HEALTH FIRST HEALTH FIRST 
The Fine Art of Living 
BY 
HENRY DWIGHT CHAPIN, M.D. 
Professor of Medicine (Pediatric Department) at the 
New York Postgraduate Medical School 
and Hospital 
NEW YORK 
THE CENTURY CO. 
1917 Copyright, 1917, by 
The Century Co. 
Published October, 1917 TO MY WIFE 
ALICE DELAFIELD CHAPIN PREFACE 
There probably has never been a time in the 
history of the world when the question of con- 
serving human life has loomed up with greater 
importance than at present. But life without 
good health is usually neither enjoyable nor effi- 
cient. We need men and women with strong 
arms, vigorous brains, and clear eyes to face the 
pressing problems of the day. 
In constructing a true map of physical life, its 
continuity in all the varying periods must stand 
out prominently. Each interval of time has a 
direct and continuous influence on the following 
age. The different spheres of life are comple- 
mental; each reacts upon the other for good or 
evil. The physical and chemical bases of life are 
the same at all periods. The changes that take 
place during the life-cycle are not fundamental 
but secondary and hence capable of being influ- 
enced. A change in form is accompanied by a 
gradual alteration of function. 
In order to understand and properly manage PREFACE 
any period, we must know the conditions that 
precede and are liable to follow it, so that we 
may make the necessary changes in our conduct 
of life. This will form a promising method of 
conserving both life and health. It is believed 
that in this way life can be prolonged and made 
more efficient; hence the writing of this book. CONTENTS 
CHAPTEB PAGE 
I Health First : 
The Need of the Time 3 
II Health for the Body: 
An Efficient Machine Needed ... 8 
III Health for the Infant : 
A Right Start 17 
IV Health for the Growing Child: 
Normal Development 40 
V Health and Education : 
Proper Training 56 
VI Health for the Middle-Aged : 
Conserving Life 74 
VII Health for the Old : 
Prolonging Life 95 
VIII Health and Nutrition: 
The Food Question 116 
IX Health and Disease: 
Avoiding Infection 139 
X Health in Different Seasons: 
Climatic Influences 172 
XI Health in City and Country: 
Local Influences 192 
XII Health and Happiness: 
Moral Influences 204 HEALTH FIRST " 'Tis life, whereof our nerves are scant, 
Oh life, not death, for which we pant; 
More life, and fuller, that I want." 
-Tennyson. HEALTH FIRST 
CHAPTER I 
HEALTH FIRST : THE NEED OF THE TIME 
IT has been estimated that one million two hun- 
dred thousand Americans die every year. 
Professor Irving Fisher believes that at least 
forty-two per cent, of the deaths now occurring 
in the United States are unnecessary. It is usu- 
ally figured that there are ten cases of serious 
sickness for every death, and yet much ill health 
is clearly preventable. 
Can human life be prolonged? This depends 
largely upon the preservation of health and the 
prevention of illness. Not only efficiency in 
every line, but the conservation of life itself 
depends upon a proper amount of vigor. Good 
health is not so much an accident as many sup- 
pose. It is largely a purchasable commodity, 
but every one must be willing to pay the price. 
One of the most interesting questions of the day 
3 HEALTH FIRST 
is the placing of a proper estimate on the price 
of good health. It is a fundamentally important 
question for the individual man as well as for 
the nation. 
Perhaps the most practical way to attempt a 
solution is to construct a health map of life. 
This will involve a study of the various condi- 
tions that make for health and vigor at different 
ages and in diverse environments. It is vastly 
more important to learn how to keep well than 
how to get well; but this involves a knowledge of 
correct habits of living in every period of life, and 
includes such commonplace topics as proper eat- 
ing, sleeping, exercise, and mental poise. A pop- 
ular topic in recent years is included under the 
term, " First Aid to the Injured." Let us try to 
popularize a course on " First Aid to the Well," 
so that people may know how to keep strong. It 
will repay consideration in results of conserved 
vigor that otherwise might have been dissipated. 
The subject of preparedness is just now in the air. 
Preparedness for life certainly requires as its 
first requisite the possession of sound health. 
We hear a great deal of infant mortality and 
the large waste of child life that has engaged the 
attention of sanitarians and statesmen. Much 
4 THE NEED OF THE TIME 
has already been accomplished in remedying this 
great evil, but little attention has been directed 
toward the needless waste of life among the mid- 
dle aged and the old. More knowledge and ef- 
fective action are required to conserve life at all 
ages. Few realize how much can really be ac- 
complished if we have the will to act upon knowl- 
edge already in our possession. Not only can 
the span of life be lengthened, but, quite as im- 
portant, the days of usefulness and efficiency can 
likewise be prolonged. Individual human life 
and the power of the race in its ascending strug- 
gle can thus be enormously strengthened, with a 
corresponding gain to civilization. 
The recognition and treatment of actual dis- 
eases, which should be exclusively the business 
of the attending physician, are not included in 
the scope of this volume. It is believed by the 
writer that much harm, sometimes of a perma- 
nent nature, follows from the attempt to diag- 
nose and handle illness from information found 
in popular treatises that the amateur has neither 
the training nor the experience properly to ap- 
ply. Every intelligent person, however, should 
have a knowledge of the general laws of health. 
They can then apply themselves successfully to 
5 HEALTH FIRST 
the art of keeping well and good health will be 
popularized. 
Vigorous health is not only valuable, but it 
is likewise a possession that it is our duty to cul- 
tivate. This thought is well expressed by 
Herbert Spencer in the closing chapter of his 
book on " Education." He says: 
Perhaps nothing will so much hasten the time when 
body and mind will both be adequately cared for as 
a diffusion of the belief that the preservation of health 
is a duty. Few seem conscious that there is such a 
thing as physical morality. Men's habitual words 
and acts imply the idea that they are at liberty to 
treat their bodies as they please. Disorders entailed 
by disobedience to Nature's dictates, they regard 
simply as grievances: not as the effects of a conduct 
more or less flagitious. Though the evil consequences 
inflicted on their dependents, and on future genera- 
tions, are often as great as those caused by crime; yet 
they do not think themselves in any degree criminal. 
It is true that, in the case of drunkenness, the vicious- 
ness of a purely bodily transgression is recognized; 
but none appear to infer that, if this bodily trans- 
gression is vicious, so too is every bodily transgres- 
sion. The fact is, that all breaches of the laws of 
health are physical sins. 
In all fields of life health counts for more than 
is usually appreciated. Even in religion the 
6 THE NEED OF THE TIME 
medieval conception of a weak or ailing body as 
an aid to spiritual development has been aban- 
doned. As a rule, a healthy body and a healthy 
soul go together. Much of the hectic and ab- 
normal in religion have come from a lack of 
bodily health. The best moral and spiritual out- 
look runs parallel with physical health. The 
exceptions to this rule, and they are doubtless 
many, do not invalidate the general principle. 
The Founder of the greatest religion told His 
followers that He came to bring them a more 
abundant life. 
A popular slogan of the day has been crystal- 
lized in a short phrase, " Safety first." Many 
accidents are prevented by having this notice 
displayed in public places. It might be well if 
another sign could be added to attract the at- 
tention of the crowd. It would read, " Health 
first." 
7 CHARTER II 
HEALTH FOR THE BODY : AN EFFICIENT 
MACHINE NEEDED 
LET us for a moment simply think of the hu- 
man body as a machine. A successful me- 
chanic whose duty it is to operate a machine 
takes the greatest care of it. His success de- 
pends on keeping his engine, whatever it may be, 
in good running order. If the mechanism needs 
oiling or a wheel or a cog gets a little out of 
place, the engine runs badly or stops altogether. 
Before starting for the day, the careful chauf- 
feur looks over the mechanism of his car to see 
if everything is in proper working order. He 
knows that the success of the day's run depends 
largely upon this preliminary care. 
Few people realize that the human body is the 
most perfect, and at the same time the most com- 
plicated, machine in existence. Moreover, this 
elaborate machine is under our own control. Its 
successful operation means that all the parts 
must work in harmony. 
8 AN EFFICIENT MACHINE 
If the stomach of a man is out of order, at 
once the whole machine works badly. The man 
becomes low spirited and not up to the work of 
the day. He is not bright and alert, but rather 
depressed and apprehensive, for the brain quickly 
sympathizes with a badly working stomach. 
This is a familiar example of many minor dis- 
orders that may be easily corrected, yet, if al- 
lowed to continue, will produce bad effects. 
Efficiency in life depends much more than is 
appreciated upon good health. Many a failure 
can be traced to low vitality. The machine is 
not working up to its full capacity. 
In a recent annual report of the New York 
Association for Improving the Condition of the 
Poor the extent to which poverty is caused by 
sickness is shown in a startling way. Out of 
many thousands of dollars spent in material re- 
lief for destitute families in their homes, ninety- 
six per cent, was given to families who had to 
seek aid on account of the sickness or death of 
the wage-earners. The Charity Organization So- 
ciety has found that fully two-thirds of the cases 
of poverty it is called upon to investigate depend 
directly or indirectly upon sickness. 
This is also an important social as well as in- 
9 HEALTH FIRST 
dividual problem, as poverty increases sickness 
and disability as well as being caused by these 
conditions. In a recent survey of several poor 
districts by the New York Board of Health an 
undue increase of degenerative diseases was 
found. The following quotation from their bul- 
letin emphasizes this point: 
Our study of the mortality of the city by sanitary 
areas has supplied us with ample proof, if such proof, 
indeed, were needed, that the family income is a most 
important factor in raising or lowering morbidity and 
mortality. Where the family income is sufficient to 
permit living under a reasonably favorable condition 
(sanitary housing, ample food, adequate clothing, 
wholesome recreation), sufficiently to permit of prompt 
and efficient medical attention in case of illness, suf- 
ficient to permit of proper nursing of the ill, mor- 
bidity and mortality are invariably lower; whereas, 
when conditions are reversed and poverty, with its 
train of social complications exists, morbidity and 
mortality are high, no matter how favorable the age 
and sex constitution or other similar factors of the 
population may be. 
Several surveys in different places made by the 
Children's Bureau of the United States Gov- 
ernment shows that the curve of sickness and 
death among infants and little children follows 
the curve of earnings of the wage-workers. 
10 AN EFFICIENT MACHINE 
While statistics show that the average length 
of human life is being prolonged, this improve- 
ment has come largely through the saving of 
infant and child life. As we shall show in a 
future chapter, this is unfortunately not due 
to a lessening of the diseases and degenerations 
that come during middle life and take off many 
in their prime. Diseases of the heart and lungs 
and of the liver and kidneys are on the increase. 
This is not only due to the added strain of life 
in modern times, but to the fact that diseased 
conditions are not recognized early enough to 
admit of preventive treatment. The machine has 
not been watched with sufficient care, and some 
vital part of it has been hopelessly disarranged. 
In considering the question of health, life may 
naturally be divided into three parts. The first 
period is that of growth, when accretion and re- 
pair are more active than waste: the cells of the 
body are built up more quickly than they disin- 
tegrate. After growth has been accomplished in 
all its details, there ensues a period when waste 
and repair are virtually equal; and finally, as 
the bodily machine begins to wear out, waste 
becomes more active than repair and a slow 
disintegration of the body naturally ensues. 
11 HEALTH FIRST 
Roughly speaking, these periods correspond to 
youth, middle life and old age. 
It is very necessary for every person to have a 
clear conception of how these different periods 
vary in their requirements, as the secret of health 
and long life is largely involved in this problem. 
In the conception of the human body as a com- 
plicated engine we may consider construction, re- 
pair and waste as the important factors in refer- 
ence to starting the machine in a satisfactory 
way and keeping it running as long and as easily 
as possible. 
Much may be done in the line of conserving 
health and life by continual education in the laws 
of hygienic living as they apply to different ages 
and conditions. As far as the person is con- 
cerned, we believe that much may be thus ac- 
complished both to increase healthfulness and 
prolong life. Many a successful man breaks 
down when he should be at the summit of his 
power. The machine has not been carefully 
watched, and some part gives out before its time. 
How can we tell when any of the parts of the 
human machine are undergoing an undue strain 
or are beginning to give out? We must do what 
the factory foreman does when his machine needs 
12 AN EFFICIENT MACHINE 
overhauling: call in a competent engineer to go 
carefully over all the parts in order to see if 
any screw is loose or any joint is in need of 
repair. In the case of the human machine the 
well-equipped doctor is the man to make the 
examination. 
The Health Department of New York City has 
recently started a system of stated physical ex- 
aminations of its many hundred employees, and 
finds a great saving of efficiency by recognizing 
and preventing the early beginnings of disease. 
Among two thousand cases reported, many 
showed some weakness or susceptibility which, 
if neglected, would be likely to be followed by 
chronic organic lesions and thus to a shortening 
of life. Twenty-two per cent, of those examined 
showed an albuminuria of greater or less extent, 
and in some this was combined with a high blood 
pressure. In these cases a kidney affection is sure 
to develop if steps are not taken to try to alter the 
condition. On a later examination about ten 
per cent, of the persons showed a very decided im- 
provement over their former physical condition. 
Large employers of labor, such as railroads 
and industrial corporations, are finding it eco- 
nomical to attend to the health and general wrel- 
13 HEALTH FIRST 
fare of their laborers, as their efficiency is thus 
much increased. The United States Steel Cor- 
poration has established a Bureau of Safety, 
Sanitation, and Welfare for its employees. This 
not only safeguards the workers in shops and 
mines, but operates a scheme of welfare work in 
the home. They find that laborers that are 
poorly cared for or worried by illness cannot do 
good work. 
The Ford factory at Detroit has recently had 
a thorough examination made of the many thou- 
sand men that had been hired, in order that they 
might be put to work in the most efficient way. 
The American Association for Labor Legisla- 
tion advises compulsory health insurance in or- 
der to favor more active work in the prevention 
of disease. They find the death-rate for Ameri- 
can wage-earners twice that of professional men, 
with a correspondingly high sick-rate. Despite 
the greater prevalence of tuberculosis among 
wage-earners, and their early susceptibility to 
the degenerative diseases of middle life, with an 
excessive death-rate among the industrial popu- 
lation, the workers are often unable to secure 
proper medical attention in time to ward off 
these evils. 
14 AN EFFICIENT MACHINE 
In a series of tests made among employees 
of commercial houses by the Life Extension In- 
stitute of New York, it was found that a large 
percentage of the men showed some physical de- 
fects. Such facts need not cause undue alarm, 
because many of these defects can be relieved if 
discovered early enough. In line with this in- 
vestigation, it is interesting to note that out of 
more than five thousand applicants recently ex- 
amined in New York for admission to the marine 
corps, only forty-five per cent, were finally ac- 
cepted as physically fit for enlistment. An an- 
alysis of the cause of rejection in these cases 
showed that in fully fifty per cent, of them early 
medical or surgical treatment would have re- 
moved the defect for which they were rejected. 
The Charity Organization Society estimates that 
out of thousands of men and women examined, 
seventy per cent, were found to have some weak- 
ness that might shorten life, but which could be 
prevented if taken in time. 
The lesson that all this teaches is that every 
person should be periodically examined in order 
to find out if the bodily machine is in good work- 
ing order. Groups of persons, such as fraternal 
societies, lodges, or trade organizations, should 
15 HEALTH FIRST 
arrange with a competent doctor to give every 
member a thorough overhauling at stated times. 
Special groups might be formed for this sole 
purpose, which could include whole families, who 
would thus also receive the benefits of periodical 
examinations. In this way it would be possible 
to prolong life and prevent much disability, as 
unfavorable conditions would thus be early dis- 
covered and in many cases prevented. 
There is an old tradition that the Chinese em- 
ploy physicians to keep them well rather than to 
attend them when sick. In case of illness, the 
doctor is not paid but penalized for allowing such 
a thing to happen. This may be largely legend- 
ary but it contains the germ of an important 
truth. As far as each individual is concerned, it 
would certainly be wiser to pay a physician to 
maintain one in health rather than for attendance 
in illness. 
Success in life in virtually all its pursuits, 
and happiness in any state, are conditioned on 
good health. Efficiency and strength go hand 
in hand. Let the human machine be constantly 
overhauled, so that it may be kept in as good a 
state of repair as possible. 
16 CHAPTER III 
HEALTH FOR THE INFANT: A RIGHT START 
IT was a saying of Dr. Holmes that the proper 
treatment of some diseases should begin one 
hundred years before birth. This is only one 
way of emphasizing the responsibility of bring- 
ing children into the world, as parents have a 
most serious duty to perform to themselves, their 
offspring, and society at large. 
While the span of a century cannot be con- 
veniently utilized as advised by Holmes, at least 
the year before birth should be regulated as 
nearly as possible in the interests of the coming 
child. 
PRENATAL CARE 
A healthy, vigorous infant presupposes healthy, 
vigorous parents. As far as the mother is con- 
cerned, her care should begin with the period of 
conception, which means that she should main- 
tain herself in as good a condition of health 
as possible while she is carrying the child. All 
17 HEALTH FIRST 
the functions of her body must be satisfactorily 
performed. No social or household duties must 
be allowed to interfere with this principal busi- 
ness of her life. 
At this period it is well for her to systematize 
her life so that the best results will be obtained. 
Plenty of pure, fresh air is essential. Her liv- 
ing and sleeping-rooms must be well ventilated, 
those with a western or southern exposure being 
preferred. She should take the outer air in daily 
walks or drives, or by sitting much on a piazza 
during warm weather. Regular exercise is very 
beneficial, but nothing severe or jolting should 
be allowed. As physical exercises involving 
much muscular exertion or fatigue are not ad- 
visable, all lifting or straining is forbidden. 
Plenty of rest and sleep is desirable. The night's 
sleep should include at least eight hours, and 
more if desired. It is also well to lie down and 
rest for a season in the middle of the day. Even 
if sleep is not possible, the rest and relaxation 
will prove beneficial. 
The clothing must be comfortable and loose- 
fitting, especially avoiding any undue pressure 
upon the chest and abdomen. Clothing that is 
so arranged as to be suspended largely from the 
18 A RIGHT START 
shoulders is well adapted for this period, and the 
constriction by ordinary corsets or tight garters 
is undesirable. Shoes with low heels should be 
worn, as the high heels in vogue put an undue 
strain upon the spine and lower part of the 
abdomen. 
A daily sponge bath with tepid water is re- 
freshing in the morning, and keeps the skin in 
a healthy condition. This may be followed by 
gentle friction of the body with a coarse towel. 
Though there is no scientific proof that special 
forms of diet have any influence upon the devel- 
opment of the child, the food should be nourish- 
ing and digestible. While full meals are desira- 
ble, all overeating and any indulgence in rich or 
made dishes, fried and indigestible foods, and an 
excess of tea, coffee, and sweets had better be 
avoided. Alcoholic beverages are not to be taken 
unless specially prescribed by a physician. 
Cereals, milk, eggs, all plain vegetables, ripe or 
cooked fruits, fresh fish, and meats, such as beef- 
steak, roast beef, lamb, and chicken, should form 
the principal part of the diet. It is usually bet- 
ter to take meat only once daily. The free drink- 
ing of pure water between meals and at bedtime 
is beneficial by keeping the kidneys in good work- 
19 HEALTH FIRST 
ing order. The bowels must act once daily at a 
regular time. This function may be aided by 
diet, such as fresh fruit, prunes, figs, bran bread, 
and the coarser cereals, with proper outdoor 
exercise. 
The influence the mind exerts on the body is 
recognized by all physicians, and therefore it is 
very important that the future mother should 
keep as composed and cheerful as possible. To 
this end, she should be kept from undue cares 
and worries and have as bright surroundings as 
circumstances will allow. Strong mental ex- 
citement and unrepressed emotions have a bad 
effect at this time. Hence, while all sane amuse- 
ments are desirable, the witnessing of exciting 
or emotional scenes or plays should be avoided. 
In a general way the care of the future child is 
taking place during the whole of the previous 
life of the mother, but in a very special way is 
such care obvious while she is carrying the baby. 
AFTER BIRTH 
In order to have healthy growth, every mother 
should, if possible, nurse her own baby. While 
occasionally cases may arise where a mother's 
milk does not seem to agree with her infant, such 
20 A RIGHT START 
instances are rarer than are supposed. These 
cases are often due to faulty habits on the part of 
the mother or irregularity in feeding the baby. 
Such conditions can usually be corrected, in order 
that the baby may continue to have its natural 
nourishment. 
The nursing mother should lead a quiet and 
regular life, eating at stated times, resting fre- 
quently, and taking moderate exercise. She 
must take no rich and highly seasoned food or 
acid substances, but otherwise she may continue 
her usual diet. If her milk tends to be scanty, 
a generous cupful of oatmeal or corn-meal gruel 
may be taken between meals and at bedtime. 
Regularity in nursing is all-important. This 
not only affects the baby favorably, but the 
mother's own milk as well. Too frequent nurs- 
ing often induces trouble. Whenever the baby 
cries, it is put on the breast by some mothers in 
order to quiet it; but this only leads to more 
fretting later on from the indigestion and colic 
induced by too frequent feedings. Young babies 
must not be fed oftener than every two hours 
through the day, and frequently they do better 
on three-hour intervals. One nursing, or pos- 
sibly two, at night will suffice, as the mother's 
21 HEALTH FIRST 
rest must not be continually disturbed. Fatigue 
and nervousness from insufficient sleep will af- 
fect the mother's milk as disastrously as a faulty 
diet. It may be occasionally desirable to take 
the infant entirely from the breast during the 
night, so that the mother may have a complete 
rest, possibly sleeping in a room out of reach of 
the baby's cries. Sometimes a few nights so reg- 
ulated will restore both the mother's poise and 
her milk. A single bottle, or perhaps even plain 
water, will tide the baby over during this tem- 
porary absence. 
In case the mother is not able to secrete suf- 
ficient milk to satisfy the baby, it is well to sup- 
plement the breast with the bottle. This is 
known as mixed feeding, and instead of alter- 
nating breast and bottle, it is usually better to 
let the baby get all it can from the breast and 
then make up the lacking amount by the bottle. 
The constant use of the breast at regular times 
will keep it stimulated and in better working 
order. It has also been found that cow's milk is 
apt to digest a little easier if mixed with mother's 
milk. 
The importance of breast-feeding is emphasized 
by the fact that bottle babies are not only more 
22 A RIGHT START 
apt to get sick with digestive troubles, but show 
a very much higher mortality than breast babies. 
It has been estimated that one out of eight babies 
born in the United States dies during the first 
year, and that half of these deaths are preventa- 
ble. Good breast-feeding plays a great part in 
this prevention. Over eighty per cent, of the 
babies dying before the completion of the first 
year are bottle fed. In many cases, however, 
mothers are unable to nurse their babies at all, 
or after a time the milk completely fails. Then 
the bottle must be exclusively employed. The 
first requisite is to get a supply of fresh, clean 
cow's milk. It was formerly supposed that the 
milk of one cow was desirable, but it is now 
known that the average -milk from a herd of 
cows, the larger the better, is more constant and 
uniform, and thus safer for feeding babies. 
Such milk must be collected with extra care. 
The cows must be kept scrupulously clean, and 
the milkers use every precaution, by washing 
the hands and avoiding soiled clothing, to keep 
dirt out of the milk. Rapid cooling of the milk 
is desirable, and it should then be carefully bot- 
tled and kept cool until used. Bacteria that 
produce changes in the milk will not grow under 
23 HEALTH FIRST 
fifty degrees Fahrenheit. Milk intended for the 
baby should never be kept in pitchers or open 
utensils, as it quickly absorbs odors or impuri- 
ties from its surroundings. An extra quality of 
cow's milk known as " certified milk " is now 
procurable in many communities, and is desira- 
ble for the baby. It is furnished according to a 
certain standard regulated by a committee of 
the local medical society, which must be lived 
up to by the producer of the milk. The term 
cannot be used unless these conditions are ful- 
filled, and hence a very pure milk is constantly 
produced. If the condition of the milk is un- 
certain, it is safer to boil or pasteurize it. The 
disadvantage of the heated food may be over- 
come by giving a little orange juice once daily. 
Cow's milk differs from human milk in several 
respects. While the fats are about the same in 
both, cow's milk contains double the quantity 
of protein (casein or curd) and less sugar than 
human milk. If it is diluted one half to get the 
protein right, there is too little fat and sugar 
in the mixture. A convenient way to regulate 
this error is to use the top half of a quart-bottle 
of milk after the cream has risen. This is tech- 
nically known as top milk. Simple boiled water 
24 A RIGHT START 
or barley-water make the best diluents, and a 
teaspoonful of plain sugar or sugar of milk may 
be added to the bottle. The amount of dilution 
depends upon the age of the infant. At birth 
about one third of the contents of the bottle may 
consist of top milk, and this may be gradually 
increased with the age of the child, according to 
the judgment of the doctor or nurse. These mat- 
ters, however, had better be regulated by a 
skilled physician, who will manage the case ac- 
cording to individual needs. The baby's feeding 
and nutrition are too important to be governed 
by any one not well versed in the various methods 
of modifying milks according to the necessities 
of each case. It must not be forgotten that 
babies daily need one or two ounces of water in 
addition to their milk food. They sometimes fret 
because they are thirsty rather than hungry. 
Whenever a baby suffers from illness of any 
sort, the food must always be temporarily weak- 
ened. When the bowels are at fault, as in diar- 
rhea, it is safe at once to clear the bowels by a 
laxative and then stop milk entirely for a short 
time, as it does not digest well under these con- 
ditions. Barley-water or plain water may be 
given in the interval. 
25 HEALTH FIRST 
Great care must be taken to keep the baby 
comfortable as far as its clothing, bed and gen- 
eral surroundings are concerned. A napkin 
placed too tightly, a pin in a bad position, or 
constriction of various articles of dress may keep 
a baby crying and uncomfortable. When an in- 
fant cries, an effort should always be made to 
ascertain the cause in order to correct it. Some- 
times simply changing its position will quiet 
it. 
Once a day the baby should be bathed. For 
young babies a temperature of ninety-five degrees 
Fahrenheit is desirable, and older infants may 
have the water at ninety degrees Fahrenheit. 
If a thermometer is not at hand, the elbow of 
the nurse placed in the water will be a rough, 
but fairly accurate, indication of a comfortable 
temperature. 
HEALTHY DEVELOPMENT 
A few facts relative to growth during infancy 
and early childhood may be of interest as a gen- 
eral guide in watching this period of life. While 
absolute rules cannot be given for every case, 
there is a normal ratio that, within certain lim- 
its, should be attained by the average infant. 
26 A RIGHT START 
The exact ratio for each individual child is gov- 
erned by hereditary influences determining the 
general framework of the body at birth as well 
as by the kind of food available after birth. 
Some infants are born with small bones, per- 
haps in this respect resembling one or both par- 
ents. The birth-weight of such an infant, as 
well as that attained later, will be less than that 
of a baby having a larger bony framework. 
Different races, as well as families, show con- 
siderable variation in this respect. Needless 
alarm is sometimes excited if the physician or 
mother merely considers averages that are taken 
from a different class or community and hence 
do not particularly apply to the baby under 
consideration. In every case, however, the ex- 
tremely rapid growth of the infant after birth 
makes careful observation of all the phenomena 
connected therewith not only interesting, but 
important. 
In a series of observations, covering several 
hundred cases, made by the author, the average 
birth-weight varied from six to eight pounds, 
the males usually weighing a little more than 
the females. The growing infant should double 
its birth-weight at five or six months and treble 
27 HEALTH FIRST 
it at fifteen or sixteen months. Growth in 
length is likewise extremely rapid during in- 
fancy, especially in the earlier months. It is 
most marked during the first month, a little less 
during the second, the rate of rapidity decreas- 
ing with each mouth. As a general guide, it may 
be said that the body lengthens about eight 
inches during the first year, three and a half 
inches during the second, three inches during 
the third, two and a half inches during the 
fourth and fifth, and at about the same rate up to 
the fourteenth year. 
While infants at birth may vary greatly in 
size, every child should develop in proper pro- 
portion, the various parts of the body having a 
symmetrical relationship to one another. As an 
example, the circumference of the head is greater 
than the circumference of the chest at birth and 
remains so up to the middle of the first year, 
when they begin to approximate in size. By the 
end of the first year the chest is growing faster 
than the head, and this disproportion steadily 
increases. At birth the circumference of the 
head averages from thirteen to fourteen inches, 
at the end of the second year about eighteen 
inches, at the seventh year about twenty and a 
28 A RIGHT START 
half inches, and at the completion of growth 
twenty-two or more inches. 
In the human being the brain assumes over- 
mastering importance in the scheme of evolu- 
tion, hence its proper growth and development 
are relatively of more importance than that of 
other parts of the body. The extremely rapid 
evolution of the brain during infancy, and the 
fact that the future efficiency and well-being of 
the child depend largely upon its normal and 
healthy growth, render a study of the infantile 
head of great interest. As the skull is fairly 
representative of the brain during the years of 
its first development, measurements taken dur- 
ing infancy are more instructive as to brain size 
and development than those taken in later years. 
The skull changes considerably in its proportions 
during the first three years of life, and then more 
slowly up to the end of the seventh year, when 
it has very nearly attained its full size. After 
birth there is noted a gradual and steady enlarge- 
ment of the great circumference of the skull, and, 
from this, of its estimated volume. 
Although no intellectual growth can be said 
to take place under two years, there should be 
an active evolution of the front of the brain, 
29 HEALTH FIRST 
with an increase of the perceptive organs. The 
first rapid growth of the brain after birth is more 
in bulk than in the size and complexity of the 
convolutions. Hence in early infancy the higher 
centers have only a slight development and func- 
tion. With proper evolution, the convolutions 
grow and become arranged in functional groups, 
which groups, by their growth, alter and modify 
the shape of the infantile skull. If the skull is 
small or improperly shaped in any part, the 
brain in such an area is imperfectly developing. 
A certain amount of asymmetry is, however, 
found in all skulls, as in other members of the 
body, and, unless very marked, has no great 
significance. 
