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Title: Personal hygiene and physical training for women

Author: Anna M. Galbraith

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Language: English

Original publication: United States: Saunders, 1916

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*** START OF THE PROJECT GUTENBERG EBOOK PERSONAL
HYGIENE AND PHYSICAL TRAINING FOR WOMEN ***

BOOKS
BY

ANNA M. GALBRAITH,
M.D.

Four Epochs of Woman’s
Life
12mo of 260 pages.
3d Edition, Ready Soon

Personal Hygiene and
Physical Training for
Women
12mo of 393 pages, illustrated
2d Edition

PERSONAL
HYGIENE
AND

PHYSICAL
TRAINING
FOR WOMEN
BY
ANNA M. GALBRAITH, M.D.
Author of “Hygiene and Physical Culture for Women” and “The
Four Epochs of Woman’s Life;” Member of the New York County
and State and the American Medical Associations; Fellow of the
New York Academy of Medicine; Ex-President of the Alumnæ
Association, Woman’s Medical College of Pennsylvania; former
Attending Physician, Neurological Department, of the New York
Orthopædic Hospital and Dispensary; late Attending Physician
and Instructor in Diagnosis and Clinical Medicine at the Woman’s
Medical College, New York Infirmary

SECOND EDITION, THOROUGHLY REVISED

PHILADELPHIA AND LONDON
W. B. SAUNDERS COMPANY
1916

Copyright, 1911, by W. B. Saunders Company. Reprinted
April 1913, and October, 1915. Revised,
reprinted, and recopyrighted
November, 1916

Copyright, 1916, by W. B. Saunders Company

PRINTED IN AMERICA

PRESS OF
W. B. SAUNDERS COMPANY
PHILADELPHIA

In Loving Memory
of
HELEN WORTHING WEBSTER, M. D.
Professor of Physiology and Hygiene and Resident Physician at Vassar College
from 1874 to 1881

An untiring worker of charming and inspiring personality,
the living embodiment of all that was womanly,
great hearted, and noble.
This book is affectionately dedicated as a slight tribute of
the esteem in which she was held, and in grateful acknowledgment
of the value of her teachings
By her former pupil
The Author

PREFACE TO THE SECOND EDITION

Since the writing of this book six years ago the entire subject of digestion
has been revised by scientific research, and thanks to the same scientists the
nutritive value of the various food-stuffs has been ascertained. The
importance of this knowledge is so great that educators are now making an
endeavor to have the nutritive value of artificial and canned goods placed
on their labels; and the New York Board of Health has requested a large
Chain of Restaurants to have the nutritive value of foods printed, beside the
cost of the various articles, on their bill of fare.
Hence the entire chapter on Digestion and Nutrition has been rewritten.
In Chapter I has been given the result of original statistical studies, showing
the urgent need for every woman to know and put into practice the
principles of personal hygiene.
Dancing has become such a popular form of exercise that a description of
the plates giving the dancing steps has been added, together with some
simple dancing exercises. For these excellent descriptions the author is
indebted to Miss Barbara Blankenhorn, a widely known teacher of music
and dancing of Englewood, New Jersey.
The reason that such a comparatively short space was given in this work
to “pelvic physiology and hygiene” was that this subject had been treated in
extenso, in “The Four Epochs of Woman’s Life.”
Anna M. Galbraith.
New York City,
November, 1916.

PREFACE

The aim of this work has been to present in a clear and concise manner
the fundamental physiological laws on which all personal hygiene is based;
together with the practical, detailed directions for the proper development
of the body and the training of the physical powers to their highest degree
of efficiency by means of fresh air, tonic baths, proper food and clothing,
gymnastic and outdoor exercise, so that the tissues will be placed in the best
possible condition to resist disease.
The spirit of the times demands nothing less than the most perfect
development of body and mind of which youth is capable, and maintaining
the highest degree of efficiency of the adult worker for the longest possible
term of years. The fiat has gone forth from the American Medical
Association for the scientific education of the public in the laws of hygiene
and sanitation. And the great civic movement inaugurated by that same
Association and the Committee of One Hundred on National Health for the
establishment of a National Department of Public Health, promises to be
crowned with success in the near future. And so it has been deemed
superfluous to expound at length what preventive medicine has already
accomplished in the short space of fifty years by the eradication of terrible
epidemics and many diseases, and what a general knowledge of applied
hygiene might reasonably be expected to accomplish in the near future.
It gives the author great pleasure to have this opportunity of expressing
her deep indebtedness to Miss Ruth Blankenhorn, Vassar College, A. B.,
1909, of Englewood, N. J., a most artistic and graceful dancer who posed
for all the illustrations; and to Miss Harriet I. Ballintine, the able director of
the Vassar College Gymnasium, who arranged the poses for the very
excellent plates illustrating the free exercises and classic dances. Also to the
Vassar College Athletic Association for 1908-09 for the especially arranged
dances and field sports which they were so extremely kind as to
demonstrate for her benefit.

Anna M. Galbraith.
New York City.

CONTENTS

CHAPTER I
PAGE
The Wisdom of Physical Efficiency 11
Physical Efficiency as an Exact Science; Marks for Physical
Efficiency; Statistical Study of the Physical Examinations of 160
Young Women; the Physical Status of the Women of To-day; the
Reflex Action of the Various Impairments of the Entire Organism.
CHAPTER II
Hydrotherapy 23
Description of the Skin; Functions of the Skin; the Physiologic
Effects of Water, Hot and Cold; the Chief Varieties of Baths;
Ablutions; the Tub Bath; the Alcohol Rub; the Cold Dip; Alkaline
and Saline Baths; the Rain Douche or Shower Bath; the Hot Foot-
bath; the Sitz Bath; Salt Ablution; the Turkish Bath; the Electric-
light Bath; Indications for the Use of Turkish Bath, and
Contraindications; the Douche; Rationale of the Douche;
Contraindications.
The Internal Use of Water; Its Action on the Heart and Blood, on
the Digestion; Therapeutic Indications for the Use of Water;
Contraindications for Drinking Cold Water.
Enemas; Vaginal Douche; Douching the Ear.
CHAPTER III
The Care of the Skin and Its Appendages 57
The Complexion; the Action of the Bath in Health; the Proper
Time to Bathe; the Care of Wash-cloths; Cleansing the Face;
Protection of the Face; the Use of So-called Cosmetics for the Face;
Facial Blemishes, Freckles, Liver Spots, Sallow Complexion,
Pimples; Acne, Eczema, Wrinkles and Their Treatment; the

Relation of Diseases of the Skin to Internal Disorders.
The Hair; Dandruff; Causes and Treatment of Premature
Thinness of the Hair and Baldness; the Care of the Hair; Gray Hair.
The Cosmetic Care and Treatment of the Hands; Cosmetic of the
Nails; the Care of the Feet; Painful Affections of the Feet.
CHAPTER IV
The Digestive System: General Principles in Human Nutrition and
80
Dietetics
The Digestive Tract; Care of the Mouth and Teeth; Controlling
Factors of Digestion; Psychic Aspect of Digestion; Importance of
Mechanical Factors; Chemical Changes of Food in the Stomach;
Intestinal Digestion; Metabolism; Constipation and Its Treatment.
The Amount of Food Required; the Classification of Foods;
Standard Dietaries; Maintenance Diet; Relations of Diet to Various
Conditions of Life; Practical Facts for Guidance; Dietary in the
Tropics; Food Economics; Table of Food Values.
The Physiologic Action of Moderate Doses of Alcohol; the Effect
of Alcohol on the Muscular System; the Effect of Alcohol on the
Nervous System.
CHAPTER V
The Respiratory and Circulatory Systems: the Kidneys 137
The Mechanics of Circulation and Respiration; the Circulatory
Apparatus; the Lungs; Hygiene of the Lungs and Its Relation to the
General Health; Relation of Respiration to Body Heat; the
Respiratory Functions of the Abdominal Muscles; the Importance
of Good Chest Development, Proper Relation Between the Height,
Weight, and Chest Measurements; Chemical Properties of Air;
Town and Country Air; Dust and Its Relations to Disease; Rôle
Played by Bacteria; Ventilation; the Injurious Effects of Overheated
Air; the Proper Degree of Moisture for the Air of the House;
Ventilation of Bed-rooms.
Care of the Nose, Throat, and Ears; Impediments to Respiration;
Ventilation of the Lungs and Breathing Exercises; Cure of Chronic
Bronchitis by Deep Breathing Exercises; Relation of Colds to
Pneumonia and Tuberculosis, and Their Prevention.

The Kidneys and Their Functions; the Physiology of the Female
Pelvic Organs.
CHAPTER VI
The Nervous System as the Balance of Power in the Body 184
The Brain the Master Organ of the Body; the Functions of the
Brain; Habit and Automatism; the Physiology of the Brain and
Nervous System; the Hygiene of Work; the Toxins of Fatigue;
Overwork; Signs of Overwork; Nature’s Restoratives; Avocation;
the Physiologic Necessity for Laughter; Vacations and Health;
Sleep; Insomnia.
The Eyes; Eye-strain; Description of the Visual Apparatus;
Optical Defects and Their Correction; the Mechanism of Eye-strain;
Local Symptoms of Eye-strain; Artificial Lighting; Hygienic
Precautions in Reading and Sewing; Injuries to the Eyes; Symptoms
and Treatment of Conjunctivitis; Trachoma; Styes.
Functional Nervous Disorders; Headache; Neurasthenia.
CHAPTER VII
The Hygiene of the Mind and Its Relation to the Physical Health 224
Heredity; Temperament; Social Instincts; Fear.
Mental Development; Self-control, the Moral Sense, the
Religious Instincts; the Advantages of College Life; Balance of the
Mental Faculties; the Effects of the Higher Education of Women.
The Environment; the Choice of Friends; Literature.
The Power of the Will or Inhibition; the Effect of the Mental
Attitude on the Physical Health; A Definite Occupation a Physical
Necessity; the Psychology of Success.
CHAPTER VIII
Dress the Fundamental Cause of Woman’s Physical Deterioration 252
The History of Woman’s Dress; the Corset in History; the
Crusade Against the Corset; the Influence of the Corset on the
Female Body; the Curved Front Corset; the Relation of Corsets to
Abdominal and Pelvic Disorders; the Effects of Corsets on the
Muscles; the Straight Front Corset; the Abdominal Corset; the
Wearing of Corsets by Young Girls; What Style of Corset is the

Least Injurious; the Shoe; the Stockings; the Essential Qualities for
Winter Underclothing; the Length of the Walking Skirt; the Winter
Street Dress.
CHAPTER IX
Physical Training the Key to Health and Beauty 283
The Ancient Greeks the Most Perfect Type of Beauty; the Cause
of the Inferior Physique of American Women; the Physical Training
of the Japanese Women; Improved Physique as the Result of
Physical Training; Increasing Stature and Improved Physique of
American Men; Report of the Royal Commission of Great Britain
on Physical Training; Physical Training Among the Ancients; the
Influence of Physical Training on the Health and Life of the
Individual; the Effect of Exercise on Brain Development and
Character; the Physiology and Pathology of Exercise; the Relative
Proportions of a Perfect Female Form; Table of Standard Weights
for Women; the Muscular System; the Benefits of Exercise; Passive
Exercise; Massage; the Balance and Carriage of the Body; Common
Defects in the Carriage of the Body; the Heart’s Need of Exercise;
the Gymnasium in the Campaign Against Disease; Gymnastic
versus Athletic Training; Exercise After Eating; Effect of Brain
Fatigue on Body Fatigue, and vice versa; Marks for Physical
Efficiency; Advantages Derived from Athletic Sports; Ethical Value
of Sports for Women; Forms of Athletic Games Best Suited to
Women.
CHAPTER X
Symmetric Development: Good Carriage and Grace of Motion
323
Through Gymnastics and Athletics
Gymnasiums, Baths, and Athletic Associations: A Fundamental
Part of a Woman’s College and a Model Woman’s Club; the Vassar
College Gymnasium; the Standardized Percentage Table for
Physical Efficiency; Special Medical Blank for Women; Self-made
Good Physique through Physical Training; Rules for Taking
Exercise; Gymnastic Dress; the Configuration of the Foot; Correct
Attitude in Standing.
Corrective Exercises: Exercises for Developing the Various

Regions of the Body; Shoulder-blade Exercises; Respiratory
Exercises; Exercise for Forward Projection of Chest and Retraction
of Abdomen; Shoulder and Back Exercises; Leg Exercises;
Squatting Exercises for Muscles of Spine and Abdomen; Alternate
Kneeling; Abdominal Exercises; Balancing Exercises for Poise and
Carriage; Balancing Exercises for Extending Depth of Chest;
Lateral Trunk and Waist Exercises; Exercises for Muscles of Back;
Exercises for Muscles of Abdomen; Swimming Exercises for Back,
Thighs, and Abdomen; Rope-pulling Exercises for Back, Chest,
Waist, Legs, and Arms; Exercises in Trunk Flexions for Back,
Abdomen, and Legs; Exercises with Chest Weights for Chest,
Shoulders, and Arms; Boxing and Fencing; Classic and Æsthetic
Dancing an Essential Feature in Physical Training; Figures of the
Dance with Some Simple Exercises.
Outdoor Exercises: Effect of Walking on the Heart and Lungs;
Running; Mountain Climbing; Swimming; Horseback Riding as an
Exercise; Rowing. Athletic Sports: Croquet; Lawn-tennis; Golf;
Hockey; Basket-ball.
————
Index 375

PERSONAL HYGIENE
AND

PHYSICAL TRAINING FOR WOMEN

CHAPTER I
THE WISDOM OF PHYSICAL EFFICIENCY
Physical Efficiency as an Exact Science; Marks for Physical Efficiency; Statistical Study of the
Physical Examinations of 160 Young Women; the Physical Status of the Women of To-day; the
Reflex Action of the Various Impairments of the Entire Organism.

