wife, of his future home, of his future children and so live 
 that, if his life is spared, he may some day give to his coun- 
 try one of the greatest gifts it is in a man's and woman's 
 power to give — healthy and patriotic offspring. It is a 
 scientific, no less than a religious principle, that to serve 
 one's country one must be sound in body, sound in mind, 
 and sound in spirit. 
 
 In opening a food and health exposition, the American 
 Museum is in cooperation with the Council of National 
 Defence and especially wdth its Medical Board, also viith 
 the National Food Commission under Herbert C. Hoover. 
 
 Henry Fairfield Osborn, 
 
 President. 
 
 3 
 
 3G135S 
 
T 
 
HEALTH AS A NATIONAL DUTY 
 
 War is no longer a conflict of armies but a struggle be- 
 tween nations. Behind the gallant bat- ^^^^ -ppcnnnci 
 talions in the field there must be other 
 
 battalions in the munition factories and on „ . i r ' ' 
 the farms whose devotion is equally essen- 
 tial to national victory. Success demands the coordinated 
 individual efficiency of the whole people; and individual 
 efficiency rests upon health. 
 
 As the United States enters upon a great war for liberty, 
 for justice and for humanity, there arises in all of us a new 
 sense of common responsibility, a new determination to 
 reach the highest level of effectiveness. There is no place 
 any more for carelessness, for meddling, for self-indulgence. 
 There is no place for preventable disease. 
 
 Health is to-day, as never before, a national duty — 
 health not merely in the sense of freedom xr ifv, a 
 from acute sickness, but in the sense of full p_ . 
 abounding vigor and vitality and power. 
 The maintenance of such vigor and vitality depends on 
 simple principles of hygiene and sanitation. It has been 
 truly said that "within natural limitations, a community 
 can determine its own death rate." It is equally true that 
 "within natural limitations, an individual can determine his 
 own physical efficiency." 
 
 It is in the belief that thousands of men and women in 
 training camps and in munition factories, on farms and in 
 homes, are determined in this hour of trial to give their best 
 to their country that this Handbook of Health and Efficiency 
 has been prepared by the Ariierican Museum of Natural 
 History and dedicated to an awakened and a reborn America. 
 5 ^ 
 
; :•■ : ;■ . .FUEL FOR THE LIVING MACHINE 
 
 The food is the fuel which runs our hving machine, just 
 . as truly as coal is fuel for an engine. Ex- 
 periments in physiological laboratories have 
 shown that in a man, as in any other well-made machine, 
 you get out an amount of work and heat that corresponds 
 directly to the amount of fuel put in. 
 
 Our first food need, then, is for a sufficient supply of 
 energy. Food energy is measured in calories, one calorie 
 being the amount of heat energy necessary to raise the 
 temperature of one kilogram (about two pints) of water 
 one degree on the centigrade thermometer. Three large 
 lumps of sugar, one large banana, one very large egg, one 
 chop, two thin slices of bread, two apples, one pat of butter, 
 two-thirds of a glass of milk — each of these food portions 
 contains about 100 calories. The average adult needs about 
 2,500 calories a day if leading a sedentary life, 3,000 calories 
 if engaged in active physical work. 
 
 The individual soldier has his dietary needs cared for by 
 those in authority. For the civil population and for the 
 nation as a whole, however, the question of the food supply 
 is a vital one in war time, and particularly at the present 
 moment when the food supplies of Europe are exhausted and 
 the whole allied world depends on America to preserve it 
 from starvation. 
 
 The attainment of proper national dietary standards de- 
 
 . .. pends partly on the available food supply 
 
 Economy in the ^^^ ^^^^^^ ^^ ^^^ intelligent selection and 
 
 Selection of ^^^ ^^ ^^^^^ r^,^^ ^^^^ ^^ ^^^ calories in 
 
 ® ^^ different forms varies enormously; and by 
 
 learning to make an intelligent selection every individual 
 purchaser and eveiy individual householder can help in the 
 great task of food conservation. 
 
 The following table, from "The Fundamental Basis of Nu- 
 trition," by Graham Lusk, shows the cost of 1,000 calories in 
 6 
 
the foi-m of various staple foods. The actual prices would 
 be higher now than in 1913, but the figures are significant 
 of more or less constant relative differences. The economy 
 in such foods as cornmeal, wheat flour, beans and pork as 
 compared with mutton, beef and codfish is worthy of special 
 note. 
 
 Cost in Cents of 1,000 Calories 
 
 (Lusk) 
 
 Glucose 134 Butter 10 
 
 Cornmeal 2 Milk 10 
 
 T\Tieat flour 2}4 Smoked ham lO^^ 
 
 Oatmeal 24/5 Cheese 11% 
 
 Cane sugar 33^ Loin pork 123^ 
 
 Dried beans 4 Mutton (leg) 16^^ 
 
 Salt pork (fat) 43^ Salt cod 193^ 
 
 Rice 5 Sirloin beef 24 
 
 Wheat bread 5}4 Turkey 40 
 
 Oleomargarin 73^ Codfish steak (fresh) . . .42 
 
 Potatoes 73^ 
 
 The supply of a suSicient calorie allowance is, of course, 
 
 only a part of the problem. The body not _ , u -u- 
 
 1 ^ r -^ r J u / 1 Body-buildmg 
 
 only gets energy from its food but also _ "l 
 
 builds up out of the foods its own substance 
 which is constantly being consumed as a result of the life 
 process. Muscle and bram and all the other tissues of the 
 body are wasting away minute by minute and second by 
 second, and the waste must be made good from the sub- 
 stances in the food. Some of the elements in living tissue 
 are present in almost all food substances and are sure to be 
 supplied in sufficient amounts in any diet which will furnish 
 2,500-3,000 calories of energy. Other building stones of the 
 body are found only in certain foodstuffs. 
 
 The most important of these building stones are found in 
 the nitrogen-containing foodstuffs known as proteins, of which 
 7 
 
white of egg and lean meat are examples. So important are 
 these substances that many authorities have divided foods 
 into two main groups. 
 
 (1) Body-builders and repairers. (Protein, chiefly con- 
 tained in meat, eggs, milk, peas, beans, kernels, grain, etc.) 
 
 (2) Energy-producers, yielding heat and work. (Fats, 
 and oils [hydrocarbons] with sugar and starch [carbohj^- 
 drates].) 
 
 A definite proportion of protein food (10-15 per cent.) is 
 an absolute essential of the diet, and people who fail to get 
 a sufficient amount of such food quickly show the result in 
 diminished vigor. Pellagra, a serious disease which occurs 
 particularly among the poor population of our southern 
 states, is closely connected with a diet poor in protein, and 
 can be cured by the substitution of one rich in meat, eggs and 
 milk. 
 
 The table below, showing the classification of certain com- 
 mon foodstuffs according to their richness in proteins and 
 fats, is taken from the excellent handbook on "How to Live," 
 by Prof. Irving Fisher and Dr. E. L. Fisk. Foods low in 
 both proteins and fats are composed chiefly of carbohy- 
 drates (sugar and starches). 
 
 Common Foods Classified 
 
 
 Poor in Fat 
 
 Rich in Fat 
 
 
 White of eggs 
 
 
 Very high 
 
 Codfish 
 
 
 in 
 
 Lean beef 
 
 
 Protein 
 
 Chicken 
 Veal 
 
 
 
 Shellfish 
 
 Most fish 
 
 High in 
 
 Skim milk 
 
 Most meats 
 
 Protein 
 
 Lentils 
 
 Most fowl 
 
 
 Peas 
 
 Whole egg 
 
 
 Beans 
 
 Cheese 
 

 Poor in Fat Rich in Fat 
 
 Very Rich 
 in Fat 
 
 Moderate 
 
 Most vegetables Peanuts 
 
 Fat meats 
 
 or 
 
 Bread Milk 
 
 Yolk of eggs 
 
 Deficient 
 
 Potatoes Cream soups 
 
 Most nuts 
 
 in 
 
 Fruits Most pics 
 
 Cream 
 
 Protein 
 
 Sugar Doughnuts 
 
 Butter 
 
 Mineral 
 
 salts, such as lime, iron, etc., are 
 
 also essential to 
 
 the body and there are peculiar substances 
 
 Importance of 
 
 ^ailC^ Vl^a.XX.lX10 y^^^^.^V XXX V^..C*X.X .WV.^0, y^g^y 
 
 such as fruits, unpolished rice, etc., which . „ , 
 are necessary for its normal development. 
 The disease beri-beri among the Philippine scouts was due 
 to the lack of such substances in a diet made up largely of 
 polished rice, and was cured by a change in diet. As wide 
 a variety of foods as possible should be included in the diet, 
 and fads as to the avoidance of certain foodstuffs frowned 
 upon. A certain proportion of hard, bulky and indigestible 
 foods, such as crusts, fibrous vegetables and nuts, is essen- 
 tial to the proper working of the bowels. Ample protein, 
 salts and vitamins will be secured by the normal instincts 
 if unhampered by economic limitations, so that the whole 
 question comes down to one of costs. Professor Lusk esti- 
 mates that the average cost of a group of staple articles has 
 increased from 11 cents in 1916 to 18 cents in 1917 for an 
 amount that would supply 2,500 calories. To help meet 
 the problem of this increased cost of living he has prepared 
 the following low-cost meatless dietary of high caloric value, 
 designed for a family of five persons, the father at work 
 and the mother doing household work. Potatoes, with 
 their valuable alkaline salts, had to be excluded from the 
 diet because of their prohibitive price. The cost amounted 
 to SI. 16 daily for 14,400 calories, or eight cents per thousand 
 calories, which is not a high price: 
 
 9 
 
Low-Cost Meatless Dietary of High Efficiency Value 
 
 FOR a Family of Five Persons, Father at Work 
 
 AND Mother doing Household Work 
 
 Essentials. — Do not buy meat until you have bought 
 three quarts of milk a day. Milk contains valuable tissue- 
 building food, valuable salts and invaluable vitamins which 
 help toward sound health. 
 
 If you buy bread remember that day-old bread is much 
 cheaper than freshly baked bread and is just as good a food. 
 
 The menus may be arranged as follows: 
 
 BREAKFAST 
 
 Cornmeal mush, fried (+milk for children and corn syrup for 
 adults), or oatmeal, or hominy, or farina, or buckwheat 
 cakes. 
 
 Bread (or toast) . 
 
 Oleomargarin. 
 
 Coffee (adults). 
 
 Stewed prunes. 
 
 Orange juice for baby. 
 
 LUNCHEON OR SUPPER 
 
 Pork and beans (bean soup for young children), or creamed 
 
 dried beef on toast. 
 Bread. 
 
 Oleomargarin. 
 
 Tea with milk and sugar, for adults. 
 Milk for youngest children. 
 Cereal, coffee or cocoa for older children. 
 Sliced bananas with sugar, or stewed dried peaches. (The 
 
 bananas may be boiled in their skins.) 
 