The principle of biology, that the development 
of the human being reproduces on a small scale 
the development of the race, is well shown in the 
infant's brain. The higher centers and the asso- 
ciation fibers are developed late in the child. 
They are likewise the last acquisitions of the 
race. The lower and more fundamental animal 
traits are more transmitted by inheritance than 
the higher ones. Good nutrition and good train- 
ing are required to develop the higher functions 
of the brain in a satisfactory manner. 
30 A RIGHT START 
The rapid growth of the body during infancy 
is accompanied by a speedy acquisition of vari- 
ous functions. For a time after birth the great- 
est relative strength is shown in the hands and 
arms, as one can easily verify by allowing an 
infant to grasp a finger and then trying to pull 
it away. At about three months the muscles of 
the neck have developed sufficiently to allow the 
infant to hold up its head in an uncertain way. 
At the seventh or eighth month the muscles of the 
back have become so strengthened that the baby 
can sit up and shortly after this it may be al- 
lowed to creep. 
Free play should be given to the muscles of 
the arms and legs from the first, as muscular 
and bony development are thereby encouraged. 
The limbs must not be so tightly bound as to 
prevent kicking and active motions. The bones 
of the legs thus grow and straighten out, but this 
will be checked if the infant is made to sustain 
the weight of the body too soon. The average 
baby should not be encouraged to stand before 
the twelfth month. Efforts to walk may be be- 
gun from then on to the fifteenth or sixteenth 
month. When walking has been established, the 
legs should be straight. The chest develops rap- 
31 HEALTH FIRST 
idly, with enlargement of the pectoral and shoul- 
der muscles, and, as stated before, its circum- 
ference usually equals that of the .head by the 
end of the first year. 
The perceptions and emotions of the little child 
are relatively active, while anything resembling 
will-power and self-control are still in abeyance. 
Just after birth the brain and nerve-centers act 
only automatically or by reflex action. For the 
first few days the baby is deaf, and it will not 
follow an object with its eyes until the third 
week. By the third month it reaches out its 
arms for objects and may recognize persons. 
The rudiments of memory are now developed, 
and by the fourth or fifth month a few familiar 
persons may be remembered and recognized. It 
is not until the third year, however, that memory 
develops very rapidly. 
The connection between names and things may 
be noted as early as the last of the first year. 
During the second year words and short sen- 
tences may be employed, and in the third and 
fourth years a marked loquacity usually shows 
THE BEGINNING OF MENTAL GROWTH 
32 A RIGHT START 
itself. As a rule, girls begin to talk earlier than 
boys. 
The beginning of emotions, such as pleasure 
or anger, may be noted at the end of the first 
year, but are more definite during the second and 
third years. While they may flare up suddenly, 
they are very transitory in nature. Small 
powers of reasoning, such as drawing inferences, 
may be seen as early as the third year. It is 
never wise to try to force any of the mental func- 
tions of the very young child, as it should merely 
develop its muscles and senses without the strain 
of trying to develop memory, the reasoning 
powers, or imagination. Infants and very young 
children are often injured by too much attention 
to these matters on the part of adults. Such 
forcing may develop precocious children, who 
are apt to become dull later on. Very young 
children who show unusual imagination or mem- 
ory should not be encouraged in the early em- 
ployment of these faculties. 
EARLY RECOGNITION OF ILLNESS 
It is always important that an early recogni- 
tion of illness should be made, in order that a 
33 HEALTH FIRST 
successful prevention or treatment can thus be 
instituted, and a continuance of the disease some- 
times thereby be avoided. It may be well to 
know that slight causes often produce very 
marked and sudden effects during the early years 
of life. This is explained by the active growth 
of infants and especially by the rapid develop- 
ment of the nervous system. 
The various structures of the body are so in- 
timately connected by the nerves that irritation 
in one organ may quickly be transmitted to an- 
other, which is aggravated by unstable nerve- 
centers that exhibit poor powers of inhibition and 
control. As an example, the irritation produced 
in the intestinal canal by undigested food may 
induce a high fever or even a convulsion. Thus 
a slight indisposition frequently presents the 
appearance of severe disease, while the converse 
of this is sometimes true, as serious illness may 
so blunt this delicate nervous susceptibility as 
to cause the real gravity of the case to be over- 
looked. 
SIGNS OF DISTURBANCE 
As the baby cannot describe its feelings, atten- 
tion may be called to various conditions that are 
evidences of some disturbance. 
34 A RIGHT START 
IRRITABILITY OF TEMPER 
In the absence of speech, the infant shows dis- 
comfort or suffering principally by cries and 
restlessness. If watched closely, it may by vari- 
ous signs indicate to a certain extent the seat of 
the trouble. In headache the hand will be fre- 
quently raised and held beside the head; in ear- 
ache, the hand will be carried to the ear and 
will often pull upon that organ; in difficult and 
painful teething the fingers will be constantly 
inserted into the mouth, as if to pull out the cause 
of distress; irritation of the stomach and bowels 
may be accompanied by a continual rubbing of 
the nose. During an attack of colic the legs 
are drawn up over the abdomen, which feels 
hard, and there is likewise a writhing motion of 
the body. 
Crying is a very constant accompaniment of 
all kinds of illness. Constant, uninterrupted 
crying is usually caused by earache, hunger, or 
thirst. If, after giving the baby suitable nour- 
ishment or a drink of water, it still keeps up a 
continuous, almost automatic cry, there is prob- 
ably severe pain in the ear. This may be con- 
firmed by pressing in front and behind this organ, 
35 HEALTH FIRST 
to see if the baby will wince. If there is some 
disease in the head, a sudden, piercing cry is 
uttered at intervals, between which there will 
probably be no fretting. 
In pneumonia there is crying only during 
spells of coughing and a short time after; in 
pleurisy there is likewise crying only during 
coughing, but it is shriller and indicates more 
suffering than in pneumonia, and it is also pro- 
duced by moving the child and pressing the af- 
fected side. 
Crying just before or after a movement of the 
bowels, with a twisting of the pelvis, gives evi- 
dence of intestinal pain. When the hands are 
tightly shut, with the thumbs thrust deeply into 
the palms, and the toes are bent, there is nervous 
irritation which may eventuate in a convulsion. 
CHANGES IN THE FEATURES 
When illness is present, it is quickly shown in 
the countenance of the infant, which, during 
health, wears an expression of easy repose. In 
general, it may be stated that the upper part of 
the face is involved in diseases of the head, the 
middle part of the face in affections of the chest, 
and the lower part in disturbances involving the 
36 A RIGHT START 
abdominal organs. Thus in congestion or other 
diseases of the brain, the forehead and eyebrows 
will be sharply contracted, and the eyes will be 
exceedingly sensitive to light. Puffiness and 
swelling about the eyelids usually point to 
dropsy, which is often caused by some disease of 
the kidneys, following scarlet fever or other in- 
fectious sicknesses. In pneumonia and pleurisy 
the nostrils are sharply defined, and dilate and 
contract with the movements of respiration, 
which will appear more or less labored. The 
mouth is most affected in abdominal diseases, 
as is shown by the drawing of the upper lip, grit- 
ting of the teeth, and other movements indicating 
pain. 
A well child always sleeps quietly, but an ill 
child sleeps fitfully and sometimes only when 
it is rocked or patted or carried about in some 
one's arms. If it is constantly kicking off the 
bedclothes, it is an almost sure sign either of 
intestinal indigestion or of early rickets. When 
it is impossible for a child to sleep well unless 
its head and shoulders are high upon a pillow, 
there is apt to be some disturbance in the heart 
or lungs. 
RESTLESS SLEEP 
37 HEALTH FIRST 
If a child sleeps with its mouth wide open and 
the head thrown back, with noisy respiration, 
there is enlargement of the tonsils or adenoid 
tissue at the upper part of the pharynx that 
interferes with quiet breathing through the nose. 
A persistent boring of the back of tlie head into 
the pillow points to irritation in the brain. 
When a child sleeps with half-open eyes, there 
is apt to be moderate pain present, and if there 
is a constant movement of the lips, the discom- 
fort is located in the gastro-intestinal canal. 
This sign, however, has not the grave significance 
that it has in later life. 
During infancy vomiting is a frequent and 
easy symptom when the stomach is simply dis- 
tended by overfeeding. The infant shows no dis- 
tress from this act and continues in a good con- 
dition of health; the stomach simply rejects any 
excess of food above that which it can conven- 
iently hold and digest. But sudden and profuse 
vomiting without any error in diet may consti- 
tute the beginning of a severe illness, such as 
scarlet fever, diphtheria, or some brain disease. 
Acute illness in early life may begin with vom- 
STATE OF THE DISCHARGES 
38 A RIGHT START 
iting in place of the chill suffered by older per- 
sons. Vomiting may also be a sign of local dis- 
turbance of the stomach, as when mucus is 
ejected in cases of gastric catarrh. Where tough 
curds are vomited, with the milk very sour, there 
is evidence of fermentation and an over-acid con- 
dition of the stomach. If this persists, the mouth 
will become red and sore from the irritation. 
Much can be learned from the character of the 
discharges from the bowels. During the first 
two months there are usually three or four stools 
a day, and during the first two years an average 
of two movements a day. The stools are of a 
soft, uniform, semi-solid consistency, and yellow- 
ish color. In cases of bowel disturbance they 
may be green or contain hard, lumpy curds or 
have an admixture of mucus or blood, or be very 
watery. The bowels should then be promptly 
cleared out, and the food temporarily stopped. 
The onset and course of sickness in the infant 
are frequently very rapid, and a good physician 
should promptly be called in all such cases. 
Early recognition and treatment will quickly 
restore to health many apparently grave cases. 
39 CHAPTER IV 
HEALTH FOR THE GROWING CHILD: 
NORMAL DEVELOPMENT 
NO subject is of greater importance than the 
health of the growing child. During the 
period of development the mind as well as the 
body must be trained, in order that the ideal of 
a healthy mind in a healthy body may be at- 
tained. 
The early years of life are, physiologically 
speaking, the most important ones we live. The 
rapidly developing body has at this time stamped 
on it the possibilities of future vigorous life or 
of early degeneration and decay. From the first 
dawn of life to full development there is con- 
stantly going on a remarkable series of rapid 
changes that are not only fraught with the great- 
est interest, but accompanied by the largest pos- 
sibilities. It is for the latter reason a most 
hopeful period. 
In the scheme of evolution the higher the ani- 
mal, the more important becomes the proper 
40 NORMAL DEVELOPMENT 
management of its time of growth. This is espe- 
cially emphasized in man not only by a great 
prolongation of the period of infancy, but by 
the many subsequent years of development re- 
quired before complete growth is attained. John 
Fiske was the first to elaborate this fruitful view 
of one of the fundamental laws of higher evolu- 
tion, which not only throws a strong light on the 
method of evolution, but lays the greatest im- 
portance on the early years as influencing the 
future health and development of the person. 
The whole period of growth is a time of plas- 
ticity when the career of the person is no longer 
predetermined by the career of its ancestors. 
The lower animal is born pretty fully formed, 
and can look out for itself almost from the begin- 
ning, independently of the parent. A slow 
growth means an increase in capacity for a high 
individual development and prolonged vigor. 
The parent must recognize the importance of 
this fact, since mistakes made at this time can 
never be completely corrected. 
HEALTHY GROWTH 
Let us briefly glance at a few facts pertaining 
to growth in children, as this will throw much 
41 HEALTH FIRST 
light upon their proper management. During 
infancy growth is steady and rapid, but in child- 
hood it is relatively slower and takes place more 
in cycles. It depends very largely upon good 
heredity and a healthy, well-nourished state dur- 
ing the first years of life. Biological researches 
show that favorable embryonic conditions and 
good nutrition during the earliest years have the 
greatest influence in determining the full height 
and development of the person. If a child is 
fortunate in its birth and is well nourished up 
to the fifth or six years, there will probably be a 
healthy growth thereafter, as, even if there are 
poor conditions later on, nature will probably be 
able to compensate and make up for them. Each 
person has a certain normal size to attain, which 
will usually be reached if the first years have 
been favorable. Nothing will completely make 
up, however, for early unfavorable conditions. 
Race and heredity, other things being equal, gov- 
ern very largely the possible limits of individual 
growth. 
The two principal periods of acceleration of 
growth occur during the second dentition, or 
when the permanent teeth are cut, and at the 
period of adolescence. This roughly corre- 
42 NORMAL DEVELOPMENT 
spends, first, with the period from six to nine 
years in boys and girls, and, second, from eleven 
to thirteen in girls and from fourteen to sixteen 
in boys. This cycle of increase in height should 
precede and soon be followed by an increase in 
weight. There also tends to be some variation 
in growth in different seasons. In a series of 
studies made by a Danish observer and quoted 
by Tanner the period of most rapid increase in 
height among seventy boys from seven to fifteen 
years of age was found to be from April to 
August, and the least from August to December, 
while the greatest increase in weight occurred 
from August to December, and the least from 
April to August. 
Whenever there is a rapid increase in height, 
the child is apt to grow thin and anemic, as the 
making of bone quickly uses up the red corpuscles 
of the blood. These children become nervous 
and irritable, requiring extra care at home and 
school. Such supervision must concern itself 
with a carefully selected diet, plenty of rest, and 
the avoidance of intellectual over-stimulation. 
These children must never be pushed at school, 
and it may even be necessary to remove them for 
a time if they are worried by their studies. 
43 HEALTH FIRST 
DIET AND HYGIENE 
I 
During infancy, childhood, and adolescence, 
proper nutrition plays a leading part in inducing 
satisfactory growth and development. Easily 
digestible, nourishing food is of the first impor- 
tance at this time. The responsibility of par- 
ents does not end in supplying proper nutriment; 
they must see that the child actually partakes of 
it in sufficient amount. This fundamental requi- 
site in healthy growth is too often left to the 
careless judgment and oversight of teachers, 
governesses, and even of servants. 
A healthy appetite for plain, health-producing 
food is a thing to be cultivated from the begin- 
ning, and will then continue through life to the 
lasting benefit of the person. Much of the dys- 
pepsia and ill health of later life come from a 
child's being allowed to indulge irregularly in 
all kinds of improper food, with the consequent 
fickle appetite and digestion. 
There is no doubt that children, especially 
girls, are frequently pushed too hard in their 
studies during their period of growth. Lack of 
vigor in the adult may have its roots in this cause, 
especially when accompanied by a highly sensi- 
44 NORMAL DEVELOPMENT 
tive nervous organization. School studies are 
piled up in endless profusion, while outside the 
session every available hour is taken up with spe- 
cial accomplishments such as music or dancing. 
The child soon becomes a little machine, to be 
wound up each hour of the day for some special 
labor or service. 
Children must early be taught to be satisfied 
with plain, nourishing, and digestible food. It 
must be remembered that when growth is active 
the proteins, or tissue-making elements of the 
food, have great value. A properly balanced diet 
should contain fats and carbohydrates as well, 
but foods having a large content of protein must 
always be administered. This subject will be 
considered more at length in the chapter on 
health and nutrition. 
In order to start digestion right, not only must 
the food be properly selected, but the greatest 
care must be given to the teeth. It should al- 
ways be remembered that the health and preserva- 
tion of the temporary teeth are necessafiy in 
order to favor a good set of permanent teeth. 
Any pus organisms allowed to lodge in the roots 
may injure the permanent teeth; milk-teeth must 
accordingly be filled if decayed, and preserved 
45 HEALTH FIRST 
as long as possible. This also helps preserve 
the proper shape of the jaw. Decayed teeth may 
cause earache, neuralgia, swelling of the glands 
in the neck, and poor nutrition from chronic in- 
digestion due to imperfect mastication. 
Warm, porous clothing in winter and light, 
loosely meshed garments in summer are the re- 
quirements to be kept in mind. In summer little 
children are often too warmly clad, and accord- 
ingly may perspire to excess. This may induce 
undue irritability and even a certain amount of 
debility, especially in neurotic children. 
HEIGHT AND WEIGHT 
In order to present a guide of average growth, 
the following tables have been combined and com- 
piled from the studies of Boas on the rate of 
growth in height and of Burke on the weight of 
American children: 
Table of height and weight of American boys 
Years 
61 
Average height (Boas) Average weight (Burke) 
43.9 inches 
45.2 pounds 
46.0 inches 
49.5 pounds 
84 
48.8 inches 
54.5 pounds 
94 
50.0 inches 
59.6 pounds 
121 
55.4 inches 
76.9 pounds 
46 NORMAL DEVELOPMENT 
Years Average height (Boas) Average weight (Burke) 
151 
62.9 inches 
107.4 pounds 
181 
67.4 inches 
• • • 
Table of height and weight of American girls 
6i 
43.3 inches 
43.4 pounds 
71 
45.7 inches 
47.7 pounds 
81 
47.7 inches 
52.5 pounds 
9| 
49.7 inches 
57.4 pounds 
121 
56.1 inches 
78.7 pounds 
15j 
61.6 inches 
106.7 pounds 
181 
114.9 pounds 
HEALTHY MENTAL AND MORAL GROWTH 
The mental growth and development of the 
child must be carefully watched from the very 
beginning. Just as the human embryonal life 
represents the various upward stages of animal 
development, so the child's mind reproduces in 
miniature the earlier stages of the growth of the 
race. The responsibility of properly under- 
standing and guiding the physical and mental 
growth of the child rests directly upon the 
parents. It cannot be shifted to any one else. 
There are constant changes and variations al- 
ways taking place that demand study and under- 
standing. The parents are the ones to make this 
intimate acquaintance, calling for constant 
47 HEALTH FIRST 
watching and effort, which cannot be successfully 
relegated to nursery-maids, governesses, or 
teachers. 
The great hopefulness in dealing with children 
lies in the fact that it is the plastic and impres- 
sionable age, but this may be equally potent for 
good or evil. It is necessary to recognize early 
the various tendencies that manifest themselves 
in a growing child in order that they may be 
understood and curbed or guided aright when 
occasion seems to call for interference. To this 
end it must be remembered that the child ex- 
hibits the elemental human forces and instincts. 
Just as the emotions are developed in the race 
before the reason, so it is with children. They 
can be moved by their sympathies long before 
they can be influenced by their intellect. Love is 
a surer guide for them than reason. This is the 
secret of the success of many mothers and a few 
teachers. The pedagogue is too apt to try to 
cultivate the intellect before the emotions and 
feelings are considered, and hence he often makes 
a failure of both. 
The most lasting impressions of childhood are 
apt to come through the feelings. Thus the grief 
of the child should always be respected. While 
48 NORMAL DEVELOPMENT 
transitory, it is likewise intense. It has been 
truly said that while to the old sorrow is sorrow, 
to the young it is despair. Parents might often 
relieve mental suffering if they would bear this 
in mind. This may be accomplished by turning 
the child's mind into other channels, as they can 
be quickly diverted. 
At the end of infancy and during early child- 
hood the imitative faculties come specially into 
play. The acts of older children, of adults, and 
even of animals, are faithfully copied without 
much idea of their significance. Up to the age 
of seven years, much of the training and educa- 
tion of the child must come from imitation. He 
learns by imitating, and little escapes his watch- 
ful eye. This throws a great responsibility upon 
parents and teachers, as a defective environment 
is at once reflected by the observing and imitative 
little child. Until the age of seven, most of the 
playing of children is imitative, shown by the 
delight in dolls and numerous toys representing 
things in real life; but after this, especially in 
boys, the games take on a more competitive form, 
involving muscular exercise. The little child be- 
ing so imitative, suggestion plays a very impor- 
tant part in training. The absence of the critical 
49 HEALTH FIRST 
faculty at this time leaves the field open for sug- 
gestion to work with full effect. 
Little children are born realists and even 
actors. They delight in truth as they apprehend 
it, and are not backward in expressing their 
exact thoughts. It is a mistake to exercise a 
constant repression on account of these traits. 
Rather should they serve as a basis for correct 
training in the broadening of their conceptions 
of right and wrong and even of life and duty. 
There exists in many children a touch of bar- 
barism that is merely an evidence of under- 
development. Lombroso goes so far as to trace 
certain analogies between the child and the crim- 
inal. He considers that the germs of criminality 
are met with, not by exception, but normally, 
in the early years of human life. As in the 
embryo there occur naturally certain forms that 
would be monstrosities in the adult, so the child 
represents a man of undeveloped moral sense. 
Lombroso places passion and vengefulness, van- 
ity and cruelty, in this comparison between the 
child and the criminal. Doubtless the great 
criminologist goes too far in exaggerating this 
analogy, but it affords food for serious thought 
and observation in those who study and bring 
50 NORMAL DEVELOPMENT 
up children. Apparent cruelty, shown in a cal- 
lousness to suffering, is often seen in children, 
but is due more to ignorance and lack of experi- 
ence as to the meaning of pain than to defective 
moral sensibility. Real cruelty is seen in the 
undeveloped races, and is a sign of defective de- 
velopment. If it exists unchecked in the case of 
a child, it is usually an evidence of faulty train- 
ing on the part of the parents. 
HEALTHY MORAL TRAINING 
In a study of the moral nature of the child the 
parent must sharply distinguish the essential 
from the non-essential in character-building. 
Thus a sort of rowdyism due to an excess of ani- 
mal spirits need not be constantly repressed, but 
any duplicity must be instantly noticed and rep- 
rimanded. If a point is once made, it must 
be carried out, no matter how much of a struggle 
is required, and it is therefore wise to make an 
issue as rarely as possible, and then only for 
really essential points. The character of many a 
child is injured by querulous rebukes, constantly 
administered, until he comes to be considered 
almost in the light of an outlaw, perhaps all for 
small offenses that involve no essential moral 
51 HEALTH FIRST 
question. A little judicial blindness and an oc- 
casional kindly talk, combined with efforts to 
interest the child and guide his exuberant energy 
in proper directions will do much to conserve 
his moral and social self-respect. 
The conduct of the child is largely influenced 
by the tone and temper of those about him. If 
a proper poise and self-control exist in the 
parents, it is sure to be reflected in the children. 
This is seen in the intellectual as well as in the 
moral sphere. A cultivated home will do more 
for a child's physical, mental, and moral health 
than the formal education of the finest schools. 
Thus the early hearing of good language will 
be of more lasting benefit than a later knowledge 
of all the rules of prammar. Many a college 
graduate uses poor or ungrammatical language 
as a result of early unfavorable surroundings 
that later cultivation has been unable entirely 
to eradicate. 
There are three great critical periods of life: 
birth, adolescence, and beginning old age, in 
which rapid and suggestive changes are apt to 
take place in the organism. 
A most interesting as well as critical time for 
ADOLESCENCE 
52 NORMAL DEVELOPMENT 
the child is the beginning of adolescence. Up to 
this time, as already noted, the child has lived 
the life of the race, but he now begins to develop 
more individual characteristics, and family traits 
also come out more strongly. There is a rapid 
growth of the body, especially marked in certain 
internal structures, such as the heart and lungs 
and reproductive organs, with increase in blood 
pressure and in general glandular activity. The 
peculiarities of sex now begin to manifest them- 
selves, and boys and girls cease to mingle in the 
indiscriminate way of earlier childhood. Up to 
twelve years there need not be much differentia- 
tion of the sexes, but after this they must be 
separately considered. 
Vague aspirations and a general restlessness 
show the stirring of a new life in the child's 
mind. Ideals begin to take strong hold, and, 
although often crude, prophesy in a general way 
the future bent of the character. If any trait is 
entirely absent at this time, it is not apt to be 
seen later in life. The emotional nature now 
becomes active, with varying phases and mani- 
festations. Religious and moral questions may 
assume importance, and it is the age of con- 
version. 
53 HEALTH FIRST 
Parents must study and guide these nascent 
emotions so that they will assume a normal and 
healthy form. This is specially important 
where the child tends to be morbid and intro- 
spective. A careful moral training is as im- 
portant as that directed toward the physical and 
mental natures. The child must be taught that 
there is a difference between real and imaginary 
conditions. An effort should be made to convert 
introspection into activity and at the same time 
to give some insight into the realities of life. 
This will be a great aid in counteracting selfish- 
ness as well as in true character-building. 
The imagination becomes very active at this 
time, and care must be taken that it is fed 
by wholesome reading and surroundings. The 
cheap novel and " penny dreadful " too often get 
into the hands of growing boys, and hysterical 
love-stories into the possession of girls, to their 
great detriment. A certain element of adven- 
ture, exhibited in books of travel or discovery, 
may be desirable, and it is wise and profitable to 
interest children in nature-books. 
As growth and development are rapid during 
adolescence, nothing must be allowed to conflict 
with the physical nature at this time. Over- 
54 NORMAL DEVELOPMENT 
strain in school must be guarded against. It is 
specially desirable that girls shall not be pushed 
in their studies at the beginning of adolescence. 
At a time when a new life function is being estab- 
lished, the nervous energy and blood should not 
be diverted to the brain, as they can be better 
utilized in other parts of the body, to the lasting 
health of the child. It must be borne in mind 
that infancy and adolescence are the two most 
rapidly formative epochs of life, and quick 
growth predisposes to all kinds of disturbance. 
At bottom, diseased processes are often due to 
an overstrained physiological activity. A cer- 
tain instability always accompanies periods of 
rapid development, and extra care is always re- 
quired. 
55 CHAPTER V 
HEALTH AND EDUCATION : PROPER TRAINING 
FEW realize how closely questions of health 
and education are intertwined and corre- 
lated. As a rule, the healthiest child makes the 
best student; and, conversely, too many studies 
that are not adapted to the age or condition of 
the child may have an unfortunate effect upon 
health. Physicians should have an important 
place on all school boards, and their advice 
should be sought in arranging the curriculum. 
While true education must be a life under- 
taking, it is in the proper training of the young 
that this question assumes its greatest impor- 
tance. Health and growth must both be con- 
sidered at this time, but, as the period is a short 
one, the tendency is toward overpressure and a 
hurried undertaking of many things. This is 
a great evil, but much of it might be avoided if 
teachers and parents had a truer conception of 
the real function of education. 
56 PROPER TRAINING 
The tendency is to confuse education with 
mere instruction. The object of the former is 
training, that of the latter information. The 
object of education is not primarily or solely to 
impart knowledge; it is, rather, so to train the 
mind that it will have the capacity for selection 
and development and can gradually put itself in 
proper adjustment with the larger and higher 
life of the race. 
The object of instruction, on the other hand, 
is to store the mind with useful and interesting 
facts. In the case of children there is apt to be 
too much instruction and too little education. 
The pressure that tries to induce much knowledge 
is in danger of lessening vitality without even giv- 
ing corresponding power, success, or happiness. 
A proper physical development is necessary be- 
fore mental growth can satisfactorily take place. 
Intellectual and spiritual education, important 
as they are to the evolution of the race, have 
their roots largely in a high physical develop- 
ment of the brain and nervous system, which in 
turn requires nourishment by good red blood. 
This general truth is not invalidated by excep- 
tional cases where great intellectual energy has 
been evolved in feeble bodies. We cannot prop- 
57 HEALTH FIRST 
erly consider intellectual life without constantly 
bearing in mind its physical basis. 
It has been proved from examinations of many 
school-children that, as a rule, the heaviest and 
tallest, or those of the best physique, stand high- 
est in their classes and show the best intellectual 
development. Hence, if a child is poorly nour- 
ished or underdeveloped, the best thing, even for 
his intellectual growth, is to focus attention on 
his body for a time and let his mind be tempo- 
rarily neglected. Competitive examinations at 
the end of the school year, after the fatigue of 
the winter's work, coming at a time when growth 
is usually most active in a child, too often result 
in nervous exhaustion. 
Apparent stupidity or bad mentality in school 
children is often the result of physical causes 
that may and should be removed. Among sev- 
eral thousand public-school children recently 
examined in New York, about thirty per cent, 
suffered from defective eyesight. Enlarged and 
diseased tonsils, adenoids, and varying degrees 
of deafness were also frequent. Many others 
showed need of medical treatment, with a gen- 
erally bad nutrition. A large number were 
found who were mentally unfit to be enrolled in 
58 PROPER TRAINING 
the regular classes, and a series of tests showed 
that this unsoundness of mind was due in most 
cases to disease or unhealthy surroundings at 
home. Among several hundred thousand chil- 
dren examined, sixty-four per cent, were found 
with defective teeth, which physicians now re- 
gard as a common cause of physical disabil- 
ity. 
The growth of forced and so-called higher edu- 
cation has been relatively more rapid with girls 
than with boys. In the former, the question is 
complicated by the importance to themselves and 
the race of proper physical and sexual develop- 
ment during the period of growth. At a time 
when a new and important life function is being 
evolved, and the future well-being of the person 
is largely dependent upon its proper evolution, 
it is most important that the brain should not be 
crowded with work. This is a critical period. 
Vitality is needed in other channels. At this 
one epoch the body is more important than the 
mind; yet this is just the time that the girl is 
pushed the hardest in her educational career if 
she expects to pursue a course in high school or 
college. The women's colleges are increasing in 
numbers and importance, and have set the edu- 
59 HEALTH FIRST 
cational pace, as is the case with the men's col- 
leges. While no one of intelligence questions 
the desirability of a thorough education for 
women, whether the training they get in their 
colleges is the best for them is an open ques- 
tion. 
The most important problem is to conserve 
proper health and growth of children during the 
educational period. The large number of studies 
required and the pressure exerted frequently 
make this a serious question. Not only is depth 
sacrificed to extent of surface in this mental 
training, but there is too little time left for physi- 
cal exercise and amusement. The pace has been 
set, and the children must keep up as best they 
may, and it is the colleges and higher institu- 
tions that are able to fix the standard. The sec- 
ondary schools are directly influenced and domi- 
nated by the college requirements, and in their 
turn react upon the primary schools. So much 
ground must be covered by these advancing re- 
quirements that the children are crowded in 
every way. Instead of constantly raising their 
standards of admission, it would be better if 
the colleges could be induced to lower them in the 
interest of the health of the coming race. 
