WARM WEATHER AND HOW TO DEAL WITH IT By Dr. Alvah H. Doty Medical Director of the Employees' Benefit Fund Committee of the American Telephone and Telegraph Company, The Western Union Telegraph Company, and The Western Electric Company Number 6. August, 1913. This is one of a series of monthly bulletins on Hygiene, San- itation, and the Prevention of Disease. In order that the articles which are to appear later may be fully understood, subjects of fundamental importance will receive first consider- ation. It is suggested that the articles be kept for reference, as in this way a hand-book on the subject of Hygiene may be secured. WARM WEATHER AND HOW TO DEAL WITH IT DR. ALVAH H. DOTY As the summer approaches the question is frequently asked by what means may the uncomfortable and sometimes dangerous conditions caused by hot weather be avoided. In reply it is usually advised to keep as cool as possible, abstain from improper food and particularly from alcoholic drinks, and avoid undue exercise. While these are valuable suggestions it will be of interest to know a little more fully why specially depressing influences are present in hot weather and what constitutes the protection against these conditions. Cold weather is rather stimulating and acts as a, tonic to the system, while warm weather is quite the reverse, for it is enervating and relaxing and unless we are in good physical condition it is apt to cause depression and lead to other uncomfortable conditions. Furthermore, warm weather is very destructive to food stuff and other products as decomposition rapidly ensues, for germs or bacteria multiply much faster when the temperature is high. Some misconception exists as to the direct cause of the prostration which occurs during the summer months and. which may range from a slight feeling of depression to a condition which involves considerable danger. It is commonly believed that the more serious cases are gen- erally due to the direct rays of the sun or "sunstroke." Whereas it is really more often caused by a continued high temperature without spe- cial regard to exposure to the sun rays and is appropriately termed "heatstroke." Nature goes far to protect us against excessive heat as it does against everything else that is a menace to our health. In this instance it ex- tends protection largely through the activity of the sweat glands in the skin for in hot weather they abstract an enormous amount of water from the blood which upon reaching the surface of the skin becomes rapidly evaporated and cools the body and in this way aids in keeping it at its normal temperature of about 981/2 degrees (Fahrenheit), although the temperature of the air may be much higher. No better illustration of this can be given than that which occurs in connection with the work of a "stoker" or "coal heaver" in the hold of a steamship. These men are often exposed to a temperature of 125 degrees or more, yet by profuse sweating they are able to maintain the normal temperature of the body. Still there is a limit to the equilibrium which nature is able to maintain in this direction for if exposure to excessive heat is pro- longed the temperature of the body cannot further be controlled and will quickly rise and may in some instances be followed by a fatal heat stroke, for this reason the men just referred to are allowed to work below only for a short period at a time and every practical means of supplying fresh and cool air to this part of the ship is made use of. Cases of prostration are not so apt to occur on the first day of a heated spell for then the resisting power of the body is better able to overcome the effect of this depressing influence but following this the number of cases rapidly increase. The danger of overcrowding, insufficient air and other unsanitary con- ditions during the summer months will be easily understood, for they add greatly to the depressing effect of the heat. It is for this reason that a large majority of cases of heat prostration occur in the tenement house districts. Abroad the public have long ago learned the value of providing within its municipal boundaries spaces which act as breathing places and which in various ways are made sufficiently attractive and convenient to bring the poorer classes away from their unhealthy environments in order that they may secure at least temporary relief from the depressing influence of the summer months. A practical and permanent way of avoiding the unpleasant effects of hot weather in the large cities and one which may be taken advantage of even by the poorer classes is residence in the suburbs; the value of this cannot be too strongly presented, particularly where there are children in the family for at least fresh air and space may be secured in this way. The expense is no greater, and the very effective means of transportation which are now available makes it practical and easy to live some distance from the workshop. There is much that we can do to relieve the discomfort of hot weather in the way of a careful selection of food and drink in order that we may diminish the work thrown upon the stomach and intestines for during this period of the year these organs are apt to be not as well prepared to perform their function as at other times, besides the food we buy is not always fresh and good. We have in a previous article learned that meat, particularly when it is taken in large quantities, undergoes fermentation and putrefaction in the intestinal tract, and is largely the cause of the discomfort which oftentimes follows its use. This is much more marked during the warm weather and therefore meat should be sparingly eaten during the summer. Fish is a good summer food provided it can be obtained fresh. This is necessary for it decomposes very rapidly in warm weather and if eaten in this condition may cause unpleasant and even serious results. 4 Cereals, fresh vegetables and fruit are also very valuable articles of diet during the warm weather. Nothing is more unfit for human consumption during this time of the year than the decomposed and filthy fruits, drinks, etc., which are found for sale on the streets, particularly the ice cream which is dispensed from the so-called "hokey pokey" wagons. This stuff is consumed chiefly by children in the tenement house districts and is usually served to them on pieces of brown paper. As a rule, no one but the manufacturer knows where this is made or the manner in which it is adulterated, or what becomes of that portion which is left from the day's sale, although it is presumably worked over for the next day's output. Considering the care which is taken by municipalities in connection with its milk supply it is difficult to understand why the sale of such an unhealthy product as this should be allowed. No greater or more practical charity could be inaugurated than the establishment throughout the tenement house districts of depots where pure and refreshing fruits, drinks and ice cream could be supplied at a low cost in order that it may take the place of that now purchased from the street vendor. While