 DINNER 
 
 Lentil soup (or potato, or bean, or pea soup). 
 Boiled rice (or spaghetti, or macaroni with cheese, or 
 baked split peas with bacon). 
 10 
 
Tomato catsup. 
 
 Bread. 
 
 Oleomargarin. 
 
 Tea for adults. 
 
 Milk for youngest child. 
 
 Dried-apple pie with cheese, for adults. 
 
 Dried-apple sauce for others. 
 
 The Approximate Cost per Day and the Nutritive 
 Values in Calories Appear Below 
 
 Cost in 
 Amount Calories Cents 
 
 Coffee 23/3 ounces .... 3 
 
 Tea Y2 ounce 2 
 
 Milk 3 quarts 1,800 27 
 
 Bread 2 pounds 2,500 9 
 
 Cereal Yi pound 800 4 
 
 Oleomargarin % pound 2,500 19 
 
 Corn syrup Y^ pound 650 2 
 
 Sugar Y pound 450 2 
 
 Rice or macaroni 1 pound 1,600 8 
 
 Dry navy beans 10 ounces 1,000 7 
 
 Fat pork 6 J^ ounces 1,000 6 
 
 Dr}^ fruit (prunes) 1 pound 325 12 
 
 Flour, lard, etc., for pie or 
 
 other extras 1,800 15 
 
 14,425 116 
 
 As cheaper meats, pork sausages, braised chuck rib of 
 beef, salt cod or herring may be added if finances allow. 
 
 The amount and hence the cost of food available for the 
 
 poor depend directly on the amount wasted _. , 
 
 by the well-to-do; and it is the duty of _, , , 
 
 A • / • • ^^\- Rule for 
 
 everv American to give serious attention „ 
 
 ^ ". ^. » T ^ ^ • • Economy in 
 
 to this question. A diet containing a sur- -. 
 
 plus of meat, fish and eggs is not only 
 
 wasteful but positively harmful, since proteins in excess 
 
 11 
 
decompose in the intestines and poison the body. An ex- 
 cellent general rule in this connection has been suggested 
 by Prof. H. C. Sherman, who advises that the average 
 family should spend as much for fruits, vegetables and milk 
 as for meat, fish and eggs, and as much for vegetables and 
 fruits as for milk and eggs. 
 
 Wastage in purchasing and preparation of foods is another 
 
 StontheW t ii^^PO'^tant cause of dietary deficiency. The 
 
 r-p , following suggestions indicate some of the 
 
 special ways in which the housewife can 
 
 economize. 
 
 Go to the store yourself and select the food, with a view 
 to quality and cost. Be sure you get full weight and take 
 home for soup or stew all bones and trimmings. 
 
 Buy the cheaper cuts of meat. They are in many cases 
 more nourishing than the more costly ones, and can be made 
 tender by proper cooking and seasoning. The cheaper cuts 
 of meats cost only one-half as much as the round and sirloin. 
 
 Buy in quantity if possible. 
 
 Use fish instead of meat as much as possible. 
 
 Milk, cheese and beans are cheaper than meat and con- 
 tain all necessary nutrients. 
 
 Use a fireless cooker, which saves time, fuel and food value. 
 
 Buy fruits and vegetables only when in season. 
 
 Buy foods in bulk, not in packages. 
 
 Omit luxuries and foods of low-energy value. 
 
 Save left-overs. 
 
 PURE FOODS AND CLEAN FOODS 
 
 In war time we should welcome the introduction of cheap 
 
 y . - food substitutes or the marketing of second- 
 
 o J >-> J grade foods if they are really valuable and 
 
 Second-Grade ?, ^, ,/ u r^ u ^ 
 
 p , if they are sold as such. Cold-storage 
 
 products are usually not as palatable as 
 
 fresh meats; but cold storage has vastly increased the food 
 
 12 
 
resources of the world by conserving the excess of one season 
 and one locality for use at other times and places. Skim 
 milk is a highly valuable food material which should be sold 
 freely if properly labeled. There are butter substitutes on 
 the market which are as valuable for food as real butter 
 and cost but half as much. 
 
 The purity in foods is mainly a question p 'tv A 
 
 of honesty. Clean food, on the other hand, _. .. 
 
 is a vital essential of health. 
 
 Polluted water in the past has been a common cause of 
 
 disease both in the camp and in civil life. _ , 
 
 All surface water supplies, lakes and streams t, „ , , „, . 
 
 ,. ,, ^ iw- r t PoUuted Water 
 
 are liable to pollution from sewers or from 
 
 material washed in from the banks, and wells and springs 
 may be polluted through crevices in the soil. No water 
 should ever be drunk if there is any uncertainty as to its 
 quality. The water for troops in the field should be purified 
 by filtration or disinfection, and it is one of the first duties 
 of the soldier to avoid the use of any unauthorized supplies. 
 Water of doubtful quality may be made safe by boiling or 
 by the addition of chloride of lime. Dissolve a teaspoonful 
 of chloride of lime in four pints of water and add one teaspoon- 
 ful of this solution to a gallon of the water to be purified 
 (one tablespoonful to four gallons, ten tablespoonfuls 
 to a barrel). The water should stand for half an hour 
 before use. 
 
 Milk is another food which often carries the germs of 
 disease, germs of tuberculosis from the cow, _^ , 
 
 or gei-ms of typhoid fever, sore throat, Twr-iif 
 diphtheria, etc., from human beings who 
 have handled it. Milk should always be pasteurized or 
 heated to 140°- 145° F. for 20 to 30 minutes before it is used, 
 and on no account should uncooked cow's milk be given to 
 young children. 
 
 The best way to pasteurize milk in the home is to set the 
 bottles in a deep pan of water on the stove, put a milk 
 13 
 
thermometer into the water, heat to about 145° F. or 
 a little over, - and then set the pan on 
 . the back of the stove, moving it back and 
 
 forth now and then to keep the tempera- 
 ture, for half an hour, as near 145° as 
 possible, say between 140° and 145°. If no milk thermometer 
 is at hand it will be almost as well to heat the pan till 
 the water boils and then let it stand on the back of the 
 stove for half an hour, although this may give the milk a 
 slight cooked taste. . 
 
 Foods of all sorts should be carefully protected from dust 
 
 _^, „ , and fhes, which may carry disease germs, 
 
 Other Safe- , - r, jr Ti. • • 
 
 , , and from unnecessary handlmg. It is im- 
 
 °; portant that foods should not be handled 
 
 by those who are "coming down" with any 
 
 communicable disease; and foods to be eaten raw should be 
 
 purchased only from careful and responsible dealers. The 
 
 greatest care should be taken to avoid tainted meats and to 
 
 keep perishable foods from spoiling. 
 
 EXERCISE AND REST 
 
 The heart, the lungs, the blood vessels, the bowels de- 
 generate if they are not given their proper 
 Value of work to do, and on the other hand they 
 
 Exercise suffer if too heavj^ a burden is placed upon 
 
 them. 
 
 The muscles make up more than one-half the total weight 
 of the human body, and their proper use is essential, not 
 only for their own gro\\i;h but on account of the inter- 
 relation between the health of the muscles and that of the 
 rest of the organs. Vigorous physical exercise not onlj' de- 
 velops the muscles themselves, it stimulates the heart and 
 the blood vessels, it deepens the breathing, it keeps up the 
 tone of the digestive system, it frees the tissues from the 
 accumulation of harmful waste products. 
 14 
 
The physique of the recruit is systematically developed 
 by setting-up exercises, marching, rifle and Avoidance of 
 sabre exercises, applied gymnastics, swim- Overstrain 
 ming and athletic games. It is overstrain 
 which the soldier must avoid, and "soldier's heart" has been 
 a common complaint in Europe during the present war. 
 Exercises should be varied so as not to overtax any one 
 group of muscles and they should never be carried to the 
 point of exhaustion. Breathlessness is a valuable danger 
 signal of overload of the heart. 
 
 It is not hard work that kills. It is prolonged strain at 
 dull tasks without variety, on the one hand, ^ tad 
 
 worry and excitement on the other. With p,_, . 
 
 a proper variety of work it is marvellous 
 what the human mind and hand can accomplish, but they 
 cannot endure too long a pull without interruption. The 
 operatives in the Zeiss Optical Works at Jena actually did 
 more work in an eight-hour day than in one of nine hours. 
 They could keep fresh and vigorous for the shorter period, 
 while they began the nine-hour day in poor condition be- 
 cause imperfectly rested from the day before. 
 
 The studies made in the English munition factories dur- 
 ing the present war have shown clearly that a limitation of 
 hours of labor may often lead to such an increase in pro- 
 duction; and this is a lesson we must bear in mind in this 
 country in the present crisis. 
 
 The first rule of the hygiene of rest, then, is to avoid so 
 far as possible overstrain due to prolonged ^ , 
 
 work of a similar kind. People vary a Restine 
 
 good deal in their rest needs. Some men 
 are rested by a change of work, some by active play and 
 some by complete rest. Nothing, however, can take the 
 place of necessary sleep, and the average individual needs 
 about eight hours of sleep out of the twenty-four. No one 
 can work hard all day and play half the night. Nervous- 
 ness and irritability are danger signals. They mean that 
 15 
 
the strength is being overtaxed and that some change in 
 habits should be made. 
 
 Cultivation of mental poise is a great help in conserving 
 vital force. Worry is as bad as monotony and a fit of anger 
 poisons the whole system and is more exhausting than a 
 hard day's work. 
 
 POSTURE AND RESPIRATION 
 
 Standing still properly is one good form of exercise. 
 _ Posture depends on the muscles which con- 
 
 _ , trol the position of different parts of this 
 
 _ . framework. With the same equipment of 
 
 bones, one body may be stoop-shouldered 
 and slouching and another may be erect and well-knit. 
 One of the most immediate good results of military training 
 is correct posture, which involves the exercise of all the 
 hundreds of muscles which help to hold the body well. 
 
 The backbone, as we have seen, is meant to be slightly 
 
 _ ., , „ , cm-ved, so as to give elasticity. In people 
 Evils of Bad , ,' ^ ■. . ^ 1 • u^ \i. 
 
 who do not sit or stand straight, these 
 
 curves become greatly exaggerated, leading 
 
 to round shoulders and a drooping head. Such bad posture 
 
 is not only ungraceful but unhealthy. If the back and 
 
 shoulders and abdominal wall are not held properly the 
 
 lungs do not get sufficient aeration and the internal organs 
 
 are crowded together and their blood supply hampered. 
 
 Many and grave disorders are traced to faulty posture and 
 
 are cured by improving it. 
 