60 PROPER TRAINING 
HOURS OF WORK AND SLEEP FOR SCHOOL 
CHILDREN 
Some years ago The Royal Sanitary Institute 
of Great Britain made a study of how much work 
could safely be put upon the growing child. The 
hours of work and sleep required during child- 
hood and youth were tabulated as follows: 
Age 
of 
pupils 
Hours of 
work 
per day 
Hours of 
sleep 
per night 
From 5 
to 
6 years 
1 
134 
From 6 
to 
7 years 
14 
13 
From 7 
to 
8 years 
2 
124 
From 8 
to 
9 years.... 
24 
12 
From 9 
to 
10 years 
3 
114 
From 10 
to 
12 years 
3 
11 
From 12 
to 
14 years 
5 
104 
From 14 
to 
16 years 
6 
10 
From 16 
to 
18 years 
7 
94 
From 18 
to 
19 years 
8 
9 
THE SCHOOL-ROOM AND APPLIANCES 
As much of the child's time is spent in school, 
it is of great importance that the room and all 
its appliances should be conducive to health. 
Ventilation and light are of great importance. 
The complicated mechanical devices for deliver- 
61 HEALTH FIRST 
ing fresh air and removing fonl air are now being 
superseded by a return to the simple cross venti- 
lation from windows opening outside. Air in 
sufficient motion to cause a draft, however, should 
be avoided. By opening the windows at the top, 
or by placing boards between the sashes, a direct 
draft can usually be prevented. During recess, 
while the children are out, the air of every school- 
room should be completely changed by opening 
all the windows to their full extent. There will 
be sufficient window space if the window sur- 
faces are about equal in combined area to one 
fifth of the floor area. 
Each child should be provided with about 
twenty square feet of floor space and allowed at 
least from two hundred and fifty to three hun- 
dred cubic feet of air space. The windows 
should be placed as high as possible toward the 
ceiling for good light as well as ventilation. A 
northern light is generally preferable, but from 
whatever direction it comes, it should strike the 
book of the pupil from above and behind, and, 
if possible, from the left. Glaring sunlight is 
hard on the eyes, and any dazzling light may 
be avoided by window-shades made of some kind 
of gray material. The walls of the room are best 
62 PROPER TRAINING 
tinted with a shade of gray, and every part 
should be well lighted. The best temperature 
for the room during winter will be about sixty- 
eight degrees Fahrenheit. 
POSTURE OF THE SCHOOL-CHILD 
Many school-children do not hold themselves 
erect, but tend rather to a slouching posture. 
This may be due to too long confinement in one 
position or to the desks and chairs not being 
proper in size or shape. This may induce an 
undue curving of the back, with a contraction of 
the chest. 
Anything that leads to a one-sided position for 
any length of time is undesirable. The desk may 
be too high or too low, and the chair may be 
placed too far back from the desk. The seat 
should be so placed that a straight line falling 
from the inner edge of the desk will strike the 
seat about an inch back of its edge. The seat 
for each child should be of the same height as 
the length of the leg from the foot to the knee, 
so that, when sitting, the sole and heel can rest 
easily on the floor. When the seat is too low, 
the body is bowed forward, and if too high, only 
the toes touch the floor, and a strain is thus put 
63 HEALTH FIRST 
on the whole body. Every seat should be single 
and slightly curved as an aid to comfort, with a 
back that curves slightly backward. 
The rear edge of the desk should be about level 
with the elbow. If the desk is too high, the spine 
is thrown into a condition of lateral curvature. 
The top of the desk should slant slightly toward 
the pupil, so that the book will rest at an easy 
angle for reading. Correct posture on the part 
of a growing child is so important that the de- 
tails here mentioned in reference to seats and 
desks should be carefully considered. If many 
hours each day are spent in unnatural or strained 
positions, the results cannot fail to be disas- 
trous. 
SCHOOL FURNISHINGS 
The floor, furniture, side walls, and ceilings 
of the school-room should be as smooth as pos- 
sible in order that no cracks for the collection of 
dust or dirt may exist. Wet or soiled outer 
clothing should not be hung in the school-room, 
as large closets exposed to the air or wide hall- 
ways should be provided with hooks for street 
clothing. In case of storm, children should not 
be allowed to remain in the school-room with wet 
64 PROPER TRAINING 
feet. This is a constant source of sore throats 
and chronic catarrhal affections. 
.THE RECESS 
The recess is a very important feature of the 
school-day. For very young children it is de- 
sirable to have several short recesses, as their 
minds need frequent relaxation, and it is diffi- 
cult and undesirable for them to concentrate ex- 
cept for short periods. They also tire of merely 
sitting still too long, and should be allowed fre- 
quent changes of position. This can be accom- 
plished by standing, marching, or, preferably, 
by light gymnastics. 
It is rarely desirable to start school attendance 
before the age of seven, and in some cases this 
may be too early. These very young children 
should not be confined for more than three hours 
daily, and even then there should be frequent in- 
termissions. 
THE SCHOOL LUNCH 
For older children who remain during the full 
school-day the recess should be long enough to 
allow time for a comfortable meal. Most chil- 
dren are inclined to eat too hastily at all times 
65 HEALTH FIRST 
unless carefully trained to proper habits in this 
respect. It is particularly at lunch that the food 
is bolted in order to engage in play. Children 
may sometimes be seen playing tag, or engaged 
in violent exercise, with a sandwich in one hand, 
from which hasty bites are taken during a lull 
in the game. This cannot fail to result in 
dyspepsia, if nothing worse, and the many diges- 
tive troubles in later life frequently have their 
source in the faulty eating habits of the child. 
When the home is near the school, it is better 
for the pupil to get a warm, comfortable lunch 
or dinner there, and sufficient time should be 
allowed for coming and going without the undue 
haste that is sure to impair digestion. If the 
distance is too great, it is better to have a warm 
lunch served at the school; but, if this is not 
possible, a basket lunch must be provided. As 
this has to be cold it is an advantage if a warm 
drink can be procured in addition, such as a 
cup of hot milk or cocoa or plain meat broth. 
In many cases even this is not feasible, and then 
the child must depend entirely upon the con- 
tents of the basket. It is accordingly very im- 
portant that the food be carefully selected for 
its nutritive value, especially as this may be the 
66 PROPER TRAINING 
principal meal of the day. The tissue-building 
and heat and energy-producing foods - proteins, 
carbohydrates and fats - must be present in 
what is known as a properly balanced ration. 
The following may serve as samples of school 
lunches, taken from one of the pamphlets of the 
United States Department of Agriculture: 
1. Sandwiches with sliced meat for filling; 
baked apples, cookies, or a few lumps of sugar. 
2. Slices of meat-loaf or bean-loaf; bread-and- 
butter sandwiches; stewed fruit; small frosted 
cake. 
3. Lettuce or celery sandwiches; cup custard; 
jelly sandwiches. 
4. Cottage cheese and chopped green-pepper 
sandwiches; or a pot of cream cheese with bread- 
and-butter sandwiches; peanut sandwiches; fruit; 
cake. 
5. Hard-boiled eggs; baking-powder biscuit; 
celery or radishes; brown-sugar or maple-sugar 
sandwiches. 
6. Baked-bean and lettuce sandwiches; apple- 
sauce ; sweet chocolate. 
Few parents appreciate the importance of the 
midday meal in the school-day as influencing the 
health and development of the pupils. Children 
67 HEALTH FIRST 
are sometimes furnished with a little money to 
supplement their lunch, and, if so, it must not 
be spent for pastries, eclairs, or cheap candy, but 
rather for some warm nourishing drink, as before 
mentioned, that will stimulate the stomach and 
increase the flow of the digestive juices. 
COMMUNICABLE DISEASES IN SCHOOL 
One of the constant dangers involved in the 
collection of children in schools is the spread of 
contagion from one to another. In many locali- 
ties the school is the hot-bed for the spread of 
an epidemic. Diphtheria, scarlet fever, measles, 
and whooping-congh are the most common of the 
diseases spread in this way. Milder infections, 
such as chicken-pox and mumps, may also be 
mentioned, as they sometimes give a good deal of 
trouble. 
If an epidemic is severe and wide-spread, it is 
often better to close the school entirely. Each 
of these diseases has what is known as a period 
of incubation, in which the virus, while present 
and preparing for greater activity, cannot be 
transmitted from one to another. Children who 
have been exposed to any infection, or who are 
ailing from some unknown cause, should not be 
68 PROPER TRAINING 
sent to school until the cause of the illness is 
apparent. Ordinary colds and influenza are 
also spread largely by schools, and children 
should always be kept at home and apart from 
others during such attacks. They should be 
taught while coughing and sneezing alwavs to 
cover the nose and mouth with a handkerchief, as 
the spray thus produced spreads about in the air 
and is highly infectious. 
When one child in the family is suffering from 
a contagious disease, it is wiser to keep any other 
children at home, as is now usually required by 
boards of health, fearing they may be in the 
period of incubation and thus suddenly attacked 
during the school session. It is now known that 
some persons may be carriers of disease germs 
without themselves succumbing to the illness. 
If, however, well children are at once removed 
from a house in which a contagious disease exists, 
and taken to some other domicile, they may usu- 
ally safely return to school at the following inter- 
vals : 
Diphtheria, seven days after immunization 
and two negative cultures. 
Scarlet fever, seven days after a thorough dis- 
infection and entire change of clothing. 
69 HEALTH FIRST 
Measles, two weeks after the last exposure. 
Whooping-cough, eighteen days after the last 
exposure, if no cough. 
Chicken pox, eighteen clays after last exposure. 
Mumps, after three weeks from inception of 
primary case. 
Children who are known to have been directly 
exposed to a communicable disease need not be 
excluded from school during the first part of the 
possible period of incubation. This results in 
quite a saving of time. This period of time, 
which begins with the day the child was last 
exposed, is as follows: Chicken-pox, exclude 
from school from the eleventh to the twenty-sec- 
ond day; measles, from the eighth to the fifteenth; 
German measles, from eleventh to the twenty- 
second; mumps, from the fifteenth to twenty- 
second; smallpox, twenty-two days, unless the 
child has been successfully vaccinated within a 
year, in which case he may return at once. 
In all cases a careful physician or board of 
health official must decide when it is safe for 
the child who has had contagious disease to re- 
turn to school. Care should be given to this by 
parents, teachers, and physicians, as children are 
sometimes handicapped for life as the result of 
70 PROPER TRAINING 
contagion contracted during school-years. More 
facts as to the methods of avoiding communica- 
ble affections will be given in the chapter on 
health and disease. 
SCHOOL ATHLETICS 
Plenty of outdoor exercise is required by the 
growing child in order to lay up a store of vigor 
for future use. While a certain amount of in- 
door gymnasium exercise may be valuable, noth- 
ing is so beneficial to the boy or girl as play in 
the open air. The wider recognition of this lack 
cannot but result favorably to the coming gener- 
ation. In certain lines, however, there may be 
danger of carrying exercise too far, especially 
during the period of adolescence. This is shown 
in the craze for athletics seen in many schools 
and colleges. The outcome of this excessive in- 
terest is a few overdeveloped athletes and a ma- 
jority of students barred out entirely, owing to 
the high physical standard required for great 
competitive contests. It is very questionable 
whether more physical harm than good does not 
eventually come even to the athletes themselves. 
The terrible strain put upon the vital organs, 
especially the heart and lungs, involved in these 
71 HEALTH FIRST 
close competitive struggles, is sometimes followed 
by lasting ill effects. The excessive development 
of the muscular system in a person who is shortly 
to settle down to sedentary pursuits may end in 
disastrous results. The blood that should nour- 
ish the vital organs is appropriated in the build- 
ing up of powerful and useless muscles, and the 
result is a loss to the general vitality. This may 
explain why some strongly formed athletes fall 
victims to consumption. The proper functioning 
of what may be called the great vegetative or- 
gans, such as the heart, lungs, and liver, are the 
important prerequisites to health and long life, 
and not enormous muscles which are not put to 
constant and special uses. A system of physical 
training that devotes excessive attention to the 
few, and hence cannot give a careful study to the 
necessary all-around development of the many, 
is not a proper system and does not make for gen- 
eral and widely diffused health and vigor. Ref- 
erence has already been made to the faulty pos- 
ture so often seen in school children. Athletic 
trainers in schools and colleges should give spe- 
cial attention to this defect. A correct poise can 
be attained by a little practice at this time which 
will last all through life. The chest should be 
72 PROPER TRAINING 
carried high and arched forward, with the shoul- 
ders held squarely back, the neck straight, and 
the chin forced in, and the abdomen also held 
firmly in. Such a carriage, accompanied by deep, 
full breathing, will make both for health and 
grace. Contrast such a physical poise with the 
slouchy position so often seen in men and women; 
the difference is startling. It is the difference in 
appearance between a West Point cadet and an 
undernourished, poorly developed street boy. 
Young men or women, however plain of fea- 
ture they may be, can become attractive to look 
upon by simply holding themselves erect and in 
the proper posture. 
73 CHAPTER VI 
HEALTH FOR THE MIDDLE-AGED: CONSERVING LIFE 
PERHAPS the most useful and important 
time of life is included in what is popu- 
larly known as middle age. The period of 
growth and preparation for life has now been 
completed, and the time of achievement is at 
hand. If the handicap of ill health occurs, the 
effects are most disastrous. Many men and 
women who have started out with brilliant pros- 
pects have ended in failure because their strength 
has not held out. 
After the period of growth is completed, 
health, efficiency, and length of life depend 
largely upon the proper management of middle 
age. The longer this time can be continued, the 
longer will the period of decline be averted, and 
the slower will be its course when it does come. 
At birth a certain amount of potential vitality is 
given to each person by his ancestors. This may 
be to a certain extent increased by a healthy 
growth, but when this has been attained, the 
74 CONSERVING LIFE 
physical effort of the man or woman must be 
largely in the line of conservation. If this is 
properly done, even those who are handicapped 
by not possessing vigorous health may frequently 
enjoy long and useful lives. The fundamental 
rule for each person is to find out his or her physi- 
cal limitations and keep within them. 
A long and healthy life thus depends to a cer- 
tain extent upon the management of middle age. 
One must now cease to be a spendthrift in health 
and vigor. After the period of growth and ex- 
pansion, the time for careful conservation of 
health and energy has arrived. Even people who 
have not had the best start in youth may fre- 
quently enjoy long and healthful lives by extra 
care during this middle period. 
It has been said that the best way to insure a 
long life is to have an incurable disease. This 
means, of course, that extra care in looking out 
for one's health is always rewarded, and in the 
case of persons with poor vitality this care may 
be shown by increased longevity. 
FOOD AND DRINK 
With reference to food, several useful rules 
may be considered. Most adults eat larger 
75 HEALTH FIRST 
amounts than are really required by the body. 
All that is needed during middle age is sufficient 
nourishment to repair any waste of tissue and 
maintain the heat of the body, as the building-up 
process has now been accomplished. Every age 
should take the food that is specially adapted to 
its needs. An excessive amount of meat is not 
desirable during middle age. A little knowledge 
of physiology will explain why this is so. In the 
first place, this kind of nutriment consists largely 
of protein, which is the tissue-building element 
of food. As growth has now been completed, a 
large amount of protein is not required, but only 
enough to repair the waste of tissues entailed by 
the processes of life. Animal protein that is not 
completely utilized must be excreted as a waste 
product by the kidneys, and disorder of these 
organs is largely prevalent in middle life. 
Fresh fish affords a wholesome and digestible 
protein, sometimes more desirable than meat, 
though the idea that fish is a sort of food for 
the brain and thus stimulates intellectual power 
has no real scientific basis. Eggs give a concen- 
trated and usually very digestible form of ani- 
mal protein. Vegetable protein, contained in 
such vegetables as peas and beans, is not so apt 
76 CONSERVING LIFE 
to cause irritation of the kidneys nor so liable 
to be followed by decomposition in the bowels. 
A properly balanced diet at this period of life 
will thus call for a moderate amount of meat, 
with plenty of fresh vegetables and a moderate 
supply of cereals. Sugar in excess should be 
avoided as it is not apt to be well tolerated in 
middle age. Fruit of all kinds can be indulged 
in freely, as the mineral salts and acids thus 
ingested have a beneficial effect. A liberal 
amount of fruit and vegetables, by means of the 
cellulose or undigested fiber they contain, is 
favorable to a proper functioning of the bowel, 
which is apt to be sluggish at this period of 
life, particularly in women. These unirritating 
waste products give a sort of ballast to the 
bowel and, by distending it, tend to free its ac- 
tion. The intestinal sluggishness of adults who 
lead sedentary lives is often encouraged by tak- 
ing too concentrated foods; most of these, by 
being absorbed, do not leave enough bulk to prop- 
erly stimulate the intestine to action. 
What is true of food is also true of drink. 
Stimulating foods and stimulating drinks must 
be taken with great moderation. The latter are 
specially exemplified by the usual alcoholic 
77 HEALTH FIRST 
drinks. Most adults will do better without their 
steady and constant use. The principal disad- 
vantage of the continuous employment of alcohol 
is that it tends to raise the blood pressure as 
well as induce too great a deposition of fat. 
Weak and anemic persons, however, may derive 
benefit from a moderate amount of alcohol, es- 
pecially such as is contained in malt liquors and 
the lighter wines. People with a marked neu- 
rotic inheritance or constitution should not take 
alcohol in any form, as this is the class most apt 
to form the habit. 
Coffee and tea in moderation are great com- 
forts to many people during middle age. Some 
care may be necessary to avoid too strong infu- 
sions as well as too frequent indulgence. A few 
people may have an idiosyncrasy against them, 
especially coffee. The active principle is the 
same in both tea and coffee. The former is 
somewhat different from the latter in other 
things beside flavor, especially in its content of 
tannin. The scare advertisements by those hav- 
ing substitutes for sale may occasionally contain 
a little truth, but their statements are nearly al- 
ways gross exaggerations, if not actual false- 
hoods. 
78 CONSERVING LIFE 
A cup of hot milk is a good substitute for tea 
or coffee if these seem to disagree. Sometimes a 
slight trace of either tea or coffee added to the 
heated milk - just enough to bring out a little 
of the flavor - gives satisfaction to those who do 
not like the taste of milk. Cocoa is also a good 
substitute in some cases. Occasionally those 
who cannot drink plain milk without disturb- 
ance can take sour milk, such as buttermilk or 
one of the fermented milks. The lactic acid con- 
tained in these preparations aids digestion by 
destroying putrefactive bacteria in the bowels, 
and the curd, by being finely divided, is easily 
digested. 
One of the cheapest and commonest drinks 
that makes for health - plain water - is too 
often neglected. Many people do not take suffi- 
cient water to maintain health. Not only does 
water form a large bulk of all the tissues, but it 
constitutes the great solvent required by the 
body. The processes of life are continually pro- 
ducing poisons that must be eliminated quickly 
if health is to be conserved. If water is lacking 
in sufficient amount to keep these poisons in so- 
lution, the emunctories cannot properly carry 
them out of the body. A glass of pure water on 
79 HEALTH FIRST 
rising, one or two during the day, and another 
on retiring will supply sufficient of this fluid for 
health. It is much better to drink water in this 
way than with the meals. It is not wise to drink 
much water, especially iced water, with meals, 
as the stomach is thus chilled and the digestive 
fluids diluted. The gouty and other poisons 
often produced during middle age tend to be 
flushed out of the system by a free supply of 
water. 
Tobacco, like tea and coffee, has a mildly 
stimulating - or to some a sedative effect - 
when used in moderation. While the active 
principle, nicotine, is very poisonous in large 
doses, experience shows that it is certainly not 
harmful if used in moderation. Tobacco is, 
however, very irritating to some persons, and 
they should not use it. In these cases, or when 
used in excess, a disturbed rhythm of the heart, 
nervousness, digestive upsets, and throat irrita- 
tion may be noted. If one cannot maintain 
moderation in the use of tobacco, it should not 
be employed at all. Every' one must be a law to 
himself in this regard. Nothing is gained by in- 
discriminate condemnation of a habit that may 
80 CONSERVING LIFE 
often help one over the many rough places of 
life. 
ILL EFFECTS OF STOUTNESS 
As middle age advances, many persons tend to 
put on flesh, and if this goes beyond a certain 
point, it does not make for health or resistance. 
When the waist-line bulges beyond the chest- 
line, the prospect for a long and vigorous life 
diminishes in direct proportion as the former 
outstrips the latter. The insurance companies 
long ago recognized this fact, and have estab- 
lished a ratio between the weight and height of 
the person beyond which they will not accept a 
risk. 
The following weights, in light clothing, have 
been approximately established as proper for the 
heights at the period of thirty years. This age 
is selected because full growth and maturity have 
then been reached. 
For Men-5 feet 126 lbs. 
5 feet 4 inches 136 lbs. 
5 feet 6 inches 144 lbs. 
5 feet 8 inches 152 lbs. 
5 feet 10 inches 161 lbs. 
6 feet 172 lbs. 
81 HEALTH FIRST 
For Women-4 feet 10 inches 116 lbs. 
5 feet 120 lbs. 
5 feet 2 inches 124 lbs. 
5 feet 5 inches 134 lbs. 
5 feet 8 inches 146 lbs. 
6 feet 161 lbs. 
As age advances, the aim should be not to in- 
crease any more than is possible beyond these 
weights. Diet and exercise must be carefully em- 
ployed with this end in view. 
To avoid excess of stoutness, the greatest care 
must be exercised in eating. The first point to 
observe is to eat sparingly or in great modera- 
tion. The food principles that tend to conver- 
sion into fat must be avoided. Thus starches, 
sugars, and fats of all kinds should be largely 
cut out of the diet. Some vegetables, like pota- 
toes, consist chiefly of starch, but others, like 
the green and succulent ones, have very little 
of this fat-forming element. As examples of the 
latter, string beans, spinach, celery, tomatoes, 
and greens of all kinds may be freely eaten. 
Bread made of gluten or bran may displace the 
ordinary white bread. All fluids should be taken 
sparingly. Thus soups should not be put on the 
menu, and no water or other fluid should be taken 
82 CONSERVING LIFE 
with meals. This applies particularly to alco- 
holic beverages, and especially to malt liquors, 
such as ale and beer. If any stimulant is taken, 
a thin acid wine will be the best. 
UNDERWEIGHT 
Although the usual condition of middle age is 
to increase in weight, there are some persons, par- 
ticularly those with a tubercular tendency, who 
weigh less than normal. In these cases, every 
effort should be made to put on flesh. It is found 
that better strength and resistance will ensue 
when the body frame is suitably padded. To this 
end, the fat-forming foods must be taken in 
abundance. This means the free administration 
of butter, cream, cod liver oil, olive oil, fat bacon, 
and the fatty meats; also the giving of plenty of 
starches and sugars. Fluids, such as rich soups 
and milk, also tend to put on weight. In the 
process of forcing nutrition, an extra strain is 
put on the digestive powers and an occasional 
upset will probably result. This may be reduced 
to a minimum by carefully graded exercise and 
plenty of rest with baths and hygienic living. 
Insomnia may form an accompaniment of under 
nutrition, which, in turn, is much aggravated by 
83 HEALTH FIRST 
such a habit; while, as a rule, natural sleep will 
come best with an empty stomach, some easily 
absorbable nourishment will often help to induce 
somnolence by drawing the blood from the head 
to the stomach. A cup of hot milk or meat broth 
on retiring may serve such a purpose, while, at 
the same time, aiding the general nutrition. A 
tepid or warm bath, followed by slow, deep 
breathing in a monotonous fashion may also help 
in inducing sleep. • 
HEALTHY EXERCISE 
A proper amount of exercise will help to main- 
tain health during middle age. The violent ex- 
ertions of youth, however, must be avoided. It 
is enough to make the judicious grieve to see a 
stout, middle-aged gentleman jumping about in 
the hot sun in a strenuous game of tennis. The 
strain on the heart and blood-vessels may have 
a very disastrous effect. Golf, on the contrary, 
need not call for such violent exertions, and 
hence is well adapted to this time of life. Horse- 
back-riding is also very beneficial to some, as 
the motion tends to shake up the liver and other 
internal organs, and thus favors their function- 
ing. Mild gymnastic exercises do well, but 
84 CONSERVING LIFE 
heavy lifting or the use of large dumb-bells or 
Indian clubs ought to be avoided. 
Although carefully regulated exercise in a gym- 
nasium, if not too violent, is frequently beneficial, 
this involves time, preparation, and change in 
dress which is hard for the busy person to take. 
The greatest benefit from exercise comes from 
its frequency and regularity. It is astonishing 
how much benefit may be obtained from very 
short periods, even five minutes, if engaged in 
daily. Light calisthenics on rising will fill this 
requirement. No apparatus is required, but sim- 
ply a free movement of the various muscles of 
the body. This may easily be accomplished by 
standing erect and swinging the arms at all an- 
gles, by bending the body forw ard and backw ard 
and from side to side, by swinging the body for- 
ward until the hands touch the feet, by moving 
each leg from side to side and forw ard and back- 
ward, and by rotating the hips. With a little 
thought and practice, all the voluntary muscles 
of the body can thus be brought into easy play. 
If desired, very light dumb-bells or Indian clubs 
will increase the vigor of the exercise. 
These movements put no strain upon the heart 
or blood-vessels, and will improve the general 
85 HEALTH FIRST 
muscular tone. Thus they may accomplish much 
in keeping the body supple and shapely. In fol- 
lowing a cool, tepid, or hot bath, they put the 
body in a glow that will give a good physical 
start to the day. Little time is lost, and the 
regular hour being appointed and kept, the course 
can be carried out from year to year to the great 
benefit of the sedentary worker. No teacher is 
required, and it is safer and saner than the oc- 
casional spurt of exercise under the direction of 
some professional athlete. The latter is not ca- 
pable of examining or knowing the condition of 
the heart, blood-vessels, and viscera of their pu- 
pils, and much harm is sometimes done by the 
vigor of their teachings. Before putting them- 
selves under the care of these athletes, the candi- 
dates for such a course should always be ex- 
amined by a capable physician. 
Dr. W. G. Anderson, the director of the Yale 
gymnasium, has recently given a few simple exer- 
cises for the average man who has neither time 
nor opportunity to go to a gymnasium. Al- 
though having easy access to the most complete 
appliances for physical exercise, he believes that 
weight can be reduced and the body kept in good 
condition in a very simple manner. The only 
86 CONSERVING LIFE 
apparatus used is the edge of a door and a small 
horizontal bar in the doorway of the bedroom. 
The exercises can be taken while dressing in the 
morning or at any odd time. They consist in 
arching the chest fully, throwing back the ab- 
dominal walls, and holding this position for 
sixty seconds. This widens and deepens the 
chest and strongly develops the front and side 
abdominal walls, and also brings the spinal mus- 
cles and the diaphragm vigorously into action. 
Next, several times a day lean against a desk and 
gently bend the body backward and forward. 
Stand against the straight edge of a door, press 
the neck against the collar, arch the chest, and 
force back the abdominal walls, touching most 
of the back to the door. Hold this for sixty sec- 
onds, but take it three times a day. At night, if 
the condition is normal in other respects, hang 
from the small bar and gently swing the body; 
later practise raising the knees while hanging. 
If the heart and lungs are fairly normal, and the 
blood pressure not too high, practise rapid walk- 
ing with vigorous arm swinging. Ordinary 
walking is a reflex or automatic exercise and thus 
physically inexpensive. Walk more and swiftly, 
and ride less. 
87 HEALTH FIRST 
The various forms of falling of the viscera, 
due to an accumulation of fat, are greatly bene- 
fited by the simple abdominal gymnastics men- 
tioned above, and at the same time the contour 
of the abdominal region becomes quite normal. 
Bad effects upon the health of middle age are 
sometimes seen in cases where young men in col- 
lege or elsewhere have been in prolonged train- 
ing for competitive athletic events that have sud- 
denly been abandoned for a sedentary existence. 
The enlarged heart and muscular system of these 
persons fare badly when a period of complete 
inaction takes the place of the former strenuous 
exercise. Young athletes should never suddenly 
or completely break off muscular exercise. 
It may finally be added that walking in the 
open air, with head and chest erect and deep 
breathing, accompanied by swinging of the arms, 
is, after all, about the best, as it is certainly the 
cheapest, form of exercise that is available to all. 
The immense conflicts of modern warfare, with 
the tremendous drain of younger men to fill the 
ranks, may cause a reorientation of our ideas 
as to the possibilities inhering in later years, 
even on the physical side. It has been estimated 
that there are fully eight million men between 
88 CONSERVING LIFE 
the ages of forty-five and sixty-five in this coun- 
try. If this large body can be put and kept in 
good physical condition, our opportunities for 
protection and defense can be indefinitely ex- 
tended. Acting on this idea, a senior service 
corps has been proposed by Walter Camp, who 
has organized an experimental body of this kind. 
It is intended to have the corps consist of men 
over military age who wish to be of service to 
the country and who are willing to act as a 
body. The only qualifications are citizenship 
and the passing of a simple physical examina- 
tion. The organization should include, in addi- 
tion to the usual officers, a surgeon or physician 
to watch the condition of the men, and a leader 
competent to direct the work and keep up the in- 
terest. The work is to consist of ten or fifteen 
minutes of simple calisthenics or setting-up exer- 
cises, and forty-five to fifty minutes outdoor 
drill, hike or march. The men are to agree to 
give an hour a day for three days in the week, 
and the signing-up period is for ninety days. No 
special attempt is intended to radically change 
the habits of life, but heavy, rich food is to be 
eliminated, together with excessive smoking, and 
the cocktail is to be forbidden altogether. This 
89 HEALTH FIRST 
interesting movement is not only promising from 
the point of view of increasing health, but it will 
prove a valuable factor in national defense. 
WORK AND PLAY 
Many people, particularly men, work too hard 
and too continuously for the good of their health. 