“Circumstances,” said Napoleon, “I make circumstances.”
Physical efficiency stands for initiative, endurance, success; it is the very
keynote of modern life and has become one of the burning questions of the
day. West Point and Annapolis have always recognized this, and in order
that their graduates should measure up to the highest standard of efficiency
a most rigid physical examination was and is demanded as a prerequisite for
admission; and during the whole of the four years’ course physical training
is systematically carried on so as to insure the most perfect physique
possible, with the result that in addition to their great powers of endurance
and initiative, is their distinguished carriage and elegance of bearing.
To increase the safety of their passengers the railroad companies were the
next to demand these same physical examinations to determine the
efficiency of their applicants and employees. Other large corporations
followed.
So long as women remained in the home, or were willing and content to
accept any small wage that was doled out to them, the public did not seem
especially interested in their physical condition. But when women, as a
large teaching body or in any other public service, began to demand equal
pay for equal work, the situation was materially altered, and in 1914 the
English Royal Commission summed up the following conclusions: “Where
the character and conditions of work performed by women approach those
of the work of men, the pay of the women should approximate that of the
men, but in so far as the efficiency of men is higher, the salaries of men
should remain higher.” This at once changed the complexion of the matter,
and physical efficiency for women became a matter of paramount and equal
importance to both employer and employee.

Again, from the standpoint of social science, the physical efficiency of
women is demanded because they are the mothers of the race, and on them,
equally with the fathers, does the welfare of future generations depend,
since it is believed that a child inherits equally from its parents—one-fourth
from father and mother each, one-fourth from its grandparents, etc. The
states are beginning to seriously take up the framing of laws for eugenic
marriages, based on fixed standards of physical efficiency of the contracting
parties. And the day is not far distant when women as well as men will have
to undergo physical examinations to secure or hold any positions of
importance.
Then, too, one of the results of the present terrible European war has
been to demonstrate that women possess a large amount of latent powers
and endurance which only needed for their development the same general
physical training that the state gives her sons. Women are now being
employed in these countries in all branches of the civil service, as well as in
agriculture and the making of munitions, engaging in a vast number of
employments and trades hitherto considered unfit for women, because of
the great physical strength and endurance which they demanded.
Physical Efficiency as an Exact Science.—Physical efficiency is
growing to be an exact science; it is demonstrable in figures. We have
standardized percentage tables for measuring the capacity of the lungs, the
strength of the heart and muscles, and, added to these, must be a normal
condition of the digestion, kidneys, generative organs, sight, and hearing. If
the sum total of these amounted to 100 per cent., that would mean capacity
for the greatest possible endurance under strain, and so the most effective
worker; for there is a direct relation between the percentage standard of
physical efficiency and the output of work, both as to quantity and quality.
Marks for Physical Efficiency.—Sir Francis Galton, the great English
scientist, was the first to conceive the idea of assigning marks for physical
qualifications. They were as follows: Breathing capacity, strength tests, both
to be regarded with reference to the height and weight; quickness of
response to a signal, made either to the eye or ear; the sense of sight and
hearing, and the color sense.
Realizing the usefulness of these tests in measuring the physical
efficiency, Professor Sargent included them in the physical examinations of

the Harvard students. The strength tests consist of that for each forearm, of
the back and legs, the dip, the pull-up, and the lung capacity. The
combination of these seven tests is what is known as the intercollegiate
strength test, and is the best means as yet devised for measuring the general
muscular strength and the respiratory power.
It is obvious that many of these tests would be needed only by men going
into the army or navy, or qualifying for civil engineers or professional
athletes, etc. So it was considered best to modify these tests to meet the
requirements of physical efficiency for women.
For the large number of measurements of the arms, legs, etc., included in
the Sargent system have been substituted the rating of the condition of the
heart and circulatory system, including the blood-pressure; lung and chest
development; digestive and nervous system; the kidneys and generative
organs; the muscular system; tests of endurance; ocular and aural tests; with
a final impression of the working efficiency.
This standardized percentage table for physical efficiency of women was
worked out and the ratings made with the able assistance of Dr. David
Bovaird, Associate Professor of Clinical Medicine, Columbia University,
and Dr. George A. Meylan, Associate Professor of Physical Education,
Columbia University; and it has seemed to us that this combination of tests
is of greater practical value, since the maintenance of physical efficiency
depends upon the integrity of all of the organs of the body. These ratings
were made to cover the Special Medical Blank for Women,[1] gotten up for
the examination of the women candidates of the Presbyterian Board of
Foreign Missions.
For many years the various Boards of Foreign Missions, which are the
great church corporations, have required that candidates for this work
should pass a physical examination similar to that demanded by the life
insurance companies, and so similar blanks were sent out to be filled by the
local examining physicians; but because of the many breakdowns of the
women on the field, and the great detriment to the work and the expense
thus entailed, four years ago the Presbyterian Board of Foreign Missions
decided to have all of their women candidates re-examined in New York by
a woman physician especially appointed by them for this purpose.

The results of these examinations have been most illuminating as to the
physical condition of women who call themselves well, to say nothing of
what the medical profession in general seem to consider as standards of
good health in women who will be obliged to do very hard work under most
trying climatic conditions, which all Life Insurance Companies rate as
extrahazardous.
The composite picture thus obtained by the statistical study of the
physical examinations of these 160 young women is of great value, not only
because it is the first of the kind made for the first decade after leaving
college; but also because it is very fairly representative of the average
physical condition of the great masses of women who are engaged in
teaching, social service, secretarial work, etc.; and, further, it demonstrates
the striking difference in physique of women who call themselves well, and
that of the normal standard of physical efficiency to which most of these
women could have attained by proper physical education.
Statistical Study of the Physical Examinations of 160 Candidates.—
This study is made from the records of four successive classes of young
women coming from all over the United States, city and country, including
college and non-college graduates, whose occupations were physicians,
teachers, students, nurses, social workers, housewives, etc. All had passed a
preliminary physical examination. The average age was twenty-eight years,
when woman should be physically at her best.
I. Acute Diseases Since Childhood and Number of Days Lost Through Illness. For
Classes of 1913 and 1914 Only, Consisting of 100 Women.[2]
History negative—i. e., no history was given of any acute illness after the children’s
30 per cent.
diseases
Acute illnesses, including operations 70 ” ”
Previous year’s record:
Lost no days from illness 42 ” ”
Operations performed, followed by complete cure 27 ” ”
Marked loss of weight 23 ” ”
Total loss of time from illness, including postoperative treatment, would equal
8½ months.
entire time of one woman for

Of the acute illnesses, the following are of the greatest interest because
now preventable: Typhoid fever, 12 per cent.; malaria, 6 per cent.;
tonsillitis, 6 per cent.

Of the causes for operations, appendicitis leads with 13 per cent.; of
these, 9 per cent. were simply for the removal of the appendix; 2 per cent.
for the removal of the appendix and diseased right ovary; and 2 per cent. for
the removal of the appendix and ovarian cyst. The recovery was not only
complete from the operation, but the general health was greatly improved in
every respect.
Of the cases of tonsillitis, 4 per cent. were operated on not only with
complete recovery, but also with the cure of rheumatism from which these
women had previously suffered.
II. Heart and Circulatory System.
Examination of heart negative, with absence of murmurs 97.5 per cent.
Action of heart weak 54.0 ” ”
Pulse weak and rapid 50.0 ” ”
Subnormal blood-pressure 63.0 ” ”
Anemia present 55.0 ” ”
Normal condition of veins 95.0 ” ”
Subnormal temperature 40.0 ” ”
Class average 7.5 ” ”

III. Lungs and Chest Development.
Examination of lungs negative, with normal frequency and character of
97.0 per cent.
respiration
Subnormal chest girth in relation to height and weight, of 5¼ inches 87.0 ” ”
Subnormal chest expansion of 1 inch 82.0 ” ”
Subnormal lung capacity, measured by spirometer, 45 cubic inches 75.0 ” ”
Unhealthy condition of nose and throat (postnasal catarrh or enlarged tonsils) 20.0 ” ”
Class average 7.5 ” ”

IV. The Digestive System.
Gastro-intestinal indigestion was present in 35.0 per cent.
Hepatic congestion with tendency to bilious attacks 20.0 ” ”
Constipation 33.0 ” ”
Catarrhal appendicitis (operation at once advised) 4.0 ” ”
Class average 8.5 ” ”

V. The Kidneys.
Urinalysis negative in 96.0 per cent.
Slight traces of albumin (with hyaline casts in 2 per cent.) 4.0 ” ”
Floating kidney 0.8 ” ”
Class average 9.6 ” ”

VI. The Generative Organs and Menstrual Function.
Pelvic organs normal 33.0 per cent.
History, menstrual periods normal 38.5 ” ”
Displacements and inflammation, uterus 67.0 ” ”
Accompanied by falling and inflammation of ovaries in 12.0 ” ”
Hemorrhoids 3.0 ” ”
Fibroid tumors 1.5 ” ”
Dermoid cyst 75.0 ” ”
Operations advised for retroflexed uterus and curetage 1.5 ” ”
Dilatation and curetage 1.5 ” ”
Class average 7.5 ” ”

VII. The Nervous System.
Subject to headache 33.0 per cent.
Tendency to nervous exhaustion 11.0 ” ”
Hysteric 3.0 ” ”
Insomnia 7.0 ” ”
Mental poise good 75.0 ” ”
Class average 8.5 ” ”

VIII. The Muscular System.
The average height 5 ft. 3½ in.
Normal weight 126 pounds.
Normal relation of weight to height and age 33.0 per cent.
Averaged 17 pounds underweight 47.0 ” ”
Posture good in sitting and standing 33.0 ” ”
Posture bad, round shoulders, stooped position, muscles flabby 67.0 ” ”
Strength tests taken only for class of 1915 (30 women):
Highest 802 points.
Lowest 338 ”
Class average 570 ”
Class average estimated 7.2 per cent.

IX. Tests of Endurance.
Took systematic daily exercise, walking 3 miles 25 per cent.
Took some exercise daily, 1 mile or under 50 ” ”
Took absolutely no systematic daily exercise 25 ” ”
Outdoor sports known, but not practised 10 ” ”
Test walk of 3 miles not given.
Heart reaction after exercise, hopping 100 feet, not given.[3]

X. General Impression of Working Efficiency.
Class average 8.2 per cent.

General Summary.
20 per cent. averaged from 67 to 75 per cent.
25 ” ” ” ” 75 to 80 ” ”
50 ” ” ” ” 80 to 85 ” ”
5 ” ” ” ” 90 to 95 ” ”
Class average estimated, 80 per cent.

Ocular Tests
Where the vision was normal, or had been corrected by glasses, this was rated as
normal; because of the occupations of these women it was practically so.

The most striking points of weakness in the entire class were the bad
postures in sitting and standing, consisting of round shoulders, a stooped
position, and flabby muscles, 67 per cent.; a deficiency of one-seventh of
the normal chest and lung development, accompanied by a deficiency of
one-third of the normal chest expansion, 85 per cent.; weak hearts with
weak and rapid pulse, subnormal blood-pressure, and anemia in over 50 per
cent.; over 66 per cent. had some form of pelvic trouble which was acting to
undermine the whole system.
Aside from tuberculosis, life insurance companies reject applicants who
fall more than 20 per cent. below the normal standard of weight, and
because of this 16 per cent. would have been rejected. The cause of this
great loss of weight was due to malnutrition and overwork, and had it
seemed practicable to adhere to Professor Meylan’s wise advice that anyone
who fell below 7.5 per cent. in any one series of tests, or below 75 per cent.
in the general average, 20 per cent. of the entire class would have been
turned down.
It must be taken into consideration that these examinations were made
during the first week of June, at the end of a hard year’s work; but, making
due allowance for this, the results of these examinations have revealed such
a subnormal condition of the vital organs of the body as to be appalling
even to those of us who have long been familiar with these subjects. In
addition to this was the fact that many unsuspected ailments needing
immediate attention by physicians or surgeons were discovered in a class of
women who considered themselves well.
The Physical Status of the Women of To-day.—The strong
presumption that the above statistics are very fairly representative for the

average woman of to-day is strongly borne out by data furnished by the
absence on account of illness of the teachers of New York, and by
corresponding statistics recently published by the Life Extension Institute of
New York City.
Statistics compiled during the year 1913-14 showed that more than 20
per cent. of the teachers of the New York public schools were absent at
some time on account of illness, and that these absentees averaged 16½
school days. The data obtainable showed four prevalent ailments: diseases
of the respiratory organs, 35 per cent.; acute contagious diseases, 16 per
cent.; nervous diseases, 15 per cent.; and digestive disorders, 11 per cent.
And on the health of the teachers ultimately depends the efficiency of the
entire educational system of the country.
The Life Extension Institute of New York, in its tabulation of 2000
examinations of young men and women clerks between the ages of thirty
and thirty-five years, showed only 3 per cent. normal, i. e., free from bodily
impairments and from habits of life which were leading to such
impairments; and showed 59 per cent. sufficiently impaired to justify their
recommendation to the definite care of their family physician. “These
statistics were compiled at an age when the human being is supposed to be
at the very prime of life. The results prove that the majority of young men
and young women in New York City begin to die as soon as they are grown
up. Deaths due to degenerative diseases have increased 86 per cent. in the
past thirty years; this means an increased death-rate whereby between
100,000 and 200,000 lives are lost every year.”
The Reflex Action of Some of These Various Impairments on the
Entire Organism.—In the normal erect position of the body the trunk is
given its greatest length, the head is held erect, the shoulders thrown back
flat against the ribs, the chest is high, and the abdomen flat. (See Plate III,
Senegalese woman.)
In the bad postures noted in 67 per cent. of the entire class, of round
shoulders with a stooped position and flabby muscles, we note four distinct
and prominent factors in the breaking down of the human organism:
I. The Effect on the Chest and Lung Development and on the Action of
the Heart.—In this malposition the upper part of the body is inclined
forward, with the result that the chest is flattened to the extent of 1 inch.