 When standing correctly, the head, body and legs should 
 
 he poised one above the other so that a 
 
 line dropped from the front of the ear falls 
 
 within the forward half of the foot. "This 
 
 is the position of the long-distance walker, the mountain 
 
 climber, the best all-round athletes; it is the position of 
 
 command and authority, and is found predominant in the 
 
 16 
 
great leaders of commerce and public life. On the other 
 hand, collapsed positions are characteristic of both physical 
 and mental weakness. They constitute a distinct aspect 
 of weakness and illness, from the tuberculosis patient to 
 the feeble-minded." * 
 
 In sitting, the body should be bent only at knees and 
 hips, and the head, neck, and trunk should be kept in one 
 straight line. 
 
 Another important element in hygiene is the exercise of 
 the organs of breathing. In ordinary breath- _ 
 
 ing only about ten per cent, of the lung _ ^. . 
 
 contents is changed at each breath, and the 
 remoter air sacs of the lungs which are not properly exer- 
 cised are peculiarly liable to disease. The high mortality 
 from tuberculosis among clerks, bookkeepers, telegraphers 
 and other indoor workers whose tasks require or invite a 
 stooping posture are examples of such harmful effects. 
 "A hundred deep breaths a day" is one physician's recipe 
 for tuberculosis, according to Fisher and Fisk. Deep 
 breathing should be slow and not forced. 
 
 FRESH AIR 
 
 Variations in the chemical composition of the air are of 
 
 little practical moment, except for the pres- „„ ^^ , * • 
 e c J J ^ J Why Bad Air 
 
 ence of poisonous fumes and dust under - ^t r^ i 
 
 special industrial conditions. Even in the 
 worst ventilated room the proportions of carbon dioxid and 
 oxygen never change sufficiently to produce harmful physi- 
 ological effects. The discomfort and injury to health that 
 come from living in badly ventilated rooms are due not 
 primarily to any chemical changes but to the rise in tem- 
 perature that obtains under such conditions. 
 
 This does not mean that fresh air is unimportant, but 
 quite the contrary. A badly ventilated room is generally 
 * Jessie H. Bancroft, in The Teaching of Hygiene. 
 17 
 
an overheated room. In such a room the blood vessels 
 
 _„ ^ , of the skin are dilated, the body tempera- 
 
 Effects of ^ • XI, 1 • XI vTi J 
 
 ^ , . ture rises, the pulse mcreases, the blood 
 
 pressure falls. The brain and inner organs 
 are robbed of blood. One feels dull and hstless and disin- 
 clined to exertion. The New York State Commission on 
 ventilation showed that when there was a powerful incentive 
 exertion was possible for short periods at high temperatures, 
 but that under ordinary conditions 6 per cent, more work 
 was done at 68° than at 75° and 15 per cent, more than at 
 86°. Prof. Ellsworth Huntington, from exhaustive studies 
 of the effect of season and climate upon physical and mental 
 work, finds a mean outdoor temperature of 60°-64° most 
 favorable for efficiency, summer and winter both showing a 
 marked falling off as compared with fall and spring. It 
 cannot be doubted that the excessive temperatures main- 
 tained in many factories (often combined with high humid- 
 ities, which accentuate the effect by checking evaporation 
 of perspiration) militate very seriously against industrial 
 efficiency. In militaiy life the important influence of climate 
 upon bodily vigor should be borne constantly in mind in 
 the selection of training camps. 
 
 The avoidance of gross overheating (temperatures above 
 68°) is not the only factor to be considered. 
 ^ The body must be protected against the 
 
 debilitating effect of heat on the one hand 
 and against the shock of excessive chilling on the other. 
 Within reasonable limits, however, variations in tempera- 
 ture, and particularly movement of the air, are important 
 factors in promoting health. The body owes its marvellous 
 power of maintaining its own temperature constant through 
 a wide range of outside temperatures to the reaction of the 
 skin blood vessels, which contract to keep the blood out of 
 the skin when it is cold and expand and bring the blood to 
 the surface when a more rapid heat loss is desired. The 
 tiny muscles in the walls of these blood vessels must be ex- 
 18 
 
erciscd like any other muscles if they are to be kept in. good 
 condition. In a person who Uves habitually in an even 
 high temperature the blood vessels do not respond readily 
 to sudden change. In such people, the mucous membranes 
 of the nose are constantly congested (filled with blood and 
 lymph) as the blood vessels dilate to keep the body at the 
 proper temperature. As a consequence, these membranes, 
 instead of shrinking and diying promptly as they should 
 when they come in contact mth cold outer air, lose their 
 quickness of response and stay moist and swollen even after 
 the blood vessels themselves have contracted; this makes 
 them an excellent breeding place for bacteria. People who 
 have been weakened in this way are very sensitive to the 
 cold air and are easily subject to chills. Benjamin Franklin 
 once said, "People who live in the forest, in open barns, or 
 with open windows, do not catch cold, and the disease called 
 a cold is generally caused by impure air, lack of exercise, 
 or from overeating." Science has amply confirmed these 
 observations of our great natural philosopher. 
 
 Fresh air, then, means air that is not too hot, or too cold, 
 or too even in temperature, — air that is _.., ^ , 
 pleasantly cool and in moderate motion. .. . 
 If the thermometer reaches 70° (except in the 
 case of elderly people, who may require a higher tempera- 
 ture) it is a sign that the window should be opened. It is 
 particularly important to have plenty of fresh air in the 
 sleeping room and windows should be kept well opened at 
 night even in cold weather. 
 
 HYGIENE OF CLOTHING AND BATHING 
 
 The clothing should protect against extremes of cold, and 
 this is particularly necessary after exercise n rt* f 
 when the skin blood vessels are dilated and j' p, .t^. 
 the body bathed in perspiration. Woolen 
 clothes may be desirable under such conditions because 
 19 
 
wool being porous is a poor conductor of heat and also be- 
 cause it takes up moisture readily and so absorbs and holds 
 the perspiration. 
 
 Cotton, and particularly linen, are rapid conductors of 
 heat and do not absorb moisture, so that 
 they are more suitable for wann weather. 
 It is quite as undesirable to wear clothes 
 that are too warm as to expose the body to undue chill. If 
 the skin cannot get rid of its heat fast enough as a result 
 of too heavy clothing the dull and sleepy feeling associated 
 with "bad air" results. The habit of wearing too many 
 clothes weakens the power of the system to respond quickly 
 to changes in temperature, and renders one susceptible to 
 colds. Most people wear too heavy underclothing in winter. 
 Cotton or linen underwear is generally better than woolen; 
 and up to the age of fifty or even sixty years it is wiser to 
 wear underclothing of the same weight both winter and 
 summer, relying on an overcoat for warmth when out of 
 doors and not exercising. 
 
 The first object of bathing is to wash off the dirt and soot 
 
 , which soil the body and to remove the waste 
 
 ^ ,^ „ ,, . materials deposited on the skin by per- 
 
 Cold Bathing . ^. „^ , ., . • j. 
 
 spiration. Warm or tepid water is most 
 
 effective for cleaning the hands or body. Bathing in warm 
 water increases the size of the blood vessels in the skin and 
 draws the blood away from the brain, making one feel com- 
 fortably sleepy. This is the reason why a warm bath is 
 usually taken at bedtime. After every hot bath cold 
 water should be applied to the entire body. A cold bath, 
 on the other hand, contracts the skin blood vessels and 
 drives the blood to the internal organs and the brain, mak- 
 ing one feel alert and keen. Cold bathing is a powerful 
 tonic to the skin, since it trains these blood vessels to re- 
 spond quickly to changes in temperature. People who take 
 cold baths regularly are likely to be hardy and little subject 
 to colds. 
 
 20 
 
In the matter of bathing, however, we must again re- 
 member that the body should be stimulated a '^ * 
 by cold water, but not chilled too severely. _, 
 A cold bath should be followed by a re- 
 action ; that is, the surface blood vessels should enlarge again, 
 so that the skin becomes warm and glowing. Brisk rubbing 
 with a rough towel helps to secure this reaction. If no re- 
 action follows, or if one feels tired after bathing, the bath was 
 too cold or too prolonged, or the body is not strong enough 
 to endure the shock. In such cases cold baths may do 
 serious harm. 
 
 No bath of any kind should be taken within an hour after 
 eating. The blood is needed in the intestines for the process 
 of digestion, and it is harmful to disturb the circulation, as 
 any bath must do at such a time. 
 
 The cleanliness of underclothing is of specially vital im- 
 portance to the soldier. The suppuration ^ , 
 of wounds is frequently due to germs _, 
 coming from dirty clothing, and the terrible 
 disease "trench-foot," which has afflicted the French troops 
 in the present war, has been shown to be due to neglect in 
 this regard. Molds from damp and dirty socks get into cuts 
 and cracks in the foot, stop up blood and lymph vessels, 
 and gangrene follows in the tissues thus deprived of the 
 protective action of the body fluids. 
 
 Shoes of proper shape and material are also primary mili- 
 tary essentials. Colonel Keefer says, "No Th vf ' ' 
 one article of the soldier's clothing plays so „, 
 large a part in his efficiency as the shoe." 
 
 As the result of an exhaustive study made by a special 
 army board created to study this subject, the problem of 
 army shoes has been satisfactorily solved. The civilian, 
 however, still often suffers from improper footgear. The 
 deformity known as flat foot, often accompanied by pains 
 reaching far up the back, may be caused by the resulting 
 strains. A hj-gienic shoe should be everywhere as wide 
 21 
 
as the sole of the foot, and wide enough in front to permit the 
 toes to move freely. The inner edge of the shoe should be 
 straight, so that a line drawn back from the middle of the 
 great toe touches the heel. The heels should be low and 
 broad. The sole and uppers should be flexible, so that the 
 foot may be bent freely at the point where the toes join the 
 instep. A high shoe should not be so tighth' laced at the 
 top as to interfere with circulation. A porous shoe, like one 
 made of russet leather, is much better than an enamel or 
 patent-leather shoe, because it allows the escape of moisture 
 and prevents overheating of the foot. 
 
 CARE OF THE TEETH AND BOWELS 
 
 Many obscure maladies of the joints, the heart and the 
 kidneys are traced to bacterial infections arising from de- 
 cayed teeth, and the care of these strong but delicate struc- 
 tures is a primary essential of personal hygiene. 
 
 The enamel is the natural protection of the teeth, and it 
 
 _, _ f i^ very important that it should not be in- 
 
 , _, , jured by cracking hard nuts with the teeth 
 
 or picking the teeth with hard objects which 
 
 might splinter them. 
 
 On the other hand, thorough chewing of the food, and 
 particularly of fairly hard foods like crusty bread, helps to 
 polish the surfaces of the teeth and to prevent deposits on 
 them. The coarse food which savage people eat helps to 
 keep their teeth in good condition, but since civilized man 
 eats few hard foods, especial care is necessary to prevent 
 tooth decay and keep the mouth healthy. 
 