The close competitions of business life often call 
for an exhausting output of energy. Hence it is 
important to remember the old adage that " All 
work and no play makes Jack a dull boy." Not 
only efficiency, but continued good health, re- 
quires a proper amount of recreation. It is real 
economy to devote a certain amount of time to 
outside pursuits that may amuse and make for 
health. Here is where the mental change and 
rest that comes from some hobby is beneficial 
to the busy person. Anything from chopping 
wood to riding a bicycle, from golf to fishing, 
from skating to swimming, even dancing, will do. 
Gardening or motoring are good outdoor recrea- 
tions. Games or music within the home also 
tend to get one out of the grind, as well as the 
various collecting hobbies. We must always re- 
member that pleasant mental interests and diver- 
sions have a directly good effect upon health. 
90 CONSERVING LIFE 
All tend to check the worry and distraction that 
is the bane of modern life in lessening both health 
and efficiency. Worry has a much more depress- 
ing effect than the hardest work, as it both de- 
presses the nervous system and lowers the vital- 
ity. When one's efforts in any line are unsuc- 
cessful, it is hard to avoid worrying, but this 
only lessens the chances of ultimate success. 
Even very difficult labor, if successful, rarely 
breaks one down. It is the addition of worry, 
when the outcome is uncertain, that makes such 
work difficult to bear. The strain of middle 
life is best borne when a cheerful spirit is cul- 
tivated, and this, in addition, will do much to 
conserve health and vitality. 
INCREASED MORTALITY OF MIDDLE LIFE 
The great importance of this subject is shown 
by the fact that the mortality of middle age is 
on the increase in this country. In a recent bul- 
letin of the New York Department of Health the 
disquieting fact is shown that, whereas the expec- 
tation of life at birth is now about ten years 
greater than it was thirty years ago, the adult of 
forty years or more has a shorter expectation of 
life than formerly, the decrease amounting to a 
91 HEALTH FIRST 
year or more, according to the age. This shows 
that most of the health work in recent years has 
been directed to the saving of infant and child 
life, while virtually nothing has been successfully 
done to prolong adult life. 
The following table shows the different expec- 
tation of life at recent periods as compared with 
some previous years: 
Table A 
Approximate Life Table, Trienna 1879-1881 and 
1909-1911, Based on New York City 
Statistics 
Ages 
Expectation of 
Life, 1879-1881 
Expectation of 
Life, 1909-1911 
Gain (-]-) or 
Loss (-) in 
Years of Expect- 
ancy 
Under 5. 
41.3 
51.9 
+10.6 
5-9... 
46.3 
51.1 
+ 4.8 
10-14... 
43.8 
46.9 
+ 3.1 
15-19... 
39.7 
42.5 
+ 2.8 
20-24... 
35.8 
38.3 
+ 2.5 
25-29... 
32.6 
34.3 
+ 1-7 
30-34... 
29.6 
30.5 
+ 0.9 
35-39... 
26.7 
26.9 
+ 0.2 
40-44... 
23.0 
23.4 
- 0.5 
45-49... 
21.1 
20.0 
- 1.1 
50-54... 
18.3 
16.8 
- 1.5 
55-59... 
15.4 
13.9 
- 1.5 
60-64... 
13.0 
11.3 
- 1.7 
92 CONSERVING LIFE 
Ages 
Expectation of 
Life, 1879-1881 
Expectation of 
Life, 1909-1911 
Gain ( + ) or 
Loss (-) in 
Years of Expect- 
ancy 
65-69... 
10.5 
9.1 
- 1.4 
70-74... 
8.9 
7.2 
- 1.7 
75-79... 
7.3 
5.5 
•- 1.8 
80-84... 
6.4 
4.3 
- 2.1 
85 
5.5 
2.2 
- 3.3 
Balance 
.. .+26.6 
-16.6 
+10.0 
A somewhat similar table taken from figures 
for the United States registration area shows 
that this condition is not confined to New York 
City, but maintains a fair average for the coun- 
try at large: 
Comparison of Mortality of Males and Females, by 
Age Groups. Death Rates per 1,000 Population. 
(Registration States as Constituted in 1900) 
Table B 
Age. 
Males 
1900 1911 
Per Cent 
Increase or 
Decrease 
Females 
1900 1911 
Per Cent 
Increase 
or 
Decrease 
Under 5 ... 
. 54.2 
39.8 
-26.27 
45.8 
33.3 
-27:29 
5-9 
4.7 
3.4 
-27.66 
4.6 
3.1 
-32.61 
10-14 
2.9 
2.4 
-17.24 
3.1 
2.1 
-32.26 
15-19 
4.9 
3.7 
-24.49 
4.8 
3.3 
-31.25 
93 HEALTH FIRST 
Age. 
Males 
1900 1911 
Per Cent 
Increase or 
Decrease 
Females 
1900 1911 
Per Cent 
Increase 
or 
Decrease 
20-24 
7.0 
5.3 
-24.29 
6.7 
4.7 
-29.85 
25-34 
8.3 
6.7 
19.28 
8.2 
6.0 
-26.83 
35-44 
10.8 
10.4 
- 
3.70 
9.8 
8.3 
-15.31 
45-54 
15.8 
16.1 
+ 
1.90 
14.2 
12.9 
- 9.15 
55-64 
28.9 
30.9 
+ 
6.92 
25.8 
26.8 
4- 0.78 
65-74 
59.6 
61.6 
+ 
3.36 
53.8 
55.1 
4- 2.42 
75 and over.. 
146.1 
147.4 
+ 
.89 
139.5 
139.2 
4- 0.22 
All ages .... 
17.6 
15.8 
10.23 
16.5 
14.0 
-15.15 
Although this table covers a period of only eleven years, the 
correspondence between it and the life tables for New York 
City is remarkable. 
It has been found that the increased mortality 
of middle age is due principally to diseases of 
the heart, arteries, kidneys, and cancer. While 
the cause of cancer is not yet thoroughly under- 
stood, the other conditions that increase the mor- 
tality at this period can and should be corrected. 
It is believed that improved hygiene in regard to 
food, exercise, and habit of life may be initiated, 
and a beginning made to check the increasing 
mortality of middle life. 
94 CHAPTER VII 
HEALTH FOR THE OLD: PROLONGING LIFE 
SOME years ago, during a celebration at Johns 
Hopkins University, William Osler made a 
casual remark in reference to the ages at which 
different kinds of usefulness were lessened, if 
not brought to a close. The two periods of forty 
years and sixty years were mentioned in this 
connection. He thought that the greatest pro- 
ductive work usually ceased at the age of forty, 
and efficiency of another sort might end at sixty. 
He believed that the effective, moving, vitalizing 
work of the world was done between the ages 
of twenty-five and forty. 
The doctor was speaking to an audience con- 
sisting chiefly of medical men, and he may have 
had in mind the fact that such work as is required 
in the laboratory, with the prolonged strain of 
the eyes and the constant use of the microscope, 
could not continue very long, and that certain 
kinds of hard professional life should not persist 
over sixty. 
95 HEALTH FIRST 
Whatever may have been in his own mind, how- 
ever, the general public got the idea that a high 
medical authority believed that after forty the 
best productive years of life have passed, and 
that at sixty the active working years are over. 
It was one of those remarks that come at a 
psychological moment. The idea spread like 
wild-fire. The papers were full of it, and the 
comic journals had pictures and suggestions of 
chloroform being quietly administered to the de- 
crepit man at sixty, and a new verb, to " osler- 
ize," was coined to describe the process. This 
single unwitting remark has done a tremendous 
amount of harm. It came at a time when there 
was a marked tendency to speed up in all kinds 
of work. Business and professional life were 
carried on at needlessly high pressure both for 
prolonged efficiency and continued health. 
If the real working years of life are to be so 
short, this needless hurry should be increased 
rather than lessened. Another unfortunate ef- 
fect was that large employers of labor, both 
manual and mental, began to look askance at 
people who were passing middle age. 
No matter how efficient the man, renewed em- 
ployment now becomes almost impossible when 
96 PROLONGING LIFE 
the hair has turned gray. All sorts of pathetic 
subterfuges are employed by aging men to con- 
ceal the ravages of the years. They know that 
in the present state of the public mind there is 
little hope or chance in the battle of life for the 
man approaching old age. Some of the news- 
papers have recently discussed gravely the pos- 
sibility of utilizing elderly clerks and business 
men as office boys, with the idea that their reli- 
ability will compensate for other kinds of dis- 
ability. 
It is high time to consider how much truth lies 
in this opinion, and, if it is erroneous, what can 
be done to induce a sounder public belief. 
There is no doubt that, if properly directed and 
controlled, the decade between sixty and seventy 
should be the most fruitful and useful period of 
life. This satisfactory condition, however, de- 
pends, above everything, on a fair state of 
health. 
Every period of life naturally lays a special 
emphasis on different kinds of usefulness. A 
man or a woman at forty should be able to do 
some things better than one at twenty, and at 
sixty or seventy better than one at forty or 
fifty. It is particularly in ripe judgment and 
97 HEALTH FIRST 
the ability to see things in their true relations, 
having a proper perspective, that the later years 
of life should excel. Persons and races no 
longer fight competitive battles with their mus- 
cles, but with their brains. A large number of 
the mistakes and calamities of life come from 
the callow judgment of immature minds. 
CONSERVING HE/YLTH 
The most important question of the day is 
how to conserve health and strength in those 
whose judgment and experience are necessary 
to carry civilization to its highest point. If 
vigor can be preserved until late in life, there 
will be a great saving to society of valuable ef- 
fort. At the outset we repeat that if a person 
lives to be sixty and is then in a fair condition 
of health, there is really no good reason why 
such a life should not be usefully prolonged 
until eighty or ninety. If one reaches the be- 
ginning of old age without any vital organ being 
seriously crippled, useful life should be con- 
tinued for a long space of time by the exercise 
of a little additional care. 
The declining period of life, while not the most 
vigorous, should be healthful and serene. It fre- 
98 PROLONGING LIFE 
quently happens, especially in the case of women, 
that this is the most comfortable time of life. 
Many deaths in advancing life are really due 
to the fact that one of the vital organs is inher- 
ently weaker than the others - has a shorter life 
limit - and hence succumbs to disease from poor 
resistance, or simply wears out. It may be the 
heart, lungs, or kidneys that exhibit this short- 
ness of life, but the results are the same. 
If the person passes through middle age with- 
out evincing special weakness in any vital organ, 
it shows that his life should be a long one, as he 
is built on the principle that Holmes exhibited in 
his inimitable poem entitled the " One Hoss 
Shay." This remarkable vehicle was so uni- 
formly well constructed that it gave way all at 
once and fell to pieces without a preliminary 
rattle or jog. The end of the human body should 
be like the passing of the wonderful " One Hoss 
Shay," that lasted one hundred years and then - 
"Went to pieces all at once- 
All at once and nothing first- 
Just as bubbles do when they burst." 
There is no principle, with scientific basis, that 
necessarily limits life. If we compare man with 
99 HEALTH FIRST 
other mammals, the life of the former is shorter 
than it should be. Thus the average duration of 
life of mammals, apart from man, is five times 
the period of growth. If this rule were applied 
to man, he should live about one hundred years. 
It is a very serious question why man should 
fall so much below other mammals in this re- 
spect. Much of the valuable experience of life is 
lost by its being brought to a close too soon. 
If longevity can be made to increase, the whole 
span of life will be conserved, as youth and mid- 
dle age will then gain ground on old age. If, as 
Professor Irving Fisher believes, forty-two per 
cent, of the deaths in this country might be post- 
poned, and if each delay could save the country, 
as has been estimated, seventeen hundred dol- 
lars, the annual unnecessary national loss of capi- 
talized net earnings would amount to about one 
billion dollars. The same authority estimates 
that we may safely say that the working powers 
of half the population is impaired ten per cent, 
by poor health. The conservation of health and 
strength as age advances offers a very important 
question for solution. The physical deteriora- 
tion that comes with advancing years can be al- 
most indefinitely retarded in many cases by a 
100 PROLONGING LIFE 
careful observance of hygienic laws that should 
govern this period. 
BODY CHANGES DUE TO AGE 
Let us now briefly inquire what the bodily and 
mental changes are that occur as age advances. 
Perhaps the most marked is a hardening of the 
tissues. The general framework of the body 
consists of a substance known as connective tis- 
sue. This fibrous material incloses, supports, 
and penetrates all the vital organs, as well as 
the bones, muscles, and arteries. As age ad- 
vances there is an increase of this connective tis- 
sue at the expense of the more highly vitalized 
tissues of the body. The cells of the various 
organs, such as the heart, liver, and kidneys, are 
compressed by the increasing connective tissue, 
and hence do not function so well as in earlier 
life. There is also a slow hardening of the ar- 
teries, with a consequent loss of elasticity in 
their walls that is due to the same cause. The 
blood-vessels also grow more brittle because of 
an increased retention of lime. The body-cells 
of old people, as well as their blood, seem to 
have a marked affinity for lime. One result is 
that the bones are much less elastic than in the 
101 HEALTH FIRST 
young persons and hence break more easily. 
As a result of the thickening of the arteries, 
the blood is not distributed as well as it should 
be to the various organs of the body, and conse- 
quently there is a gradual weakening of func- 
tion. 
Another of the lower grade of tissues, fat, 
often increases with years, but in extreme old 
age there is usually a wasting because of the 
shrinking of all the tissues. The cells of the 
body then tend to become sluggish. 
The first effort of every person should be to 
postpone these changes as long as possible and, 
when they do occur, to regulate one's life ac- 
cordingly. These bodily changes take place 
much more rapidly in those who have suffered 
serious illnesses. Hence the care of the body in 
previous years and continuous good health favor 
longevity. Nearly every serious disease, even 
when followed by apparent complete recovery, 
leaves some lesion or change in the part affected 
that later may cause trouble. Preventive meas- 
ures beginning at forty, or even earlier, may be 
necessary in order to conserve the health of later 
years. 
There are many minor ailments that by con- 
102 PROLONGING LIFE 
stant repetition undermine vitality or lead to 
serious illness. Healthy old people have usually 
been fairly free from illness during their earlier 
years. 
DIET AND HYGIENE 
In the decline of life, great care must be exer- 
cised in avoiding undue stress and strain if living 
is to be prolonged. The diet must be very sim- 
ple, digestible, and moderate in amount. Too 
much work put upon the digestive, assimilative, 
and excretory organs is specially disastrous. 
Not only is a large amount of nutriment unnec- 
essary, but the organs destined to throw out the 
waste are thus overworked, although they them- 
selves are beginning to degenerate. If put to a 
needless strain, this natural degeneration is 
much hastened and aggravated. 
Violent exercise and needless exposure are also 
to be avoided. It is a true saying that a man is 
as old as his arteries. When these vital tubes 
begin to lose their elasticity, it is time to avoid 
putting any strain on them. Here is where many 
widely advertised schemes of physical exercise 
are likely to do incalculable harm to those who 
are advancing in years. While gentle and sys- 
tematic exercise is often beneficial late in life, 
103 HEALTH FIRST 
it should be carefully graded and based upon the 
known conditions of the heart and blood vessels. 
Careful attention to food and hygiene will do 
much to prolong life as well as make a comfort- 
able old age. With reference to nutriment, it 
must be remembered that the old do not require 
so much food as younger people, and digestion 
and assimilation are both slow and compara- 
tively weak. 
Sometimes food cannot be properly chewed, 
owing to defective teeth, and softer food should 
then be taken, as lumps of undigested food un- 
dergo putrefaction in the bowels and cause much 
disturbance. As digestion is slow, food should 
not be taken between meals. A five-hour in- 
terval will give the stomach a chance to empty 
itself. Meat should be taken in great moderation 
and is often best digested when a little under 
done. If the teeth, either natural or artificial, do 
not work well, meat and similar foods should be 
finely chopped before being eaten. 
The heat and energy foods, such as fats, 
starches, and sugars, may be freely given. 
Sweet oil, butter, and bacon are among the most 
easily digested fats of this kind. All the cereals, 
potatoes, and green and succulent vegetables are 
104 PROLONGING LIFE 
likewise good. The more bulky vegetables, con- 
taining much fiber or cellulose, such as carrots, 
cabbage, sweet potatoes, or celery, often have a 
good effect by giving a ballast to the bowel. 
The lower digestive power of the stomach, with 
weakened gastric juice, may cause a craving for 
sour, salty, or savory articles, which should be 
gratified to a certain extent, as they stimulate 
the stomach to greater effort. The more insipid 
foods, usually alkaline, may not be digested so 
well as those more highly seasoned. Excess in 
this direction must, however, be avoided. Con- 
stipation, with decomposition of the intestinal 
contents, is often a source of great trouble to old 
people. 
metchnikoff's theory of age 
The well-known theory of Metchnikoff may here 
be mentioned. This great scientist believed that 
old age is in itself a sort of disease produced by 
the continual absorption of poisonous products 
from the large intestine. He taught that this 
auto-intoxication from the large intestine pro- 
duced the slow changes in the tissues that we 
have previously noted as accompanying old age. 
As putrefactive germs do not thrive in an acid 
105 HEALTH FIRST 
medium, he recommended that lactic acid - the 
acid of sour milk - be freely given to kill off the 
harmful germs. The various germs that produce 
lactic acid may also be taken, accompanied by a 
little starch or sugar, which are necessary to 
nourish them. 
As proof of his theory, Metchnikoff pointed to 
the fact that certain races that partake freely 
of sour milk live to a great age, but he never 
succeeded in convincing' scientists that he had 
really found the potent cause of old age. In 
order permanently to change the flora of the 
large intestine, it would probably be necessary 
to start with the infant and administer these sour 
milks throughout life. The sluggish action of 
the bowel, however, favors the absorption of 
ptomaines and other poisons, and should be 
avoided as much as possible. 
Laxative foods, especially those that leave a 
bulk in the bowel, are favorable to its action. 
Prunes, figs, fresh vegetables, whole wheat, bran, 
and most fruits may here be advised. 
A treatment much in vogue at present for in- 
testinal stasis consists in the administration of 
INTESTINAL STASIS 
106 PROLONGING LIFE 
one of the heavy paraffin oils. These prepara- 
tions are not absorbed and act mechanically in 
sweeping out the intestinal tract. A tablespoon- 
ful once or twice daily is usually sufficient. A 
Japanese seaweed product known as agar-agar 
also acts mechanically in cleansing the intestine 
by means of bulk from the water it absorbs, and 
it is sometimes very effective. 
THE USE OF LIQUIDS 
In the way of drinks, water, weak coffee, tea, 
cocoa, buttermilk, the fermented milks, and small 
quantities of hot milk are advisable. It is usu- 
ally not best to consume large amounts of cold 
milk, which is often constipating, and may form 
large masses of casein in the bowel that are hard 
to expel. Mild alcoholic stimulants are often 
beneficial, such as the light wines or malt liquors, 
which act by improving the digestive powers and 
sustaining the circulation in old age. Wine is 
sometimes called the milk of the aged. The 
sweet and strongly alcoholic wines, such as port 
or Madeira, do not serve as well. When there is 
great weakness, a mellow, old whisky, well di- 
luted, may have a quick effect. 
As a general rule, it is not well for old people 
107 HEALTH FIRST 
to eat heartily before sleeping, as insomnia and 
increased blood-pressure may thereby result. 
This is the reverse of what may be true in 
younger subjects, who sometimes sleep fairly well 
on a full stomach. 
The general subject of the diet for the old was 
wTell epitomized many years ago in a quaint 
aphorism by George Cheyne: 
Every wise man, after fifty, ought to begin to 
lessen at least the quantity of his aliment, and, if he 
would continue free of great and dangerous distem- 
pers and preserve his senses and faculties clear to the 
last, he ought every seven years to go on abating 
gradually and sensibly, and at last descend out of 
life as he ascended into it, even into the child's diet. 
PHYSICAL AND MENTAL EXERCISE 
A moderate amount of exercise is beneficial, 
but it should never be carried to the point of 
fatigue or exhaustion. Above all, any form of 
exercise that leads to shortness of breath should 
be promptly abandoned. Driving or walking in 
the open air is the best and most available relaxa- 
tion, and very mild calisthenics on rising are 
sometimes helpful. 
Mental exercise and stimulation should always 
108 PROLONGING LIFE 
be kept up. This tends to keep the body alert 
as well as the mind. Statistics show that in 
every community professional and business men 
who work principally with their brains are the 
longest-lived. Congenial amusements are also 
very desirable, especially those that divert the 
mind. Many people as they grow old become 
very self-centered. This leads to a constant 
study of symptoms and a selfish lack of interest 
in anything not subjective. This is both a cause 
and an effect of senility. A change of scene 
and occupation may prevent or alter such a con- 
dition of mind in those who are growing old 
rapidly. 
REST AND SLEEP 
While a proper amount of activity should be 
encouraged, plenty of rest and sleep is desirable. 
A nap during the afternoon is refreshing, but 
old people do not require so many hours of sleep 
at night as when engaged in the active work of 
life. 
As people grow older, they become very sensi- 
tive to cold. This is due to two causes, a lessen- 
ing of the power of heat-regulation within the 
body and a poorer circulation of the blood on the 
surface. They do not often run a fever except 
109 HEALTH FIRST 
from excessive irritation, and a beginning illness 
may not be recognized owing to this peculiarity. 
The skin must be carefully protected from cold 
by woolen underwear. In winter this must be 
thick and warm, as it is more beneficial to pro- 
tect thoroughly the immediate surface of the 
body than to pile on heavy outside wraps. The 
extremities of the body are specially sensitive, 
and cold feet and hands must always be pre- 
vented. 
SUSCEPTIBILITY TO DISEASE 
While the general vital resistance is poor in 
old age, susceptibility to infection, strange to say, 
is much less marked than in earlier years. The 
body seems to be better able to resist bacteria 
and other disease germs; hence infectious dis- 
eases are rare, and, when present, usually run 
a mild course. Most affections tend to take a 
subacute course that renders them likely to be 
overlooked, especially in the early stages. This 
is markedly true of pneumonia, which is apt to 
attack old people in a most insidious form, with 
little cough or fever, but accompanied by great 
prostration. Thus will serve to emphasize the 
importance of carefully protecting the body from 
110 PROLONGING LIFE 
undue exposure as age advances. If this were 
more carefully done, many useful lives would be 
prolonged. 
In a consideration of the subject of age and 
old age we are, after all, dealing with relative 
terms. Age is really measured not so much by 
years as by the condition of the tissues. When 
degenerative changes have taken place in the 
body, old age has begun. In this aspect some 
people are older at fifty than others are at sev- 
enty. Some are even old at forty, and others 
may be well preserved at eighty. 
The factors that keep the body young are a 
good heredity, hygienic living, and the absence 
of constitutional diseases that hasten the degen- 
eration of tissues. We cannot help our heredity, 
but we can try to improve on it by extra care in 
our environment, especially as age advances. 
There is no doubt but every one has the power 
to prolong life and keep it in useful operation 
by a proper understanding of the conditions that 
make for such a result. 
We must not confuse senility with old age; 
the former means an excessive deterioration of 
tissues, leading to great helplessness, while the 
latter refers only to the passing of the years. 
111 HEALTH FIRST 
It is easy, by a glance at the history of the 
world, to see how much has been accomplished 
by persons who have reached the declining period 
of life. Dorland, in an interesting and exhaust- 
ive study published in a little book entitled " The 
Age of Mental Virility," finds that many of the 
finest achievements in business, statesmanship, 
literature, and all other activities have been 
wrought by men long past sixty. In looking over 
the whole field of life, he finds that most of the 
masterful achievements of the workers and 
thinkers of the world in all fields have been made 
by men working in the decades from forty to 
seventy. This author compiled and analyzed the 
records of four hundred men famous in all lines 
of intellectual activity in order to find when 
these persons accomplished the greatest work 
of their lives. While in the earlier years of life 
the emotional element is at its highest, and con- 
structive work comes largely from this side of 
man's nature, as in artists and musicians, the 
higher mental qualities mature later, and are 
exhibited by scientists, philosophers, and states- 
men. He makes a most remarkable showing of 
many cases - ninety in all - where persons even 
accomplished their greatest work at an advanced 
112 PROLONGING LIFE 
age. This list deserves to be reproduced in any 
study of age. In the whole four hundred rec- 
ords the average duration of mental activity was 
forty years. While the ninety great men had 
been fruitful producers all through their lives, 
their masterpiece was reserved until toward the 
end. A few of these are so remarkable as to be 
pertinent here. 
Galileo, "Dialoghi delle nuove Scienze," at 72 
Bancroft, "History of the United States," at 85 
Buffon, "Natural History," at 81 
Lamarck, "Natural History of Invertebrate Ani- 
mals," at 78 
Herbert Spencer, "Synthetic Philosophy," at 76 
Goethe, "Faust" (second part), at 80 
Tintoretto, "Paradise," at 70 
Verdi, "Falstaff," at 80. 
Magnum Opus 
Moltke planned the successful campaign of 
the Franco-Prussian War at the age of seventy. 
It is a remarkable fact that many of the most 
successful generals in the great European War 
are comparatively old men. The broad grasp of 
events, the concentration, and quick decisions 
required in leading a military campaign, cer- 
tainly depend upon the highest powers of body 
113 HEALTH FIRST 
and mind. If such great abilities can "be exer- 
cised in the destructive agencies of war, what 
a wide field must lie open to those who are ad- 
vancing in years in the constructive activities of 
the world in times of peace! 
Let us give up the idea that there is a dead- 
line at fifty, sixty, seventy, or even eighty as far 
as intellectual possibilities and usefulness are 
concerned. This is an entirely individual mat- 
ter. Some cross the dead-line at thirty, others at 
forty, others at fifty, and others at eighty; some 
are even born on the wrong side of this line and 
never show any particular signs of mental or 
vital activity. 
By conserving the later and riper years of 
life we will do much for civilization. The clos- 
ing years should be made the happiest of life, 
and a right amount of health, with quiet content- 
ment, will redound to the well-being of both the 
individual man and society. The thoughtful 
cultivation of a fair degree of health and a good 
deal of optimism is needed to round out the later 
years of life in an altogether satisfactory and 
hopeful way. 
Robert Browning caught and expressed the 
ideal of optimism for the aging: 
114 PROLONGING LIFE 
Grow old along with me! 
The best is yet to be, 
The last of life, for which the first was made; 
Our times are in his hand 
Who saith, "A whole I planned," 
Youth shows but half; trust God; see all, nor be 
afraid 1 
115 CHAPTER VIII 
HEALTH AND NUTRITION: THE FOOD QUESTION 
GOOD health and vigor depend in a very 
large degree upon proper nutrition. This, 
in turn, is conditioned by digestion, assimilation, 
and a right selection of food. It is not what we 
take, but what we are able to assimilate thor- 
oughly, that really nourishes the body. 
There are several preliminary questions con- 
cerning nutrition that may be considered before 
taking up different kinds of food. 
WHEN AND IIOW TO EAT 
When and how we eat is often as important 
to good nutrition as what we eat. It is not only 
important to consider the quantity and quality 
of food, but how to eat it. Do not sit down to 
the table when nervously fatigued. A few min- 
utes' rest before and after a meal will often be 
of the greatest aid to a weak digestion. By eat- 
116 THE FOOD QUESTION 
ing slowly and chewing properly, we not only 
favor digestion, but avoid the danger of taking 
too much food. 
The mouth now assumes great importance in 
the economy of digestion and assimilation. If 
the process is started aright in this cavity, all 
the other organs and secretions act to better ad- 
vantage. By first splitting up the food into 
small particles, the various digestive secretions 
are able to come into close and effective contact 
with all the ingested food. 
It is also a peculiarity of digestion that each 
secretion has a stimulating effect upon all the 
other secretions that come into action later in 
the digestive process. When appetizing food is 
smelled, the mouth is said to water. This actu- 
ally does take place by the saliva being poured 
forth in anticipation of a tempting morsel 
through the stimulation of the olfactory nerves. 
It follows therefore that tasty and inviting food 
digests easier than that which is unattractive. 
The mouth starts the process right by an abun- 
dant secretion of saliva, which, in turn, stimu- 
lates the gastric juice, bile, pancreatic and in- 
testinal juices. The whole round of digestion is 
thus satisfactorily carried out, first, by a careful 
117 HEALTH FIRST 
selection and preparation of food, and, secondly, 
by properly eating it. 
It is often a mistake to try to diet too rigidly 
on the theory that certain foods will not agree 
in various conditions. As a general rule, the 
food that most tempts the appetite will be di- 
gested and assimilated most easily. Good re- 
sults often follow the most diverse methods of 
curative diet, and this is explained more by the 
regulation of the food in amount, time of con- 
sumption, and method of administration, than 
in the specific articles allowed or forbidden. 
LOSS OF APPETITE 
When there is loss of appetite and disinclina- 
tion to eat, it is a mistake to try to force food 
upon a reluctant stomach. This is sure to be 
followed by indigestion and malassimilation. It 
is simply filling up the system with nutriment 
that, by not being absorbed, acts as a foreign 
body. In many sicknesses, harm is done by 
anxious friends insisting upon administering 
nourishment that is repellent to the patient, and 
which is sometimes given so often that neither 
the stomach nor the individual can get a much- 
needed rest. 
118 THE FOOD QUESTION 
When the appetite lags, the trouble begins in 
the mouth, as sufficient saliva is not secreted. 
As previously noted, when this occurs, the gastric 
juice, bile, and other secretions will later become 
sluggish, and the body cannot take proper care 
of nutriment that has been forced in the absence 
of any craving on the part of nature. It like- 
wise happens that undigested food in the stomach 
is sure to ferment, as warmth, moisture, and 
stasis all favor this process. When the appetite 
is lost, it is better to give the stomach a complete 
or partial rest, in the meantime trying to find 
and correct the cause of the disinclination to 
eat. 
FOOD AS FUEL 
The human body, like the automobile, is run 
as an internal combustion engine. While the 
latter is fed with gasolene, and the electric spark 
starts a marvelously quick combustion, in our 
bodies the food is the fuel which undergoes very 
slow combustion. Thus the gasolene motor is a 
quick-burning, high-temperature machine, while 
the human motor is a slow-burning, low-tempera- 
ture machine. 