The restriction which this must mean to the expansion of the lungs is
evident; and when it is realized that in the erect position the heart occupies
the space between the breast bone and the spine, with practically no space
to spare, the resulting interference with the heart’s action is evident.
It is a very serious matter when we have superadded to a deficient chest
development a deficient chest expansion. For these are the very women in
whom because of their general run-down condition and undeveloped
muscles the breathing is very superficial; the apices of the lungs, the
favorite site of tuberculosis, and the deeper portions are seldom expanded;
and not only does the body suffer from a deficient oxygen supply, but there
is an equally defective suction power on the part of the heart, which means
a poor circulation and a lowered general nutrition of the whole body.
The main function in metabolism is oxidation, and scarcely a step in the
series of chemical changes proceeding within the body is possible in the
absence of an abundant supply of oxygen, constantly renewed. Living in
close rooms lowers the vitality to an extent little dreamed of by most
persons.
II. The Effect on the Abdominal Viscera.—In the normal erect position
the abdominal muscles remain taut and afford proper support and pressure
to the abdominal viscera and the great splanchnic circulation of large blood-
vessels; whereas in the stooped position the muscles of the abdomen, not
being properly used, become weakened and sag forward, causing the
downward displacement of all of the abdominal viscera, with consequent
disturbance of their circulation and function. Many cases of indigestion,
congestion of the liver, and constipation can be explained in this way.
III. The Effect on the Circulation of the Spinal Cord.—The circulation of
the spinal cord is very largely dependent on the tone of the muscles of the
spine; hence the weakness of these muscles interferes with its circulation. In
the spinal cord are large nerve-centers which have to do with the control of
the arms and legs as well as of the organs of the trunk, so that anything
which lowers the tone of these centers depresses the vitality of the organs
supplied by them; and this is believed to be the cause of many cases of so-
called nervous indigestion.
IV. The Waste of Energy which Results from Faulty Posture.—Weak foot,
in its final stage flat-foot, is more common in women than in men because it

is not purely a local condition in the arch of the foot, but primarily due to a
weakened condition of the leg muscles that support the arch. Weak feet are
gradually converted into flat-feet by faulty standing and walking and lack of
leg exercises.
Many cases of nervous prostration are to be traced not merely to
overwork or worry, but to the waste of energy which results from the faulty
posture of the body and with the interference of the circulation in the spinal
cord, and the consequent weakness of the nerve power which results. In
other words, it is not the load which breaks the bearer down, but the way in
which the load is carried.
Good chest and lung development, a strong heart, well-developed and
firm muscles are the tripod on which rests physical endurance and
resistance to disease. And this was just where the entire class was found to
be gravely subnormal.
Physical training consists primarily of heart training; in increasing the
breathing capacity; in strengthening and developing the heart and other
muscles of the body. As the muscles become stronger the body is held more
erect, and this favors, as we have seen, all of its functions.
And it is not generally understood how great is the effect of physical
training on the brain and mental activities. With a strong and vigorous
action of the heart there is a feeling of courage and general exaltation;
whereas with a weak heart and feeble circulation fear and impaired mental
activity predominate.
The charge is constantly laid at the door of women that they seldom rise
above the mediocre, and have never been leaders in the world of art,
literature, the drama, science, or the learned professions; that it is men who
have invented devices for the home!
According to statistics, of the 25,000,000 wage earners in the United
States, 8,000,000 are women, of whom 1,250,000 are over forty-five years
of age and 637,000 under fifteen years of age. From an economic point of
view, anything which will raise the working efficiency of one-third of our
producing population, whose average wage is now the paltry sum of $6 per
week, must be welcomed, because it not only prevents loss of time from
work, but also the cost of illness. The study of the above statistics

demonstrates the fact that the physical efficiency of women can easily be
doubled; that should mean that the average wage should be raised to $12
per week, which would be a vast economic gain to the individual, the home,
and to the state.

FOOTNOTES:

[1] See page 330.
[2] Similar records for the classes of 1915 and 1916 were not preserved.
[3] As the physical examinations are made during the time of the Annual
Conference, in order to shorten the time as much as possible the Board requested
that the tests of endurance be omitted.

CHAPTER II
HYDROTHERAPY
Description of the Skin; Functions of the Skin; the Physiologic Effects of Water,
Hot and Cold; the Chief Varieties of Baths; Ablutions; the Tub Bath; the Alcohol Rub;
the Cold Dip; Alkaline and Saline Baths; the Rain Douche or Shower Bath; the Hot
Foot-bath; the Sitz Bath; Salt Ablution; the Turkish Bath; the Electric-light Bath;
Indications for the Use of Turkish Bath, and Contraindications; the Douche; Rationale
of the Douche; Contraindications.
The Internal Use of Water; Its Action on the Heart and Blood, on the Digestion;
Therapeutic Indications for the Use of Water; Contraindications for Drinking Cold
Water.
Enemas; Vaginal Douche; Douching the Ear.

The term hydrotherapy will be used here in its broadest sense, and may
be defined as the hygienic and systematic use of water, both externally and
internally, for the preservation and restoration of health and the prevention
of disease.
The hygienic and therapeutic value of the systematic use of water is just
beginning to be appreciated by the medical profession. When this newly
acquired knowledge is put to practical use by the great masses of the
people, there will be a greatly diminished necessity for the use of drugs.
Indeed, water has been pronounced by a high medical authority to be, and
probably is, more nearly a panacea for all human ills than any other known
agent.
The bath is generally considered merely as a cleansing procedure,
whereas this is only one of its beneficial effects. There is, in addition, the
stimulation of all the functions and organs of the body obtained through the
temperature of the water, and the mechanical stimulation which is obtained
by the mode of application.
Again, the skin is not a mere covering for the body, but one of its most
important organs, with well-defined functions; so that, in order to obtain a
clear understanding of the subject, it is necessary first to consider briefly the
functions of the skin; and, secondly, the physiologic action of water.

Description of the Skin.—The skin is a very sensitive and complex
organ, and upon the condition of the skin and the vicissitudes to which it is
exposed the health of the individual is dependent to a very great degree.

Fig. 1.—Vertical section of skin. sbg, Sebaceous glands; ep, epidermis; h, hair; d, derma (Fox).

The skin is composed of three distinct layers—the epidermis, the corium
or true skin, and the subcutaneous connective tissue. The appendages of the
skin are the hair, nails, the sebaceous and sweat-glands. This complicated
structure is supplied with blood-vessels, lymphatics, and nerves.
The Epidermis.—The outer layer of this is the horny layer; when a blister
is formed, its fluid raises the entire epidermis from the true skin. The flat
scales forming the horny layer are continually being thrown off; this
process of desquamation is increased by the friction of the clothes, of
bathing, massage, and so forth, and is as constantly being replaced by new
cells from underneath.

The corium, or true skin, is the most important part of the integument.
This is a thick, felt-like tissue which is pierced in all directions for the
passage of the blood-vessels, lymphatics, sweat-ducts, and nerves, and
affords lodgment for the hair follicles and sebaceous glands. The tension of
the skin is produced by its muscular structure and elastic network, and is
subject to temperature changes. This power of contractility is known as the
tone of the skin.
The skin has two kinds of glands, the sebaceous and sweat-glands. The
sebaceous glands consist of a gland structure, with a short excretory duct,
which opens upon the epidermis or into the hair follicles. These glands
secrete an oily substance, which keeps the hair and skin soft and protects
them from the sweat.
There exists in the sebaceous glands of the skin an infinite number of
vulnerable points for infection, and the greater part of the process of
cleanliness is directed toward their protection. If in any part of the skin
there is an accumulation of bacilli, their toxins, or excretions, and, at the
same point, a collection of sebum, the friction of the clothes, caused by the
movements of the body, becomes an active agent in effecting their
absorption by the skin. Hence, the scientific basis for the necessity of the
daily bath.
In the subcutaneous tissue we find the fat; it is this part of the skin that
contributes to the roundness and beauty of the body. It is increased by
abundant fatty food, sedentary habits, and freedom from care.
Functions of the Skin.—The skin exercises three distinct functions; first,
as an organ of sense; second, as an organ of excretion; and third, as an
organ of heat regulation.
Next to sight, the sense of touch is the most important of all the senses.
Through this sense the human organism is made conscious of its contact
with the outer world. The cutaneous nerve-endings stand guard, as it were,
over most of the functions of the human body.
The importance of the action of the skin as an organ of excretion will be
better understood from the well-known fact that the skin is one of the most
important aids to the kidneys. That the perspiration and the urine are to a
certain extent vicarious excretions has been proved.

The blood is the circulating medium which not only serves to convey
nutritive materials from the stomach to the tissues, and the excrementitious
materials from the tissues to the excretory glands, but also to equalize the
body temperature. It conveys the surplus heat from the interior of the body
to the surface, where it may be dissipated by conduction, radiation, and
evaporation. Nearly nine-tenths of the daily heat-loss takes place through
the skin; and of this, one-seventh is due to evaporation, which is
enormously increased by perspiration.
The amount of perspiration produced daily is about two pints, or in the
neighborhood of 1/64 the body weight. This is double the amount of water
thrown off by the lungs. The watery portions of the perspiration are readily
evaporated, and the solid constituents are deposited upon the skin. Urea and
uric acid, together with more subtle poisons, are found in the sweat.
Animal Heat.—The heat of the body is wholly derived from foods,
which, when completely oxidized within the body, produce practically the
same amount of heat and energy that would be generated by their
combustion outside the body.
But it is essential, in order to keep the body of warm-blooded animals at
a constant or normal temperature, that an increase in the heat-production
should be accompanied by a corresponding increase in the heat dissipation;
the functions are reciprocal, and this equilibrium is regulated and
maintained by a special nervous and functional mechanism.
The automatic protective measures against the effects of heat are:
First.—Dilatation of the cutaneous vessels and an acceleration of the
circulation through the skin and the subcutaneous tissue. By this means the
dissipation of heat is increased; the sweat at the temperature of the blood,
deposited upon the surface of the body, evaporates under favorable
circumstances, and in this way considerable amounts of heat are abstracted
from the body. In consequence of sweating and its evaporation, the blood
circulating through the skin is cooled, and returning to the internal organs at
a lowered temperature, prevents their overheating.
Second.—Should the action of heat be continued for a greater length of
time, a large amount of blood will be retained in the skin in consequence of
the loss of tonicity of the cutaneous vessels; the cutaneous circulation will

be slowed, and thereby the blood, heated at the surface of the body, is
prevented from returning to the internal organs and so overheating them.
Third.—In consequence of the accumulated amount of blood in the skin,
a diminished amount of blood will remain in the internal organs; thus their
activity, and thereby also the production of heat, will be lessened.
In these processes will be found a safeguard against the excessively rapid
penetration of heat to the internal organs, and against the unduly rapid
elevation of the body temperature through thermic influences.
As a result of the stimulating influence of cold, there first occurs
contraction of the skin and its vessels. This, by restricting the dissipation of
heat, brings about perfect compensation if the abstraction of heat be but
slight; and but partial compensation, if the abstraction of heat is more
marked. In the latter event the body temperature will continue to decline, to
a greater or less degree; in the former it will remain constant.
The rôle played by the skin in maintenance of the normal temperature of
the body is indispensable.
The normal temperature of the adult human body is 98.6° F. in the
mouth, and that of the rectum and vagina is one degree higher.
Fasting, sleep, and short applications of heat all decrease heat-
production; during sleep the temperature of the body falls half a degree or
more.
Respiration by the skin varies from ½ to 1 per cent. of the total amount of
oxygen taken into the body, and a somewhat lower percentage of carbonic
acid is thrown off through this channel.
The skin absorbs substances in watery solutions with difficulty, on
account of the oil lying upon and in the epidermis; substances dissolved in
oil and rubbed in are more rapidly absorbed; absorption takes place rapidly
after the skin has been washed with ether, chloroform, or alcohol.
The Physiologic Effects of Water.—These depend on whether the water
is taken internally or applied externally. If applied externally, the effects
will depend upon the temperature, whether hot, tepid, or cold; also on the
manner of application, but, most of all, on the length of time which it is
applied and the state of health of the individual.

The temperature of water is classified as very cold, from 32° to 55° F.; as
cold, from 55° to 65° F.; cool, from 65° to 80° F.; tepid, 80° to 92° F.;
warm, 92° to 98° F.; hot, 98° to 104° F.; very hot, 104° F. and above.
Heat.—A general hot bath produces dilatation of the vessels of the skin
and contraction of the vessels of the brain; a general activity of the glands
of the skin, both perspiratory and sebaceous. Perspiration may be produced,
either to the degree of slight moisture or of profuse sweating, according to
the length of time and the intensity of the application made. In a very hot
bath the rate of perspiration may be increased from fifty to sixty times the
ordinary amount. The most pronounced effect possible may be secured by
either the electric light or sun bath.
Loss of fluids from the body has a depressing effect similar to, though
somewhat less marked than, that produced by bleeding, so that there is a
vital necessity for administering water internally before, during, and after
the bath.
Prolonged and repeated perspirations induced by artificial means weaken
the skin, and thus lessen its power to resist cold impressions, unless
counteracted by frequent cold applications.
The general and usual reactions following the applications of heat are
atonic and depressing in character. For the most part, the reactions
following cold applications are to be preferred to those following hot ones.
The three great vascular areas of the body are the muscles, the portal
system, and the skin. Each of these parts may be regarded as a great
reservoir, capable of retaining a large part of the entire amount of blood of
the body. When one of these areas is in a state of congestion, the others
must be in a comparative state of anemia.
The restorative effects due to the application of heat are due partly to the
elimination of fatigue poisons which is thereby encouraged, as well as by
the reflex stimulation of the nerve-centers. The good effects are much more
decided and lasting, and the exhausting effects neutralized, if the hot
application is followed by a short cold one.
The effects of a neutral bath, 92° to 95° F., is sedative, diminishing
nervous irritability.