 The most important help in keeping the teeth in good 
 Th T tVi condition is, of course, the toothbrush. It 
 
 , , J has been said that in an army the soldier's 
 
 J ^j toothbrush should be inspected every morn- 
 
 ing as systematicall}'' as his gun. The teeth 
 should be brushed regularly night and morning at least. 
 22 
 
It is well to brush them after each meal, because the sooner 
 deposits of food are removed, the better. Once a day a good 
 tooth powder may be used to aid in cleaning the teeth. For 
 soldiers in the field, where no tooth powder is available, wood 
 ashes or wood charcoal has been recommended. 
 
 The toothbrush should not be too large, and the bristles 
 should be of medium hardness and so shaped that they will 
 get between the teeth. Both sides and the top of the teeth 
 should be thoroughly brushed. It is much better to brush 
 do^Ti or up from the gums to the cutting edge than side- 
 ways across the teeth, because when the brush passes side- 
 ways the bristles do not get in between the teeth. The most 
 effective method is to place the bristles of the brush firmly 
 against the teeth, apply pressure as if trying to force the 
 bristles between the teeth, and then give the brush a rotary 
 or scrubbing motion. Care should be taken to go over 
 both the back and the front of the cutting teeth in both 
 jaws, as well as the flat crowns of the grinding teeth. The 
 gums above and below the teeth and the surface of the 
 tongue should also be cleaned. 
 
 When the brushing is finished, lukewami water should 
 
 be taken into the mouth and forced between tn ^ -i r ^y. 
 
 and around the teeth several times by «, ^, o^ ., x 
 » ^, ,. , , , ^ ^ Tooth Toilet 
 
 means of the lips, cheeks, and tongue. 
 
 This is as important as the proper use of the toothbrush 
 
 itself. The tooth toilet should take from three to five 
 
 minutes. 
 
 Even the best use of the toothbrush will not always keep 
 the spaces between the teeth entirely clean. If food par- 
 ticles collect in these spaces, a bit of dental floss may be 
 passed up and down between the teeth, care being taken not 
 to injure the delicate gums. 
 
 With all precautions tooth decay is likely to begin in 
 places; and the teeth should be regularly examined by a 
 competent dentist twice a year to detect such troubles in 
 time. 
 
 23 
 
Another common cause of obscure ailments, headache, 
 
 „ X A -J dullness and feeling of oppression is decom- 
 How to Avoid ... f r J , • .1 • , . • 
 
 p . . position of food wastes in the intestines. 
 
 If the bowels are not emptied regularlj^ 
 bacteria form poisonous products of decay, which are ab- 
 sorbed along with the food and produce far-reaching 
 harmful effects. 
 
 It is important to form the habit of cleaning out the in- 
 testines regularly at least once a day and perhaps oftener, 
 so as to keep the intestinal tube clean. If this does not 
 happen naturally, the remedy should be found, not in medi- 
 cines, but in drinking plenty of water and eating more fruit, 
 green vegetables, and coarse foods, or in more exercise, sleep 
 and fresh air. 
 
 Too frequent loose movements of the bowels (diarrhea) 
 are often due to the growth of special kinds of 
 harmful microbes in the digestive tract. The 
 best remedy is cut down the food, particularly meats and 
 eggs, and to take a dose of castor oil or some other medicine 
 which will help the body to get rid of both microbes and 
 poisons. If the trouble continues, a doctor should be 
 consulted. 
 
 AVOIDANCE OF DRUGS AND STIMULANTS 
 
 Among the influences which work to deprive the body 
 
 of its maximum efficiency, none is more 
 
 _j f T\ important than certain dangerous drugs, 
 
 among which alcohol is the chief offender. 
 
 Alcohol, like many other drugs, acts chiefly on the nervous 
 
 system; it does not serve to make any part of the nervous 
 
 system work more readily, but numbs or puts to sleep certain 
 
 parts of it. It acts first of all on the inhibitions, with the 
 
 result that some of the nerve actions which would ordinarily 
 
 be inhibited or held in check are allowed to go on more freely. 
 
 This seems like a stimulation or increase of power, but it is 
 
 24 
 
really only a breakdown of the system of control. The situ- 
 ation is somewhat similar to the ease of a runaway hoi-se. 
 The horse is no stronger, but is much more dangerous, 
 when it is running away than when it is held firmly by the 
 reins in the hands of a skilled driver. 
 A long series of experiments, of which the most recent 
 
 have been carried out by Prof. F. G. Bene- ai<,^i,^i ««/i 
 , ^ • TV' , •,• T 7 J Alconol and 
 
 diet, m the Carnegie JSl utrition Laboratory, Efficiency 
 have made it abundantly clear that even 
 very moderate doses of alcohol tend seriously to interfere 
 with the working of the nervous machinery of the body and 
 to make its reactions slow and clumsy. Of eleven different 
 tests of efficiency made by Professor Benedict, all but two 
 showed a decrease in quickness or accuracy of from 3 to 46 per 
 cent, in the persons who had taken alcohol. The relation of 
 the use of alcoholic liquors to industrial accidents is well rec- 
 ognized; and the attitude of public sendee corporations and 
 other large employers of labor toward alcohol offers eloquent 
 testimony to its harmful influence. No one who has ever 
 been a steady user of alcohol is accepted as a member of an 
 arctic expedition, and alcoholic drinks are never used by 
 those engaged in these enterprises. Such persons have been 
 found by experience to be lacking both in efficiency and in 
 the ability to endure the necessary hardships. 
 
 Nor are the results of the use of alcoholic liquors limited 
 to a temporary interference with mental and . , , . 
 physical powers. Exhaustive studies of the , , 
 
 death rate among abstainers and non-ab- _ th T? t 
 stainers conducted by English and American 
 life insurance companies have yielded most significant results. 
 One such recent investigation made by forty-three American 
 life insurance companies showed that the death rate of those 
 who used alcohol steadily and freely was 86 per cent, above 
 the normal, while the rate among steady moderate drinkers 
 (persons taking the equivalent of two glasses of beer or 
 one glass of whiskey a day) was 18 per cent, above the normal. 
 25 
 
It is evident that alcohol does a great deal of harm to 
 certain individuals and a certain amount of harm to all who 
 use it habitually. No man who wants to do anything diffi- 
 cult, and to do it well, uses alcohol beforehand. No sur- 
 geon about to perform a difficult operation would dream of 
 taking a drink. No athlete would think of drinking before 
 running a race. When a person wants to be at his best, to 
 have his nerves and muscles and his whole body working 
 most smoothly and effectively, he does not use a drug. 
 
 So it is with nations. The evil effects of alcoholic drinks 
 upon national efficiency, and the wastefulness involved, were 
 strikingly recognized in the European War. The Russian 
 government stopped the sale of vodka (the Russian strong 
 drink), and the governments of France and England passed 
 laws to restrict drinking. As soon as the European nations 
 wanted to be at their best, to meet a great crisis, they laid 
 aside the burden of alcohol. 
 
 Now that the United States has entered the world con- 
 flict the policy of "down glasses till the war is over," 
 should be the slogan of every man determined to give his 
 country his best service in an hour of crisis. 
 
 It is important to remember that both alcohol and many 
 
 _,, p other harmful and often habit-forming 
 
 •Kjr J' ' T- -1 drugs are often taken unknowingly in vari- 
 
 Medicme Evil ,• , . ^ ^ j- • a f 
 
 ous kinds of patent medicmes. Some ot 
 
 the commonest and most widely advertised "tonics" and 
 "spring medicines" owe any effect they have to the fact 
 that they are composed largely of whiskey. Remedies sup- 
 posed to cure catarrh, tuberculosis, and other diseases often 
 contain opiates that may lead to a drug habit. Medicines 
 advertised to soothe babies usually contain morphine or 
 opium, and headache cures frequently contain deadly 
 poisons, such as acetanilid. The use of such preparations, 
 except on the order of a physician, is most unwise. Patent 
 medicines and their misleading advertisements do immeasur- 
 able harm by arousing a false sense of confidence and de- 
 26 
 
laying the medical or surgical care, prompt use of which is 
 essential in such diseases as cancer and tuberculosis. The 
 well person has no need of drugs of anj^ kind, and if one is 
 ill enough to need drugs, he is ill enough to benefit by medical 
 advice. 
 
 HYGIENE OF ADULT LIFE 
 
 Statistics show that at ages over 45 the death rate in the 
 
 United States is apparently increasing and _. -^ ^u 
 J. 1 ■ J.I. 2. ^^ The Death 
 
 not decreasmg, as is the case at earher age ^ . 
 
 periods. The increase is manifested almost _, ^ ^ 
 
 wholly in the degenerative diseases of the 
 
 heart and blood vessels and kidneys, and in cancer. Most 
 
 of the degenerative diseases cannot be cured in the sense 
 
 that diseases of early life are cured. Old age prevails in 
 
 time. The important fact is that in too many cases old 
 
 age comes on prematurely and without the victim suspecting 
 
 its insidious onset. 
 
 The premature onset of old age, when not due to specific 
 congenital defects, is usually the result of _ - 
 
 unhygienic living and particular!}^ excesses p 
 
 of various kinds. Under the unnatural con- _. , . 
 
 ditions of modern life too many of us suffer 
 from too little air, too little exercise, too much work and 
 too much food. 
 
 The degenerative diseases of adult life are gradual in 
 
 their onset and could generally be checked „ . , 
 
 if the enemy were detected in time. When •«, ,• , ^ 
 
 disease of the heart or arteries or kidneys . ^. 
 
 ,, c ^ ^ • xu J- ammation to 
 
 or any other organ nrst sets in, the ordinary _^ -^. 
 
 rules of personal hj^giene must be supple- . -,. 
 mented by special rules of daily living 
 which take into account the particular defect. Even can- 
 cer, one of the most deadly of the diseases of adult life, can 
 be cured in a large proportion of cases by a surgical operation 
 27 
 
if the condition is recognized early in the disease, while if 
 treatment is delayed, there will be little hope. 
 
 The only way in which these physical defects can be de- 
 tected early enough to check their course is through a com- 
 plete examination of the whole body by a competent phj^si- 
 cian. It is the conviction of pubhc health authorities that 
 every person over f ortj^-five should consult a physician at least 
 once a year, for a complete examination of the whole body, 
 to learn in time of the beginnings of disease and the precautions 
 necessary to prevent it from extending. Such a course would, 
 it is conservatively estimated, add five years to the average 
 life of persons between forty-five and fifty years of age. 
 
 MAN AND THE MICROBE 
 
 There are many different kinds of microbes (or little living 
 , _ , things, which is the meaning of the word), 
 some of them classified by the biologist as 
 animals and some as plants. Most microbes 
 are harmless and some are actively beneficial to man, as, for 
 example, the bacteria which ripen cream and make vinegar 
 and those which fix the nitrogen of the air and make it avail- 
 able for the food of higher plants. A few of the microbes, 
 however, are parasites which live in the tissues or on the 
 surface of the human body as a mold grows in jelly. As the 
 mold forms chemical products which give the jelly a musty 
 taste, so the microbes form chemical substances called toxins, 
 which poison the body and produce the symptoms of disease. 
 Disease germs are normally propagated only by transfer 
 
 \iTu -n- from one human being (or animal) to an- 
 
 Wnere Disease . rri, • r x- j. 
 