In a previous chapter we likened the human 
body to a machine in which all the parts required 
119 HEALTH FIRST 
watching, in order that they may be kept in the 
best possible working order. To keep it in good 
operation, every machine needs fuel of some 
kind. This fuel, by its combustion, generates 
the energy that makes the machine go. If the 
fuel is piled in to excess, the fire is smothered. 
If poor or improper fuel is used, the grate gets 
clogged, and the fire does not burn well. 
It is the same with the human machine. Food 
is the fuel and, if it is poor, or used too lavishly, 
it fails to get the best work out of the body. 
While this analogy is true as far as it goes, we 
must also recognize the fact that food of a cer- 
tain kind has, besides the power of combustion, 
the ability to build or repair tissues. 
The great variety of articles used for food can 
be reduced to a few substances that are neces- 
sary to life. These are known as proteins, min- 
eral matter, fats, carbohydrates, and water, the 
latter forming an essential ingredient of all 
foods. All these food principles are found in a 
variety of forms. Protein exists as lean meat, 
the curd of milk, fish, poultry, eggs, a certain 
part of cheese, beans, barley, oatmeal, and the 
gluten of flour. The mineral matter consists 
largely of earthy salts, such as phosphate of lime 
120 THE FOOD QUESTION 
and compounds of magnesium, sodium, potas- 
sium, and iron. These substances are usually 
taken into the body in combination with the pro- 
teins. The fats are seen incorporated with 
meats, or as lard, butter, the cream of milk, and 
vegetable oils. The carbohydrates are the vari- 
ous starches and sugars that are combined in 
cereals, potatoes, flour, and vegetables. The 
human body itself is likewise composed of these 
basic principles in the following proportions: 
proteins, eighteen per cent.; mineral matter, six 
per cent.; fats, fifteen per cent.; carbohydrates 
one per cent.; water, sixty per cent. We here 
see what a liberal proportion of the body con- 
sists of water. It forms a large bulk of all 
the tissues, besides acting as the universal sol- 
vent. 
FUNCTIONS OF DIFFERENT FOODS 
When we take various substances into the body 
as food, they have different functions to perform. 
The proteins minister to the growth and repair 
of the body; the fats supply heat and energy and 
may be deposited as fats in the tissues; and the 
carbohydrates also supply heat and energy, and 
may be changed into fat in the system. 
121 HEALTH FIRST 
It is wise and economical to employ these food 
principles in the proper proportion to serve the 
function for which they were intended. While 
it is possible to employ protein to supply heat 
and energy, if enough carbohydrates or fats are 
not given, this is not good practice. Not only 
are protein foods usually much more expensive 
to purchase, but they leave a greater residue of 
waste material in the body, and this ash must 
be excreted by the kidneys in the form of urea 
and uric acid. A predisposition to many diseases 
is caused by the retention of these waste prod- 
ucts in the body. 
The fats and carbohydrates are usually burned 
and turned into gas, which is passed out by the 
lungs in an unirritating form as carbon dioxid. 
Although fats and carbohydrates to a certain 
extent may serve the same purpose and may often 
be used interchangeably, they can never take the 
place of protein. A sufficient amount of the 
latter must always be furnished. 
As the human body must be built from food, 
the character of the body will be largely deter- 
mined by the materials from which it is con- 
structed. Each ingredient of food, namely, pro- 
122 THE FOOD QUESTION 
teins, fats, carbohydrates, mineral matter, and 
water, has, as already noted, a definite function 
to perform, the proteins and mineral matter 
forming the tissues and bones, and the fats and 
carbohydrates giving the supply of energy that 
runs the human machine. It is, therefore, of 
vital importance to see that the food contains 
these materials and to know what quantities are 
present. We must look to the chemist for this 
knowledge. 
There has been some difference of opinion as 
to the amount of protein the body requires for 
daily building and repair. In Europe, Voit con- 
siders that a man of one hundred and sixty 
pounds, doing a moderate amount of physical 
work, needs at least one hundred and twenty 
grams of protein daily. In this country, Atwater 
considers that a man at hard labor calls for one 
hundred and fifty grams of protein daily, and 
Chittenden states that for a man of one hundred 
and fifty-four pounds there is required only sixty 
grams of protein daily. This would represent 
approximately four ounces, five ounces, and two 
ounces avoirdupois. As Chittenden's require- 
ments are only about half those of the other 
123 HEALTH FIRST 
authorities, they have not as yet been generally 
accepted. Any theory on matters such as foods 
and feeding must eventually stand or fall by 
the results of practice. 
A convenient grouping of foods has been fur- 
nished by one of the bulletins of the United 
States Department of Agriculture - No. 712 - 
as follows: 
GROUPING OF FOODS 
Group 1. The protein-rich foods.-Milk, cheese, 
meats-except the very fattest, fish, poultry, dried 
beans, peas, and cow peas, peanuts; most other nuts 
are likewise rich in protein. 
Group 2. The cereal or starchy foods.-Breads, 
cereal mushes, ready-to-eat cereal breakfast foods, 
rice, macaroni, tapioca. 
Group 3. The fatty foods.-Butter, cream, salad 
oils, bacon. 
Group 4. Vegetables and fruits.-Here some con- 
fusion may arise because the term vegetable is some- 
times used to mean all foods of plant origin, and in 
this sense would include cereals, dried beans, and 
other foods which have been classified above. As 
here used, it applies only to those which are used as 
side dishes with meat, or as salads, and in similar 
ways: Potatoes, greens, lettuce, celery, green peas 
and beans, carrots, asparagus. Under this heading 
124 THE FOOD QUESTION 
come also all cooked or raw fruits, with the exception 
of those that are preserved, and dried fruits in which 
the percentage of sugar is high because most of the 
water has been driven off. 
Group 5. Simple sweets.-Cakes and cookies which 
contain little fat, cane sugar, plain candies, maple 
sugar, sweet chocolate, jellies, preserved fruits, jams, 
marmalades, honey, molasses and other syrups, dried 
figs, dates, raisins and other dried fruits, and similar 
foods are members of this group. 
If, as a general rule, each of the above groups 
is represented, the diet is likely to maintain all 
the important nutrients - protein, fat, starch, 
sugar, mineral matters, and growth-stimulating 
substances. 
BALANCED DIETS 
As a properly balanced diet calls for a com- 
bination of the different food principles in order 
that they may supplement one another, foods 
must be chosen in such a way as to give the 
needed balance. As an example, bread is high 
in carbohydrates, moderate in protein, and de- 
ficient in fat; therefore butter must be added in 
order to furnish a properly balanced diet. In 
like manner we may combine potatoes and cream 
and fruits with nuts. While these and similar 
125 HEALTH FIRST 
combinations respond to the sense of taste and 
are thus often used instinctively, they have a 
true physiological reason back of them. 
In the same way, certain fruits and vegetables, 
while not containing much actual nutriment, 
possess elements that are necessary to maintain 
the chemical equilibrium of the body. Various 
fruit and vegetable acids and some of the in- 
organic salts, especially those containing phos- 
phorous, lime, and iron, may be mentioned in this 
connection. Most fruit acids also have a bene- 
ficial effect in cleansing the mouth and thus help- 
ing to preserve the teeth. A mixed diet, includ- 
ing fruits and vegetables, will usually furnish 
the necessary amount of these substances. 
Animal and vegetable foods differ somewhat 
as to their digestibility. As the meats derived 
from animals resemble the muscles of our own 
bodies, they do not require much change before 
they are assimilated. Vegetable compounds are 
more difficult of digestion, on account of the 
nutrient portions being surrounded by a woody 
tissue called cellulose, which resists the action of 
the digestive juices. Prolonged boiling or cook- 
ing ruptures this and enables the digestive fluids 
to act to better advantage. A collateral use of 
126 THE FOOD QUESTION 
this woody fiber is that it furnishes a ballast to 
the bowels that favors regular evacuation. 
Bulky, uncooked foods are often beneficial in 
this way. 
It has been found that the real nutritive values 
of foods depend not only on the essential food 
principles, proteins, carbohydrates and fats, and 
the caloric value of the foods, but upon other 
essential substances that are necessary to health. 
These are living entities that have been called 
vitamines; although these substances may be 
present in only very minute traces, they are 
necessary factors in nutrition if health is to be 
preserved. The vitamines are especially present 
in all the grains, such as barley, wheat, oats and 
rye, and also in eggs, fresh milk, meats, and 
yeast extracts. No diet can be long continued 
that does not contain one or more of the foods 
containing vitamines. It is doubtless due to 
this fact that the prolonged absence of fresh 
fruits and vegetables in the diet is fol- 
lowed by profound nutritional disorders, of 
which the disease known as scurvy is the com- 
monest. 
VITAMINES 
127 HEALTH FIRST 
FOOD VALUES IN TERMS OF CALORIES 
The question of calories is well explained in 
one of the bulletins of the United States Depart- 
ment of Agriculture, No. 34, where it is stated 
that during digestion, assimilation, and utiliza- 
tion, food in the body undergoes great chemical 
changes, by many of which heat is liberated. 
It is through such chemical processes that the 
energy required for internal and external muscu- 
lar work is provided and the body temperature 
maintained. 
Energy may be conveniently measured in terms 
of heat, the calorie, or heat unit, being used for 
this purpose. A calorie is the quantity of heat 
required to raise the temperature of one liter of 
water one degree centigrade, or very nearly the 
amount of heat required to raise the temperature 
of one pound of water from 0° to 4° F. In order 
to find the energy value of any food, a given 
quantity is burned in an apparatus surrounded 
by water, and the energy value in calories is de- 
termined by the number of liters of water that 
will be raised in temperature 1° centigrade. 
It has been found by experiment that when 
one ounce of either protein or carbohydrate is 
128 THE FOOD QUESTION 
burned, sufficient heat will be given off to raise 
the temperature of 120 liters of water 1° centi- 
grade, and one ounce of fat, when burned, will 
raise 280 liters of water 1° centigrade. Hence, 
the first two substances are said to yield 120 
calories, and the last 280 calories per ounce. We 
can now understand that while all nutrients are 
possible sources of energy, the body should de- 
pend upon fats and carbohydrates as energy-pro- 
ducing foods, rather than upon protein, which 
has tissue-building functions not possessed by 
the other nutrients. Moreover, fats are more 
efficient as sources of energy than either protein 
or carbohydrates. It has been estimated that 
one pound of digestible fat yields 4260 calories 
of heat or energy, while one pound of protein 
yields 2000, and the same amount of carbohy- 
drates, I860 calories, the fat thus giving over 
twice the number of calories that the other food 
principles are capable of yielding. This accounts 
for the fact that fatty articles are consumed in 
greater amounts in cold weather and in frigid 
climates. It has been estimated that for every 
100 calories, about 10 per cent, should be pro- 
duced from proteins, 30 per cent, from fats, and 
60 per cent, from carbohydrates. 
129 HEALTH FIRST 
Foods yielding about 2500 calories a day are 
required by the average person in sedentary pur- 
suits. The following table, arranged by Dr. R. 
H. Rose, will show a sample maintenance diet 
giving the required number of calories: 
Sample Maintenance Diet for a Person Weighing 
150 Pounds in Light Exercise 
Breakfast 
Orange 
Grams of 
Proteins 
. . .. 1 
Calories 
70 
Cereal 
.... 3 
110 
Roll 
.... 3.5 
115 
Coffee1 
1 
60 
Cream, two tablespoonfuls . .. 
.... 1 
100 
Sugar, three tablespoonfuls .. 
80 
Butter, one ball 
30 
535 
Eggs, two 
.... 13 
160 
Slices of bread, two 
.... 4.6 
140 
Butter, one ball 
80 
Sugar, two teaspoonfuls 
66 
Rice pudding 
.... 4 
160 
30.1 
606 
Lunch 
i Coffee has no protein or caloric value, which shifts other 
figures lower, as indicated. 
130 THE FOOD QUESTION 
Grama of 
Proteins 
Calories 
150 gms. roast beef, 5x3x| inch.. 
.. 34.5 
450 
Potatoes, medium size 
.. 2 
90 
Bread, two slices, 4x4x| inch ... 
.. 2.6 
140.. 
Soup, thickened, 250 gms 
.. 5.5 
160 
Squash, two tablespoonfuls 
.. 0.5 
80 
Peas, two tablespoonfuls 
.. 5 
160 
Cream 
.. 2 
60 
Sugar 
166 
Apples, baked 
.5 
75 
- - ■ 
- 
51.6 
1,421 
- 
- 
Total, three meals 
.. 81.7 
2,562 
Dinner 
THE NUTRITIONAL VALUES OF COMMON FOODS 
The following table has been arranged from 
various sources to show the nutritional value, 
together with a possible yield in calories, of com- 
mon articles of diet. The reader can thus esti- 
mate the nutritional, as well as the heat and 
energy value, of every-day foods: 
131 HEALTH FIRST 
Approximate Composition and Caloric Value 
FOODS DERIVED FROM ANIMAL SOURCES 
Composition. 
Carbo- 
1 ounce 
avoir, 
yields 
w 
Meats and Fish. 
Protein 
Fat 
hydrates 
Grams of 
■a 
Per Cent. 
Per Cent. 
Per Cent. Protein 
Q 
Lean pound of beef . 
. .22.6 
2.8 
0 
6 4 
34 
Lean pound of beef 
(cooked) . 
. .27.6 
7.7 
0 
7.8 
52 
Lean leg of mutton ., 
. .19.8 
12.4 
0 
5.6 
55 
Lean leg of mutton 
(cooked) 
. .25.0 
22.6 
0 
7.0 
90 
Chicken (broilers) 
. .21.5 
2.5 
0 
6.0 
32 
Chicken (fowls) ... 
. .19.3 
16.3 
0 
5.5 
65 
Bacon 
. .10.5 
64.8 
0 
2.9 
183 
Fish (mackerel) ... 
. .18.7 
7.1 
0 
5.3 
40 
Soups 
Beef 
.. 4.4 
0.4 
1.1 
1.2 
8 
Chicken 
. . 3.6 
0.1 
1.5 
1.0 
6 
Meat stew 
Milk and its deriva 
.. 4.6 
4.3 
5.5 
1.3 
23 
tives 
Cow's milk (poor) . 
.. 3.0 
3.0 
5.0 
0.85 
18 
Cow's milk (good) .. 
.. 3.2 
4.0 
5.0 
0.90 
21 
Cow's milk (rich 
Jersey) 
.. 3 5 
5.5 
5.0 
1.00 
25 
Cream 
.. 2.5 
40.0 to 16.0 
4.0 
0.70 
119 
Skimmed milk 
. . 3.4 
0.3 
5.0 
0.96 
11 
Buttermilk 
.. 3.0 
0.5 
4.8 
0.85 
10 
Condensed milk 
(sweetened) 
. . 8.8 
8.3 
54.1 
2.50 
95 
Evaporated milk ... 
. . 9.6 
9.3 
11.2 
2.70 
49 
Butter 
.. 1.0 
85.0 
0.0 
0.28 
225 
Eggs 
Hen's eggs (boiled) ..13.0 12.0 
FOODS DERIVED FROM VEGETABLE 
0.0 
SOURCES 
3.6 
48 
Cereal Products 
Rolled oats 
. .16.0 
7.3 
67 0 
4.5 
115 
Cracked wheat 
. .11.0 
1.7 
75.5 
3.1 
105 
132 THE FOOD QUESTION 
Composition 
Carbo- 
hydrates 
Per Cent. 
1 ounce 
avoir, 
yields 
Grams of 
. Protein 
Calories 
Protein 
Per Cent. 
Fat 
Per Cent. 
Farina 
..11.0 
1.4 
76.3 
3.1 
105 
Hominy 
.. 8.3 
0.6 
79.0 
2.3 
103 
Flaked rice 
.. 7.9 
0.4 
82.0 
2.2 
105 
Bread and Crackers 
Brown bread 
.. 5.4 
1.8 
47.1 
1.5 
65 
Whole wheat bread . 
.. 9.7 
0.9 
49.7 
2.7 
71 
White wheat bread . 
.. 9.1 
1.6 
53.3 
2.5 
76 
Toasted wheat bread 
. .11.5 
1.6 
61.2 
3.2 
88 
Butter crackers .... 
.. 9.6 
10.1 
71.6 
2.7 
121 
Saltine crackers .... 
..10.6 
12.7 
68.5 
2.9 
125 
Soda crackers 
.. 9.8 
9.1 
73.1 
2.7 
120 
Starch and Sugars 
Cornstarch 
.. 0.0 
0.0 
90.0 
0.0 
105 
Arrowroot starch ... 
. . 0.0 
0.0 
97.5 
0.0 
113 
Granulated sugar ... 
. . 0.0 
0.0 
100.0 
0.0 
116 
Milk sugar 
.. 0.0 
0.0 
100.0 
0.0 
116 
Vegetables 
Beans, string (cooked) . 0.8 
1.1 
1.9 
.22 
6 
Beans, baked (cooked) 6.9 
2.5 
19.6 
1.90 
37 
Peas, green (cooked) 
. . 6.7 
3.4 
14.6 
1.90 
34 
Potatoes, boiled .... 
.. 2.5 
0.1 
20.9 
.70 
28 
Potatoes, mashed and 
creamed 
. . 2.6 
3.0 
17.8 
.71 
31 
Potatoes, sweet 
(cooked) 
.. 3.0 
2.1 
42.1 
.85 
58 
Spinach (cooked) ... 
. . 2.1 
4.1 
2.6 
.59 
16 
ECONOMY IN FOODS 
The question of expense is an important one 
in considering healthful nutrition, especially at 
the present time. The increasing cost of food of 
133 HEALTH FIRST 
all kinds makes this problem very urgent to those 
having small incomes. 
The first necessity is to eliminate waste as 
much as possible. There must be more care in 
the practice of household economies. The secre- 
tary of agriculture in discussing the food situa- 
tion recently, stated that more than seven hun- 
dred million dollars worth of edibles was wasted 
in our kitchens annually. 
It has been aptly stated that the high cost of 
living is due partly to the cost of high living. 
All sorts of waste can be included in the latter. 
The housewife also needs instruction in the rela- 
tive value and cost of food. The most expensive 
foods are not necessarily the most nourishing or 
desirable. Among the meats, prolonged and 
proper cooking will enable the cheaper and 
coarser cuts to serve all necessary purposes. 
American cheese, dried peas, and beans are high 
protein foods that can take the place of meat. 
Rice and corn-meal mush make good substitutes 
when potatoes are scarce or high: besides being 
cheaper, they are likewise more nutritious. 
Oleomargerine and cotton-seed oil are wholesome 
and cheap substitutes for butter. Ordinary ce- 
reals, such as oatmeal, hominy and corn-meal, 
134 THE FOOD QUESTION 
are as good as patent cereals and much cheaper. 
A glance at the table of food values on a previous 
page will enable one to be sure of the desirability 
of any selected foods. 
The Life Extension Institute of New York 
recently made an interesting experiment in 
which twelve policemen were fed for three weeks 
at an expense of twenty-five cents a day for each 
individual. The cost of the food was based on 
prices prevailing in January, 1917. The menus 
for one week were as follows: 
Sunday. Breakfast-Oatmeal and milk, corn griddle 
cakes, syrup and butter, coffee; cost five cents. 
Dinner-Rolled steak, graham bread and butter, 
mashed sweet potatoes, chocolate ice cream, cheese, 
tea; cost eleven cents. 
Supper-Creamed oysters on toast, Parker House 
Rolls, stewed peaches and raisins, butter, cheese, 
tea; cost nine cents. 
Total value 3160 calories. 
Monday. Breakfast-Hominy and milk, graham 
toast and butter, coffee; cost seven cents. 
Luncheon-Scalloped rice and tomatoes, corn 
muffins and butter, apple dumplings and hard sauce, 
tea; cost seven cents. 
Dinner-Hamburger steak, Lyonnaise potatoes, 
EXPERIMENTS IN ECONOMY 
135 HEALTH FIRST 
whole wheat bread, cottage pudding with clear 
sauce, tea; cost eleven cents. 
Total value 3370 calories. 
Tuesday. Breakfast-Oatmeal and milk, crullers, 
rolls and butter, coffee; cost seven cents. 
Luncheon-Potato soup with carrots, rye bread 
and butter, stewed prunes and ginger snaps, tea; 
cost eight cents. 
Dinner-Parsnips, baked with sausage, samp, 
whole wheat bread with butter, bread pudding with 
fruit sauce, tea; cost ten cents. 
Total value 3005 calories. 
Wednesday. Breakfast-Hominy and milk, toast 
with butter, coffee; cost seven cents. 
Luncheon-Baked lima beans, Boston brown 
bread and butter, sliced oranges and bananas with 
shredded cocoanut, tea; cost eight cents. 
Dinner-Liver and bacon, creamed potatoes, 
whole wheat bread and butter, coffee jelly, tea; cost 
ten cents. 
Total value 3035 calories. 
Thursday. Breakfast-Oatmeal and milk, buttered 
toast, coffee; cost seven cents. 
Luncheon-Macaroni croquettes with tomato 
sauce, graham bread and butter, corn starch pud- 
ding with raisin sauce, tea; cost eight cents. 
Dinner-Beef pot roast, carrots and onions, 
whole wheat bread and butter, caramel tapioca, tea; 
cost ten cents. 
Total value 3030 calories. 
136 THE FOOD QUESTION 
Friday. Breakfast-Hominy and milk, buttered 
toast, coffee; cost seven cents. 
Luncheon-Baked rice and cheese, raisin bread, 
apple sauce, tea; cost seven cents. 
Dinner-Escalloped salmon, German fried pota- 
toes, graham bread and butter, prune pie, tea; cost 
eleven cents. 
Total value 3070 calories. 
Saturday. Breakfast-Oatmeal and milk, rolls and 
butter, coffee; cost seven cents. 
Luncheon-Fried mush and syrup, white bread 
and butter, stewed apricots, tea; cost seven cents. 
Dinner-Baked beans with salt pork, whole wheat 
bread and butter, molasses cake, tea; cost eleven 
cents. 
Total value 3120 calories. 
Of course this experiment was conducted by 
experts and skilful shoppers, but still it shows 
what can be accomplished by a careful study 
along this line. Most of the men gained in 
weight during the three weeks of the experiment. 
About the same time the social service depart- 
ment of one of the New York hospitals arranged 
a dietary plan by which two adults and three 
children could be fed and maintained in good 
health at a weekly cost of seven dollars and 
thirty-one cents. 
While prices vary somewhat with seasons and 
137 HEALTH FIKST 
the conditions of supply and demand, the general 
increase in the cost of living makes it very neces- 
sary to study the relation of the cost of food in 
connection with its nutritional value. 
It is finally important to note that some people 
have idiosyncrasies in reference to certain ar- 
ticles of diet. Violent disturbances may follow 
taking the smallest amount of such foods. This 
phenomenon is sometimes known as allergy. 
Shell-fish, strawberries, and other innocuous 
foods have been known to cover the skin with 
profuse rashes, to cause bowrel upsets and diffi- 
cult breathing. As a rule, these disturbances 
pass off in a few hours, but occasionally they are 
dangerous. It is desirable that these food idio- 
syncrasies be early recognized so that the diet 
may be arranged accordingly. ' Not only tem- 
porary, but more permanent trouble may thus 
be avoided. The various forms of food shock 
are more apt to be seen in early years while 
tolerances are being established. 
Epicurus wrell sums up the question of food: 
"To habituate self, therefore, to plain and inexpen- 
sive diet gives all that is necessary for health, and 
enables a man to meet the necessary requirements of 
life without shrinking." 
138 CHAPTER IX 
HEALTH AND DISEASE: AVOIDING INFECTION 
IN a previous chapter attention has been called 
to the fact that a long and efficient life de- 
pends largely upon freedom from illness. All 
severe sicknesses and even some mild attacks, are 
apt to leave a change in the bodily machine that 
may eventually interfere with its proper and 
prolonged operation. It is, therefore, the part 
of wisdom to learn how to avoid illness. The 
parents should begin early in life instructing 
children so that they can later look out for them- 
selves. Few of us realize how much can be done 
along this line. Many evils of life are clearly 
preventable, and this particularly applies to not 
a few of the common diseases. 
PREVENTION OF DISEASE 
The great achievements of modern preventive 
medicine are having far-reaching effects. It is 
only necessary to speak of a few of these triumphs 
139 HEALTH FIRST 
in order that the overwhelming debt of humanity 
to modern medicine may be appreciated. 
To-day the plague is unknown except among 
the ignorant, superstitious people of India, who 
refuse proper measures of relief; yet in the four- 
teenth century twenty-five millions in Europe 
died the horrible death of this disease. In civi- 
lized countries vaccination has virtually elimi- 
nated smallpox. During the eighteenth century 
in Europe, sixty millions died from this loath- 
some infection and multitudes who did not die 
were permanently scarred and mutilated. The 
reign of destruction and death accompanying 
this disease continued until Jenner's great dis- 
covery in 17'96. 
Sanitary improvements have reduced the death- 
rate in large cities all over the world; and a 
lower death-rate means a much lower percentage 
of sickness. No one can estimate the amount of 
suffering, as well as the economic loss to society, 
thus avoided. 
Coming to very recent years, treatment by 
antitoxin of that scourge of childhood, diphtheria, 
has in many localities induced the mortality 
by more than thirty per cent, and, in the fatal 
140 AVOIDING INFECTION 
and agonizing croup variety, by nearly fifty per 
cent. 
The germ of malarial diseases has been dis- 
covered, as well as the kind of mosquito that 
spreads the poison. By draining swampy areas 
and by taking measures for the destruction of 
the mosquito, large tracts of hitherto waste land 
are rendered safe and productive, and a wide- 
spread cause of debilitating sickness, and even 
of death, is removed. 
It is known that only one variety of mosquito 
(Anopheles) can spread malaria by its sting, 
and then only after having previously bitten a 
person already infected. Large marshes, where 
fresh-water streams empty into salt water, al- 
though breeding numberless mosquitoes, rarely 
produce the kind that spreads disease. The 
germ-carriers are usually fresh-water mosqui- 
toes. The latter may breed in any small pool 
of water, even such as may be found in a tin can 
or a gutter. The smallest collection of water 
must be completely drained away; and if marshes 
or moist areas cannot be so treated, the water 
may be sprinkled with kerosene oil, one ounce to 
fifteen square feet of surface. In this way, a 
141 HEALTH FIRST 
locality can be freed from these pests, which 
are always annoying and sometimes very danger- 
ous. As the disease-carrying mosquitoes are 
only active at night, they must be kept out of 
houses and sleeping-rooms by screening windows 
and doors with a fine netting. 
Unless caught by a high wind, mosquitoes 
rarely travel more than a few hundred yards 
from their breeding-spots. A person suffering 
from an acute malarial attack must be carefully 
protected from them, as, if the disease-carrying 
kind bites such a patient, the malady may be 
spread to others in the community. Thorough 
screening and a free use of quinine will soon 
bring a possibly dangerous patient to a state not 
so threatening to others. 
Another variety of mosquito (Stegomia) 
spreads yellow fever in the same way. By ex- 
terminating this variety, yellow fever has virtu- 
ally been banished from Cuba, although it fol- 
lowed its destructive course there for nearly two 
centuries. 
The known agency of rats, flies, and various 
insects in the spread of disease germs has en- 
abled the physician to control cholera, the plague, 
and similar diseases. It is now recognized that 
142 AVOIDING INFECTION 
the common house-fly takes an active part in the 
spread of disease; the germs stick to their bodies 
and are so carried from one person to another. 
Dysentery, typhoid fever, and bowel disorders 
are known to be spread in this way, and it is 
highly probable that scarlet fever, diphtheria, 
smallpox, cerebrospinal meningitis, tuberculosis, 
infectious eye disorders, and possibly infantile 
paralysis, may likewise be disseminated by the 
fly. It is believed that infected flies can be dan- 
gerous for a long time after they have become 
contaminated. 
Good health, therefore, requires the destruc- 
tion of the fly. It has been estimated that a fe- 
male fly lays an average of one hundred and 
twenty eggs at a time. These eggs are deposited 
in filth of some kind, where maggots are first 
developed, and finally the full-grown fly. 
The popular slogan, " Swat that fly," is not so 
far-reaching as supposed. It deals with effects 
rather than causes. It would be wiser and much 
more effective to direct any " swatting " toward 
the dirt-heap that produces the fly. Manure piles 
are favorite breeding-spots. They should not be 
exposed, but always kept under cover, and in 
dark, protected places, as the fly does not breed 
143 HEALTH FIRST 
in darkness. In this respect it would help the 
farmer to give a coat of black paint to the inside 
of the manure bin. Flies are usually plentiful 
where horses are kept. 
While flies, like mosquitoes, do not usually 
stray more than several hundred yards from their 
breeding-places, they may be carried anywhere 
by vehicles or horses and thus spread infection 
through a wide area. The menace of the fly to 
health can only be obviated by a thorough clean- 
ing of town and house. Where the fly is found, 
we may be sure there is, in the near vicinity, 
some dirt or filth that offers the opportunity for 
breeding. 
Municipal hygiene is most important in the 
preservation of health. The value of a good 
water-supply and proper drainage is shown by 
the stamping out of typhoid fever and similar 
diseases where these sanitary agencies are suit- 
ably employed. 
VARIETIES OF DISEASE 
Two general classes of disease may be con- 
sidered in reference to the maintenance of health : 
first, those due, at bottom, to disturbances of 
digestion, with faulty metabolism and the vari- 
144 AVOIDING INFECTION 
ous degenerative processes that come with ad- 
vance in life; and secondly, those due to infec- 
tion by disease-producing germs. The former 
have been considered in previous chapters, espe- 
cially those dealing with middle age and old age. 
GERM DISEASES 
Many diseases are produced by very minute 
microbes; they are usually of low vegetable 
origin and are classed as bacteria. These germs, 
when introduced into the body, grow with great 
rapidity, and in this process various toxins are 
elaborated that cause the symptoms of disease. 