A hot-water bottle or fomentations, placed over the stomach for an hour
or two after eating, increase the gastric secretions, and, when placed over
the liver, increase the flow of bile.
The Physiologic Effects of Cold.—In suitable cases a short general
application of cold is a powerful heart tonic. Cold causes a contraction of
the vessels of the skin and of those of the brain, with a dilatation of the
internal vessels. There are pallor and coldness of the skin, and an almost
instantaneous suspension of perspiration, which is dangerous only when the
body is in a state of fatigue.
If the application of cold is long continued, the surface becomes blue, the
temperature of the muscles beneath the skin is lowered, thus checking heat-
production in these muscles; the circulation is slowed, and the heart’s action
is diminished in frequency. There is a goose-flesh appearance of the skin; a
sensation of chilliness, trembling, shivering, chattering of the teeth; at first a
quickening and then slowing of the pulse, and deep gasping respiration.
When the cold application is considerably prolonged, the tendency to
reaction is suppressed. There is an exhaustion of the nerve-centers as well
as of the heat-producing powers of the body. Thus, the system gradually
loses its power to resist the depressing effects of cold. The repeated
chillings of the body increase the length of time required to return to the
normal temperature. Applications of water below the temperature of the
body always lower the temperature.
Reaction.—If the application of cold is of very short duration, of very
low temperature, and given under high pressure, the phenomena of reaction
begin immediately on its cessation.
The reaction consists in a dilatation of the surface capillaries, with
contraction of the internal vessels; redness of the skin; the skin is smooth,
soft, and supple; there is a sensation of warmth, comfort, and well-being;
respiration is slower and deeper; there are a fall of the internal temperature
and increase of perspiration.
Certain measures to favor reaction should be taken before the bath, such
as exposure to the air of a warm room, drinking hot water, and short
exercise of a rather vigorous kind.

During the bath the measures which favor reaction are short, sudden
applications of cold, friction while in the bath with the hand, and pressure
effects in the douche.
After the bath reaction is favored by vigorous rubbing, a thorough drying
of the body, warm clothing, warm air of the room, and as vigorous exercise
as the strength of the individual will permit.
Conditions which are unfavorable to healthy reaction are: old age,
infancy, exhaustion, either temporary or from an excessive loss of sleep, or
extreme nervous exhaustion, obesity, rheumatic diathesis, unhealthy or
inactive skin, profuse perspiration when accompanied by a state of fatigue,
extreme nervous irritability, a very low temperature of the skin, an
immediately preceding or impending chill, and extreme aversion to cold
applications.
The average temperature of the human nude skin is in the neighborhood
of 90° F. The difference between the temperature of the skin and water is
the chief element in determining the reaction of the individual. It is evident
that water at a temperature of 90° F. would be neutral or indifferent; the
difference of intensity of effect is in proportion to the difference of
temperature of the water and skin. The duration of the cold procedure is an
important element in the production of reaction. It may be laid down as a
rule never to give any cold-water application without friction. The physical
and psychic state of the individual exerts more or less influence upon his
reactive capacity. An anemic, or otherwise depressed individual must be
managed with great circumspection, because she bears heat abstraction
badly. The hydriatic procedure must always be adapted to the reactive
capacity of the bather.
The woman must be thoroughly rubbed after the bath until a good
reaction has occurred. Especial attention must be paid to the feet and legs.
The bather should first be rubbed with a warm towel or sheet, and then with
the bare hands of the attendant, as the warm hand greatly facilitates the
reaction. The bather is by no means dry when the skin ceases to feel wet. So
long as the skin is soft and spongy, it still contains moisture which has been
absorbed by the superficial layers of the epidermis. The absorbed moisture,
being left to evaporate after the bath, the individual is liable to become
chilly and contract a cold, which is erroneously attributed to the bath itself.

Other injurious effects following imperfect reaction after the cold bath
are secondary chills or a continuous chill lasting for several hours. The
hands and feet are cold, there is headache, not infrequently diarrhea, and
other evidences of internal congestion, such as abdominal or ovarian pain,
vertigo, etc.
Reaction may be favored by covering the patient with blankets,
surrounding her with hot-water bottles, and giving her hot tea to drink.
Exercise should follow the bath. Walking for from twenty minutes to an
hour is the most usual form of exercise. Very vigorous exercise for a short
time cannot be substituted for moderate exercise for a longer time.
The Tonic Effect of Cold Upon the System.—The effect of cold upon the
muscles, when given in the form of a cold bath, douche, or spray, is to
augment muscular energy and tone to a very great extent; this increased
muscular tonicity is the cause of the slight shivering. The cold douche, if
short,—one or two seconds,—and given with a pressure of from 25 to 30
pounds, is a powerful restorative in fatigue resulting from severe muscular
effort, but it must be immediately preceded by a short hot bath, and must be
followed by vigorous rubbing and wrapping in a hot blanket.
Short cold applications cause elevation of temperature and increased
metabolism, while prolonged cold applications cause a fall of temperature
and decrease of metabolism.
The tonic effect of cold water is believed to be due to the stimulation of
the sympathetic nerve-centers. The sympathetic nervous system controls the
blood-vessels, heart, the functions of secretion and excretion; and, indeed,
all the vital functions of the body.
The sensation of well-being which accompanies the reaction following a
general cold application is largely due to an increased activity of the
cerebral circulation. Cold water is a physiologic tonic, and the cold bath,
properly employed, increases the vital resistance to pathologic processes.
All applications of water at a temperature low enough to provoke vital
resistance are tonic; hence, tonic effects are produced by all temperatures
below 90° F., but the most certain and pronounced results are obtained from
the douche in every form, which adds mechanical impact to the thermic

effects of cold. The most durable tonic effects are produced by the frequent
use of very cold and very short baths.
A tepid bath causes a lowering of the body temperature.
The Chief Varieties of Baths.—These, in the order of frequency with
which they are used, are: ablutions; tub; foot-tub; sitz; salt sponge; shower;
Turkish; horizontal jet; needle; fan douche; Scotch douche; Roman and
electric-light baths.
Ablutions or Sponge Baths.—These baths are of universal use. The
sponge is one of the dirtiest and most impossible articles of the toilet to
clean and to keep clean. It is a collector of dirt and germs, and should be
banished from every bath-room and from every house. It is not sufficient
that each member of the family should have her own sponge; it is quite
possible for the individual to become infected or reinfected from her own
sponge. Incidentally, it does not afford sufficient friction, and thus does not
favor reaction. In taking ablutions, the application of water may be made
with the hand, though it is best made by means of a wash towel. The good
effects of the simple ablution will be greatly enhanced by the use of the hat
tub, and this especially where there is no bath-tub in the house.
When the bath is taken for the purpose of cleanliness, the water should be
warm or hot, and pure Castile soap is one of the best that can be used. If the
skin is rough, a good sand soap will be more beneficial. The bath should be
completed by dashing cold water over the body with the wash-towel.
The body must be quickly and thoroughly dried by means of a rough
bath-towel. After this, the skin may be still further toned up by a good
alcohol rub.
If the ablution is taken simply for the tonic effect, it is generally taken on
rising in the morning, and the water used is cold. The ablution may be
confined to the upper part of the body, that is, the chest and back; and
consists in friction with a rough wash-towel, followed by dashing the water
over the body; followed by brisk friction with a rough bath-towel. This
procedure causes a marked stimulation of the heart and lungs, and is
followed by a rise of temperature.
In winter all baths must be taken in a warm room.

There is a decided increase of muscular and mental capacity after the
cold ablution, demonstrating the tonic effect it has produced.
The cold ablution may also serve as an introductory to other and more
heroic hydriatic procedures. If the reaction is not good, water at a higher
temperature should be used, and only small portions of the body should be
attacked each day, followed always by brisk friction. As the reaction
becomes better, the temperature of the water should be gradually lowered
from day to day.
There must be a decided sensation of warmth of the body before
proceeding to take any form of cold bath. This may be induced by sipping a
cupful of hot water before rising, and then being well covered with the bed-
clothes until the body is in a glow. In conditions of anemia or neurasthenia,
where the circulation is markedly poor, in addition to drinking the hot
water, the bather may stand on hot blankets while taking the cold ablution,
and after it be rubbed briskly with hot towels.
Nothing is gained, and a great deal of harm is done, by trying to
persevere in the daily cold ablution when it is followed by a pallor of the
skin, chilliness, etc.
The Tub Bath.—This is much more refreshing, more salutary, and may
be used to produce a much greater variety of effects than the simple
ablution. Tub baths may be classified according to the amount of water in
the tub as half or full tubs; and again, according to the temperature of the
water, as warm, tepid, hot, and cold. The half tub contains about 30 gallons
of water.
In a general way it may be said that the half tub of warm water is used for
the purpose of cleanliness; the hot baths for breaking up colds, for
rheumatism, etc.; the tepid bath to allay nervousness; and the full cold tub,
for the tonic morning dip.
For cleansing purposes the so-called half tub, that is, the tub contains a
sufficient amount of water to reach above the pelvis when one is seated in
the tub, is used. The temperature ranges from 98° to 102° F. Five minutes is
as long as the bather should remain in the tub, as all hot baths are more or
less exhausting. After an initial immersion in the water, the scrub takes
place by means of the Turkish bath-towel, or, better, by the use of the flesh

brush. If there is a shower attached, the hot bath should always be followed
by a brief cold shower; if not, the cold water should be turned on and
dashed over the body by means of the wash-towel. This closes up the pores
of the skin, prevents the profuse perspiration from taking place that so often
follows a hot bath, and greatly diminishes the susceptibility to taking cold.
An alcohol rub completes the procedure. This insures a further toning up of
the cutaneous vessels. A small quantity of alcohol is poured into the hand
and applied to a limited area of the body. It is well rubbed in with friction
until the alcohol has wholly evaporated. Beginning with the arms, the legs,
chest, and back are successively gone over.
The hot bath is best taken immediately before retiring, and should not be
repeated oftener than twice a week. Retiring to bed at once, the bed acts as
the cooling chamber of the Turkish bath. The hot bath is most restful, and,
except in rare cases, tends to the production of refreshing sleep.
If the bather has a weak heart, suffers from shortness of breath, or is
weak from any cause whatever, she should only take a half tub bath, since it
has been learned from experience that when the water covers the entire
body, there is increased difficulty in the respiration, and the heart’s action
often becomes embarrassed, palpitation of the heart is experienced, with a
feeling of impending suffocation. There is sometimes also a feeling of
faintness. On getting into the tub, the temperature of the room should never
be above 68° to 70° F.
The Full Tub or Immersion Bath.—In this form of bath there is a
complete submersion of the body in the water, so that the water reaches the
under surface of the chin, the head of the bather resting on a cross strap,
being the only portion of the body uncovered by the water.
If the bath is tepid, that is, has a temperature of from 80° to 90° F., great
care should be taken to have the chest covered, in order to prevent
pulmonary congestion. This is best accomplished by placing a Turkish
towel, wrung out of hot water, about the chest and shoulders of the bather
just after she enters the tub.
If the bath is hot, from 98° to 104° F., before entering the bath the face
and neck are rubbed with cold water, in order to relax the vessels of the
brain and so prevent cerebral anemia. Except when the hot bath is given for

especial therapeutic purposes, as for rheumatism, cystitis, colic, etc., it
should always be followed by a cold application.
The Cold Dip.—For the dip, the tub is filled with water at a temperature
of from 65° to 55° F. The duration of the dip varies from two or four
seconds to one or two minutes. The bather should wet the face and chest
before entering the water. It is best to enter the bath suddenly, as the
sensation of cold is thus far less noticeable than when the bath is entered
gradually. If the stay in the tub is more than momentary, vigorous rubbing
must be kept up during the entire time spent in the tub.
For persons in good health a cold dip on rising in the morning is
excellent. It creates an appetite, accelerates the circulation, arouses the
nervous system, and produces decided exhilarating effects in those who are
strong enough to react after it. When employed for this purpose, the
immersion should not be more than from three to fifteen seconds. The
bather must rub herself vigorously while in the tub, and follow the bath
with brisk toweling and plenty of friction. She should then take moderately
active exercise for fifteen to twenty minutes.
For any one just beginning to take the cold dips, the temperature of the
water should be just 1 degree below that of the body, and gradually lowered
by a drop of 1 degree every morning or two. Or, the dip may be preceded by
a preliminary warm bath or warm shower.
The salient point in connection with bathing is not to allow the skin to
lose heat too rapidly. To apply this as a warning in the case of cold baths: it
has been estimated that the heat loss from the body immersed in cold water
at the temperature of 86° F. is double the normal; at 77° F., three times, and
at 68° F., five times, the normal.
The daily use of the cold dip for those who are able to react after it is one
of the best means of fortifying the system against both acute and chronic
diseases.
Contraindications.—The use of the cold dip is contraindicated for young
children, the aged, and in run-down conditions of the system; in all cases
where the action of the heart is weak, in Bright’s disease, or in any acute or
chronic congestion of the kidneys; in all acute inflammations, as

inflammation of the bowels, peritonitis, or inflammation of the uterus and
ovaries.
Alkaline Baths.—For these baths from 4 to 12 ounces of the carbonate
of soda should be used to 30 gallons of water. The water should have a
temperature of from 92° to 96° F. This bath is useful in many forms of skin
disease, and relieves the itching of jaundice and urticaria.
Saline Baths.—The typical saline bath is the salt-water bath. Sea-water
contains in solution from ⅓ to ¼ pound of solids to the gallon of water. The
principal ingredients are common salt, magnesium chlorid, and magnesium
sulphate. These substances have a decidedly stimulating effect upon the
skin and encourage reaction. For an artificial sea-water bath, 8 pounds of
sea-salt should be used to 30 gallons of water.
Ordinary coarse salt is purer, contains from 97 to 98 per cent. of the
chlorid of sodium, is cleaner, and makes a clearer solution, and it dissolves
in about one-third of the time required for sea salt, and can be obtained for
about one-third of the cost.
As a cleansing agent, a 5 per cent. brine is equal or superior to soap.
Further, the axilla and hairy parts remain clean and sweet for a much longer
time than after the use of soap. These brine baths, taken three times a week,
are followed by a great improvement in the general health.
The Rain Douche or Shower Bath.—The shower is the most tonic of all
the baths that can be taken at home, and no bath-room should be considered
complete without it. In this form of douche the water is projected through a
perforated disc, falling upon the bather in a number of fine streams. It is
necessary for the bather to wear a rubber cap in order to keep the hair dry.
In taking the shower bath the bather stands up; the disc is generally placed
about 3 feet above the head. The water should be allowed to fall first upon
the feet, then the hands, arms, shoulders, back, and, lastly, upon the chest
and abdomen. The bather should keep in active motion during the
application, flexing the limbs, and rubbing the chest with the hands. At the
beginning of the shower the hands should be placed over the chest, in order
to protect the precordial region from the impact of the water.
The cold shower should be preceded by some kind of a heating process—
either a hot plunge or a hot shower bath. A shower of from 100° to 104° F.