 _, _ other. I hey may survive lor a time out- 
 
 _ side the body, but with rare exceptions they 
 
 do not multiply under such conditions, but 
 
 gradually and progressively perish. In an experiment by the 
 
 English bacteriologist Houston, of 470,000 tjrphoid germs 
 
 placed in ordinary tap water, only 480 were alive after one 
 
 28 
 
week, 31 after two weeks, 5 after three weeks, and none after 
 four weeks. The danger against which we must guard is the 
 rather direct transfer of infectious material from one person 
 to another (or in a few instances from one of the higher 
 animals, such as the cow, to man). 
 
 The source of disease germs is then the human (or in a few 
 cases, the animal) bodJ^ An important „ ^ 
 
 part in the spread of communicable disease . . 
 is played by early cases (not yet displaying 
 any characteristic sjTnptoms of illness) and 
 by ''carriers," persons who have recovered from their illness 
 or may never have themselves suffered from a particular dis- 
 ease at all, and yet are cultivating in their bodies and spread- 
 ing to others the germs which are capable of causing the 
 malady in question. An outbreak of over three hundred 
 cases of typhoid in New York City was caused by a milkman, 
 a typhoid carrier, who had had typhoid in Michigan forty- 
 six years before and had been cultivating the germs in his 
 body ever since. One or two out of a hundred well persons 
 in a given community may be cultivating the germ of diph- 
 theria in their noses or throats, and one or two out of a 
 thousand may be cultivating the germ of typhoid fever in 
 gall bladder or intestines. In such diseases as pneumonia 
 and epidemic cerebro-spinal meningitis, the proportion of well 
 carriers may be much higher, and infant paralysis appears to 
 be chiefly spread in this manner. 
 
 Bacteria are sohd particles not easily detached from moist 
 surfaces. Quietly expired air is germ-free, „ -p.- 
 and disease microbes are not transmitted by _ 
 the atmosphere except where there is gross „ , 
 local pollution by the spray thrown out in ^ 
 coughing or sneezing or by clouds of infected dust. Cloth- 
 ing, books, toys, or other objects handled by the infected 
 person play a much smaller part in the spread of disease 
 than was thought a few decades ago. There is no absolute 
 sharp line to be drawn between objects of this sort, which are 
 29 
 
dangerous, and those which are not, since the dying out of 
 disease germs outside the body is a gradual one. We know, 
 however, that the danger varies inversely with the time 
 which elapses, and that the legends of disease caused by 
 toys, locks of hair, etc., put away for months and years, are 
 almost certainly apocryphal. 
 
 There are three principal vehicles which commonly serve 
 to effect a rather direct transfer of infectious material from 
 one person to another, and which between them account for 
 99 per cent, of all cases of communicable disease. These are 
 articles of food and drink, flies and other insects, and more 
 or less direct personal contact — food, flies, and fingers. 
 
 DISPOSAL OF WASTES 
 
 The germs of disease leave the infected person or the 
 -^ - carrier, in most instances, in the body dis- 
 
 ^ charges. The care of sputum and the fine 
 
 ^ spray thrown out in coughing or sneezing is 
 
 essential in the control of such nose and 
 throat diseases as tuberculosis, diphtheria, measles, whoop- 
 ing cough, scarlet fever, septic sore throat, and the like; 
 while in the control of the bowel diseases, typhoid fever, 
 cholera, hookworm disease, and dysentery, the care of intes- 
 tinal and bladder discharges is of primary importance. 
 In army camps and in all unsewered districts, particularly 
 . , , in warm climates, the proper care of excre- 
 
 ^^ . ment, so that the germs it contains may not 
 
 be carried by flies or in other ways to food, 
 is a first essential of sanitation. 
 
 Typhoid fever earned the name, "the scourge of armies," 
 on account of the epidemics which occurred up to the pres- 
 ent century whenever large bodies of men were brought 
 together without adequate precautions in regard to the dis- 
 posal of bodily wastes. In our war with Spain, we had 
 20,738 cases of typhoid with 1,580 deaths among 108,000 
 men in a period of less than four months, nine-tenths of all 
 30 
 
deaths among the troops encamped in the United States 
 being due to this cause. 
 
 In the disposal of excrement it is essential to avoid 
 pollution of water supplies, and above all _ 
 
 the exposure of the wastes in such a manner .^ . 
 
 that infection may be carried by flies or in 
 other ways to food. In fixed garrisons satisfactory methods 
 of disposal will usually be provided. For use in camp good 
 portable incinerators have been devised; but when these 
 are not available, sink or latrine trenches may be dug to 
 receive the excreta, in such a position as not to menace any 
 source of water supply. In fly season the trenches should 
 be provided with seats with the lids and the open space be- 
 neath the seats boxed in or covered to the ground with mus- 
 lin or sacking. When it is impossible to prepare pit covers, 
 crude oil, kerosene or chloride of lime well distributed over 
 the sides and bottom will help to keep flies away. 
 
 Indiscriminate soil pollution is a military offense which 
 may be of serious magnitude, since an individual in perfectly 
 normal health may be a typhoid caiTier and through care- 
 lessness may infect scores of his fellows. For the same 
 reason the habit of washing the hands after resort to the 
 toilet is of the greatest importance. 
 
 In civil life, where sewers are not available, the provision 
 of tightly built fly-proof outside toilets is _. . , 
 
 of vital sanitary importance. The screen- __ ... 
 
 ing of such closets in Jacksonville, Fla., _.. 
 and elsewhere has been followed by phenom- 
 enal decreases in the typhoid death rate. For thickly 
 settled communities the installation of a sewerage system 
 of course offers the ideal solution of the difficulty from the 
 standpoint of the individual householder. The sewage 
 collected by such a system may be so treated as to be purified 
 to any desired degree by screening, sedimentation, filtration 
 or disinfection before it is discharged into adjacent water- 
 courses. 
 
 31 
 
INSECTS AND DISEASE 
 
 Insects were in the past a far more important factor in 
 
 p. , the spread of disease than is the case today. 
 
 _, , ,T>. Bubonic plague, which destroj-ed a quarter 
 
 Olden Times « ^, f^- c t? • ^u a/t-jji 
 
 of the population of Europe in the Middle 
 
 Ages, is primarily a disease of the rat, spread from rat to rat, 
 and from rat to man by the bite of the flea. The dreaded 
 typhus fever, which once decimated jails and camps, is 
 spread by the bite of the body louse. With improvements 
 in habits of personal cleanliness these pestilences have dis- 
 appeared from civilized countries. Plague broke out in 
 1894, ravaged India, and found its way to ports all over 
 the knowTi world, but nowhere outside of Asia could it gain 
 a foothold. T^-phus was almost forgotten until the con- 
 fusion and ruin of the European War permitted its appear- 
 ance on the Eastern battle front. It is controlled by de- 
 stro^dng lice through rigid measures of disinfection of the 
 bodies and clothing of those who have been exposed to 
 infection. 
 
 The most important insect carriers of disease todaj^, out- 
 _, side of certain regions in Africa, are the fly 
 
 _.. , _ and the mosquito. The common house fly 
 
 or filth fly is only an accidental carrier of 
 such disease germs as it may happen to pick up on its feet 
 or body; but in warm climates, where excreta are improperly 
 disposed of, it is an important factor in the spread of t ji^hoid 
 fever, and studies in New York City and Richmond, Va., 
 have showTi that it may play a considerable role in distribut- 
 ing the genus of infant diarrhea. The first essential in con- 
 trolling the fly is to do away with its breeding places by 
 proper care of stable manure, in which it lays its eggs by 
 preference, and by the elimination of other decaying rub- 
 bish. Manure should be stored in a closed dark bin with 
 an impervious floor and removed once a week. The tight 
 floor and complete removal are essential, since the fly mag- 
 32 
 
got burrows down into the ground or out into the outer drier 
 
 portions of the manure to go into its resting or pupa stage, 
 
 before it hatches out as an adult fly. Fly maggots in 
 
 manure may be destroyed bj^ the use of borax or hellebore. 
 
 x\dult flies may be trapped or poisoned. The traps most 
 
 commonly used consist of a wire cone in a -^, ^ , 
 
 box or cage largely of wire, with bait under ^, „ . 
 . . *, ^ * . ' , „ Fly Poisons 
 
 the large lower openmg of the cone. On 
 
 leaving their food the flies go upward toward the light, 
 through the small opening, and into the cage, in which they 
 perish. For fly poisons the U. S. PubHc Health Service 
 recommends formaldehyde or sodium salicylate. For house- 
 hold use these solutions may be prepared by the addition of 
 three teaspoonfuls of either the 40 per cent, solution of 
 formaldehj^de found on the market or the powdered sodium 
 salicylate to a pint of water. Nearly fill a glass tumbler 
 with the solution, place over this a piece of blotting paper 
 cut to a circular form and somewhat larger in diameter than 
 the tumbler, and over this invert a saucer. Invert the 
 whole device and insert a match or toothpick under the 
 edge of the tumbler, to allow access of air. The blotting 
 paper will remain in the proper moist condition until the 
 entire contents of the tumbler have been used and the 
 strength of the formaldehj^de solution will be maintained. 
 A little sugar sprinkled upon the paper will increase the 
 attractiveness of the poison for the flies. 
 
 The conquest of mosquito-borne disease is one of the most 
 brilliant triumphs of sanitation. The fact rp, p 
 that yellow fever, the curse of tropical r y 11 
 
 America, was transmitted by the bite of _ 
 
 Fever 
 the ^des mosquito was demonstrated by 
 
 Major Walter Reed and three other surgeons of the U. S. 
 Army in 1901, by experiments on themselves and other 
 volunteers, Jesse W. Lazear, one of the intrepid investi- 
 gators, giving his life for the cause. As a result of this dis- 
 covery the pestilence which had caused 750 deaths a year in 
 33 
 
the City of Havana alone was wiped out in a few months, 
 the building of the Panama Canal was made possible, and 
 tropical America was rendered habitable for the white race. 
 
 Malaria, our principal insect-borne disease, is held re- 
 ^ . sponsible for an annual money loss of 
 
 d^M 1 ^^ $100,000,000 in the United States alone. 
 It is transmitted by the bite of the Anopheles 
 mosquito, which breeds in pools of stagnant water and woody 
 sluggish streams. The adult mosquito of this type can be 
 distinguished from the common or Culex mosquito by the 
 fact that its wings are spotted and by its posture when 
 lighted. Its body stands out in a straight line at an angle 
 to the surface on which it rests, while the body of the com- 
 mon mosquito stands in a humpbacked position, with the 
 posterior part of its body roughly parallel to the wall or 
 ceiling. 
 