Some of these toxins or poisons are more virulent 
than others. Nature tries first to destroy the 
bacteria by means of the living body cells, espe- 
cially the white blood-corpuscles, and next to 
overcome the action of the toxins by developing 
antitoxins. 
In order to avoid this class of diseases, every 
one should try, by cultivating good health, to 
keep the resistance of the body at its highest 
point. Healthy tissues are not easily infected. 
If, however, they should be, the defensive mechan- 
ism of the body will act to best advantage in 
those who are in good condition. The soil is 
145 HEALTH FIRST 
often as important as the seed when we con- 
sider the reaction of the body to various disease 
germs. It is the resistance of healthy body cells 
that prevents the growth of bacteria and of 
minute animal parasites that are everywhere 
present. It may be added, however, that com- 
paratively few of the numberless microbes that 
abound in nature are capable of producing dis- 
ease in the human body. Indeed most of the 
beneficent processes of nature are carried out 
through the agency of various micro-organisms. 
There are fortunately more good microbes than 
bad ones. 
HOW INFECTION SPREADS 
The common way in which germ diseases are 
spread is by direct contact between the sick and 
the well. These communicable diseases, as they 
are called, may be passed on, not only by direct 
contact, but by indirect methods as well. The 
first way is by touch, or by coughing, by sneezing 
and even by talking. By these means a fine 
spray, consisting of very minute droplets, is 
thrown out from the mouth or nose and the per- 
son within reach may be infected. By the indi- 
rect method, the germs in the various secretions 
146 AVOIDING INFECTION 
or excretions of the body, may become attached 
to various utensils, such as cups or forks or 
towels or handkerchiefs. They may also be 
present in dried sputum, in dust, and in food or 
water. 
Communicable diseases may be grouped into 
two classes in reference to the method of dis- 
seminating their poisons. The first group in- 
cludes smallpox, chicken-pox, scarlet fever, 
measles, whooping cough, diphtheria, septic sore 
throat, mumps, epidemic cerebrospinal menin- 
gitis, tuberculosis, and infantile paralysis, in 
which the infectious agent is generally limited 
to the discharges from the nose, throat, eyes, 
ears, and suppurating glands. The second group 
includes typhoid fever, para-typhoid fever, dysen- 
tery and Asiatic cholera, in which the infective 
material is found chiefly in the bowel and urinary 
discharges. Infantile paralysis and tuberculosis 
may, however, be included in either group. 
It was formerly believed by scientists, and is 
still popularly thought, that germs of disease 
are floating in the air of the room occupied by 
the infected person. These microbes were sup- 
posed to attach themselves to objects on the wall, 
such as picture-frames or moldings, where they 
147 HEALTH FIRST 
were apt to drop on and infect any one who might 
come into the room. There is no scientific proof 
that this ever happens, and the theory of aerial 
transmission of disease is not now held by ex- 
perts. While disease germs are thus not air- 
borne, they may be at first carried in little drop- 
lets a short distance into the surrounding air, 
but probably not more than a few feet from the 
person coughing them out. Accordingly, fumi- 
gation of rooms after infectious diseases is be- 
ing abandoned. A thorough cleaning and airing 
of the room is considered sufficient. Plenty of 
soap and water and soda has taken the place of 
irritant gases generated from sulphur or for- 
maldehyde. The floors and woodwork may be 
scrubbed with a solution of one pound of wash- 
ing soda and three gallons of hot water, as ad- 
vised by the New York Board of Health. Wash- 
able clothing may be soaked in a five-per-cent, 
chlorinated lime solution, or in a five-per-cent, 
carbolic solution, and then boiled. Books and 
toys that have been constantly handled should 
be burned. Sunlight, when available, is the most 
effective disinfectant, as no germ can live when 
exposed to the sun's rays. 
The most efficient control of infectious diseases 
148 AVOIDING INFECTION 
consists of a prompt destruction of all the body 
discharges as soon as passed. The nose and 
mouth secretions are the commonest sources of 
infection. 
Outside the house, the collection of many peo- 
ple in closed spaces does much to spread infec- 
tious diseases. Crowded cars, where people are 
standing in close contact, moving-picture shows, 
schools, and similar places spread disease of all 
kinds. Coughing, sneezing, and even talking at 
close range will here spread infection. It has 
been proved that virulent bacteria are present in 
many closed and crowded spaces. 
Indirect infection may be avoided by not using 
common drinking-cups, towels, or various dishes 
that have not been thoroughly cleaned. Dusty 
rooms should be cleaned by the use of moist 
cloths rather than by the familiar feather duster 
that may spread about any germ-laden dust. 
Most disease germs live only a short time after 
discharge from the body, but a few may survive 
by drying and so be carried in dust. The con- 
sumption germ and diphtheria and typhoid 
bacilli are examples of the latter. It used to be 
thought that sewer gas was active in the spread 
of infection, but this effluvium is now known to 
149 HEALTH FIRST 
be comparatively harmless and certainly incapa- 
ble of spreading disease. The worst sewer bnilt 
is usually better than no sewer, and workmen 
employed in sewers do not usually suffer in 
health. 
There are two ways in which infections may 
be spread that are very hard to obviate. The 
first is by exceedingly mild and unrecognized 
cases of disease. Persons thus attacked mingle 
freely with others and disseminate the germs that, 
while having little effect upon them, may yet 
cause a severe or malignant attack in another. 
The second method of spreading germs is by what 
is known as a carriers." These people harbor 
active germs of disease in their bodies without 
being made ill by them. While immune them- 
selves, they unfortunately give out the germs of 
disease to those who may be susceptible to attack. 
It is fortunately true, however, that it usually 
requires many germs to start an infection, and 
the cells and secretions of the body can be de- 
pended on to kill off a few of them. 
Attention will now be directed to various com- 
mon infections, as a little knowledge as to how 
they act and the principal sources of danger will 
150 AVOIDING INFECTION 
help in avoiding them. It has been estimated 
that seventy per cent of the deaths in the United 
States are caused by some sort of contagion. 
Therefore the question of avoidance is a vital 
one. 
COMMON COLDS AND RESPIRATORY DISEASES 
Few appreciate what damage can be done by 
ordinary colds. Most cases of bronchitis and 
many attacks of pneumonia have their origin in 
this way. An important point to consider is 
that one cold, unlike some affections, does not 
confer immunity, but rather predisposes to fu- 
ture attacks. A number of different germs may 
produce colds in the nose and throat, and com- 
paratively mild germs may pave the way for 
the more dangerous types, such as the pneumococ- 
cus, or tubercle bacillus. This is what makes 
many ordinary colds serious. There is often a 
quick descent of an inflammation from the nose 
and throat through the bronchial tubes and 
finally to the cells of the lungs. As many people 
are constantly carrying the germs of respiratory 
diseases in their upper air-passages, particularly 
in winter, every effort must be made to prevent 
151 HEALTH FIRST 
their growth. This means keeping up the vi- 
tality by hygienic living. When the digestion is 
upset, one catches cold easily. A coated tongue 
and sluggish bowel predispose to all kinds of 
infection. A free action of the skin is also de- 
sirable. 
The two reflexes that lead to quick congestion 
of the nose and throat start from the back of 
the neck and the feet. A chilling of these parts 
is always apt to induce a cold. When the neck 
is too warmly covered and shortly afterward ex- 
posed to a cold draught, with the skin relaxed 
or perspiring, the mucous membranes of the nose 
and throat will quickly respond by a reflex irri- 
tation. Little girls with heavy masses of hair 
covering the back of the neck often catch cold 
in the same way, but braiding the hair or holding 
it back from the neck will reduce this risk. It 
is well to try to toughen this susceptible region 
by sponging the neck and chest with cold water 
on rising. 
The feet, when wet or chilled, also quickly con- 
gest the upper air passages. In snowy, wet 
weather many colds can be avoided by properly 
protecting the feet with rubbers or arctics. 
Children should never be allowed to sit in school 
152 AVOIDING INFECTION 
with cold, wet feet. They had better be sent 
home for a change rather than run the chance of 
illness. Cold feet at night also keep the throat 
irritated and should be avoided by booties or 
some similar protection. 
We must remember that, whenever a mucous 
membrane is irritated or congested, it affords 
favorable soil for the growth of germs, either 
those already present or others received from 
some one else. This is one reason that adenoids 
at the back of the throat or enlarged, congested 
tonsils not only harbor germs, but favor their 
development. 
As most of the secretions of the respiratory 
tract are infective during inflammation, the 
greatest care must be exercised, whether we are 
dealing with a simple nasal secretion or the 
sputum from a deep-seated affection of the lungs. 
It is a common experience to have colds and 
influenzas spread all through a household or a 
school. This is due to a constant spraying of 
the air with infective droplets from coughing or 
sneezing, and indirectly from mucus deposited 
on towels or handkerchiefs. Complete 'or par- 
tial isolation is desirable during the acute stage 
of any catarrhal affection, and all the secretions 
153 HEALTH FIRST 
should be kept from contact with articles that 
may be in common use. It has been found that 
droplets coughed out in influenza sometimes re- 
main suspended in the air for several hours, 
capable of infecting others. 
Good ventilation, with well-aired, sunny rooms, 
will do much to prevent the spread of infection. 
Clean, fresh air is very effective in dissipating 
poisons and preserving health. The New York 
Board of Health has recently demonstrated the 
effect of lack of good ventilation and fresh air 
upon the mortality curve in common respiratory 
diseases. This was done by the following vivid 
illustration: 
Deaths from PneumoniaBronchitis.Colds and Grip 
injYew Tor/c City 
WINDOWS SHUT 
X 
WINDOWS 
WIDE OPEN 
Some care must be exercised, however, not to 
allow a direct draft on the body from wide-open 
windows, especially in sleeping-rooms. Undue 
exposure during cold, damp weather may be 
154 AVOIDING INFECTION 
harmful during sleep. Common-sense must be 
called into play in the distribution of fresh air. 
Dry, furnace-heated rooms, kept at too high a 
temperature, are always unfavorable. 
During inclement weather, special efforts must 
be made to avoid the danger of contracting re- 
spiratory diseases. This means an avoidance of 
fatigue and excesses of all kinds both in eating 
and drinking. Sufficient sleep is a good pre- 
ventive and many a severe cold or influenza would 
be cut short if a person could rest quietly in 
bed for twenty-four hours during the first onset 
of the attack. 
Whooping-cough. This is a severe disease, 
which is especially dangerous to little babies. 
The cause has been found to consist of a specific 
germ that locates in the upper air tract and is 
thrown out with the spray that follows the cough. 
It is, therefore, during the paroxysms of cough- 
ing that the disease is commonly spread. Kiss- 
ing may also be a means of infection. While 
others are usually infected by direct exposure, 
it is considered possible that the disease may 
occasionally be contracted by means of a third 
person or by various utensils that have received 
the spray from the cough. All specific infections 
155 HEALTH FIRST 
have what is known as a time of incubation, 
which includes the period from exposure until 
the disease becomes active. During this time, 
however, the disease is not contagious. The in- 
cubation of whooping-cough is from one to two 
weeks. 
The disease is most contagious during the early 
paroxysmal stage. Two weeks after the first 
whoop the contagion rapidly diminishes. The 
paroxysmal stage usually lasts from four to six 
weeks. 
Fresh air is the best diluent of the whooping- 
cough poison. Keep the windows open, but 
avoid a direct draft if possible. It is desirable 
frequently to change rooms that have been freely 
aired. Unless the weather is very stormy, keep 
the patient out-of-doors and in the sunlight as 
much as possible. This will be more effective 
in quieting the cough than medicines. 
Tuberculosis. While tuberculosis, the great, 
white plague, is a disease of all ages, its ravages 
are peculiar and wide-spread at the beginning of 
life. This disease holds the awful record of one- 
seventh of all the deaths in the world. The 
germ that causes it has a long period of infec- 
tivity, while most other disease germs die soon 
156 AVOIDING INFECTION 
after being cast out of the body and thus have 
only a limited interval of infectivity. It has 
been estimated that one billion bacilli a day may 
be coughed up by a patient with active consump- 
tion of the lungs. It is these so-called open cases 
that are dangerous to others. The bacilli are 
given oft in small droplets in coughing, sneezing, 
or even in the current of air that comes from 
the lips when the person is talking. If all the 
secretions from the cough are received in little 
boxes made for this purpose, or in cheese cloth 
that is afterwards burned, there will be no dan- 
ger to others. In consumption hospitals, where 
these precautions are scrupulously enforced, the 
disease is not spread to the healthy attendants. 
Expectoration may also be made into receptacles 
containing water, as one of the dangers consists 
in the drying of infected sputum that has been 
carelessly dropped on floors or rugs. The dust 
in rooms inhabited by consumptives may in this 
way be a source of danger to others. 
The tubercle bacilli may be swallowed as well 
as inhaled. This takes place largely through 
milk that has been infected by bovine germs. 
Children are more apt to be affected by the latter 
than grown-ups, but, as a rule, there is, at all 
157 HEALTH FIRST 
ages, greater clanger from inhaling than from 
swallowing the germs. Care must always be ex- 
ercised, however, in food supplies that can carry 
this disease. The knowledge of its possible 
spread by meat and milk has led to careful in- 
spection of carcasses and an improvement and 
cleaning up of the milk supply in large areas of 
country. 
There are certain peculiarities of the disease in 
early life, such as specially involve the lymph- 
glands, bones, and joints rather than the lungs, 
and these constitute " closed " cases that are not 
dangerous to others. It is now believed that 
most attacks of tuberculosis in adult life have 
started from some focus of infection that began 
in the child and remained latent. Repeated 
colds, some of the specific infections such as 
measles or whooping-cough, or a general lower- 
ing of the vitality, may cause these latent foci 
to become active. This emphasizes the impor- 
tance of avoiding infection during the growing 
period, and later, the desirability of keeping 
one's health at the highest point. Some believe, 
however, that a slight infection during childhood 
may help protect the adult by early developing 
the immunizing powers. It is, however, always 
158 AVOIDING INFECTION 
desirable to depend on a good vitality to resist 
these and other harmful germs. A knowledge 
that this dreaded disease is usually preventable 
and often curable acts as a stimulus to renewed 
and successful efforts for its final elimination. 
The disease is now slowly diminishing all over 
the civilized world in response to careful hygiene, 
the fresh air treatment, forcing the nutrition of 
the individual, and the prompt destruction of 
the germs so constantly thrown off. 
SPECIFIC INFECTIONS WITH AN ERUPTION 
Certain specific diseases are accompanied by 
an eruption on the skin and are known as exan- 
themata. They form the most common com- 
municable diseases and they could often be 
avoided if there were a more general knowledge 
of how they spread. 
Measles. This is one of the most highly con- 
tagious diseases that is met with in ordinary life. 
The incubation period varies from eight to four- 
teen days. It begins like an ordinary cold and 
the distinctive rash does not come out until the 
fourth day. In these preliminary days, with 
running nose and remittent fever, the disease is 
highly contagious, and this accounts for its 
159 HEALTH FIRST 
rapid spread in schools, as it requires fairly close 
contact. Two-weeks' isolation is usually suffi- 
cient as the infection comes from secretions of 
the nose and throat which disappear by that time. 
In many cases it ceases to be infective five days 
after the appearance of the rash. If there is a 
running ear, however, it may carry the contagion 
longer. The virus when separated from the body 
does not generally live longer than twenty-four 
hours. Scaling skin is not infective. The late 
winter and early spring are the periods when 
the disease is most active. 
German Measles. This is a mild, although 
highly contagious affection that is apt to be con- 
fused with regular measles or very light scarlet 
fever. It is, however, a distinct disease, different 
from both the latter. The incubation is from 
ten days to three weeks. The eruption lasts a 
few days and then fades, and the infection is 
spread by the secretions of the nose and mouth. 
Two weeks is a safe period of quarantine. 
Scarlet Fever. Few diseases vary so in type, 
from very mild cases that are difficult to recog- 
nize, even by an expert, to severe or malignant 
attacks. The former variety is active in spread- 
ing the disease, and a very slight attack in one 
160 AVOIDING INFECTION 
person may produce a bad attack in another. It 
may be stated that in recent years most epidemics 
have not assumed a very severe type. The incu- 
bation varies from two to seven days. A scarlet 
rash appears in from twelve to forty-eight hours 
after the first invasion, which is particularly 
marked by sore throat and a high fever. Infec- 
tion is carried by the secretions of the mouth, 
nose, and ears, and not by the skin. It was 
formerly supposed that the flakes from the peel- 
ing skin were highly infective. The skin, how- 
ever, does not infect unless contaminated by 
mucous from the nose and throat. 
Stories of particles of skin caught in a book 
that is opened years later, and of some one thus 
infected are not now believed. Toys and similar 
objects may, however, be contaminated by the 
secretions of the mouth and thus spread the dis- 
ease. The period of quarantine is usually placed 
at six weeks, although most cases cease to be 
infective long before this time. Thirty days is 
sufficient in an average case. Even the mild 
cases should be kept in bed during three weeks 
for their own safety* as well as that of others. 
Like measles, this disease is most prevalent in 
late winter and early spring. 
161 HEALTH FIRST 
Smallpox. This severe and loathsome disease 
has, as a result of general vaccination, virtually 
disappeared in advanced communities. In order 
that prevention and change in the severity of 
smallpox may be continued, vaccination must be 
repeated occasionally. When this simple opera- 
tion is performed in infancy, the disease is pre- 
vented during the period of growth, or so altered 
as to be innocuous. In after life it had better 
be repeated every ten or twelve years to make 
sure of protection. The period of incubation is 
from twelve to twenty days, and the victim is 
usually ill four days before the eruption begins. 
The pustules on the skin generally dry by the 
third week. The contagion exists in the pustules 
and in the dried crusts on the skin, as well as in 
the secretions and excretions of the body. The 
poison may thus be transmitted by a third person 
or by contaminated objects. 
Chicken-pox. This is a mild, but acutely con- 
tagious disease that sometimes may be confused 
with a very light attack of smallpox. The incu- 
bation period averages two to three weeks. The 
eruption appears within twenty-four hours after 
the beginning of the attack and consists of sev- 
eral crops of little papules and vesicles. The 
162 AVOIDING INFECTION 
contagion is located in the vesicles so that the 
quarantine must be continued until they dry and 
disappear. This will usually happen in about 
ten days. 
SPECIFIC INFECTIONS WITHOUT AN ERUPTION 
Some of the severe communicable diseases 
have no rash to distinctly mark them. They 
must be recognized in other ways. 
Diphtheria. In this disease a false mem- 
brane, caused by specific germs, appears in the 
nose or throat. Millions of these germs will be 
found growing in the throats of a patient. The 
incubation is from two to five days. It is a 
strange fact, recently discovered, that many 
people are immune to the diphtheritic germ. 
Recent studies show that fully seventy-five per 
cent, of adults and eighty per cent, of new-born 
infants are immune. From two to five years is 
the most susceptible period. The explanation of 
this immunity is that certain individuals can 
develop in their own bodies enough natural anti- 
toxin to protect them from attack. As the germs 
may be present in their noses and throats, these 
people, if exposed, may become carriers, and 
163 HEALTH FIRST 
thus be a means of spreading the disease while 
they themselves are not ill. It has been found 
that nearly two per cent, of people are carriers. 
Diphtheritic germs may also live for a time 
on books or toys that have been coughed upon 
or handled by the sick. If the hands of the 
patient are put in the mouth they quickly be- 
come infected. The disease can, in this way, be 
spread directly and indirectly. Everything 
touching the diphtheritic patient must be 
cleansed and disinfected. For those exposed, an 
immunizing dose of antitoxin will usually pre- 
vent the disease. Every patient is dangerous to 
others until a culture shows that there are no 
germs in the nose and throat. A large-sized 
dose of antitoxin, given at the beginning of an 
attack, will, in a majority of cases, produce a 
cure and also help to ward off some of the dan- 
gerous complications. Diseased tonsils, ade- 
noids, and decayed teeth form a good soil in 
which diphtheritic germs may live and develop. 
Infantile Paralysis. The subject of infan- 
tile paralysis is just now very much in the air, 
but, fortunately for the peace of mind of nervous 
parents, the germs of the disease are not in the 
air, even in localities where the affection is epi- 
164 AVOIDING INFECTION 
demic. The virus, in the absence of carriers, 
does not spread through the atmosphere and in 
that way pass from one victim to another. This 
is really a very old disease, which has only re- 
cently been thrust into wide-spread public atten- 
tion. 
There has never been a time when this affec- 
tion has not, in a sporadic form, been present in 
almost every community. Although serious to 
the patient, these cases were never looked upon 
as a menace to the community. They were 
treated in the general wards of hospitals, and no 
effort was made to isolate the cases in the home. 
The disease did not appear to be communicated 
from one to another. In recent years, however, 
it has become epidemic and communicable, pos- 
sibly from some change in the nature of the 
virus. 
The first reported epidemic occurred in Stock- 
holm, Sweden, in 1887, and since then many epi- 
demics have broken out in various parts of the 
wrnrld. The disease now tends to assume the 
epidemic form. A more frequent occurrence of 
epidemics has been observed since 1905. This 
has been noted both in this country and in 
Europe. Since 1906 there has been an epidemic 
165 HEALTH FIRST 
of some sort every year in some part of the 
United States. In spreading, the disease follows 
the lines of travel, showing that the poison is dis- 
seminated by means of the activities of human 
beings. A peculiarity of the epidemics hereto- 
fore observed, especially in this country, is that 
they have always occurred during the hot 
months, usually from July to the end of Sep- 
tember. The seasons of attack have generally 
been noted as being unusually dry. 
The incubation is from five to ten days, with 
an average of seven days. The disease is infec- 
tious and communicable and is not always ac- 
companied by paralysis, although this is usually 
the case. Abortive types with nothing but 
spinal and muscular pain are not infrequent. A 
very minute, filterable micro-organism is be- 
lieved to be the cause. This germ is located in 
the nose and throat and is sometimes cast off by 
the bowels. The virus both enters and leaves 
the body by the mucous membrane of the upper 
respiratory tract. It is believed that the disease 
is spread, not only by direct contact, but by car- 
riers who harbor the virus in the secretions of 
the nose and mouth, although themselves im- 
mune. The control of the disease, as attempted 
166 AVOIDING INFECTION 
by health authorities, calls for the following pro- 
cedures : 
1. That all recognized and suspected cases be 
promptly reported. 
2. Isolation of patients in screened premises. The 
duration of infectivity being unknown, the period of 
isolation must necessarily be arbitrary. Six weeks 
has been recommended by the Conference of State and 
Territorial Health Officers with the Surgeon-General 
of the Public Health Service as sufficient, and this 
period has been generally accepted throughout the 
United States. More recently, a three weeks ' quaran- 
tine has been considered sufficient. 
3. Disinfection of all body discharges. 
4. Restriction of the movements of intimate associ- 
ates of the patient, so far as practicable. This should 
include at least exclusion of the children of the family 
from schools and other gatherings. 
5. Protection of children so far as possible from 
contact with other children or with the general public 
during epidemics. 
6. Observation of contacts for two weeks after the 
last exposure. 
The New York Board of Health gives the fol- 
lowing advice to prevent the spread of infection: 
1. The children from an infected house should be 
allowed out of doors but should be kept by themselves 
and away from large groups of other children. In 
167 HEALTH FIRST 
one and two-family houses it is advisable not to allow 
the children from an infected family outside of the 
yard for several weeks after onset of the case. 
2. During the continuance of an epidemic of polio- 
myelitis children should not be allowed to congregate 
in public places. 
3. Fresh air outings or vacation camps are allowed, 
if kept under competent medical supervision, with an 
adequate physical examination of each child before 
enrollment and the exclusion of any child from an 
infected family. 
4. Absolute cleanliness of all homes is essential; 
such cleanliness should include: 
(a) screens in all windows; 
(b) flies kept out of all rooms; 
(c) thorough cleanliness of all floors, woodwork, 
bedding and clothing; 
(d) avoidance of dust (all sweeping should be done 
after the floors have been sprinkled with sawdust, 
bits of newspaper or tea leaves, all thoroughly mois- 
tened) ; 
(e) garbage cans kept covered and washed out in 
hot soapsuds after they have been emptied; 
(f) no refuse, either of food or other waste, allowed 
to accumulate. 
5. Personal habits of cleanliness are essential; the 
hands should be washed before each meal, after each 
visit to the toilet, and before going to bed. Children 
should be warned about putting the fingers into the 
mouth or nostrils. 
168 AVOIDING INFECTION 
6. When sneezing or coughing, a handkerchief 
should be held over the mouth. Kissing of children 
is also a dangerous practice and should be avoided. 
Adults are not very susceptible to the disease, 
and many children are also immune. After a 
great epidemic, there is usually a lull in the 
manifestation of the disease, as, it is supposed, 
all the susceptible people have been attacked, and 
the immune naturally escape. It is like a fire 
that has burnt itself out. When a new collec- 
tion of susceptible subjects comes upon the field, 
the epidemic is likely to break out afresh. 
Bowel Infections. Disease-producing, intes- 
tinal germs are seldom air-borne and this class 
of diseases is thus not acquired by inhaling. 
The germs of cholera, dysentery, various diar- 
rheas, typhoid fever, and paratyphoid may be 
spread by contaminated milk, water, or surface 
vegetables. As the virus exists in the discharges 
from the bowels and sometimes of the kidneys, 
their prompt disinfection as soon as passed by 
the sick, will prevent the spread of these diseases. 
The typhoid bacilli may remain active after 
drying. 
A pure, well-regulated water-supply should be 
169 HEALTH FIRST 
insisted upon by all communities. An epidemic 
of typhoid fever in any place is a reflection 
either on the intelligence or the watchfulness of 
the citizens. 
An efficient preventive now exists in typhoid 
vaccination. This consists in three injections of 
killed typhoid germs at ten-day intervals. This 
develops the immunizing substances in the 
human body so that they can overcome the 
typhoid virus even after it has been taken into 
the system. Its efficiency is indicated by the 
fact that typhoid fever has been largely elimi- 
nated in armies during the exposure and risks of 
actual warfare, although this disease killed many 
more than bullets in numerous campaigns before 
vaccination was made compulsory. 
It has been ignorantly thought by some objec- 
tors that certain diseases may be produced in the 
body by the vaccines that are used against them, 
but such an accident is rendered impossible by 
the preliminary destruction of the living germs. 
A most hopeful outlook is now held as to our 
power of enforcing the resistance of the body to 
various microbes and utilizing the substances in 
their dead bodies to stimulate the production of 
antitoxins and other defensive agents, in this 
170 AVOIDING INFECTION 
way rendering innocuous the toxins produced by 
their life processes. 
The struggle for existence frequently resolves 
itself into a prolonged contest between microbes 
and men. The modern science of bacteriology 
has done much to conserve health and life by 
studying the natural history and development of 
the microscopic plants and animals that act as 
parasites, and which could perhaps destroy all 
higher life if they were not held in abeyance. 
Finally, the question of illness has not only a 
vital but a very important economic side. It 
has been estimated that $500,000,000 is the yearly 
wage loss due to sickness in the United States. 
171 CHAPTER X 
HEALTH IN DIFFERENT SEASONS: CLIMATIC 
INFLUENCES 
EACH season of the year has its own pe- 
culiar charm and likewise its special dan- 
gers. We must recognize the latter if health is 
to remain intact during the changing seasons. 
What is the first requisite of health under such 
conditions? We must change our habits, like 
our clothes, with the season. Only in this way 
will special risks be avoided. 
In winter the cold weather and harsh winds 
put a strain upon the breathing organs, and, as 
a result, bronchitis, pneumonia, and various 
throat troubles are extremely prevalent. In the 
changing periods of spring and autumn, certain 
conditions of earth and atmosphere, aided by 
various insects, favor the development of typhoid 
and malarial fevers. As soon as the hot weather 
of summer sets in, the digestive tract and a de- 
pressed nervous system bear the brunt of trouble. 
172 CLIMATIC INFLUENCES 
The extremes of life - the very young and very 
old - are especially vulnerable to any depress- 
ing effects that may accompany the different 
seasons. 
THE WINTER SEASON 
It must be remembered that cold has a de- 
pressing as well as a stimulating effect, depend- 
ing largely upon the age and physical condition 
of the individual person. January, February, 
and March show the highest mortality of the 
year, with the last-named month usually in the 
lead. It is particularly the old and feeble who 
succumb at this period. Extra care must, there- 
fore, be given during these months to those whose 
vitality is low. It is always the extremes of 
temperature, either summer heat or winter cold, 
that lowers the resistance of the body. Winter 
seasons that are accompanied by cold rains and 
a heavy snowfall tend to increase sickness, and 
epidemics of grippe and pneumonia abound. 
All people should avoid undue exposure, such 
as leaving off overcoats or heavy wraps in very 
cold weather and not protecting the feet. Proper 
underwear is very important in the effort to 
maintain the surface of the body at an even 
temperature. It may consist of wool and cotton, 
173 HEALTH FIRST 
linen mesh, or silk, according to the experience 
or occupation of the individual. It is a mistake 
to be too warmly clad in the house, and it is not 
wise to wear heavy sweaters while at work or 
exercise indoors. One easily becomes overheated 
in this way and is more apt to catch cold on going 
out. 
The costumes of women and girls in winter is 
often especially faulty. With the back of the 
neck protected by heavy fur, and the front of the 
waist wide open so that the chest is exposed to 
cold winds, they finish by wearing thin, paper- 
soled shoes that leave the feet unprotected and 
chilly. It would be hard to improve on such a 
costume as far as danger of respiratory diseases 
is concerned. 
The rooms of our houses are often overheated 
in winter. Whatever the temperature desired, it 
should be kept as constant as possible. Varying 
temperatures are hard to resist. An average 
day temperature from sixty-eight to seventy 
degrees Fahrenheit, with plenty of good ventila- 
tion, will afford the best results in health. Oc- 
casionally old or feeble people require more 
warmth, and seventy-two to seventy-four degrees 
may then do better, but there must always be 
174 CLIMATIC INFLUENCES 
free admission of fresh air. Good ventilation 
may be hard to procure in very cold weather 
when doors and windows are kept tightly closed 
in order that the room may be warm. 