may be applied for one to three minutes before the cold application. A cool
shower of 75° to 65° F. is an excellent training for persons who are sensitive
to cold. The neutral shower, 92° to 97° F., given for three to five minutes, is
sedative in its effects.
The cold shower, 60° to 70° F., duration from five to thirty seconds, is
useful in phlegmatic neurasthenics and dyspeptics; sedentary people in
whom the general metabolic activity is diminished; also in obesity and in all
cases after a sweating process. By standing in hot water the bather is much
more tolerant of cold.
The neutral shower is one of the most effective measures for the relief of
insomnia; especial attention should be given to the back and legs. The
action is quicker than that of the neutral immersion bath.
As a hygienic measure, the shower bath offers a most agreeable and rapid
means of cleansing the whole surface of the body.
Since the effect of the douche depends on the pressure, it will be readily
understood that the hose attached to the faucet of the domestic bath-tub is
merely a sprinkler, and not a douche, in the proper sense of the word. Such
a procedure can only be tolerated by the most robust. In the upper stories of
most city houses the pressure is probably not more than from 3 to 10
pounds; the stream of water from the sprinkler is really only a drizzle; the
mechanical effects being so slight, there is no reaction produced; the result
is that its use is followed by a feeling of chilliness and depression.
The Hot Foot-bath.—The temperature of this bath should be at the
beginning from 102° to 104° F., and the duration from three minutes to half
an hour. The pail is nearly filled with water, care being taken that it shall not
be so full as to overrun when the feet and legs of the bather are put in. A
blanket, closely wrapped about the patient and the pail, should come up
above the knees. As the water cools off, hot water should be added.
This form of bath is most commonly used to relieve congestion and
inflammation. The dilatation produced in the blood-vessels of the feet and
legs relieves congestion of the brain and the organs of the upper half of the
body, as well as of the pelvic viscera. It should be taken immediately before
retiring.

The Sitz Bath.—The sitz or hip bath requires a tub made for that
particular purpose. The back of the tub, which is most commonly made of
tin, is cut high, while the front must be sufficiently low for the patient to sit
comfortably in it, without undue pressure being made on the under side of
the knees.
The tub is half filled with water of the prescribed temperature. It is well
to begin with water at a temperature of 102° F., and increase the
temperature while the patient is in the tub, making it as hot as is
comfortable.

Fig. 2.—Sitz-bath tub made of tin (Ashton).

In giving all hot baths a thermometer must be used, and a word of
warning must be given about adding hot water in case of sickness, as well-
authenticated cases of paralysis are recorded in which the temperature sense
of the patient was lost, and, in adding hot water, it was raised to such a
temperature that the legs and feet of the patient were scalded.

During the sitz bath the patient keeps on her stockings and bedroom
slippers, and, unless friction is ordered, the entire body, as well as the feet
and legs, are enveloped in blankets.
The duration of this bath is from three to ten minutes. This bath is
especially useful in restoring the menstrual function when it has been
suspended as the result of chill or other causes; also, for relieving
hemorrhoids, uterine colic, neuralgia of the ovaries, and inflammation of
the bladder.
To prolong the effect of the bath the patient may be put to bed wrapped
up in her blankets. In cold weather it is a good precautionary measure to
have the bed heated with hot-water bottles, in order to prevent chilling.
Salt Ablution.—As the name indicates, this is a salt-water bath, and the
best results are obtained by using a saturated solution, which is in the
proportion of 1 pint of salt to 1 gallon of water. Sea-salt is the best, but, if
that cannot be obtained, ordinary salt may be used.
If there is no bath-tub in the house an ordinary wash-bowl may be used,
but the bath is most effective when taken in the tub. The salt and water are
put in a papier-mâché pail, which is placed at the foot of the tub. The
chilliness which might be caused by sitting on the cold porcelain is avoided
by placing a heavy folded bath-towel on the bottom of the tub. In cold
weather the tub should be previously heated by allowing the hot water to
run in.
The salt water feels very much colder than plain water at the same
temperature. It is well to begin with a temperature of from 90° to 85° F.,
and gradually lower the temperature until 70° F. is reached.
The water is applied by means of a Turkish wash-towel, accompanied by
vigorous friction, beginning with the face and neck, arms, legs, back, and,
lastly, the chest and abdomen are gone over. After that, the water is dashed
over the entire body, and is followed by a brisk toweling and friction with
the hands or hair glove. The salt water should not be washed off, except in
those rare cases where it causes a disagreeable sensation; it is then removed
by the use of the hot followed by the cold shower, as previously directed.
Indications for Its Use.—It is an excellent nerve tonic in cases of
depression with loss of appetite, insomnia, etc., also in anemia and

neurasthenia. In this class of cases it is best taken in the afternoon, on rising
from the siesta, and just before dressing for dinner. It is especially
refreshing in the hot weather.
Its use is contraindicated under the same conditions that other cold baths
are, and must never be taken when the bather has a tendency to chilliness.
The various kinds of baths previously described can all be obtained in the
home, but the Turkish bath, with its various accessories, can only be taken
in a properly equipped bathing establishment.
The Turkish Bath.—This form of bath dates back to the time of the
Romans. The essential features of a modern establishment are: dressing-
rooms; a warm room, with a temperature of from 110° to 130° F.; a hot
room, temperature of 150° to 170° F.; a steam room; a shampoo room; a
douche apparatus; a plunge bath, and a cooling room. In many
establishments there is only one hot, dry-air room. The air of the room may
be heated by steam-coils.
The bather, having disrobed, is enveloped in a sheet, and enters the hot
room, where she reclines on a steamer-chair. A towel wrung out of cold
water is placed on the forehead and changed as often as it becomes hot. The
bather should drink a glass of cold water immediately before or on entering
the hot room, and several glasses should be taken at intervals during her
stay in this room.
The skin is highly stimulated and profuse perspiration results. The
profuse sweating promotes absorption from the alimentary canal, and so is a
powerful stimulant to nutrition. It also emphasizes the necessity for copious
water-drinking.
Great harm often results from a too prolonged stay in this room.
Ordinarily, the bather should leave the room as soon as free perspiration is
established; that is, in from fifteen minutes to half an hour.
From this room the bather next enters the Russian bath or steam room. It
is very much more agreeable to have very little steam in the room on
entering; when the steam is very dense, a feeling of suffocation may occur.
Any one with a weak heart should avoid the steam room altogether, as it is
apt to cause a sense of great oppression. For the complexion, bronchitis, or
laryngitis, it is excellent.

From the hot room the bather goes to the shampoo-room, where, lying
upon a marble slab, she is first gone over from head to feet by the wet hands
of the attendant. This manipulation removes the layer of cuticle which has
been loosened by the free perspiration. These rubbings and strokings are
continued until the skin feels smooth and polished.
The bather is next shampooed with soap and water, applied with a bath-
brush. This may in turn be followed by a salt rub. After this comes a
douche, given with a horizontal jet, at a temperature of 104° to 106° F.,
followed by a cold douche.
If the bather is a strong woman, she may now enter the cold plunge. The
temperature of this should be from 70° to 60° F.; this must only be a quick
dip. She is then vigorously rubbed and dried. After this she lies down in the
cooling room and has an alcohol rub, which completes the procedure. She
should rest here for half an hour at least before dressing. The pulse should
be normal and the skin perfectly dry before she dresses and goes out on the
street.
In winter, instead of the ordinary alcohol rub which is given, it is much
better to have a thorough massage with cocoa-butter or almond oil—the so-
called Roman bath. Just following the Turkish bath much of this oil will be
absorbed, which is beneficial for thin people, and, in any case, it will lessen
the danger of getting chilled on going out into the cold air.
The woman unaccustomed to these baths should under no circumstances
go to a Turkish bath without consulting her physician, as great harm might
result. The bath should not be taken oftener than twice a week, unless by
special orders of the physician. Care must be taken not to overuse them, as
frequent and prolonged exposures to the sedative influence of heat is very
debilitating. The wise woman will provide her own bathing cap, bath-brush,
and straw sandals.
The use of the Turkish bath is indicated in rheumatism, toxemia, chronic
dyspepsia, biliousness, obesity, sciatica, and lumbago.
The contraindications to its use are, in Bright’s disease of the kidneys, in
most pulmonary affections, in the advanced stages of arteriosclerosis, and in
diabetes with emaciation.

The Electric-light Bath.—This is now frequently used instead of the
hot-air room of the Turkish bath, and possesses many advantages. A cabinet
is lined on three sides with mirrors, on which are arranged 50 or 60 electric-
light bulbs; the mirrors multiply the number of lights by reflection. A stool
is placed in the cabinet for the patient to sit on, while the head protrudes
above the top, which is closed. By means of switches and a proper,
grouping of the lamps in wiring, the number of lights, and so the
temperature, can be instantly and perfectly controlled. The heat is derived
by radiation, so that it is not necessary to have the air confined. In this form
of light bath the body is directly exposed to the effects of radiant light and
heat.
The incandescent electric-light bath is superior to every other form of
heating procedure in which the only object is the preparation for the cold
bath. The time required is not more than from three to five minutes. When it
is desired to produce profuse perspiration, the patient may remain in from
eight to fifteen minutes. A longer stay than this is apt to produce an
overstimulation of the nervous system and an excessive elevation of
temperature.
The electric-light bath possesses the distinct advantages that, while the
body is exposed to a high degree of heat, the air of the room in which the
head is, and which one is breathing, may be cool, and unique advantages in
the exactness of the dosage as regards time and intensity. It can also be used
in a much greater number of diseases than the hot-air room of the Turkish
bath.
The finishing treatment on leaving the cabinet is identically the same as
that for the ordinary Turkish bath.
Indications for Its Use.—While the electric-light bath is not a complete
substitute for sweating produced by exercise, it comes nearer to that than
any other heating procedure, and, when followed by some vigorous cold
application, it possesses a hygienic value which cannot be overestimated.
It is especially valuable in cardiac disease and diabetes. It stimulates
oxidation, and is thus valuable in obesity and the toxemia of chronic
dyspepsia; also in malarial cachexia, syphilis, neuritis, neuralgia, sciatica,
habit chorea, hysteria, rheumatism, and anemia.

It is superior to all other treatment in chronic rheumatism and all diseases
dependent on uric-acid diathesis or diminished metabolism, by the
combined action of the elevation of temperature and the vigorous cutaneous
activity. The elevated temperature stimulates the oxidation of the proteid
wastes and augments vital combustion, while the increased skin activity
carries off all waste-products prepared for elimination.
As a prophylactic, this form of bath is especially valuable for all persons
leading a sedentary life; it is the best substitute for exercise in the open air,
and, where there are no contraindications to its use, should be taken once a
week.
In cases of obesity, sweating may be used to reduce the weight; but, in
order to obtain the best effects, it must be combined with exercise, and it
must be borne in mind, that in obesity there is great danger of overheating
the blood, in consequence of the obstacles to heat elimination presented by
the thick layers of non-conducting fat. Therefore, these hot applications for
the reduction of fat should never be too much prolonged, and the bath
should always be finished by vigorous applications of cold. These cold
applications have also a tonic effect upon the nervous system, and increase
the muscular disposition for exercise, and this is the most rational treatment
for obesity.
Loss of Weight.—There are many cases in which metabolism has been so
sluggish, allowing an accumulation of imperfectly oxidized matters in the
body, that the first active stimulation of the nutritive processes is in
disproportion to the increased destructive metabolism. Under these
circumstances there is necessarily a decrease in weight. The rubbish must
first be removed and old defective structures before new and highly
organized tissues can be deposited. A slight loss of weight need, therefore,
give rise to no apprehension, but if the loss is considerable, or continues for
some time, especially if accompanied by loss of strength or appetite, it is a
matter for investigation.
Palpitation of the heart and fulness of the head are an indication that the
applications have been too hot or too long continued. Vertigo and fainting
are apt to occur when hot applications have been continued too long, but
they are quickly relieved by cold applications, especially by cold affusions
to the chest and shoulders. Headache may result, either from excessively

hot or cold procedures. Deficient reaction is generally the result of a too
prolonged application of cold.
On entering the electric-light cabinet, a wet towel wrung out of ice-water
is placed around the neck and another around the forehead; or an ice-bag
may be placed on the top of the head.
The Douche.—A douche consists of a single or multiple columns of
water directed against some portion of the body. The apparatus is
complicated, and it is essential that an accurate pressure-gauge and
thermometer should be introduced into the circuit of the douche. It can only
be properly administered in a hydriatic establishment. In the employment of
the douche three factors must be considered—the temperature, pressure,
and the mass.
The range of temperature employed varies from 45° to 125° F. The
pressure ordinarily employed varies from 10 to 60 pounds. The mass varies
according to the effect desired, and may be regulated by means of the
finger, placed in the water column near the nozzle.
The douche is applied by means of the rubber hose, which is connected at
its proximal end with the water-supply, and at its distal end is attached a
nozzle, the average diameter of which varies from 2 inches to ⅜ inch. From
these a fine or coarse jet or a fan douche may be produced. The latter is
formed by placing the index-finger of the hand holding the nozzle upon the
lower border of the outlet, producing an expansion of the otherwise solid jet
into a fan-shaped stream.
The mechanical effects of the douche are derived from atmospheric
pressure, and this is of more importance in the effects produced than the
temperature.
The Scotch douche consists of alternate streams of hot and cold water.
The general cold douche is the most powerful of all the tonics; the warm or
neutral douche is sedative; the very hot douche is frequently followed by
atonic reactions.
Rationale of the Douche.—The douche is a thermic massage. Since the
douche is a sorbefacient of pathologic products, the French have availed
themselves of its use to aid the body to throw off an excess of uric acid,
fatigue toxins, etc.