 The control of malaria depends on the elimination of 
 breeding places by drainage of swamps, by cutting out and 
 clearing ditches, streams and pools, and by the elimination 
 of small receptacles of stagnant water. Mosquito larvae, 
 or "wigglers," may be destroyed by the use of oil or poison- 
 ous larvicides or by stocking ponds with fish, which feed upon 
 them. Adult mosquitoes should be kept out of houses, and 
 particularly excluded from malaria patients by screening, 
 and in seriously infected regions, quinine should be system- 
 atically employed as a prophylactic. 
 
 SPREAD OF DISEASE BY CONTACT 
 
 While the diseases carried by food and by insects have in 
 _ . . ■. large measure been brought under control, 
 
 ' the diseases which are chiefly spread by 
 
 contact, particularly such diseases as diph- 
 theria, measles, scarlet fever and whooping cough, which are 
 disseminated by the discharges from the nose and throat, 
 have been much less successfully controlled. The methods 
 34 
 
by which infection finds its way from one mouth to another 
 are almost without number. The common ch'inking cup 
 and the direct discharge of mouth spray in coughing or 
 sneezing furnish two obvious modes of infection. A hun- 
 dred times a day fingers and other things that are not bac- 
 teriologically clean go to the mouth or nose, and to one who 
 considers the possibiUties the wonder is, not that we contract 
 diseases, but rather that we so often fail to do so. 
 
 The only reliable defense against contact disease is the 
 cultivation of habits of personal cleanHness that will keep 
 everything but food and the toothbrush away from the 
 mouth, and that will make the thorough washing of the hands 
 before handling food an absolute and inevitable routine. 
 
 In all communicable diseases, but particularly in those 
 
 which are spread by contact, it is important j i ^. f 
 
 to surround all known infected persons with _ . , , 
 
 , , „ Communicable 
 
 special precautions, so as to reduce as tar _. 
 
 as possible the danger of the spread of 
 
 disease germs from them. For this reason the reporting of 
 
 communicable diseases to the health authorities is required 
 
 by law, and boards of health maintain special laboratories 
 
 to assist in the early diagnosis of suspicious cases of disease. 
 
 When the infected person is found he must be isolated or 
 
 cared for under such conditions that family and friends will 
 
 not be endangered; and if this cannot be done at home, he 
 
 must be removed to an isolation hospital. 
 
 In isolation emphasis is laid particularly upon limiting 
 
 direct contact with the patient to the nurse or person in 
 
 immediate charge, upon the prompt disinfection of body 
 
 discharges and clothing, bedding, etc., soiled with discharges, 
 
 and upon the disinfection of objects which leave the sick 
 
 room, and particularly of the hands of the attendant. If 
 
 such precautions are not conscientiously observed during the 
 
 course of the disease, fumigation at its close will be of little 
 
 use, since susceptible persons in the house will already have 
 
 been infected. If isolation has been thorough, terminal fumi- 
 
 35 
 
gation is unnecessary, since there will be no gro?s soiling of 
 the sick room with discharges, and occasional germs coughed 
 out onto the floor or wall will soon die out and disappear. 
 
 Each communicable disease has its own definite period of 
 „ , ^. , duration, and experience teaches that a cer- 
 P 1 «;h IH ^^^^ number of days or weeks must pass be- 
 _ T 1 f J foJ*6 i^ is safe for the patient to mingle with 
 other people. The periods of isolation for 
 the more common communicable diseases are shown in the 
 following table. In each case, of course, the patient should 
 be isolated until he has entirely recovered from the disease, 
 and running of the nose and ears has ceased. In diphtheria 
 the only safe rule is to wait until tests made by a bacteriolo- 
 gist show that the nose and throat are free from diphtheria 
 germs. 
 
 Isolation Periods of Common Commtjnicable Diseases 
 
 . Isolation Period from Time 
 
 of Beginning of Attack 
 
 Chickenpox 12 days 
 
 German measles 8 days 
 
 Measles 10 days 
 
 Mumps 2 weeks 
 
 Scarlet fever 30 days 
 
 Whooping cough 8 weeks, or until one week 
 
 after last whoop 
 
 The fact that many diseases are particularly catching just 
 ^ , when they are beginning makes it very im- 
 
 ^ portant to watch for the onset of disease 
 
 , ^ . ^ and to start isolation as soon as possible. 
 
 or 13lS63.S6 
 
 Measles, for instance, begins like an ordi- 
 nary cold in the head, with sneezing and running nose and 
 eyes. It has been shown by the investigations of Anderson 
 that there is far more danger of spreading the germs of 
 measles at this time than there is later, when a rash has 
 appeared and the patient has been put to bed. 
 36 
 
Children should never be sent to school and should not 
 play with other children when they have any of the signs 
 which may mean an attack of communicable disease, par- 
 ticularly if there is reason to think they may have been 
 exposed to infection. 
 
 The principal signs of the beginning of an attack of com- 
 municable disease are the following: 
 
 Coughing, Watery eyes, 
 
 Sneezing, Headache, 
 
 Running nose, Vomiting, 
 
 Sore throat, Diarrhea, 
 
 Feverishness, Swelling or pain back 
 Rash or spots of any kind, of or under the ears. 
 Weak, tired feeling, 
 
 In each particular disease a certain time must elapse 
 between the day when a person first gets the . , , 
 
 germ into his body and the day when the p • h ' 
 
 actual symptoms of disease appear. This is _ 
 
 called the period of incubation. During this ^. 
 
 J_JlS63SGS 
 
 time the germs are growing in the body until 
 there are enough of them to make the person feel sick. The 
 incubation period varies with different diseases, from a few 
 days to several weeks. The periods for the commoner dis- 
 eases are shown in the table below. 
 
 Disease Incubation Period 
 
 Chickenpox 11-22 days 
 
 German measles 1 1-22 days 
 
 Measles 8-15 days 
 
 Mumps 15-22 days 
 
 Scarlet fever 7 days 
 
 Whooping cough 14 days 
 
 Those who have been exposed to any of the communicable 
 diseases should be kept under observation, and if possi*ble 
 37 
 
isolated from others until the period of incubation has passed 
 without any signs of the disease appearing. In the case of 
 chickenpox, German measles, measles, mumps or whooping 
 cough, this is not necessary if the person has had the disease 
 before, and is, therefore, immune. In diphtheria the incu- 
 bation period is short (from one to five days), but carrier 
 cases are so common that all those who have been exposed to 
 diphtheria should have their throats examined and a sample 
 taken from the throat for bacteriological examination. 
 
 Everyone takes typhoid and scarlet fever seriously, but 
 _ , measles and whooping cough are often re- 
 
 __ , , garded as unimportant and negligible in- 
 
 Measlesand f ^. a., •• u 1 
 
 _-_ . fections. This is by no means the case. 
 
 _ u Measles is an important cause of in- 
 
 validism in the army. " In the Union Army 
 during the Civil War, there were 76,000 cases with more than 
 5,000 deaths. Among the Confederates whole brigades were 
 temporarily disbanded on this account in the early part of 
 the war." Among the civil population measles is in most 
 cities the cause of more deaths than either typhoid or scarlet 
 fever, while whooping cough stands very close to it. Above 
 all it should be remembered it is to young babies that these 
 maladies are most deadly. Measles and whooping cough 
 are more than five times as fatal in infants under one year 
 of age as in children over five. Every possible effort should 
 therefore be made to protect infants from contact with those 
 who have any symptoms of what may prove an infectious 
 disease. 
 
 IMMUNITY AND ITS CONTROL 
 
 Every attack of communicable disease is a struggle be- 
 ^. . tween the invading microbes and the body, 
 
 _ . for as soon as foreign germs enter, the sol- 
 
 dier cells of the blood attack the invaders 
 while the tissues of the body begin to produce chemical sub- 
 38 
 
stances which tend to destroy the germs or neutralize their 
 poisons. The degree of this natural vital resistance varies 
 widely. Disease germs, like other enemies, are more likely 
 to attack weak people than strong ones, though some dis- 
 eases, like measles and smallpox, affect all alike. 
 
 Besides this sort of general vital resistance, a person who 
 
 has recovered from an attack of some spe- _ .^ 
 
 .^ • 1 1 T . • , Immunity 
 
 ciric communicable disease enjoys a special . . ^ o -^ 
 ., • X -1 - • 1 • Agamst Specific 
 
 immunity agamst the particular germ in ° 
 
 question as a result of the struggle through 
 which it has passed. In a number of diseases it is now pos- 
 sible to produce at will a state of immunity by the introduc- 
 tion into the body of weakened or killed cultures of the germ 
 which have lost the power to produce active disease, but 
 are still able to stimulate the tissues of the body, so that they 
 can defend themselves against a later attack of living and 
 virulent microbes. 
 
 This principle was applied over a century ago in the case 
 of smallpox by Edward Jenner, an English „ .. 
 
 physician. It has been said that this dis- ,^ . ^. 
 
 V ^ccixi^Liori 
 covery of vaccination by Jenner was the 
 
 greatest single practical benefit ever bestowed by one man 
 upon the human race. As soon as vaccination was generally 
 introduced, the dreaded epidemics of smallpox ceased, and 
 this disease now exists only as far as vaccination is neglected. 
 During the eight years before the American Army entered 
 Havana, there were 3,132 deaths from smallpox in the city; 
 during the next eight years, when vaccination was enforced, 
 there were seven. 
 
 Vaccination has conquered smallpox so successfully that 
 people have almost forgotten what a terrible disease it was, 
 and some of them have grown careless about vaccination. 
 Others object to being vaccinated for fear some infection 
 may get into the wound. All vaccine used in the United 
 States is now tested as to its purity by the National Gov- 
 ernment, and there is no danger from its use, provided that 
 39 
 
the place where the vaccine is rubbed into the arm or leg 
 
 is kept clean and free from dirt germs. The protective 
 
 effect of vaccination wears off after a time. Every child 
 
 should, therefore, be vaccinated when about a year old, and 
 
 again at about the seventh year. 
 
 The most brilliant practical application of the principle 
 
 . ,. ^ , ,, of vaccine therapy, since the time of Jenner, 
 Anti-Typhoid , . ^u ^- c ^u 
 
 , *;. has been the preparation ot the vaccme 
 
 now used for the prevention of typhoid fever. 
 
 Its adoption in the United States Army has been attended 
 
 with brilliant results, as indicated by the table below. 
 