this article does not admit of sufficient space to discuss in detail the selection and care of milk particularly during the warm weather it must be said that no article of food is so vitally important as this to mankind, particularly to the young, and there is no food which is more unfavorably affected by the heat. Therefore every possible means should be taken to secure milk in its best and healthiest condition. "Dipped" milk, or that which is dispensed from cans in the various stores should never be used, for the receptacle is opened whenever a purchase is made and probably many times besides, therefore bottled milk should be used instead, for although it costs more, the protection it affords really in the end constitutes a matter of economy. Milk should always be kept close to the ice in order that the growth of bacteria may be prevented. During the summer and in the presence of suspected danger, milk may be boiled or Pasteurized; while the former is quite certain to destroy all germs which may be present it renders less valuable some of the nutri- tious constituents of the milk, therefore for prolonged use Pasteurization is employed. This refers to the treatment of milk by subjecting it to a temperature of 150 degrees for 20 minutes, then placing it on the ice. While this temperature does not injure the constituents of milk as occurs in boiling, it will render harmless the germs of tuberculosis and other forms of bacteria. This simple method may be carried out as follows: The bottles containing the milk, properly sealed, may be placed in a pan of water, the latter being raised to a temperature of 150 degrees (Fahren- heit) and kept at this point for twenty minutes. The bottles are then to be removed and placed close to the ice. As a matter of economy so far as the ice is concerned, the temperature of the milk may first be lowered by subjecting the bottles to a flow of cold water. 5 The use of powders or other mixtures which may be advertised as preservatives of milk should be avoided, for they cannot be depended upon and may do considerable harm. There is an urgent call for fluid on the part of our system during hot weather for as it has already been stated the skin is constantly abstract- ing large quantities of water from the blood which must be replaced, therefore the question of summer drinks is a matter of considerable con- cern. Water is the most valuable agent for this purpose for it is the natural drink and is most satisfying and should be freely taken. Iced water moderately used, chiefly between meals, is not only not injurious but helpful, for it supplies the need of fluid and aids in reducing the temperature of the body. The so-called "soft" drinks are of value pro- vided they are not adulterated, but unfortunately this only too often occurs, principally because there is not proper supervision over their manufacture. The excessive use of alcohol contributes largely to the uncomfortable or serious conditions which occur in hot weather, for it is commonly those who use alcoholic drinks in large quantities and of bad quality who first succumb to heat prostration. Another very important means of avoiding the unpleasant results of hot weather is to keep the bowels properly open, for if this is attended to there is less danger of the absorption of poisonous products from the intestinal tract and the temperature of the body is kept under better control. An occasional dose of Rochelle Salts or one of the other saline laxatives which do not irritate the stomach or the intestinal tract are helpful agents in this direction. Some exercise is not only healthy but necessary even in very hot weather, unless a person is suffering from some organic disease or some other debilitating physical condition which contraindicates it. However, judgment should be used in selecting the form of exercise. A vacation is a very important aid in preserving a good physical con- dition during the summer, but a large part of the population of a city cannot enjoy this pleasure but must depend upon some form of night or day entertainment and relaxation. Unfortunately the great mass of people in this country do not select the recreation which is of most value to them. In this we are far behind European countries for there they secure the most suitable and valuable means of rest and comfort at the minimum cost. Observing foreigners as well as others who have watched the struggling mass of humanity who daily visit our various seaside resorts and who with little children are packed in crowded cars both coming and going, and while at these resorts are encouraged at every point to eat improper food and take alcoholic drinks, and who return home at night, tired, sunburned and irritable and at considerable ex- pense, cannot quite understand what benefit is derived from this form of so-called pleasure. The more quiet inland nlaces should rather be selected for a day's outing. While sea air has its advantages, but little is derived from it in 6 a day's excursion, particularly when the weather is hot and there is a constant exposure to the direct rays of the sun. There are many inland places which provide shade, quiet and a lower temperature and an abundant supply of good drinking water, the latter being a very import- ant consideration. A luncheon taken from home offers far more pleasure than the purchase of food of a questionable character. These conditions offer a better opportunity for rest and recuperation. The lesson we should learn from what has been said regarding the heated term as it is called, is not that it is to be regarded an evil which can only be dealt with by change of diet, rest, etc., but rather that the summer months constitute the normal climatic conditions of a certain season of the year and that it is not intended we should unduly suffer if we properly prepare ourselves for it. In other words, we must so far as possible keep ourselves in good physical condition at all times. The question of diet, etc., being a part of personal hygiene. Hot and cold weather like disease select for their victims those who are in poor health or who are careless about their physical condition, while on the other hand those who present a formidable resisting power are but little affected by the various climatic changes. No better or more striking illustration of this can be given than in the instance of athletes, particularly baseball players, for these men during the hottest part of the day are continuously engaged in the most active exercise for two or three hours and it is rare that we hear of heat prostrations among them. This simply means that by careful training they have developed a resisting power which is but little affected by hot weather. It will be found that they are subjected to the most careful discipline as to their habits, foods, etc., and while it may not be possible or practicable for all to attain this splendid physical condition we can use it as a text and remember that the preservation of our health is largely in our own hands, it matters but little what season of the year is present. 7