It has been demonstrated that a rain douche of 50° F., under a pressure of
two atmospheres, increases threefold the work that the muscles are capable
of doing, while the Scotch douche, oscillating between 98° and 53° F.,
doubles the working capacity of the muscles. Even tepid douches increase
the working capacity of the muscles, while a tub-bath of the same
temperature is without decided effect. The pressure under which the douche
is given adds a powerful element, which is absent in other hydriatic
procedures. The percussion and vibration affect the vasomotor system much
more powerfully than any form of still bathing.
The power and action of the heart are greatly improved by the use of the
douche, the capacity of the lungs is increased, and the digestion is
improved.
Brief douches of from ten to fifteen seconds generally act better than
those of longer duration. The general condition of the patient must always
be carefully studied, and, like the Turkish bath, the douche should always
be taken under the direction of a physician, as they are also capable of
doing a great amount of harm as well as good. The best results from the
douche are obtained when it is taken following the use of the electric-light
bath.
The neutral douche is particularly applicable in cardiac affections and in
cases of high arterial tension. The sensation afforded should not be either
that of hot or cold, and the duration from one to two minutes. The douche
for this purpose should be given with only a slight degree of pressure, and
to avoid irritation it should be directed to either side of the spinal column.
This is a sedative application.
Contraindications for the Use of the Douche.—In all acute
inflammations and in eruptive disorders of the skin. The cold douche is
contraindicated in inflammation of the uterus, ovaries, kidneys, stomach,
liver, bowels, and bladder, in intestinal catarrh, chronic inflammation of the
stomach, and general neuritis. It must also be avoided in rheumatism,
arteriosclerosis, cardiac insufficiency, valvular diseases of the heart with
deficient compensation, fatty degeneration of the heart, and in cases of
extreme nervous irritability.
The Internal Use of Water.—The internal use of water is essential to
life. Water constitutes about two-thirds of the body weight; it is found in

every tissue and organ of the body; it acts to dilute the foods so that they
can be absorbed from the digestive tract; its presence in the blood is
essential, both to carry foods to the tissues and to convey the waste matter
away from the tissues. Its use in the form of a lavage is even more
necessary, to keep clean and free from impurities the mucous membrane
lining the 30 feet of the digestive canal and the tubules of the kidneys than
is the external use of water to keep the skin in a healthy condition. Its use is
also needed to keep the blood-pressure and the heart in a normal condition.
About 4½ pints of water are given off daily in the excreta and
exhalations; but, since about one-half of the solid foods taken consist of
water, 3 pints of water, taken daily as such, are sufficient to counterbalance
the loss.
All water for drinking purposes should be filtered. The best method is to
have a filter attached to the pipes of the house-supply, so as to insure
filtered water running from all the spigots.
If the water is not filtered, it should be boiled for thirty minutes. The
water should be run off in the morning, then poured into a well-kept tea-
kettle and boiled. It is then allowed to stand and become partially cooled in
covered vessels, when it is poured into large bottles—quarts are the most
convenient size; these should be stoppered with corks of absorbent cotton.
When cool, the bottles are placed in the refrigerator beside the ice. Water
should be boiled every morning for the twenty-four hours. Boiling for this
length of time secures the destruction of all the germs of disease, and it is
doubly essential on the return to town in the fall, when the house has been
closed for some time; also when typhoid fever in the neighborhood
indicates the strong possibility of the impurity of the water-supply.
The mistake should not be made of undoing the good that has been done
by boiling the water by the addition of ice to the water when it is placed on
the table. Furthermore, ice-water is so cold that it retards and interferes with
the digestive processes.
In the internal use of water the same marked difference is caused by the
different temperatures at which the water is taken, as was seen in the
external applications of water; but, while the temperature of the skin is
about 90° F., that of the mucous membrane lining the digestive tract is 98.6°
F. and above.

The Action of the Internal Use of Water on the Heart and Blood.—Water
improves the quality of the blood, both by its direct action on the
constituents and by the increased elimination of waste-products. By the
increase of the volume of blood, a more energetic contraction of the heart is
caused, and the activity of all the glands of the body is increased. There is a
greater amount of oxygen absorbed by the lungs; oxidation in the tissues is
carried on more perfectly, the result of which is that there is a diminution or
absence of the products of incomplete combustion in the body, such as uric
acid, the oxalates, etc.
By the increase of the blood-pressure, caused by drinking water in
sufficient quantities, the activity of the kidneys is increased, and this not
only in the amount of urine passed, but also of the solid constituents, which
are the waste-products, removed from the body through the agency of the
kidneys.
The Action of Water on the Digestion.—Very little water is absorbed from
the stomach; it passes from the stomach to the intestines, where it is
absorbed. In order to obtain a thorough cleansing of the stomach, and at the
same time not to cause its overdistention, not less than ½ pint of water and
not more than 1½ pints should be taken at one time. The water must be
taken one hour before meals, in order to insure its removal from the
stomach and the proper rest of that organ before food enters it, as it has
been found by actual experiment that in a quarter of an hour after water had
been taken one-half of the quantity remained in the stomach, but that none
remained after the lapse of half an hour. Cold water is more quickly
absorbed than warm, and the absorption is hastened by the presence of
carbonic acid, while salt of any kind delays its absorption.
The Therapeutic Indications for the Use of Water.—First, the temperature
of the water taken must be regulated by the effect desired. Briefly stated, if
the water is taken for dyspepsia in any form, whether acute or chronic
catarrhal inflammation of the stomach or the intestinal canal, ½ pint of
water, just as hot as it can be sipped with a spoon, should be taken three
times a day, one hour before each meal.
No water should be taken during the meal, and only one glass, at a
temperature of about 60° F., on its completion.

If the water is taken as a diuretic, or, in other words, to increase the
activity of the kidneys, the most of the water should be taken in the morning
on rising and the remainder about 4 o’clock in the afternoon. Probably the
best natural waters for this purpose are the waters of the Vosges, France.
The Vittel water, “Grande Source,” acts on the kidneys alone; where the
bowels are regular or inclined to be loose, this is the best water to use. If, on
the contrary, there is constipation or biliousness, the “Source Salée” should
be taken in connection with the first named or alone. The “Source Salée”
has a decided action on the liver and is laxative.
In order to obtain a pronounced effect, at least 3 pints of these waters
should be taken daily; in some cases more is required. Two glasses may be
taken on rising in the morning, with an interval of twenty minutes between;
the last glass must be taken one hour before breakfast. The temperature of
the water should be 50° F., which is the temperature of the water at the
springs and that of the water when placed in bottles in the refrigerator
against the ice. In the afternoon the other two glasses may be taken, with
the same interval between.
In gastric catarrh, where there is an accumulation of mucus or fermenting
matter, with or without nausea and vomiting, hot water alone is useful. In
addition to its action in diluting the contents of the stomach and the
intestines, and its cleansing and antiseptic effect on their mucous
membranes, the reflex effect of very hot water, slowly sipped, is a
stimulation of their muscular coats, which furthers the passage of the
digested food from the stomach into the intestines. The quantity taken must
be from ½ to 1 pint, in order to obtain a thorough cleansing and yet not to
cause an overdistention of the stomach.
In acute nephritis, inflammation of the kidneys, small quantities of very
cold water, repeated at half-hourly intervals, act as a diuretic. Care must be
had, however, not to overtax the stomach and heart by overfilling the
system with fluids.
In obesity, water-drinking is essential as a means of dissolving and
carrying out of the body the large amount of broken-down material which
results from the increased tissue destruction caused by exercise, hot and
cold baths, and other means employed to decrease the weight.

For constipation and biliousness two glasses of cold water should be
taken before breakfast, with an interval of twenty minutes between, the last
glass being taken one hour before breakfast.
Contraindications.—Cold water taken into the stomach produces more
marked effects than water applied to an equal area of the skin. The quantity
of water taken is a factor as well as the temperature. Cold-water drinking
lowers the temperature and slows the pulse, so that drinking cold water
must be strictly prohibited when one is in a state of fatigue, whether
perspiring or not. Feeble persons should not drink cold water, except in very
hot weather, or just before starting out for a brisk walk in the open air, or
when about to engage in other exercise. With the air of the room at 70° F., a
woman in fair condition, moving about making her toilet, may safely drink
cold water slowly, except when there is a feeling of chilliness. In the latter
case, the powers of reaction being diminished, chill and internal congestion,
often resulting in great injury, may be produced. Cold-water drinking is
always prohibited when in a state of fatigue. Ice-water should never be
taken. When taken with meals, it greatly retards digestion and may do much
harm.
Enemas.—Coloclysters.—Another valuable internal use of water is for
emptying the lower bowel, and washing out the large bowel in cases of
catarrhal inflammation.
For constipation, in which the object is to unload the bowel as quickly as
possible, 1 or 2 pints of water, at a temperature of from 104° to 110° F., is
made into a suds by means of Castile or other good soap, and poured into a
fountain-syringe. If the enema is being given by an attendant, the patient
lies on the right side in the Sims’ position; the under leg is stretched out so
that it forms a straight line with the trunk, while the upper leg is sharply
flexed at the knee, so that the foot is opposite the knee of the under leg; the
right arm is thrown back from under the body.
If the patient is administering the enema to herself, the best position is
the knee-chest. In this the patient kneels on the floor, the thighs are held
rigid, and while the shoulders are brought to touch the floor, the face is
turned to one side. The position can only be taken satisfactorily with the
corsets and all tight bands around the waist removed. In this position
gravity causes the intestines to fall upward toward the waist, and the water

naturally follows this course. In this position the water goes up higher, and
is retained longer, than when taken in the other positions. Two pints of the
soap-suds are prepared at the proper temperature, and the patient uses as
much of this as she feels that she can retain. The water should be retained
from five to ten minutes, to get the best results.
For the purpose of washing out the large intestine more water is used, but
not more than 2 quarts should be used for this. The position of the patient
and the temperature of the water are the same. But for this clyster, instead
of adding soap to the water, cooking salt is used, in the proportion of 1
teaspoonful of salt to 1 pint of water.
This lavage of the intestine removes rapidly large masses of decomposing
material, swarming with microbes and ptomains and the toxins produced by
them. It also increases the activity of the portal circulation.
In cases of chronic constipation there are atony and dilatation of the
colon, and the patient always carries about with her an enormous
accumulation of fecal matter, and lives in a state of chronic
autointoxication. In this class of cases the coloclyster should be
administered daily for from two to three weeks; if need be, so long as the
patient complains of gaseous distention and fetid flatulence. After the
discharge of the warm water, 1 pint of cool water should be introduced,
beginning with a temperature of 85° F., and gradually decreasing this from
day to day until 70° F. is reached. This water should be retained if possible;
it acts as a tonic bath for the colon.
Care should be exercised to avoid the distention of the colon by an
excessive amount of water, and, after the colon has been thoroughly
cleansed, the amount of water used should be decreased from day to day,
until finally only 1 pint is used. Warm water is always relaxing, whereas
cold water stimulates and tones up the bowel. If the quantity of water used
is small, the cold coloclyster may be used indefinitely without producing
constipating effects.
Great care must be used to avoid the introduction of air into the bowel
with the water; to this end the water is allowed to run out of the nozzle
before its introduction into the rectum. A small-sized nozzle should always
be used, and this should be lubricated with vaselin or some other emollient,
in order to prevent irritation of the mucous membrane.