 Cases of Typhoid Typhoid Deaths 
 Year Vaccination 
 
 Nu-ber RJ|^« Number ^f^' 
 
 1907 None 237 3.79 19 .30 
 
 1908 None 239 3.20 24 .31 
 
 1909 Voluntary 282 3 .35 22 .26 
 
 1910 Voluntary 198 2 .43 14 .17 
 
 1911 Voluntary 70 .85 8 .10 
 
 1912 Compulsory 27 .31 4 .04 
 
 1913 Compulsory 3 .03 .00 
 
 Mixed vaccines which will protect against typhoid fever 
 
 and the two distinct forms of a similar 
 
 .„. , disease, paratyphoid fever, have been used 
 
 the Allied .^, ^^ -i • ■ ^.u -c^ 
 
 with striking success in the European armies 
 
 during the present war. The number of 
 cases of typhoid fever among British troops in France up 
 to November 1, 1916, was 1,684, of paratyphoid cases, 2,534, 
 and of indefinite related fevers, 353, a total of 4,571. In the 
 South African War nearly 60,000 cases of typhoid f eve r alone 
 were admitted into hospital, and there were 8,227 deaths. 
 
 Armies in the past have been an important agent in spread- 
 ing typhoid and other infections through the regions where 
 they operated and in the homes to which they returned. 
 Today the success of typhoid vaccination in our military 
 establishments points the way to the elimination of this 
 40 
 
disease in civil life. Every man and woman under 45 
 
 should make use of this simple and efficient safeguard. 
 
 Another method of controlling immunity is by the use of 
 
 antitoxins, or antitoxic sera, as they are n^. tt r 
 
 ,, , ,. , • , ,• 1 .1 • /-^ The Use of 
 
 often called, of which diphtheria antitoxin .... . _ 
 
 , , , Antitoxic Sera 
 
 is the best example. 
 
 Diphtheria antitoxin was introduced into the United States 
 by the New York City Department of Health in 1894, and 
 it has reduced the death rate from diphtheria in that city 
 from 155 deaths for every hundred thousand of the popula- 
 tion, to 24. The antitoxin is of comparatively little value 
 when the attack has gone on for a long while and the body 
 has become severely poisoned, but if it is used as soon as the 
 disease begins, it is a practically certain cure. 
 
 Antitoxic sera are also used in the treatment of tetanus, 
 meningitis and more recently in certain forms of pneumonia. 
 
 From a mihtary standpoint some of the most important 
 appHcations of the principles of vaccine and r tr 1 f 
 
 serum therapy are those which have been _.. , 
 
 worked out in connection with the treat- iff 
 
 ment of wound infections. The surgeon in 
 his operating room relies on antiseptic and aseptic methods 
 to keep out the germs of suppuration. Wounds received in 
 battle are generally already infected and the destruction of 
 germ life is impossible without serious injury to the tissues 
 themselves. The military surgeon must therefore rely 
 largely on the stimulation of the defensive machinery of the 
 body (except in the case of tetanus, for which a specific and 
 powerful antitoxin is at his disposal). The newer solutions 
 used in the treatment of wounds, such as Dakin's chloramine, 
 are specially adapted to check bacterial growth without 
 harming the soldier cells of the blood; and the use of a strong 
 salt solution for the treatment of an infected wound pro- 
 duces an increased flow of lymph from the tissues into the 
 wound, thus relieving the inflamed tissues of congestion and 
 setting up a flow of fluid from within outwards, which tends 
 41 
 
The Great 
 White Plague 
 
 to wash away bacteria. Both the lymph and the strong 
 salt solution are unfavorable to the gro\vth of bacteria. So 
 far as the white corpuscles are concerned, strong saline solu- 
 tions are unfavorable to their vitalitj^; but when the wound 
 has become healthier, it is usual to decrease the strength of 
 the salt solution until its saturation has reached that of a 
 fluid of the same specific gravity as the blood. In a fluid 
 of this degree of concentration the body cells can hve and 
 act freely. 
 
 TUBERCULOSIS 
 
 Tuberculosis, a disease which causes about one-third of 
 all the deaths which occur between the 
 ages of 18 and 45, and kills each year about 
 150,000 people in the United States, is 
 caused by a bacterium which may grow in a great many 
 different parts of the body, although it is most likely to be 
 found in the lungs, causing tuberculosis of the lungs, or 
 consumption. The germ does not grow all through the 
 lungs in this disease, but here and there at special points, 
 where there form hard little knots or tubercles, from which 
 the disease is named. 
 
 Tuberculosis of the bones is not uncommon among children, 
 and a great many of the lame people we see on the streets 
 are crippled from this cause. 
 
 The primary cause of tuberculosis is a germ discharged in 
 -,, _ , the spray and sputum coughed out by con- 
 
 -, , . . sumptives, and infection comes in most 
 cases from getting these human discharges 
 into the mouth. Sometimes the germ is inhaled in dust, 
 but it is more frequently transferred from one person to 
 another by rather direct contact. 
 
 A great many cattle suffer from tuberculosis, and children 
 may become infected by drinking the milk of tuberculous 
 cows. 
 
 42 
 
To prevent the spread of tuberculosis it is necessary first 
 
 of all to destroy the germs discharged „ _ 
 
 from the mouths of consumptives; and ... o j 
 
 , , . • -. 11 f n vent the Spread 
 
 second, to pasteurize the milk of all cows , _, , , . 
 
 , , . , , X t f r ^i of Tuberculosis 
 
 not certainlv known to be free from the _ , ,. 
 
 J. ^ - Infection 
 disease. 
 
 The careless consumptive is a great danger to his family 
 and associates, but one who is always careful to destroy his 
 sputum and to avoid coughing out mouth spray into the air 
 need not be a menace to the health and life of others. The 
 consumptive should always cough into a cloth or handker- 
 chief, or a paper napkin, which can be burned, and all sputum 
 should be received in paper cups and burned at the end of the 
 day. If handkerchiefs are used, they should not be put into a 
 laundry bag or basket with other soiled linen, but should be 
 boiled for twenty minutes in a strong soapsuds solution. 
 
 Tuberculosis is a disease in which vital resistance plays a 
 
 specially important part. The germ is un- v"f 1 P * 
 
 fortunately very common; in fact, almost . . 
 
 every individual, sooner or later, is slightly ^ , , . 
 ■ f . 1 uu -^ Tuberculosis 
 
 iniected with it. 
 
 This does not mean that ever}^ man has tuberculosis, in 
 the sense of suffering from actual disease. The human body 
 has a wonderful power of defending itself against this in- 
 vader, and a few germs entering a healthy body are quickly 
 overcome. It is when a great many germs are taken in, and 
 particularly when the strength is reduced b}^ attacks of other 
 diseases, or when resistance is lowered by intemperate habits, 
 by living and working in overheated rooms, by eating insuf- 
 ficient food, or by breathing sharp dust particles, that the 
 invisible enemy overcomes the defenses of the body. France 
 has today some 500,000 cases of tuberculosis to care for 
 because of the deadly effects of the strain of trench life 
 upon soldiers who, in a time of crisis, had to be sent to 
 the front whether they were in full physical health or 
 not. 
 
 43 
 
People who have recovered from tuberculosis, and those in 
 
 J whose family there has been a case, should 
 
 ^ , , . be specially on guard aeainst allowing their 
 Tuberculosis -^ , • / ^ u i j a 
 
 vital resistance to become weakened. Among 
 
 the most important causes of tuberculosis are the unsanitary 
 conditions of factory life. An overheated, unventilated 
 workshop is certain to lower vital resistance and make the 
 worker an easy prey to the tuberculosis germ, particularly if 
 he is weakened by long hours of labor. An especially dan- 
 gerous thing about some industries is the fact that the air of 
 the workshops is full of fine particles of mineral or metallic 
 dust. These dust particles are inhaled and injure the deli- 
 cate tissues of the lung, so that tuberculosis germs find it 
 easy to grow there. The workers in some of these industries 
 — granite workers and grinders, for instance — are two or 
 three times as likely to contract tuberculosis as are people 
 who work at less dangerous trades. 
 
 In all such places there should be special pipes with exhaust 
 fans to draw off the dust from the air. Where this cannot be 
 done, the worker should wear a respirator over his mouth, to 
 keep out the dust particles. 
 
 Just as the tuberculosis germ fails to gain a real foothold 
 
 in the body of a thoroughly healthy person, 
 
 ^ , , . so by proper hygienic treatment it can be 
 Tuberculosis ■, r^ •. u u v i 
 
 conquered even after it has begun its work. 
 
 There are no medicines, in the ordinary sense, that will 
 cure tuberculosis. All so-called "Consumption Cures" are 
 frauds which take the money of their victims and do them 
 immeasurable harm by wasting precious time. The cure for 
 tuberculosis is hygienic living under the advice of a compe- 
 tent physician, properly directed rest and exercise, plenty of 
 fresh air, and a sufficient amount of wholesome food. If 
 such treatment is taken early in the disease, tuberculosis can 
 generally be cured. 
 
 The main thing is to begin the treatment of tuberculosis as 
 soon as possible. The time to put out a fire, or to control 
 44 
 
a disease, is before it gets well under way. When tuberculosis 
 
 has gone far, it cannot usuall}^ be checked, t ^t f 
 
 but if the disease is attacked at its beginning, ^ 
 
 there is every reason to be hopeful. Among ^ \_ ^ 
 ^ , . , ,1 Treatment 
 
 the common danger signals are loss oi 
 
 weight, loss of appetite, prolonged ''cold" with cough and 
 spitting — the expectorations sometimes blood-tinged — fre- 
 quent hoarseness, afternoon fever, chills, nightsweats, easy 
 tiring, and pains in the chest. One of the earliest symptoms 
 of pulmonarj^ tuberculosis is a sense of weakness and loss of 
 energy, both of body and mind, not infrequently out of all 
 proportion to the extent of the disease. If any of these 
 symptoms are present, the patient should go to a physician 
 and have his lungs examined. 
 
 RACIAL HEALTH 
 
 Success in the struggle for existence involves 
 
 Individual efficiency 
 
 Perpetuation of the Race 
 
 Both personal health and success in leaving progeny are 
 threatened by the grave communicable _. __ 
 maladies which are known as the venereal , _. . 
 
 diseases. Lack of self-control endangers _. 
 
 13lS6£LS6 
 
 one's life ; it threatens the hfe of the wife; 
 it endangers the life of the mother; it imperils the life and 
 the sanity of the child. From the medical standpoint it 
 is vitally important that these diseases should be more 
 fully controlled by public health authorities, that facilities 
 for laboratory diagnosis should be furnished, and that pro- 
 vision should be made for dispensary and hospital treat- 
 ment. Concealment, delay in securing treatment, and resort 
 to advertising quacks and charlatans are in large measure 
 responsible for the extent of the damage wrought by these 
 infections. 
 
 45 
 
Around all the camps of England and France the great- 
 
 est enemy of the soldier is the diseased 
 
 ,, ^ , ,. prostitute. Some of the finest British and 
 
 the Soldier i • , • . u u ' • i 
 
 colonial regiments have been seriously 
 
 affected. The British government is 
 now taking stern measures to protect its soldiers by 
 the establishment of health zones, and the keeping of 
 the men within certain bounds. In view of the special 
 temptations which will surround our new army in this 
 country and on the continent, the most earnest efforts 
 should be made to control the surroundings of encamp- 
 ments in this regard. 
 