Where a number of persons are confined in a 
closed, unventilated space, the vitality is de- 
pressed, appetite and digestion suffer, and a 
heavy, drowsy feeling is experienced. This was 
formerly supposed to be due to the extra amount 
of carbon dioxid gas that is constantly expelled 
from the lungs of every individual in the room. 
There is too little carbon dioxid, however, in such 
exhausted air to do much harm. The trouble is 
rather occasioned by the heat, moisture, and 
exhalations from the skin that are constantly 
given off from the body. It is the collection of 
these exhalations in stagnant air that causes 
harm. The skin becomes moist and clammy, the 
sweat glands do not functionate well, and the 
elimination of impurities is thus checked. 
It is not the chemical ingredients of the air, 
such as diminished oxygen and increased carbon 
dioxid, that are injurious, but the warmth and 
water vapor that interferes with healthy activity 
of the skin. By letting in fresh air, with proper 
ventilation, the moist, stagnant, depressing air 
175 HEALTH FIRST 
is quickly renovated, and the accompanying dis- 
ability disappears. Schools, churches, theaters, 
and all public places where people meet in con- 
fined areas should be carefully regulated in win- 
ter, so that a suitable supply of fresh air may 
be constantly sujjplied and foul exhalations 
promptly removed. This would have a very 
favorable effect upon health in this inclement 
season. 
For people who suffer from chronic respira- 
tory diseases, a change to a warmer climate in 
winter is desirable if finances permit. It is par- 
ticularly in the latter months of winter, Febru- 
ary and March, that these troubles are most apt 
to occur. If such a change is made, it is not wise 
to return until the weather is completely settled, 
as the cold and wet of early spring are very try- 
ing, and all the benefits of the stay in a warm 
climate may thus be lost. 
THE HEATED TERM 
While great heat may come in the latter part 
of June, the mean temperature in July is gen- 
erally the highest in the year. The thermometer 
registers, on an average, from one to two degrees 
higher in this month than in August. The rea- 
176 CLIMATIC INFLUENCES 
son for this is that during August the nights 
are not only a little longer, but are apt to be 
cooler. Although the days may be very hot, this 
has a slight effect in reducing the average mean 
temperature. The first half of September is 
often particularly hard to bear on account of 
the weariness produced by the many preceding 
weeks of continuous heat. When humidity is 
added to heat, as frequently occurs during Au- 
gust and September, the effects of the heat are 
much aggravated. 
INFANT MORTALITY 
As the infant suffers most from heat, a few 
hints as to proper care during the summer 
months will point the way to conserve health and 
lower mortality. The latter has already been 
accomplished in many of our cities by establish- 
ing infant welfare stations and pure milk depots 
and by keeping a close medical oversight over 
the little children. July is the hardest month 
for them, and the mortality then is from one 
third to one half higher than in August, which 
is the next most trying month. The slightly 
higher temperature of July, already noted, may 
partly account for this, but a further explanation 
177 HEALTH FIRST 
probably lies in the fact that the weaker infants 
succumb during the first half of the summer, 
while those surviving this period are stronger 
and better able to endure the later heat. 
One of the worst effects of heat consists in the 
changes produced in milk, which is the principal 
food of the infant. In general, a bottle baby 
should have less bulk of food and a higher dilu- 
tion of milk in very hot weather than that to 
which it is accustomed under more favorable con- 
ditions. If this simple precaution were taken, 
much digestive trouble would be avoided. The 
interval between feedings may also be prolonged 
if the digestion shows any signs of derangement, 
but pure water is to be given freely during these 
intervals. In very hot weather the milk should 
be boiled or pasteurized as soon as it is received, 
and then kept cool until used. It is often well 
to place the milk bottle, well stoppered, next to 
a cake of ice. 
It may sometimes be necessary to stop milk 
entirely and to give such substitutes as cold 
whey and thin gruels made from barley or wheat 
flour. If cow's milk is withheld for several days, 
mutton broth, from which all the fat has been 
carefully skimmed, makes a good substitute. 
178 CLIMATIC INFLUENCES 
Expressed beef juice, diluted three or four times 
with cool water, makes a stimulating and mildly 
nourishing drink. Cold weak tea is also occa- 
sionally beneficial. 
Attention has already been called to the fact 
that the very young and the very old are unusu- 
ally susceptible to the depressing effects of heat, 
and that the treatment of both the extremes of 
life is a good deal the same. We must not over- 
look the fact, however, that all ages are likely 
to be affected, and should therefore know how 
to guard against the dangers of summer heat. 
The life of people in the tropics is regulated 
according to the conditions of the climate; as 
the summer climate of a temperate zone is often 
very like that of the tropics, we may with profit 
imitate the mode of life in the more southern 
countries. 
Exercise. During a prolonged hot spell all 
undue activity should be abated, especially dur- 
ing the oppressive midday hours. In their vaca- 
tions, many people of sedentary habits indulge 
in violent exercise, with a mistaken idea that 
their health is thereby benefited. This may re- 
HOT WEATHER HABITS 
179 HEALTH FIRST 
suit in lassitude and even in illness during hot 
weather when outings are generally taken. Un- 
necessary exposure to the rays of the hot sun 
should always be avoided, and, if necessary, pro- 
tection by an umbrella or a light well ventilated 
straw hat is helpful. The habit in some summer 
resorts of going around in the sun bare-headed 
is bad alike for the hair, the skin, and the health. 
The cooler hours of the morning and late after- 
noon should be reserved for any special activity. 
A midday siesta is often desirable on hot 
days. 
Food and Drink. Eating and drinking must 
also be regulated according to the weather. 
Food of a somewhat different kind, and smaller 
in amount, is called for in hot, as distinguished 
from cool weather. Meat and heat-producing 
substances, such as animal fats, can be cut down 
to a low point; cereals, fresh vegetables, and 
fruits may form the main articles of food. For 
those who crave a heartier diet, fresh fish and 
eggs will come in well. 
The mild, non-stimulating drinks are best for 
hot weather. It is well to utter a caution, how- 
ever, against continually drinking large quan- 
tities of ice-water. When one is thirsty, a small 
180 CLIMATIC INFLUENCES 
quantity of cool water held in the mouth for 
a few seconds and then swallowed, will assuage 
the thirst as well as much larger amounts that 
may distend or derange the stomach. A large 
bulk of icy water does not long satisfy the thirst 
and is apt to weaken the digestive power of the 
stomach already disturbed and depressed by the 
heat. 
Fresh milk, buttermilk, grape juice, raspberry 
juice, lemonade, barley water, cold tea, and cof- 
fee, and the various charged waters are all re- 
freshing in hot weather. It must always be re- 
membered that milk has a nutritive value, and 
hence can take the place of food, and, therefore, 
puts some work on the digestive organs. Milk 
should always be sipped slowly to prevent a 
large, hard curd forming in the stomach. It is 
a mistake to hurriedly pour down a glass of milk 
at the end of a meal, and thus add a large jelly- 
like mass of curds that will interfere with begin- 
ning digestion. Skimmed milk is a good hot- 
weather drink, as the removal of the cream makes 
an easily digested fluid for a stomach that may 
be depressed by the heat. Alcoholic drinks had 
better be abandoned, but if any are taken, light 
beers and very mild, dry wines will be the best. 
181 HEALTH FIRST 
If the appetite is poor and needs a little stimu- 
lation, these latter drinks, in great moderation, 
may occasionally prove helpful. 
Clothing. The clothing must also be spe- 
cially adapted to the season. It should be light 
both in weight and color. The underwear may 
be of very light gauze merino, and the outer gar- 
ments of loose-woven material. Sudden cooling 
of the skin must be avoided, and there are times, 
specially in the mountains, where a sudden drop 
of many degrees may occur after the sun has 
gone down. Unless suitable outer wraps are at 
hand, a chilling of the body may induce sickness 
of various kinds. Summer colds are apt to be 
very intractable and may even lead to more seri- 
ous forms of illness. 
Bathing. One of the most healthful summer 
exercises is bathing. The free use of water on 
the skin not only removes dirt and perspiration, 
thereby keeping the pores open, but also is of 
service in helping to regulate the bodily tempera- 
ture. A bath may be stimulating, sedative, or 
cooling, according to the temperature of the 
water. It may also be considered hot, warm, 
tepid, or cold, according to the temperature of 
the water as follows: 
182 CLIMATIC INFLUENCES 
Hot, 98° to 110° Fahrenheit. 
Warm, 92° to 98° " 
Tepid, 85° to 92° " 
Cold, 30° to 60° " 
It is a mistake to suppose that a cold bath 
is always the most cooling for the body in very 
hot weather. While the first effect of cold 
water applied to the skin is to chill the surface 
by contracting the minute blood vessels, thus 
driving the blood inward and producing the fa- 
miliar goose-skin, there is a secondary dilatation 
of the vessels, resulting in the glow that is felt 
in all healthy reactions. The cooling effect is 
only temporary when a proper reaction oc- 
curs. 
A more prolonged cooling effect often follows 
a tepid bath; the reaction is not so marked as 
the blood vessels do not become so dilated. In 
a prolonged hot spell, it is sometimes of benefit 
to allow children to play for an hour at a time 
in a tub partly filled with tepid water. The 
restlessness of a hot, oppressive night is often 
relieved and sleep induced by taking a warm or 
tepid bath just before retiring. 
A few important facts about bathing should 
be kept in mind; the most important is that one 
183 HEALTH FIRST 
should always feel refreshed and comfortable 
after a bath. When the skin glows and the 
bather has a general sensation of feeling better, 
the bath has done good. If, on the contrary, 
there is a feeling of chilliness or depression, the 
bath has done more harm than good. It must 
be remembered that while a cold bath is a fine 
tonic and stimulant to the body, these beneficial 
effects only occur when the reaction is im- 
mediate. 
At the beaches every summer one sees both 
children and adults standing around with blue 
lips and finger nails. They have stayed in the 
water too long and have failed to get a reaction. 
These shivering people, covered with goose-skin, 
have received more harm than good from the 
bath. The instant such feelings ensue, the 
bather should leave the water and briskly rub 
the skin with a coarse towel to bring on a suita- 
ble reaction if possible. This should be followed 
by a brisk walk or some such exercise. Many 
bathers stay in the water too long. Twenty min- 
utes is a good average for a bath in cool water 
during the summer season. A bath should never 
be taken after a meal, or when a person is greatly 
fatigued and perspiring from active exercise. 
184 CLIMATIC INFLUENCES 
CHANGE OF SCENE 
While the well-to-do in our large cities seek 
coolness and health by removing to the moun- 
tains or seashore during the summer months, 
many thousands cannot afford to travel at this 
time. With a little extra care, however, many 
of the disadvantages of the city can be overcome. 
Perhaps the most important problem is to avoid 
exercise and exposure to the direct rays of the 
sun during the middle of the day. If rooms are 
kept closed and shaded at this time, they will 
usually be cooler than if they remain open. Pro- 
vision may then be made for an ample supply 
of the fresh, cool air of early morning and late 
afternoon and evening. 
Infants and children may be taken out as 
early as six in the morning and remain in the 
open air until the sun gets hot, usually about 
nine or ten, after which they should be kept 
indoors until late in the afternoon. Open spaces, 
where there are trees, such as parks or wide 
avenues, should be utilized as much as possible. 
Open trolley cars afford a chance for short, fresh- 
air excursions. In towns that are situated near 
the water, river banks or ferry-boats can be em- 
185 HEALTH FIRST 
ployed as fresh-air agencies. These breathing 
spaces, employed for short periods, morning and 
evening, often do more good than the long, tire- 
some, day excursions. The latter are frequently 
accompanied by overcrowding, discomfort, heat, 
fatigue, and poorly-prepared food, and these un- 
fortunate influences may entirely counteract any 
of the good effects of the fresh air during the 
excursion. 
Sometimes even the better-favored do not get 
the benefit desired from a change to the country 
or seashore, because of poor hygienic surround- 
ings. A large, well-ventilated room in a city 
home is frequently better than a small, stuffy 
chamber in a farm-house. Many a summer 
boarding-house, with swarms of mosquitoes dis- 
turbing one's rest, and the food contaminated 
by flies, is not healthful. These things and the 
conditions of drainage and water-supply should 
be investigated before settling down for a sum- 
mer outing. It is needless to add that both 
health and recreation are favored by a change to 
the country under proper conditions. 
186 CLIMATIC INFLUENCES 
MUNICIPAL HOUSECLEANING 
Much may be done by the authorities of cities, 
towns, and villages to conserve health during 
the heated months. There should be a general 
clean-up before the hot season conies on if sick- 
ness due to the heat is to be avoided. The streets 
must be kept scrupulously clean. All garbage 
and decaying animal and vegetable matter should 
be promptly removed and destroyed. Perisha- 
ble food stuffs, and particularly cows' milk, re- 
quire careful watching and regulation. A cer- 
tain standard of freshness should be required in 
quickly perishable articles of food or drink. 
The number of bacteria found in each cubic 
centimeter of milk bears a direct ratio to the 
age of the milk. What is needed is a better regu- 
lation of a city's milk supply at its source, 
namely, the dairy-farm. If the farmer were 
compelled by municipal rules, carefully laid 
down and enforced, to regulate the production 
and handling of milk according to cleanly and 
scientific principles, and if this milk could be 
delivered to the consumer within twelve hours, 
much of the summer sickness would be avoided. 
187 HEALTH FIRST 
CLEANLINESS IN THE HOME 
When food is delivered, the housewife must 
see that it is quickly placed in a cool, clean spot. 
There is not much change in milk and other 
perishable foods when the temperature is kept 
below fifty degrees Fahrenheit. To attain this 
end, plenty of ice must always be kept in the 
refrigerator, which should be opened as little as 
possible in order to maintain the desired low 
temperature. The refrigerator must be fre- 
quently washed and kept scrupulously clean. 
Food of all kinds should be promptly removed 
from the table as soon as a meal is ended. De- 
caying refuse must not be allowed to remain 
long in the garbage pail, which should be 
screened and placed in a dark spot so as not 
to attract flies. Cistern water must also be 
screened, and no puddles allowed to form about 
the place. 
MODIFICATION OF AIR BY TREES 
A very efficient way in which a city can modify 
the deleterious effects of the heated term is by 
planting trees and furnishing small parks and 
188 CLIMATIC INFLUENCES 
breathing-places. Several years ago one of the 
health authorities called attention to vegetation 
as a remedy for the summer heat of cities. In 
this article it was shown how trees are of the 
greatest utility in modifying and equalizing cli- 
matic conditions. It is a well-established fact 
that an average temperature of the air of fifty- 
four degrees Fahrenheit is best adapted to public 
health, as at that temperature the decomposi- 
tion of animal and vegetable matter is slow, and 
normal temperature is most easily maintained. 
Every degree of temperature above or below this 
point requires an action of the heat-regulating 
powers of the body to maintain a proper equi- 
librium. 
As the heat-regulating centers in young chil- 
dren are most unstable, the direct action of pro- 
longed heat on their bodies is a powerful agent 
in increasing summer mortality. In a large and 
densely populated town, the solar heat is con- 
served and reflected by the stone and asphalt of 
the streets, as well as by the bricks and mortar 
of buildings. The artificial heat generated in 
the latter for cooking arid manufacturing pur- 
poses is also a factor to be considered. Even 
189 HEALTH FIRST 
during the night, the stones, by retaining their 
heat, prevent any fall in temperature sufficient 
to afford relief. 
Here is where the modifying effect of trees 
would be most beneficial. As trees maintain an 
average mean temperature of fifty-four degrees 
Fahrenheit in all seasons, it is easy to see what 
a constant cooling influence they would possess 
in an atmosphere of ninety degrees Fahrenheit. 
Add to this the constant exhalation from the 
leaves of water vapor that has been absorbed 
from the moisture in the soil, as well as from 
the surrounding air, and the cooling effect is 
much enhanced. This takes place most actively 
during the heated portion of the day, when it is 
most needed. 
A general purification of the air is not the 
least benefit to be derived from vegetation, as 
carbon dioxid gas is absorbed and oxygen given 
out, which is just the reverse of the process that 
takes place in animals. Animal and plant life 
thus act as complemental influences. 
The Tree Planting Association of New York 
has proved that certain species of trees are 
adapted to city soil and, with a little extra care, 
190 CLIMATIC INFLUENCES 
can be made to thrive. If our blazing thorough- 
fares were lined with shade trees, the summer 
heat would not be so intolerable and unhealthful. 
191 CHAPTER XI 
HEALTH IN CITY AND COUNTRY: LOCAL 
INFLUENCES 
ONE of the most remarkable social move- 
ments in recent years has been the rapid 
growth of cities. This has not been confined to 
any one country, but has been a world-wide move- 
ment. In the United States, in 1800, three per 
cent., and in 1900, thirty-three per cent, of our 
population lived in cities. The Census Bureau 
has made estimates based on the rate of popu- 
lation increases from 1900 to 1910, disclosing 
the fact that forty and nine-tenths per cent, of 
the country's inhabitants now live in cities of 
more than eight thousand as against thirty-eight 
and nine-tenths per cent, in 1910. 
All great social movements have causes that 
should be carefully investigated before trying to 
alter or condemn them. Most people who pour 
into our cities go because they get more money, 
and, on the whole, are better off than in the 
192 LOCAL INFLUENCES 
country. Manufactories employing much labor 
and paying good wages are nearly always lo- 
cated in cities, and this economic movement is 
growing. Men will always go where they can 
make the best living. In addition to this, there 
are social needs that the city in many ways meets 
better than the country. This exemplifies the 
old scriptural adage that " man doth not live by 
bread only." 
Many problems have been raised as to the 
ultimate effect of city life upon the race. The 
most pertinent question naturally concerns 
health. Some gloomy prophecies have been 
offered about its degenerating physical effects 
upon future generations. A careful study of 
this question, however, will show that, contrary 
to current belief, the average, modern city- 
dweller is usually healthier than the resident of 
the rural districts. An effort must be made to 
find out what conditions in both city and coun- 
try tend to impair health. 
CITY CONDITIONS 
In the city the outside air is not so pure as 
in the country owing largely to its being more 
dust-laden. This dust consists of minute par- 
193 HEALTH FIRST 
tides worn off from pavements and buildings, 
of waste materials from stores, factories and 
houses, of the dried detritus from animals and 
human beings, of food-waste and of various 
micro-organisms. These substances are carried 
about by the wind and by automobiles or other 
vehicles. Such impurities are more harmful in 
summer than in winter as there is a greater abun- 
dance of dust, with the decomposition of the 
particles of animal matter contained in it. As 
windows are usually open at this time, the con- 
taminated air has free access to houses. 
City streets should be well watered during the 
hot season to prevent the spread of dust. It is, 
of course, during the heated term that the city 
suffers in health from unfavorable atmospheric 
conditions. 
Attention has been called in a previous chap- 
ter to the manner in which trees modify and 
purify the air; their growth in cities should 
certainly be encouraged. This not only makes 
for health, but beautifies the surroundings. 
Cities that have streets lined with trees are much 
more attractive than those with bare stone walls 
as the only background. 
Many small parks also add to a city's health, 
194 LOCAL INFLUENCES 
not only by affording recreation places, but also 
by giving space for vegetation. Sections that 
are overcrowded not only suffer from impurities 
in the air and in the general surroundings, but 
favor the spread of disease by the close contact 
of individuals. Improved tenement-house laws 
that provide for sufficient air-space and access to 
sunlight, have bettered the conditions in many 
large cities. The rear tenement, and rooms 
opening on small, dark air-shafts, have time and 
again been causes of physical decline in the occu- 
pants. The famous " lung " block in the slums, 
reported many years ago, where tuberculosis -was 
fearfully prevalent, formed one of the plague- 
spots of New York due to dense overcrow'ding 
in the dark, unventilated rooms of rear tene- 
ments. Fortunately most municipalities are 
now alive to the importance of this subject, and 
are enforcing building and tenement laws tend- 
ing to abate these evils. 
GARDEN CITIES 
For those who are obliged to live in the con- 
gested areas of large cities, the garden city sub- 
urban idea, first developed in England, offers a 
good solution. These ideal towns have been 
195 HEALTH FIRST 
built around some of the great centers of popu- 
lation to which they have easy and quick access. 
Land in these towns, free from speculative in- 
fluences, is parceled out in large lots, and good- 
sized spaces are set aside for parks and play- 
grounds. The people are particularly encour- 
aged to cultivate gardens, in order that the 
houses may be surrounded by flowers. 
A study of the children brought up in these 
surroundings has shown them to be larger and 
healthier than those living in the slums. Hamp- 
stead is one of the best examples of these garden 
cities. The problem of health in the city is con- 
nected with the slum-dweller, not with the indi- 
vidual who can live in the better part of the 
town 
Good drainage and a plentiful, wholesome 
water-supply are essentials to good health in 
every community. It is in these elements that 
the city is frequently better placed than the 
country. The latter has to depend largely upon 
wells and cesspools for water supply and drain- 
age, and, without constant hygienic oversight, 
unwholesome conditions can easily prevail. In 
winter and early spring the soil gets saturated 
COUNTRY CONDITIONS 
196 LOCAL INFLUENCES 
with moisture, the exhalations from which 
favor various catarrhal conditions. This is one 
reason for the prevalence of different forms of 
influenza and grippe. 
In a well-organized city, the soil is completely 
covered in by pavements, and drying quickly 
takes place as the slush and water drain into 
sewers. There is no doubt that such conditions 
have a great influence on health. 
It is a remarkable fact that for some years 
the death-rate of New York City has been lower 
than that of rural New York. When we con- 
sider the dense population and overcrowding of 
the city, the poverty and ignorance seen in large 
masses of people, the heavy infant mortality dur- 
ing the summer in the crowded tenement houses, 
and the large hospitals and other institutions 
full of human derelicts, we can appreciate what 
this means as to general conditions of health. 
This favorable showing is due to a purer water- 
supply, to good natural and artificial drainage, 
and to a watchful board of health, which has 
the power to regulate health conditions in the 
homes and habits of the people. These form the 
influences that are somewhat lacking in many 
rural districts. 
197 HEALTH FIRST 
Much sickness could be prevented among the 
poorer classes in the country if such agencies 
as welfare-stations, district nursing, and dispen- 
saries for ambulant cases of illness could be es- 
tablished. This would mean free advice in many 
cases of incipient illness that are liable to eventu- 
ate in prolonged or chronic disease if not cor- 
rected in time. A quick diagnosis in such dis- 
eases as diphtheria often requires a laboratory, 
and a life may often be saved by an early report 
followed by immediate treatment. It is in the 
lack of such facilities that many parts of the 
country suffer in comparison to the city. 
Coming to the home and the school, they are, 
as a rule, not so sanitary or so well-organized 
for health in the country as in the city. The 
operation of general hygienic science has not 
been very actively carried out in the country for 
lack of proper organization. As far as there is 
any physical inferiority of the country to the 
city dweller of the same class, an explanation 
is found in the causes just enumerated. 
In the matter of food, a greater diversity can 
be found in the town, and nutrition suffers when 
a variety of articles that will appeal to appetite 
and digestion cannot be readily procured. The 
198 LOCAL INFLUENCES 
rosy-cheeked farmer's daughter is not so often 
seen in real life as in fiction. The standard of 
living as regards heating and ventilation in 
many homes of the sparsely settled country dis- 
tricts is not in favor of healthy development. 
RURAL SCHOOLS 
The rising generation usually suffers most 
from hygienic disadvantages. In a recent arti- 
cle, Dr. Thomas D. Wood has given some inter- 
esting data as to the condition of children attend- 
ing rural schools. He found that more than 
half of the twenty million school children in the 
United States are attending these country 
schools. In a carefully prepared table, which 
includes all parts of the country, it is shown 
that children attending the rural schools are less 
healthy and are handicapped by more physical 
defects than are the children of the cities, even 
including those living in the slums. Dr. Wood 
finds that more than twice as many country 
children as city children suffer from malnutri- 
tion ; the former are also more anemic, have more 
lung trouble, and include more mental defectives 
than do the latter. 
In order to remedy this condition, the Health 
199 HEALTH FIRST 
Committee of the American Medical Association 
and the National Council of Education have 
tabulated the following measures to try and con- 
serve the health of rural school children : 
1. Health examination and supervision of all rural 
school children. 
2. Dental examination and care for the teeth of all 
children in the rural schools. 
3. The service of the school or district nurse to pro- 
vide practical health service and "follow up" work. 
The work of the nurse is even more vitally important 
in rural than in city schools. 
4. Warm school lunches for all school children in 
rural as well as in city schools. The indirect educa- 
tional benefits of the school lunches upon the children 
and the homes are even more important than the im- 
mediate health improvement of the children them- 
selves. 
5. Correction of physical defects which are inter- 
fering with the health, the general development, and 
progress of rural children. For this remedial and 
constructive health service, practical rural equiva- 
lents of medical clinics, dental clinics, and commu- 
nity health centers of the cities are urgently needed 
in all parts of the United States. The county unit 
of organization and administration for health as well 
as other rural interests has already proved successful 
and promises the best results. Every county should 
have one full-time health officer, one or more school 
200 LOCAL INFLUENCES 
and district nurses, and one or more community 
health centers to provide rational, self-supporting 
health and medical service for all the people. 
6. Cooperation of physicians, medical organizations, 
health boards, and all other available organizations in 
the rural health program. 
7. Effective health instruction for the rural schools 
which shall aim decisively at the following results: 
(a) Establishment of health habits and inculcation of 
lasting ideas and standards of wise and efficient living 
in pupils, (b) Extension of health conduct and care 
to the school, to the homes, and to the entire commu- 
nity. 
8. Better trained and better paid teachers for rural 
schools, who shall be adequate to the health problems 
as well as to other phases of the work of rural educa- 
tion. 
9. Sanitary and attractive school buildings, which 
are essential to the health of pupils and teachers. 
10. Generous provision of space and facilities for 
wholesome play and recreation. 
11. Special classes and schools for the physically 
and mentally deficient, in which children may receive 
the care and instruction requisite for their excep- 
tional needs. 
It may be suggested that it would be too ex- 
pensive to carry out such a program, but eventu- 
ally even larger sums will have to be expended 
for the relief of sickness, inefficiency, and various 
201 HEALTH FIRST 
forms of disability. Such a scheme would have 
a beneficent effect upon the health of all classes 
in a rural community. 
In the matter of fresh, clean air, free from 
human exhalations and bacteria, the country, of 
course, has the advantage. Any dust that may 
occasionally be present comes more from dirt 
pulverized in the roads than from particles of 
decomposing animal and vegetable detritus. 
The oiling of roads does much to lessen its dis- 
integration by frost and rain and the spreading 
of dust. Oiling should be repeated frequently 
enough to prevent drying, which may be followed 
by particles of irritating tar oil being carried 
about by the wind. 
In furthering the health movement, city and 
country have special and often divergent needs, 
and much more may be accomplished by both in 
the line of conserving health and vitality. So 
far, however, the country has lagged behind the 
city despite the natural advantages of purer 
air and lack of crowding. In any locality the 
death rate can be lowered and the public health 
enhanced if the community is willing to pay the 
price. The idea is well expressed by the Depart- 
ment of Health of New' York: 
202 LOCAL INFLUENCES 
" Public health is purchasable. Within natu- 
ral limitations a community can determine its 
own death-rate." 
203 CHAPTER XII 
HEALTH AND HAPPINESS: MORAL INFLUENCES 
WHILE health is one of the first prerequi- 
sites of happiness, we must not overlook 
the fact that happiness has a strong influence in 
the production, as well as the continuance of 
health. Happiness should thus be sought and 
cultivated if only for the sake of good health. 
The unhappy are rarely very healthy. 
PHYSICAL CONDITIONS 
Unhappiness, if continuous, usually leads to 
a nervous depression that tends to a lowering 
of all the vital processes. Digestion and assimi- 
lation suffer first, followed by a general lessening 
of glandular activity. The internal secretions 
of the various ductless glands, whose effects on 
physical condition and vitality are so large, are 
greatly influenced by mental states. These secre- 
tions, that may act depressingly on the body 
when disturbed by worry or anger, tend to revert 
204 MORAL INFLUENCES 
to a more normal state under the influence of 
confidence or hope. Their proper functioning is 
always aided by a good mental equilibrium. 
The circulation may also be affected, as shown 
in an acute way by the sudden pallor of a face 
at the receipt of bad news. If even the minute 
capillaries are thus quickly affected by a mental 
impression, it is not difficult to understand how 
the heart and circulation may be constantly af- 
fected by chronic worry and unhappiness. It is 
evident that the latter influences, if prolonged, 
may have a distinct effect in undermining health. 
The effect of ill health upon one's disposition, 
strange to say, varies somewhat with the parts 
affected. The great vegetative organs of the 
body are lodged in two large cavities of the 
trunk, separated by a thin muscle, the dia- 
phragm, corresponding roughly to the waist. 
The chest cavity is above, containing the heart 
and lungs; below is the abdominal cavity, hold- 
ing principally the liver, spleen, pancreas, kid- 
neys, stomach, and intestines. 
If disease attacks the organs above the waist, 
even when severe, the general spirits are not apt 
to be much affected. Below the waist the case 
is different, especially when the liver or stomach 
205 HEALTH FIRST 
and intestines are involved; even mild seizures 
here cause depression of spirits and discontent. 
A person may be plunged in the depths of de- 
spair by a simple functional dypepsia. Many 
people with chronic diseases, although not pos- 
sessed of much strength or vigor, live compara- 
tively happy lives, if their digestive organs func- 
tionate fairly well. On the contrary, the dys- 
peptic individual, no matter how strong he may 
otherwise be, is rarely happy. The lesson is not 
hard to apply. 