Vaginal Irrigations.—To be of any service the vaginal douche should be
taken in the horizontal position. It may be taken on the bed, couch, or lying
on the floor. When taken on the floor, a heavy rug or steamer blanket should
be doubled four times, and two pillows are used: the under one goes up and
down for the support of the back, while the second is used for the support of
the head. A douche-pan is, of course, indispensable. The agate pans holding
4 quarts of water are the most serviceable. The douche-pan is placed against
the lower edge of the under pillow, which is protected by a bath-towel. The
woman must throw a heavy shawl or blanket over herself while taking the
douche, otherwise there is great danger of becoming chilled, and thus doing
actual harm instead of good.
The most common and best form of syringe is the fountain-syringe. This
is hung about 6 feet above the bed or floor. It should hold 4 quarts of water;
this quantity of water is necessary when the douche is given, as it most
commonly is, for pelvic inflammation. On beginning its use, the
temperature of the water must be controlled by the sensitiveness of the
patient; generally one can use a temperature of at least 112° F., but not
always; sometimes one must be content with a beginning temperature as
low as 104° F., gradually increasing the temperature by two degrees every
few days, until from 114° to 120° F. is reached. The use of a bath
thermometer is always essential to test the temperature of the water. The
temperature of the douche should never go above 120° F., or actual harm
will be done.
On lying down, the lower part of the body rests on the broad strip of the
douche-pan, the nates coming over the edge, and the clothing well pushed
up, otherwise the water will seep up the back.
The water acts as a hot poultice about the uterus and its adnexa; it is also
astringent, and greatly relieves ovarian irritation and congestion. It is highly
sedative, and is best used at night just before retiring. In severe cases better
results will be obtained by its use twice daily. In that case one douche must
be taken in the morning, but in cold weather it must never be taken
immediately before going out-of-doors; there must be at least one hour
between the time of taking the douche and going out into the cold air.
Patients taking hot douches must be warned that the pelvic viscera are much
more susceptible of chilling because of these heating procedures, and of the

necessity to counteract this tendency by the wearing of woolen abdominal
bands, both night and day.
Ordinarily, plain hot water is all that is necessary to use, but if the vaginal
discharge is irritating, one teaspoonful of borax may be added to the pint of
water; or one teaspoonful of cooking salt; or one-half teaspoonful of the
sulphate of zinc.
Douching the Ear.—This procedure is made use of to remove impacted
ear-wax or to relieve the pain of earache. A small fountain syringe should be
used, hung not more than 3 feet above the head. The water should have a
temperature of from 105° to 110° F. The nozzle must be small, and have a
very fine opening, and great care must be used in its introduction not to
allow the nozzle to enter beyond the external opening of the ear. A pus-
basin or small dish may be used to protect the clothing from getting wet.
After the procedure is finished, the ear is dried by means of a very fine
handkerchief or a little absorbent cotton.

CHAPTER III
THE CARE OF THE SKIN AND ITS
APPENDAGES
The Complexion; the Action of the Bath in Health; the Proper Time to Bathe; the
Care of Wash-cloths; Cleansing the Face; Protection of the Face; the Use of So-called
Cosmetics for the Face; Facial Blemishes, Freckles, Liver Spots, Sallow Complexion,
Pimples, Acne, Eczema, Wrinkles, and Their Treatment; the Relation of Diseases of
the Skin to Internal Disorders.
The Hair; Dandruff; Causes and Treatment of Premature Thinness of the Hair and
Baldness; the Care of the Hair; Gray Hair.
The Cosmetic Care and Treatment of the Hands; Cosmetic of the Nails; the Care of
the Feet; Painful Affections of the Feet.

The face is a complete index of the life of the individual written large, so
that he who runs may read. By looking at the condition of the skin and the
whites of the eyes we can judge very fairly of the digestion. From the
dulness or brilliancy of the eyes we can make a very good diagnosis of the
mental condition. From the general expression of the face we can read the
kind of life that has been led by the individual, whether of pleasure,
dissipation, or sorrow.
From greatest antiquity men and women have striven to beautify their
bodies. To be indifferent to the personal appearance is an indication of some
abnormal condition in the individual or her environment.
The Complexion.—The skin of the face is known as the complexion,
and this is the part of the skin that is most exposed to the vicissitudes of
dust and grime of the streets or of the occupation, as well as to heat, cold,
and winds.
An ideal complexion combines the qualities of clearness, translucency,
and fineness of the outer skin, with a proper disposition of the blood-supply.
The beauty of the skin is evidence of good respiration, good digestion,
proper excretion by the bowels, skin, and kidneys, good condition of the

blood, and plenty of outdoor exercise.
It is now well known that the skin, as well as other parts of the body,
depends for its integrity upon the general nervous system. Disturbance
anywhere in the body acts upon the central nervous system. A simple case
of indigestion often manifests itself over considerable areas of the skin.
It cannot be too earnestly impressed on the reader that beauty is entirely
dependent on the health. It will readily be seen that no external applications
can produce such qualities as fineness of texture, translucency, and delicate
play of coloring produced by the contraction and dilatation of the blood-
vessels.
The natural order in which to consider the skin will be first as subservient
to health, and then as it is conducive to beauty.
The Action of the Bath in Health.—Not only in the art of pleasing, but
in the maintenance of health, neatness of person must be carried to
perfection. By the use of friction, soap and water, the scarf-skin becomes
more and more constantly renewed by the layers underneath it. It becomes
softer, more pliant, and finer than satin in appearance and texture. Besides
this, as has already been shown, bathing has upon the corium or true skin,
and thence upon the general system, a revitalizing influence. Combined
with the proper kinds of soap, avoiding the use of irritating ones, bathing
removes from the skin all effete oily matters, scales of the scarf-skin, crusts,
the saline matters excreted by the perspiration, dust of all kinds, soot,
particularly that from the clothing, and so forth.
Caustic soaps and borax in excess may remove the oil in so great
quantities as to be detrimental to the skin.

PLATE I
Facial expression.

Within twenty-four hours the skin, especially those parts which are
covered, becomes vested with a pellicle of impurities, which, when allowed
to remain, become thicker every day, and may produce injurious effects by
obstructing the excretory openings and affording lodgement for disease.
The effects would be felt not only in the skin, but in the whole organism.
The skin when not cleansed will be irritated chemically and mechanically.
The Proper Time to Bathe.—This depends on the nature of the bath to
be taken, the strength of the woman, the temperature of the room, and the
season of the year.
To repeat, a cold bath of any description must never be taken unless the
body has a decided sensation of warmth. In winter, if she will drink a glass
of hot water before rising and has a warm room, the woman in average
health may take a cold sponge bath. But the body must be very gradually
trained to the application of cold, just as it is to vigorous muscular exercise.
For the woman who has never in her life taken a cold bath of any sort,
except in midsummer, to begin a heroic treatment with cold baths in winter
would be utter folly, which might easily be the cause of pneumonia and

even of death. The time to begin a systematic use of cold water is in
summer, continued through the autumn, and by the time midwinter has
arrived, the system has become so toned up that nothing but good can
result.
If the woman is not very strong, she had better begin with the cold
ablutions, just to the waist, on rising in the morning. These must always be
followed by a vigorous toweling and friction. In case of inflammation of the
kidneys or pelvic viscera, cold applications to the abdomen should be
avoided, as they are badly borne.
If the woman is anemic, has a poor circulation, or is conscious of her
heart, she will feel at her best in the afternoon. In that case, after a cup of
hot bouillon, taken on rising from her siesta, she may take a quick hot
scrub, followed by a cold shower. This is much more invigorating than the
cold ablution, and the reaction at that time of the day is more vigorous than
in the early morning.
From the simple ablution, the next step in training would be the cold wet
sheet. It is impossible to take this without an attendant, but a good maid
may readily be taught to give the necessary rubbing. Ordinarily, this will be
enough to attempt in one winter.
A strong woman, who has always been accustomed to taking cold baths,
may all the year round, except just before, during, and immediately after the
menstrual period, take a cold dip on rising in the morning. It must be
literally a quick dip in a tubful of cold water, from 65° to 55° F., or, if she is
sufficiently strong to stay in the tub longer, there must be a constant brisk
friction kept up while in the water.
It is permitted only a woman in good health, with a strong heart and
normal kidneys, to get into a tub of cold water, take a cold plunge, or
attempt sea-bathing.
For the woman who is a semi-invalid, the only time allowable for a cold
tonic bath is in the afternoon.
In cold weather the shower, like all other forms of baths, must be taken in
a warm room. The shower bath can be taken every day to the greatest
possible advantage. An ideal way is to rest for half an hour on coming home
in the afternoon; to sleep, if possible, then take a quick scrub, and follow it

first by the hot shower of 100° to 104° F., and finish with the cold shower.
A brisk rubbing should be kept up until the skin is in a good healthy glow.
This bath is followed by a feeling of great exhilaration, and it gives a
beautiful glow to the face and skin. It removes the tired feeling of the day’s
work, and leaves one feeling greatly refreshed for the evening. A daily
ablution or a daily shower, with friction, will not cause an undue removal of
the oil of the skin. All cold baths, when given in suitable cases, tone up the
system to resist disease, and are the best preventives against ordinary colds
and sore throat.
A hot tub-bath is best taken at night just before retiring. In winter it must
never be taken immediately before going out-of-doors, because the pores of
the skin are more or less open and there is great danger of chilling. A hot
tub-bath, remaining in the bath for some minutes, should not be taken more
than twice a week, as it is too debilitating, and a prolonged stay in the hot
water causes an actual loss of flesh.
A woman may take a warm sponge bath in a warm room at any time of
the month, but during the menstrual period she must, under no
consideration, take a cold tub-bath or even a cold sponge-bath, since this
would be apt to cause a chill of the surface of the body and a congestion, if
not an actual inflammation, of the pelvic organs.
No bath should be taken within two hours after eating, as the bath draws
the blood from the stomach toward the surface of the body and so interferes
with digestion.
The Care of Wash-cloths.—After using each time, the wash-cloth must
be thoroughly washed, well rinsed, and hung up to dry. But this is not
sufficient: once every week all wash-cloths must be sent to the laundry to
be boiled, thus insuring the destroying of any germs that may lurk in the
cloth. If a woman has any kind of skin disease, it is quite possible for her to
reinfect herself after the disease has apparently become cured. Further, each
member of the family should have her own individual towels, soap, and
wash-cloths. Aside from all sanitary questions, in a matter so intimate as the
bath, there is something repulsive in the thought of having your toilet
articles used by any one else.
A pure Castile soap is one of the best that can be used. All cheap scented
soaps should be avoided, as they are apt to contain impure materials that

will actually injure the skin. If the skin is rough, rubbing it with a good
sand-soap, and rubbing the same on the flesh-brush, will remove many of
the scales and leave the skin much smoother and softer. Medicated soaps
should never be used except by the direction of a physician.
Cleansing the Face.—The face should be well washed twice a day with
cool or cold water, but the temperature of the water should not be below 60°
F. The degree of coolness must be determined by the feelings and judgment
of the individual. If the face were washed with very hot or very cold water,
and then exposed to the cold air, the skin would become rough and chapped.
The water should be soft. To soften hard water, put 1 pound of bran into a
muslin bag, place in 4 quarts of water, and boil for fifteen minutes. Add
enough of this bran water to the bath to make the water milky.
A soft, woven face towel, kept for the face and neck only, should be used
with a moderate degree of friction. Great care must be used to wipe the skin
thoroughly dry.
It is a question whether the daily use of soap on the face is advisable; for
the healthy skin it is not essential and may prove very injurious. Soap
should never be used on the face in winter just before going out-of-doors, as
this would cause a roughening of the skin. When the hot tub-bath is taken,
the face should be well washed with soap and hot water, plenty of friction
being applied by means of the face towel, after which the face is thoroughly
rinsed with pure water. This will open the pores of the skin, and should be
followed by the use of cold water, which has a stimulant action on the
blood-vessels and improves the circulation in the skin. It also improves the
tone of the elastic fibers in the skin and tends to delay the appearance of
wrinkles.
If there is any tendency to dryness of the skin, a good cold cream should
be well rubbed in just after bathing the face. The cream must be a good
quality and perfectly fresh, as a rancid cream is irritating to the skin. Only
so much of the cream should be applied as will be absorbed by the skin.
When the skin is very thin, and there has been loss of subcutaneous fat due
to ill health or other cause, the systematic application of cream in this
manner aids in the nutrition of the skin; and, when applied to the neck with
good massage, is a great protection against sore throat due to exposure to
drafts and cold.

Protection of the Face.—The cold winds of winter cause a dryness of
the uncovered skin of the face and lips, which often leads to a painful
chapping, and, in the case of the lips, small fissures may be produced. In
addition to the use of cold cream, a good rice powder may be applied,
which serves as a further protection to the skin.
In very cold weather a veil should be worn to protect the face from the
cold and winds. In summer a parasol should always be carried, to protect
the eyes and brain as well as the face from the hot rays of the sun.
The Use of So-called Cosmetics for the Face.—All skin specialists, and
these are in the very best position to judge of the great amount of harm that
is done, say emphatically that the use of face lotions and “paints” can only
work the lasting injury of the complexion. They may assist in hiding the
defects of nature, but they frequently contribute to increase these defects.
Many of them merely fill up the pores of the skin and give it a pasty look.
Numerous cases of eczema and other diseases have followed the use of
paints. Of the advertised cosmetics, many are not only worthless, but
actually injurious.
Certain applications to the skin of the face are permissible and beneficial.
“Virgin milk,” which is a milky-looking mixture, composed of the tincture
of benzoin and rose-water, renders the skin soft, and is said to prevent the
formation of freckles. If the skin is dry, glycerin may be added to this. The
formula for this mixture is as follows: Take of the tincture of benzoin and
glycerin each 1 ounce, mix well, and then add 2 ounces of rose-water. This
should be applied by the fingers, just after the face is washed. Pure glycerin
is irritating, and should never be applied to the face without dilution.
The various good preparations of rice and talcum powder on the market
are perfectly harmless, and, if there is a tendency to greasiness or shininess
of the skin, the use of these is essential from an esthetic point of view. In
case of greasiness a little calcined magnesia may be used. In hot weather
the use of face powder is very refreshing, and in the hot climates it is used
for this purpose to a very striking extent. But the true cosmetics, and the
only ones that can procure and keep a beautiful complexion, are plenty of
exercise in the open air, attention to the diet, to the daily evacuation of the
bowels, to the condition of the kidneys, to baths, and to proper dress.