 Lieutenant-Colonel Frank R. Keefer, in his text-book on 
 _ . . , "Military Hygiene and Sanitation," says: 
 
 __ . . "Venereal infections are responsible for an 
 
 . ^. ?!. enormous amount of sickness in the army — 
 
 Authonties ,, ^, ^, -" , 
 
 vastly more than any other cause — and 
 
 constitute the most important health problem with which 
 
 we have to deal." In the "Manual of Military Hygiene," by 
 
 Colonel Valery Havard, the author points out that on 
 
 account of the importance of this question, "soldiers should 
 
 be taught all knowledge deemed necessary and useful on 
 
 the subject. For instance, that sexual intercourse is not 
 
 necessary for the attainment of the best physical and mental 
 
 health, and that a strong, manly character is developed only 
 
 by self-control and continence. They should have a proper 
 
 appreciation of the prevalence and gravity of venereal 
 
 diseases. 
 
 " Many men expose themselves thoughtlessly, with the 
 
 impression that, at the worst, a few days in hospital will 
 
 suffice to get rid of the consequences. This is foolish 
 
 and dangerous ignorance which officers, especially medical 
 
 officers, should endeavor to dispel by a few plain talks, 
 
 demonstrating to them the many complications and sequels 
 
 of gonorrhea as well as the ravages of syphilis, which affect 
 
 not only the incontinent, but, through matrimony, many 
 
 46 
 
innocent women and children. Let them know that, in 
 the opinion of gynecologists, a majority of the hazardous 
 surgical operations performed upon married women are 
 made necessaiy in consequence of gonorrheal infection 
 by the husband; and another terrifying fact, that 
 sj^philis, so far as absolutely known, is not only directly 
 transmitted from father to children, but the sole disease 
 thus transmitted, as it were, a special curse upon the 
 human race." 
 
 jNIore recent studies have shown that the proportion of 
 prostitutes afflicted with venereal disease is far higher than 
 has been assumed by earlier writers. Dr. Walker in an in- 
 vestigation in Baltimore found over 90 per cent, of a group 
 of prostitutes suffering from syphilis alone. 
 
 The good soldier owes to his country today his full meas- 
 ure of strength and vigor. He owes to his country of the 
 future a full measure of strength and vitality to be handed 
 on to coming generations. Both may be fatally jeopardized 
 by a moment of weak self-indulgence. 
 
 ACCIDENTS AND FIRST AID 
 
 Slight cuts and scratches should be washed free from dirt, 
 
 then carefully dried and painted with a ^^ ^ j 
 
 r^^i *• ^ ^ • ]• Tvi • Cuts and 
 
 little tmcture of lodme. More serious __, , 
 
 wounds should be dressed temporarily, until 
 the doctor can attend to them, by covering them with sur- 
 geons' gauze fastened on with a bandage. A deep wound, 
 particularly if produced by a rusty nail or other dirty object, 
 should always receive prompt medical attention; so should 
 even the slightest scratch, if, after a few days, it is red, hot 
 or painful. Any wound will heal without much pain or 
 redness if there are no germs in it. Remember that germs 
 get into a wound, not from the air, but from dirty things 
 that touch it. A scratch or cut should never be touched 
 with anything but sterilized surgeons' gauze. In connec- 
 47 
 
tion with automobile accidents, it is well to remember that 
 gasoline is a good disinfectant. 
 
 If the blood comes from a wound in jets or spurts, an 
 artery is bleeding, and the result may be serious if the flow is 
 not checked. Fortunately, at most parts of the body the 
 arteries are deeply buried in the flesh. A severed artery 
 calls for prompt action. Put firm pressure close to the bleed- 
 ing part, between the wound and the heart. In case the 
 wound is in the arm or the leg, the pressure is best applied 
 by tying a knot in the center of a folded handkerchief, and 
 laying this knot over the artery. Tie it loosely around the 
 limb, but with a good knot. Place a stick under the bandage 
 and twist it round and round until the bandage is tight 
 enough to stop the bleeding. 
 
 The pain and swelling of an ordinary bruise will be much 
 
 . less if something cold is placed on the bruise 
 
 ruises an ^^ ^^^^ ^^ ^^^^^^ ^^^ blood away. Ice in a 
 
 prams ^^^^^ ^^^ 1^^ ^^^^ ^^^ ^j^-^ p^pp^gg^ qj. simply 
 
 a cloth wrung out in cold water. 
 
 If a joint has been sprained (which means that the Uga- 
 ments that hold the bones together have been strained or 
 torn), the same treatment with cold cloths is very useful, 
 and should be kept up at intervals for twelve hours. In 
 old and enfeebled patients, hot wet cloths are better. The 
 injured part should be placed as high as possible, so as to 
 keep the blood out of it. 
 
 If a bone is broken, medical care is, of course, necessary. 
 
 While waiting for the doctor, the only thing 
 
 '■^ ^ to do is to keep the broken limb in as com- 
 
 ^^^^ fortable a position as possible. Above all, 
 
 do not let the linib bend at the place where the bone is 
 
 broken, because that gets the splinters of bone out of place, 
 
 and may drive them through the skin and lead to an infected 
 
 wound. If you find it necessary to lift a broken limb, put 
 
 one hand on each side of the break and lift it with both 
 
 hands at the same time. 
 
 48 
 
A person who has become faint and dizzy from the direct 
 effect of strong sunUght shining on the Sy^stroke and 
 head should be placed in a seated position Pros- 
 
 in the shade. His clothing should be loos- ^ 
 ened, and cold water poured on his head, or 
 his body rubbed with bits of ice. Cool drinks should be 
 given, if possible. 
 
 Heat prostration due to excessive heat acting on the whole 
 body, and not to the direct sun's rays, should be treated 
 somewhat differently. The patient should be laid flat on 
 his back in a cool place, his clothing loosened, and his hands 
 and feet rubbed, to restore the circulation. The face and 
 body should be bathed in warm water and warm drinks 
 should be given. 
 
 If the clothing catches fire, there is only one thing to do, 
 
 and it must be done quickly: smother the „ 
 
 flame. Fire needs plenty of oxygen, and -,. th'np- and 
 
 if a person whose clothing is on fire is -, . .. . , 
 . , , 111 1 • . Treatment or 
 
 qmckly and closely wrapped in a coat, „ 
 
 shawl, blanket, or rug, the fire will go out. 
 
 It is important to remember to wrap the cloth from above 
 
 down. If the Avrapping is done from below, the flames 
 
 may be driven up and inhaled into the lungs with very 
 
 serious results. If your clothing catches fire when you 
 
 are alone, do not run for help, but lie down flat and roll 
 
 over and over on the floor or on the ground, to smother the 
 
 flames. 
 
 In the case of a slight burn which only reddens the skin 
 
 without forming a bhster, the pain -will be lessened if the air 
 
 is kept from the burned place. A paste of ordinary baking 
 
 soda and water applied to the burn will do this, or carbolized 
 
 vaseline, or any grease, like lard, may be used instead. The 
 
 burn should then be covered by tying a piece of cloth or 
 
 bandage around it. If there is extensive blistering, the 
 
 application of soda or vaseline may do harm; and severe 
 
 burns should be treated like open wounds. 
 
 49 
 
If ears, nose, or fingers are frost-bitten, the affected part 
 p, , . should be rubbed with snow or very cold 
 
 water until the blood has come back and 
 the flesh begins to sting and burn. On no account should 
 the person go into a warm room until this has been done, and 
 until the frozen part has become gradually warm by rubbing. 
 Even after the circulation has come back, the patient should 
 become waraa only gradually. 
 
 When a person has been under the water or in some suffo- 
 
 _ . J eating gas for a long time, the breathing 
 
 Drowmngand , , -, ^- fu • 
 
 „ „ . stops, and the patient becomes unconscious. 
 
 If breathing can somehow be started again, 
 recovery may follow. The starting of the breathing move- 
 ments in a person who has ceased to make them for himself 
 is called artificial respiration. 
 
 Artificial respiration should be begun by laying the patient 
 face downward upon the ground. The feet should be raised 
 to drain out any excess water. Stretch the arms of the 
 patient straight above his head and let them rest on the 
 ground in that position. Turn his head a little to one side, 
 so that the air will not be impeded in entering the nose and 
 mouth. Next stand astride of the patient, with your body 
 directly over his hips and facing his head. Put your hands 
 on each side of his back, below the shoulder blades. Your 
 hands now rest upon the patient's lower ribs. The fingers 
 are spread out, pointed toward the head and away from the 
 spine. 
 
 Swing your body forward, keeping your arms straight and 
 allowing your weight to rest on the patient's back; then 
 swing back, taking all your weight off the patient. Do this 
 fourteen or sixteen times per minute. This imitates the 
 motions of breathing. When you put your weight on the 
 patient, you press his chest together and force the air from 
 the lungs; when you release the pressure, the chest springs 
 back into place, and the lungs expand and draw air into 
 them. 
 
 50 
 
Recovery may be very slow; keep up your work for at leiist 
 two hours. 
 
 While this process is going on, some one should remove the 
 patient's clothing. If necessary, he should be dried with a 
 towel and then covered with a blanket. This work must 
 not interfere with the operator who is causing artificial 
 respiration. Compel bystanders to stand back. The patient 
 needs every bit of air he can get. 
 
 When the patient begins to breathe, — ^but not before, — he 
 should have his legs and arms rubbed toward the body. 
 This should be done without removing the blanket. The 
 patient will not breathe well all at once, and it will be neces- 
 sary to help him at first by continuing the artificial respira- 
 tion every little while. Of course, if he stops breathing at 
 any time, the artificial respiration must be renewed. 
 
 After he is breathing well, put him to bed. Surround him 
 with hot water-bottles and cover him up well. As soon as 
 he can swallow, give him some hot coffee. Open the win- 
 dows wide, and allow him to sleep quietly. 
 
 Cases of electric shock (from contact with live wires, for 
 example) and cases of gas poisoning require the same treat- 
 ment — artificial respiration. 
 
 If some poisonous drug has been taken, the first thing to 
 
 do is usually to get it out of the body again -^ . 
 
 • 11 1 1 u x- Poisons 
 
 as quickly as possible by causing vomiting. 
 
 This may be done by running the finger down the throat, by 
 
 drinking a large quantity of warm water, or by taking some 
 
 substance which will cause vomiting, called an emetic. A 
 
 teaspoonful of mustard or salt in a glass of lukewarm water 
 
 will serve as an emetic. Promptness is more important than 
 
 an exact dose. After the emetic has been taken, large 
 
 quantities of warm water should be drunk, to dilute the poison 
 
 that remains. 
 
 51 
 
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