MENTAL INFLUENCES 
The possession of a proper sense of humor 
makes for happiness. With this function de- 
veloped, even misfortune may often present 
streaks of amusement that will make it more 
tolerable. There is a constant, if small, enjoy- 
ment to be derived by the humorous mind from 
the daily incidents of life that will do much to 
ease the cares of existence. A tragical situation 
may often be lightened, if not averted, by a smile. 
Another underlying condition of contentment 
is not to take oneself, or even the affairs of life, 
too seriously. In looking back, every one can 
see how much unhappiness has been derived 
206 MORAL INFLUENCES 
from an overweening sense of one's importance. 
Each person is apt to think that his or her trou- 
bles are unusual and correspondingly hard to 
bear. A larger insight will show that others 
have equally serious troubles, and that misfor- 
tunes are fairly well distributed. The constitu- 
tionally depressed must be taught to dwell more 
on the bright side of things. Their outlook on 
life must be recreated and a reeducation in hap- 
piness undertaken. Most anticipated evils never 
come true. It is also well not to expect too 
much in life. A very common source of unhap- 
piness comes from anticipating too much from 
the various relations of life. An old proverb 
attributes happiness to him who expects little 
and thereby avoids disappointment. While we 
must always try to cultivate cheerfulness, there 
is occasionally seen a tendency to play the glad 
game of Pollyanna more strenuously than the 
occasion warrants. In the long run, a medium 
ground between too much elation or depression 
will be the safest. The hard and stern facts of 
life will have to be faced as well as the responsi- 
bilities that accompany a recognition of these 
facts. There is both a wrong and a right side to 
many questions, and we must range ourselves 
207 HEALTH FIRST 
on one side or the other. But underneath all, 
the optimistic spirit helps and elevates. It will 
put one in the way of living earnestly, bravely, 
and cheerfully. 
The effort to influence the body by the various 
activities of the mind has been much emphasized 
in recent years, and various systems have been 
launched with this as the exclusive method of 
operation. Attention has been called in a previ- 
ous paragraph to the way the body may be de- 
pressed by low mental states. Acting on this 
principle, various sects have been organized and 
extravagant claims put forward. People who 
have been restless and depressed become con- 
tented and fairly happy. It is for this reason 
that it seems well to apply the pragmatic test 
to any system and inquire, " How does it work? " 
In studying the operation of any cult, we 
must consider not only its immediate effect, but 
its ultimate influence upon the individual and 
the community. For the neurotic person, the 
immediate effect frequently appears to be good. 
A well-to-do, nervous woman, who has not 
enough of the real things of life to occupy her 
MENTAL HEALING 
208 MORAL INFLUENCES 
mind, becomes restless and unhappy. Her health 
suffers and imaginary diseases occupy her atten- 
tion. She goes from one physician to another, 
and her various organs are scrutinized by spe- 
cialists. Unfortunately, many physicians fail 
to recognize the type, and a few are willing to 
exploit it; so that no real service is rendered. 
Such a person needs occupation, with mental and 
moral toning-up, rather than medical advice. 
The old Egyptian idea of combining priest and 
physician was not without its advantages. Many 
restless, discontented, ailing people seek the aid 
of physicians who really require psychologists 
or moralists to try and minister to their needs. 
Such an unsatisfied, neurotic person after hav- 
ing many affections, most of which are completely 
or partly imaginary, and having consulted phy- 
sicians without relief, finally gravitates into the 
care of some healer. The latter is apt to be a 
woman with placid face and personality, dressed 
in the height of fashion and radiating prosperity 
and happiness. She thoroughly understands the 
type with which she is dealing and speaks sooth- 
ing words about the " All-Good," and the " spir- 
itual thought that will cast out the qualities of 
the carnal mind." 
209 HEALTH FIRST 
One by one the distressing ailments disappear 
and the restless person becomes fairly saturated 
with happiness. A strange fact may be here, 
noted. Different sects, claiming to act from the 
most diverse principles, all have much the same 
effect. Each of these differing cults aims to in- 
fluence bodily functions by the exercise of mind 
or will power. Experience shows that a certain 
class in every community is impressed by the pro- 
nouncements of these various cults, especially 
those claiming psychic or supernormal powers. 
The trained mind, accustomed to weigh and ana- 
lyze evidence, can easily detect the fallacies and 
partial truths that are covered by vague generali- 
ties. The unthinking may not find it so easy. 
Every one knows that all these sects have more 
or less influence in selected and special cases. 
The mental composure that some nervous and 
imaginative people derive from these faiths is 
given as a sort of explanation as well as pallia- 
tion of their existence. A similar composure as 
well as a partial success in certain kinds of 
healing is attained by East Indian fakirs in the 
same manner as that attained by a so-called 
Christian sect, both aiming to produce in the 
210 MORAL INFLUENCES 
brain an abnormal state of either quiet or ex- 
citation. 
INFLUENCE BY SUGGESTION 
The root principle of all these systems, no mat- 
ter how diverse their apparent action may be, is 
always the same - suggestion. There is prob- 
ably no principle so widely applied in every-day 
life, consciously and unconsciously, in various 
ways. It undoubtedly has a place as in the 
treatment of disease, especially of the nervous 
variety. Every successful physician sometimes 
employs suggestion, in connection with other 
treatment, in certain ailments. This is very dif- 
ferent from its exclusive employment by those 
who are ignorant of the structure and functions 
of the human body and of the natural history 
of disease. It is proper to add that permanent 
benefits from treatment by suggestion in real 
disease are comparatively limited and untold 
harm often results from the efforts to use it to 
the exclusion of rational treatment. 
When we see a neurotic person relieved of 
forebodings by the various methods of mental 
impression, whether called faith cure, new 
thought, mental healing, or Christian Science, 
211 HEALTH FIRST 
the sympathetic friends shake their heads and 
say, " There must be something in it." There 
is something in it - always the same "it," one 
of the diverse forms of mental suggestion. A 
careful observer may likewise note that many 
of the extreme forms of suggestion end in an 
atmosphere of delusion in which the facts and 
realities of life have small place. Trouble and 
sorrow seem to fade away in a blunting of the 
senses by a sort of auto-suggestion. A state of 
mind is now reached in which one dodges the 
actual problems, diseases, and tragedies of life 
by denying their existence. What an easy way 
to rid oneself of the difficult work of dealing with 
hard facts! It is possible that temporary hap- 
piness may be attained at too great a cost to 
the individual and the community. A shifting 
of responsibility for suffering means an extra 
load for some one else to bear. It thus eventu- 
ates in a sort of satisfied selfishness that gradu- 
ally becomes callous to many of the real troubles 
of life. There is scant provision in this happi- 
ness scheme for those who really " labor and are 
heavy laden." It is rather a luxury for the self- 
satisfied and well-placed. All false ideas, no 
matter what their immediate effect may be, are 
212 MORAL INFLUENCES 
eventually and intrinsically harmful. It is not 
wise or human to fill the mind with beautiful 
abstractions or a mystic optimism that does not 
involve a direct, concrete obligation of service. 
It is thus desirable in our pursuit of well- 
being to make a sharp distinction between tem- 
porary and permanent happiness. The former 
may often be secured by a dulling of the senses 
or false hopes; the latter can only be obtained 
by depending upon truth and reality. The peace 
that comes from worthy effort in recognizing 
evils and overcoming them will always lead to 
the truest and most lasting happiness. Finally, 
truth is better and higher even than peace; any 
attempt to obtain the latter by ignoring the 
former will be short-lived and unsatisfactory. 
COMMUNITY RESULTS 
In discussing this subject, we must not forget 
that the physical, mental, and moral health of 
the community is involved in the operation of 
these cults. This is especially true of Christian 
Science on account of its speciousness and the 
activity of its propaganda. In one of its as- 
pects, this cult may seem to present a com- 
paratively harmless side; in another it appears 
213 HEALTH FIRST 
absurd; but in a final estimate it is always 
liable to show a cruel or tragic aspect. Unfortu- 
nately, the helpless child is apt to be the chief 
sufferer. The danger to the community lies 
specially in the fact that communicable diseases 
may be handled by this sect. One of the healers 
wrote that she had treated " hundreds of cases of 
measles, typhoid, scarlet, and slow fevers " with, 
she thought, success. Assuming that part of 
these illnesses were properly diagnosed, the final 
results must be unknown. 
How can people, who confessedly have not 
made a scientific study of the pathology and 
natural history of disease, give reliable reports 
as to the results of any or no treatment? Many 
of them deny the real existence of the very dis- 
eases they pretend to cope with successfully. 
Every thinking person must realize that reports 
and statistics of ordinary or miraculous cures 
from such a source cannot stand real investiga- 
tion. Yet such statements sometimes influence 
people who are not accustomed to verify claims 
when positively made. When these assertions 
are coupled with generalities that sound elevated 
and pious, the unthinking may be impressed. 
Even scarlet fever may be treated by high 
214 MORAL INFLUENCES 
thoughts and lofty utterances. Those who have 
scientifically studied this malady are constantly 
looking for some of its insidious, severe, and per- 
manent complications. Some cases, however, as 
we all know, are mild in type and need no special 
medical treatment except careful watching for 
complications and an avoidance of the spread 
of infection to others. The only way to detect 
these complications is by careful examination of 
the vital organs liable to be affected by the poi- 
son of the disease. The various healers are not 
competent to do this; therefore the eventual 
results are unknown. One of the cases referred 
to above, having a " claim of diphtheria," 
" passed on." How many other cases of infec- 
tious diseases thus treated finally " passed on " 
or are now passing through life with crippling 
and avoidable complications, no one will ever 
know. Neither will it ever come to light how 
many cases of scarlet fever and similar dan- 
gerous infections have been spread to others 
by this sort of treatment. Here lies the most 
serious social aspect of this question to the com- 
munity. 
A teacher in a public school recently reported 
the death from scarlet fever of one of her most 
215 HEALTH FIRST 
promising pupils. Investigation showed no pos- 
sibility of infection in the home and apparently 
no cases at school. The mystery was soon after 
solved by a Christian Science mother telling the 
teacher that her child, in the same class, recently 
had a " false claim " of scarlet fever which she 
had quickly controlled and the child was soon 
sent back to school. Comment is unnecessary. 
Careful, conscientious teachers are very much 
afraid of this cult after having seen such things 
happen. Mild cases of diphtheria, measles, and 
similar diseases are spread in the same way. 
While this cult has evidently reached the acme 
of its influence, others with similar action will 
take its place, and the effect upon the community 
must always be considered. 
Many irregular systems of medicine get great 
credit from their handling of light attacks of 
the communicable diseases. We all know, how- 
ever, that the milder forms are the most danger- 
ous in the spread of infection and that a light 
case in one may produce a malignant and fatal 
attack in another. The public is sometimes con- 
fused by seeing patients recover from disease 
without medical treatment. This is easily ex- 
plained. 
216 MORAL INFLUENCES 
PHYSICIANS AID NATURE 
The scientific physician does not pretend to 
cure maladies by drugs or medicines. Nature 
performs the cure. All diseases are self-limited 
and end in complete or partial recovery or in 
death. By understanding the natural history of 
disease, however, the physician aids nature at a 
critical point in her struggles. This may be 
accomplished in many ways. He may assist in 
the elimination of rapidly collecting poisons, or 
in sustaining a failing heart or relieving a con- 
gested lung. By many similar actions, the physi- 
cian daily saves lives that would otherwise be 
lost. Needless death and disability are fre- 
quently avoided by the art of the scientific physi- 
cian. It is in imaginary, functional, or quickly 
limited diseases that the patient may get along 
well without any special treatment. Unfortu- 
nately, the mental healer does not always attend 
this kind. Imaginary cancers disappear, but 
the real ones persist, with the hopeful time of 
early removal irrevocably gone. Incipient tuber- 
culosis and many other diseases, in the early and 
curable stage, are allowed to become chronic and 
hopeless. The real diseases eventually get into 
217 HEALTH FIRST 
the hands of the physician, but often too late to 
save health or life. Here is where the tragedy 
comes in. 
It must be remembered that to some, mental 
healing, apart from its sordid and commercial 
side, represents a reaction against much of the 
gross materialism of the day. Physicians and 
teachers must take account of this bald material- 
ism and be careful not to yield too much to it. 
The great majority of the human race will never 
face the brutal logic of pure materialism. The 
true leaders of religion and medicine, clergymen 
and physicians, must guide the popular thought 
in these matters and not allow the field to remain 
in possession of moral quacks. But we must not 
try to detach the spiritual from the material as 
both are exemplified in actual life. The real 
thinkers must utilize the modicum of truth pos- 
sessed by all these systems to be rationally uti- 
lized as far as it can be safely and properly ap- 
plied. The credulous and distressed can thus 
get any inherent benefit without being exploited. 
The wide-spread materialism of to-day is re- 
sponsible for much discontent.. Materialism 
EFFECTS OF MATERIALISM 
218 MORAL INFLUENCES 
that is interested only in eating, drinking, and 
striving to be nierry does not make either for 
health or for happiness. It is too ephemeral. 
The senses fail to react to the old stimulation, 
and the body wears out. The whole material 
fabric of the world is in a state of constant flux. 
The mind that is engrossed in materialism has 
nothing permanent to grasp and hold. As this 
slowly dawns on the consciousness, a restless un- 
happiness settles on the passing life. The need 
of the day is faith in something more enduring. 
The so-called ages of faith, however, have passed, 
and, in so far as they were likewise ages of ig- 
norance and superstition, we may not unduly 
grieve. Yet a strong and simple belief is a help 
both to health and happiness and hence should 
be cultivated. 
It is a strange fact that while materialism is 
growing stronger with a large portion of society 
as a social force, with the thinking classes it is 
losing ground as an interpretation of life. De- 
spite a powerful drift toward this materialism, 
there is a strong counter-current among some of 
the finest minds of the day toward spiritual con- 
cerns. This is having a stimulating effect upon 
all life. It should leaven and energize both 
219 HEALTH FIRST 
church and state and disseminate an atmosphere 
of cheer and encouragement that will aid both 
body and mind. Cheerfulness is, to a certain 
extent, a habit, which, when once formed, has a 
beneficial effect upon all conditions of life. 
Finally, health and lasting happiness must 
be based upon a belief in the moral order of the 
world and upon faith in a Supreme Being who 
is working by means of the laws of life and na- 
ture for the ultimate good of the race. If we 
try to understand these laws and live as far as 
we are able in conformity with them, we will 
make the best of our lives. The ultimate result 
of life will be ourselves, also our deeds for good 
or evil. Let us strive eagerly for health of body, 
mind, and spirit, and face the facts of the world 
and of life as they are, always doing our best in 
spite of wrong directions or darkening tragedies. 
The highest results will be attained by cultivat- 
ing an optimistic spirit and working, not only 
for ourselves, but for others. Happiness is a 
state that comes easiest when unsought. 
As the body decays, let the spirit remain serene 
in the belief that life in its widest conception is 
more than meat and drink and opens out the 
greatest possibilities. In the unending order of 
220 MORAL INFLUENCES 
nature, birth, development, and death form the 
cycle that comes to all. If the body can be 
properly attuned to life, death will finally come 
as a sort of normal and peaceful ending. 
The complete life then requires a cultivation 
of the spiritual as well as the physical and moral 
sides of our nature. This must involve faith in 
a spiritual realm outside ourselves with which we 
may be in relation, and the " will to believe," as 
James the great philosopher taught, will help us 
attain it. 
To make for lasting happiness, we must try to 
enter into the belief of the seer who, even in trou- 
blous times, could sing: 
' ' God's in his heaven: 
All's right with the world." 
221 INDEX INDEX 
Abdominal gymnastics, 88 
Accidents, precaution against, 
7 
Adolescence, 44-55, passim 
Age, Metchnikoff's theory of, 
105, 106 
Air, 18, 176 
Alcohol: use of, in middle age, 
77, 78; in old age, 107, 
108 
American Association for La- 
bor Legislation, 14 
Anderson, Dr. W. G., 86, 87 
Anopheles mosquito, spread of 
malaria by, 141, 142 
Antitoxin, 140, 141 
Appetite: of children, 44 et 
seq.; loss of, 118 
Approximate life tables, 92, 93 
Arteries, influence of old age 
on, 103 et seq. 
Athletics, 71-73 
Auto-intoxication, 105, 106 
Baby: diet for, 20-26; signs 
of illness in young, 35 et 
seq. See infant 
Bancroft, 113 
Barbarism in children, 50 
Barley water, 25 
Bathing: the baby, 26; sum- 
mer, 182-184 
Blood, effect of old age on, 102 
et seq. 
Boas, Dr., 46, 47 
Bodily functions, performance 
of, 18 
Body: health for, 8-16; 
changes in, due to old age, 
101-103 
Bottle-feeding, effect of, on 
baby's health, 22-25 
Bowels: influence of diet on, 
20; in middle age, 77 ; in old 
age, 114 et seq.; infections 
of the, 169-171. 
Boys, table of height and 
weight of American, 46, 47 
Brain, development of chil- 
dren's, 29, 30 
Breast-feeding for infants, 20- 
26 
Browning, Robert, quoted, 
114, 115 
Buffon, 113 
Burke, Dr., 46, 47 
Calisthenics, 85 et seq. 
Census Bureau, 192 
Charity Organization Society, 
9, 15 
Cheyne, George, quoted on 
diet for the old, 108 
Chicken-pox, 68, 70, 162 
225 INDEX 
Child life, waste of, 4 et 
seq. 
Children: parental care of, 
17-20; care of newborn, 20- 
26: weight of growing, 27 
et seq.; development of 
brain of, 29, 30; nutrition 
of, 30; mental growth of, 
32-34; how to recognize ill- 
ness in, 33 et seq.; cause 
of anemia in, 43; diet and 
hygiene for, 44-51; clothing 
for, 46; moral development 
of, 47 et seq.; feelings of, 
48, 49; eyesight of, 58; table 
of work and sleep hours 
for, 61; posture of school-, 
63, 64; infectious diseases 
of, 68-71; athletics for, 
71-73 
Children's Bureau of United 
States Government, 10 
Chinese, use of doctors by, 16 
Cholera, 142, 143, 169 
Christian Science, 211, 216 
Cities: health in, 192 et seq.; 
conditions in, 193-195 
Cleanliness in the home, 188 
Clothing: 18; for the baby, 
26; winter, 173; summer, 
182 
Coffee, 78, 79 
Colds, cause and treatment of, 
151-155 
Colleges, 59, 60 
Conservation of health, 3 et 
seq., 12 
Country: health in, 192 et 
seq.; conditions in, 196 et 
seq. 
Cow's milk, 23-25 
Death percentage of United 
States, 3 
Death-rate of New York, 197 
Dentition, 42 
Destitution, influence of dis- 
ease on, 9 et seq. 
Development: of young chil- 
dren, 26 et seq.; effect 
of heredity and race on, 
42 
Diarrhea, 25 
Diet: after conception, 19, 
20; children's, 44-51; for 
the middle-aged, 75-81; for 
the old, 103-107; balanced, 
125-127 
Digestion, children's, 44 et 
seq. 
Digestive troubles of infants, 
£3 
Diphtheria, 68, 69, 163, 164 
Discharges, infant, 38, 39 
Disease: preparedness against, 
4; cause of poverty, 9 et 
seq.; susceptibility of old 
to, 110 et seq.; prevention 
of, 139-144; insects as 
agents of, 143; varieties of, 
144 et seq. 
Diseases: of vital organs, 11; 
communicable in school, 
68-71; germ, 145 et seq.; 
control of infectious, 148 et 
s.eq.; respiratory, 151 et 
seq. 
Disinfectants, 147 
Doctors, Chinese use of, 16 
Dorland, author of " The Age 
of Mental Virility," on in- 
tellectual activities of old 
age, 112-115 
226 INDEX 
Drink: for the middle-aged, 
77-81; for the old, 107, 108 
Drunkenness, Herbert Spencer 
on, 6 
Dysentery, 169 
Dyspepsia, influence of, 206 
Economy: food, 133-137; ex- 
periments in, 135 et seq. 
" Education," by Herbert 
Spencer, quotation from, on 
physical sins, 6 
Education, influence of, on 
health, 56-73 
Efficiency, dependence of, on 
health, 9 
Emotions, beginning of, 33 
Employers, attention of, to 
laborers' health, 13 et seq. 
Eruption, infections with, 
159-162 
Examination: physical, 15, 
16; scholastic, 58 et seq. 
Exercise, 18; for the middle- 
aged, 84-90 
Feelings of children, 48, 49 
" First aid to the well," 4 et 
seq. 
Fisher, Professor Irving, on 
conservation of life, 3 
Fiske, John, view of, on 
normal development, 41 
Flies, 142, 143 
Food: for infants, 20-25; for 
the middle-aged, 75-81; for 
the old, 103 et seq.; ques- 
tion, 116-138; as fuel, 119- 
121; principles, 120 et seq.; 
vitamines in, 127; values, 
in terms of calories, 128- 
133; care of food in sum- 
mer, 188 
Foods: functions of different, 
121-124; grouping of, 124- 
125; table of nutritional 
value of common, 131-133; 
economy in, 133-137 
Ford factory, 14 
Galileo, 113 
Garden cities, 195, 196 
German measles, 160 
Girls, table of height and 
weight of American, 47 
Goethe, 113 
Growth: 41 et seq.; effect of 
heredity and race on, 42; 
effect of study on physical, 
44, 45 
Gymnasium work for the mid- 
dle-aged, 85 et seq. 
Habits, correct, of living, 4 
Headache, 35 
Health: 3 et seq.; price of 
good, 4; quotation from 
Herbert Spencer's " Educa- 
tion " on vigorous, 6; re- 
lation of religion to, 7; for 
the middle-aged, 74 et seq.; 
for the old, 95-114; dis- 
ease and, 139 et seq.; men- 
ace of insects to, 141-144; 
influence of seasons on, 
172-191; relative, of city- 
dweller and country resi- 
dent, 193; effect of city and 
country on, 192-201; effect 
of, on disposition, 20£, 206; 
influence of, on happiness, 
204 et seq.; mental influ- 
227 INDEX 
ences on, 206-208; effect of 
suggestion on, 211-213; in- 
fluence of materialism on, 
218-223 
Health Committee of the 
American Medical Associa- 
tion, measures of the, 200, 
201 
Heredity: 30; effect of, on 
development, 42 
Holmes, Dr. O. W., 17; quo- 
tation from the " One Horse 
Shay," by, 99 
Hot weather habits, 179 et 
seq. 
Hunger, signs of, in children, 
35 
Hygiene: for children, 44-51; 
for the middle-aged, 74 fit 
seq.; for the old, 103-107 
Hygienic living, effect of, on 
longevity, 12 
Illness, how to recognize, in 
children, 33 et seq. 
Infection: avoiding, 139 et 
seq.; how spread, 146 et 
seq. 
Infectious diseases, control of, 
148 et seq. 
Infants: mortality of, 4 et 
seq.; health for, 17-39; diet 
for, 20-26; death-rate of, 
in United States, 23; 
weight of, at birth, 27; 
vomiting in, 38; meaning of 
crying in, 35 et seq.; irri- 
tability of, 35, 36; dis- 
charges of, 38, 39 
Infantile paralysis, control of, 
164-168 
Irritability in infants, 35, 36 
Jenner, Edward, 140 
Jolins Hopkins University, 95 
Laborers, health of, 13 et seq. 
Lamarek, 113 
Life^ waste of, among middle- 
aged and old, 5 et seq.; 
Christ and, 7; divisions of, 
11 et seq.; conservation of, 
12, 74-94; table of ap- 
proximate expectation of, 
92, 93; prolongation of, 95- 
114 
Life Extension Institute of 
New York, 15, 135 
Local influences on health, 
192-201 
Lombroso, on the criminal 
germ in children, 50, 51 
Longevity, hints on, 5 et seq. 
Malaria, 141-142 
Malnutrition, country chil- 
dren victims of, 199, 200 
Manure piles, disease bred in, 
143, 144 
Marine Corps, men fit for en- 
listment in, 15 
Materialism, effect of, on 
health, 218-221 
Measles, 68, 70, 159, 160 
Memory, 33 
Mental exercise in old age, 
108, 109 
Mental growth, 32, 34, 47 et 
seq. 
Mental healing, benefits of, 
208-210 
228 INDEX 
Mental influence on health, 
206-208 
Menus, experimental econom- 
ical, 135-137 
Metchnikoff, theory of age, 
advanced by, 105, 106 
Microbes, 147 et seq. 
Middle age: health in, 74 et 
seq.; proper drink for, 77- 
81; blood pressure in, 78; 
stoutness in, 81-83; under- 
weight in, 83, 84; exercise 
in, 84-90; military fitness 
in, 88, 89; effect of worry 
in, 91; work and play in, 
90, 91; increased mortality 
in, 91-94 
Milk: proper, for infants, 21- 
26; pasteurization of, 24; 
benefits of, in middle age, 
79 
Mind, amusement for, during 
pregnancy, 20 
Miners, health of, 14 et seq. 
Minor disorders, hints on, 9 
Moltke, 113 
Moral growth of children, 47 
,et seq. 
Morality, relation of health 
to, 7 
Mortality: increase of, in 
middle age, 91-94; table of 
comparative, of males and 
females, 93, 94; effect of 
winter on, 173 et seq.; ef- 
fect of heat on infant, 177- 
179 
Mosquitoes, disease spread by, 
141-143 
Mother, the nursing, 20-22 
Mumps, 68-70 
Municipal housecleaning in 
summer, 187, 188 
Muscles, in children, 31, 32 
National defense, 88-90 
National Council of Educa- 
tion, rural health program 
of the, 200, 201 
Nervous system, development 
of, 34 
Neuralgia, 46 
New York Association for Im- 
proving the Condition of 
the Poor, 9 
New York Board of Health, 
10, 148, 154 
New York City Health De- 
partment, 13, 91 
Nutrition, 30, 42, 116 et seq. 
Organs, effect of athletics on 
vital, 71-73 
Osler, Dr. William, on the 
lessening of usefulness, 95, 
96 
Old age: conserving health in, 
90-101; body changes due 
to, 101-103; exercise in, 
103 et seq.; diet and 
hygiene for, 103-107; phys- 
ical exercise for, 108, 109; 
intellectual activities of, 
112-115 
Parents: duty of, to off- 
spring, 17 et seq.; care of, 
during child's adolescence, 
54, 55 
Physical exercise in old age, 
108, 109 
229 INDEX 
Physical sins, Herbert Spen- 
cer cited on, 6 
Physician, scientific, 217, 218 
Plague, 140 
Play in middle life, 90, 91 
Pneumonia, 36 
Posture of the school-child, 63, 
64 
Poverty traceable to disease, 
9 et seq. 
Prenatal care, 17-20 
Preparedness against disease, 
4 et seq. 
Preventive medicines, 139-144 
Professional men, 14 
Race, effect of, on growth, 42 
Rats, 142 
Recreation places, 194, 195 
Relative age, 111-115 
Religion, relation of, to 
health, 7 
Rest for the old, 109, 110 
Rose, Dr. R. H., diet table 
arranged by, 130, 131 
Royal Sanitary Institute of 
Great Britain, 61 
Rural Schools, 199-201 
Sanitary improvements, pre- 
vention of disease by, 140 
Scarlet fever, 68, 69, 160, 161 
School, 61-63; lunch, 65-68; 
communicable diseases in, 
68-71; athletics, 71-73 
Senility, old age versus, 111 
Shoes, 19 
Sickness: poverty caused by, 
9 et seq.; among infants 
and children, 10-11; pre- 
vention of, among the poor, 
198, 199 
Sick-rate, 14 
Sleep: 37; in old age, 109, 110 
Slum-dweller, influence of the, 
on health, 196 
Smallpox, 140, 161, 162 
Spencer, Herbert, 6, 13 
Sponge baths, 19 
Stimulants, effect of, in mid- 
dle age, 77, 78 
Stomach, relation of, to man's 
efficiency, 9 
Stoutness, ill effects of, 81- 
83 
Study, effect of, on physical 
growth, 44, 45 
Summer, influence of, on 
health, 176-186, passim 
Table, approximate life, 92, 93 
Table: diet, 130, 131 
Table: height and weight of 
American boys, 46, 47 
Table: height and weight of 
American girls, 47 
Table: hours of work and 
sleep for school children, 
61 
Table: mortality of males and 
females, 93, 94 
Table: nutritional value of 
foods, 132, 133 
Table: weights and measures 
of persons of thirty years, 
81, 82 
Tea, 78, 79 
Teachers, 48 
Teeth, 45 et seq. 
Teething, 35 
230 INDEX 
Tendencies of children, 48 et 
seq. 
Tenement houses, 195 
Time, in its relation to health, 
3 et seq. 
Tintoretto, 113 
Training of children, 30 
Tobacco, proper use of, 80 
Tree Planting Association of 
New York, 190 
Trees, modification of air by, 
188-191 
Tuberculosis, 14, 156-159 
Typhoid, 169, 170, 172 
Underweight, 83, 84 
Underwear, 173, 174 
United States Department of 
Agriculture, 124 
United States Steel Corpora- 
tion, 14 
Vaccination, 140 
Varieties of disease, 144 et 
seq. 
Ventilation of school-room, 61, 
62 
Verdi, 113 
Vigor, conservation of, 4 et 
seq. 
Vitamines, 127 
Vomiting in infants, 38 
Wage-earners, 14 
Water: as a drink for the 
middle-aged, 79, 80; effect 
of, on kidneys, 19, 20; pro- 
tection of in summer, 188 
Water-supply, importance of 
pure, 169 
Weight: of infants at birth, 
27; of growing children, 28 
et seq. 
Weights, table of, of men and 
women, 81, 82 
West Point, 73 
Whooping-cough, 68, 70, 155 
Wines, use of, 78 
Winter, influence of, on 
health, 173-176 
Wood, Dr. Thomas D., on chil- 
dren in rural schools, 199 
Work: table of hours of, for 
school-children, 61; in mid- 
dle age, 90, 91 
Worry, effect of, on the mid- 
dle-aged, 91 
Yale gymnasium, 86 
Yellow fever, 142 
231