Facial Blemishes.—Among the most common facial blemishes are
freckles, liver spots, a sallow complexion, pimples, acne, eczema,
superfluous hairs, and wrinkles.
Freckles.—These are brownish or yellowish pigmentary spots, varying
from the size of a pin-head to that of a pea. They occur on the face and the
backs of the hands. They consist of a circumscribed deposit of pigment; not
much is known about their origin. The pigment is situated in the deep layers
of the epidermis, and, in order to remove the freckles, it is necessary to use
something capable of producing desquamation. As a rule, if left alone, they
will gradually disappear.
Liver Spots.—The so-called liver spots are irregular patches of a
brownish color, which appear most frequently on the face, neck, chest,
back, arms, and hands. If not caused by disorders of the liver and digestion,
they are certainly aggravated by them. They are not only unsightly
blemishes on the skin, but sometimes cause great nervousness by the
intense itching which accompanies them.
Sallow Complexion.—This is generally caused by disorders of the liver,
and is most frequently met with in hot countries. It is seen in chronic
dyspeptics, and, indeed, in most forms of chronic disease, and is not only a
symptom of the disordered bodily state, but a cause of its perpetuation. This
appearance of the skin is due to the accumulation of effete matters in it and
to its impaired nutrition, and this state exists not only in the skin, but in the
whole body.
Pimples, or Blackheads, and Acne.—These are affections of youth, and
are generally seen together, the last-named being simply a second stage of
the first. Pimples, or blackheads, appear as small elevations in the skin, with
a small black point in the center. The cause of the pimple is the alteration in
the quality of the sebum, the oily secretion, which becomes and remains a
hard mass in the excretory ducts of the sebaceous glands and plugs up its
external opening. The dust of the air becomes mixed with the fat, and thus
makes a black point. When the ducts cannot get rid of the sebum, they
become stopped up, and in consequence become swollen. This irritation
spreads to the adjacent tissues, and so inflammation arises. Finally, the
contents of the duct undergo degeneration, suppuration occurs, and the

contents become mixed with pus, small abscesses result at various depths in
the skin, and so require more or less time to break out.
This inflammatory condition of the sebaceous glands with their ducts is
apt to become chronic and may prove an obstinate affection. It occurs most
commonly about the face, on the back between the shoulders, or on the
chest. The skin is rough to the touch, the ducts of the sebaceous glands are
enlarged, and the skin is greasy.
Eczema.—This is the most common of all skin affections. It is a non-
contagious, inflammatory disease of the skin, sometimes acute, but more
often chronic, attended with itching and desquamation or loss of cuticle.
With the itching may be a feeling of heat and tension in the part.
Eczema is a local disease, brought about by a local irritation in the skin;
but, in addition to this, there is generally a predisposing cause, as some
disorders of the digestive tract, a bad condition of the blood, and so forth.
The skin, like other organs of the body, depends on the whole system for its
nutrition. When this nutrition is not sufficient, the skin appears pale, of a
peculiar color, and is easily taken up in folds, an evidence of poor nutrition
of the skin. When the skin is not properly nourished, every slight irritation
is liable to produce eczema.
Treatment of Liver Spots, Sallow Complexion, Pimples, Acne, and
Eczema.—First, the general treatment. While every case of skin disease
must be treated according to the peculiarities of that patient’s case, still,
there are general rules which should be followed in the treatment of all
cases, and first in importance comes attention to the bowels. There must be
procured, by some means or other, a free daily evacuation. A hard,
constipated movement is not sufficient. Fruits and vegetables are both
laxatives and the very best. Water is also a laxative, and 3 pints a day should
be taken, not only for the laxative effects, but also because this amount is
needed to keep the kidneys properly flushed. Of the simple medicinal
laxatives, one of the best is the effervescing granules of the phosphate of
soda; the dose is from one teaspoonful to one tablespoonful, to be taken in a
glass of cold water on rising in the morning. Sometimes patients who are
troubled with gas cannot take anything which effervesces; in that case, the
plain phosphate of soda may be substituted.

Next in importance to the attention to the bowels comes the diet. All
articles of diet must be easily digested, while at the same time they are
nourishing. Cereals, pies, pastry, fried foods, hot breads, rich gravies, rich
salads, pork, and veal must be excluded from the bill of fare.
Fresh meat must be eaten by a woman in health at least once a day, and
young girls need it twice a day. This should be supplemented with eggs and
milk, fresh vegetables, and not an excess of stale bread or toast. The latter is
constipating. Tea and coffee should both be avoided.
A glass of hot water, taken one hour before meals, will do much to rid the
stomach of mucus and put it in a good condition for the digestion of the
food.
For the congestion of the liver, which is so often at the bottom of these
disorders, it is generally necessary to consult a physician.
Pure air, associated with the proper kinds of exercise, promotes the
functions of the skin, assists in keeping the blood in good condition,
increases the vigor, keeps the complexion clear and increases its beauty;
while, on the other hand, a sedentary life in a confined air produces a pallid
and frequently a blotched skin, with headache and dyspepsia.
Steaming the Face.—It seems that the blood-vessels of the skin are much
better able to absorb vapor than water. The vapor penetrates and softens the
epidermis much better than the simple application of water would. The
increased secretion from the skin which is thus caused is beneficial. After
using the vapor bath the outer layers of the epidermis peel off and the
complexion is improved by the substitution of new pigment. The absorption
of the moisture also causes a roundness of the skin and a filling out of the
wrinkles. Generally, vapor baths can be used in those cases of skin diseases
where the skin is rough and dry. Next in importance to the vapor bath is
steaming the face. Bathing the face with very hot water is also
recommended.
Massage of the Skin.—Where the complexion is sallow, or there is a
tendency to pimples or blotches, massage of the skin of the face will do
much to improve the circulation.
The massage is most effective when it follows steaming or washing the
face in hot water. The tips of the fingers should be dipped in cold cream,

and then, pressure being exerted by them, the skin of the forehead should be
deeply stroked from the middle line out over the temples. The nose should
be stroked from the bridge outward and downward. The skin of the cheeks
should be pinched up and rolled between the fingers and thumb. All these
movements facilitate the emptying of the follicles.
Never use an ointment on the face that contains vaselin or lanolin, but
particularly the former, as they are both apt to produce a growth of hair, but
these preparations are excellent to increase the growth of the eyebrows.
Wrinkles.—In very many cases wrinkles are the result of habit of
expression, as in scowling; or an expression of dejection, when the angles
of the mouth curve downward, and so forth.
There are twenty-eight muscles about the mouth. Since all these muscles
are developed by use, the mouth comes to assume the expression given to it
by the thoughts of the individual. The figurative expression, “down at the
mouth,” comes to be literally true, and the angles of the mouth are seen to
be habitually drooping, until at last this is the fixed expression of the face.
A healthy frame of mind is the only means to keep the face from being
converted into a map of wrinkles and drooping angles at the mouth.

Fig. 3.—Muscles of the right side of the head and
neck.

The wrinkles are not, as a rule, caused by any trouble in the skin itself,
but in the underlying muscles, the tissues of which have become relaxed or
weakened. The circulation of the parts may be stimulated, and so increased
nourishment be secured by deep massage of the muscles, and, at the same
time, the use of a good cold cream will aid in the nourishment of the skin.
The face should first be washed and steamed according to the directions
already given. The massage of the face should always be carried out in a
systematic manner. Begin with the forehead. Stroke with the two thumbs
over the forehead, starting near the eyebrows, and work out toward the
roots of the hair. In the second movement one hand is used to stretch the
part worked upon, while deep friction is made with the tips of the fingers of
the other hand.
For wrinkles about the eyes, stroke with the tips of the fingers, over and
below the eyes, from the nose toward the temples. Great care must be taken

not to apply too much cold cream about the eyes, lest some of it should get
into them. For the removal of the “crow’s feet” at the outer angle of the eye
stretch the part with the thumb and finger of one hand, and perform friction
with the tips of the fingers of the other hand.
To remove the lines that run from the corners of the nose to the angles of
the mouth, stroke with both hands, one on each side of the face, beginning
at the center and lower part, and stroke upward toward the temples. This
upward motion counteracts the drawn and pulled-down condition of the
face.
For the cheeks, use both friction and deep kneading; pick up the muscles
between the thumb and finger.
To remove wrinkles under the chin and a double chin, begin at the middle
line, and with both hands make deep pressure upward and outward. To
remove superfluous fat, make deep friction with the tips of the fingers. In
the latter case, only use enough cocoa-butter on the fingers to prevent the
friction against the skin. The benzoin preparations, already given, will help
to contract the tissues.
A cold cream which is a good skin food is the following: Take of the oil
of sweet almonds, 2 ounces; of spermaceti, ¼ ounce; of white wax, ¼
ounce; and of rose-water, ½ ounce. Melt together at a moderate heat, the oil,
spermaceti, and wax, then gradually add the rose-water; stir the mixture
briskly and constantly until it is cool, and continue the stirring until it has
become uniformly soft and creamy. The Dover egg-beater will give it the
desired creamy appearance.
The Hair.—From an esthetic point of view, a head of luxuriant hair is a
matter of prime importance to the woman.
The hairs are peculiar modifications of the epidermis. The hair follicle is
a cylindric-shaped depression of the skin, whose funnel-shaped mouth
opens on the free surface. Immediately below this is a constriction, called
the neck, which is the narrowest part of the follicle; the duct of the
sebaceous gland, which supplies the hair with oil, opens at this point. The
base of the follicle is bulb-shaped, to accommodate the hair-papilla and the
hair-bulb. The hair-papilla contains the blood and nerve supply for the hair.
When a hair is plucked or falls out, a new hair grows from the hair-papilla.

According to Pincus, the life of a hair ranges from two to six years, after
which it falls out, to be replaced by a new one. In this way about fifty or
sixty hairs are normally shed every day.
In order to have thick, luxuriant, silky hair great attention must be paid to
the condition of the scalp, since it is the scalp which contains the blood-
vessels that nourish the hair. The scalp should be thick and pliable and
move freely over the bones of the skull. If the scalp is drawn tightly over
the bones of the skull, it tends to constrict the blood-vessels, and so lessen
the supply of blood to the scalp and cause atrophy of the roots of the hair
from pressure.
The hair has a great tendency to accumulate dirt. It catches the dust
flying in the air, and also retains the secretion of fat and the desquamated
epithelium of the scalp and the products of perspiration.
The two chief causes of the premature thinness of the hair are a deficient
circulation of blood in the scalp and dandruff, and it is said that dandruff
causes the loss of hair in 70 per cent. of all cases.
Dandruff.—The last few years has witnessed a revolution in the views
of the skin specialists in regard to the cause of dandruff. Previous to that
time it was considered as simply a collection of epithelial scales mixed with
more or less oily matter. Now, following the investigations that were first
instituted by Unna, dandruff is considered as a symptom of a parasitic
disease of the scalp, called seborrheic eczema. Sabouraud believes that the
same parasite that produces seborrhea causes the loss of hair. It is believed
that the parasite grows down into the hair follicle, between its walls and the
hair.
Seborrheic eczema is a chronic desquamative inflammation of the scalp
of bacterial origin. It is divided into two stages: the first may last from one
to seven years; it is attended with more or less dandruff in the form of
scales and dryness of the hair; or the dandruff may unite with the oil,
producing fatty crusts which are removed with difficulty. This is followed
by the second stage, in which the hair falls out.
Symptoms of Seborrheic Eczema.—In the dry form of the disease, in
which there is a scaling of the scalp, the hair is dry and unmanageable, the
head itches, especially when the patient sits under a light or becomes

overheated. There is a more or less constant falling of the scales upon the
clothes. The scalp looks pale, and will be found covered with fine grayish
or yellowish, readily detachable scales. Sometimes there is more or less
redness of the scalp. This is the mildest grade of the disease.
That dandruff is contagious has been proved by experiment, experience,
and treatment. Lassar and Bishop made a pomade of the scales taken from
the head of a student who was suffering from this disease, and rubbed it into
the backs of guinea-pigs, which caused the same disease in them, and
falling out of the hair.
Cases have been reported in which husband and wife have contracted
dandruff after marriage, he or she having been free before.
The drugs that are most efficacious in the cure of seborrhea are active
antiparasitics.
Causes of Seborrheic Eczema.—The general causes are debility,
constipation, and anything which undermines the general health. The local
causes are lack of cleanliness of the scalp, and using combs or hair-brushes
which have been used on the scalps of persons who were suffering from this
disease.
In most families will be found one or more members who possess enough
seborrheic infection to cause the spread of the disease throughout the rest of
the household.
Causes and Treatment of Premature Thinness of the Hair and
Baldness.—It has already been stated that 70 per cent. of these cases were
caused by seborrheic eczema. Among other causes may be mentioned a
progressive tightening of the scalp upon the skull, the scalp having lost the
cushion of fat that is under it in early life; insufficient or improper care of
the scalp; daily sousing of the head in cold water, combined with improper
drying of the hair afterward; sweating of the head; constant mental strain,
either on account of intellectual work or worry; wearing stiff, unyielding
hats; gout, and all diseases which lower the general nutrition.
The chief treatment is by prophylaxis, or using preventive measures to
insure the healthy condition of the scalp. And first and most important of
these is cleanliness. Because of the great length of time which it takes to dry

long, thick hair, many women do not wash the scalp often enough. In the
healthy state of the scalp it should be washed at least once a month.
The Care of the Hair.—There is never any danger of shampooing the
healthy scalp too frequently. The oil in the scalp is not removed by washing,
but is, on the contrary, always increased through the improvement in the
circulation. Where there is much dandruff, or if the hair has begun to fall
out prematurely, owing to long neglect or following an illness, it is well to
begin by washing the hair two or three times a week, and then gradually
increase the interval to every two or three weeks.
Borax in the water cleanses the scalp well, but its continuous use is
injurious; the same may be said of ammonia water.
One of the best shampoos is the tincture of green soap. If this cannot be
obtained, take of the official green soap 2 ounces, and of alcohol, 1 ounce;
mix well, and make shampoo. One ounce of the tincture or its substitute
should be diluted with twice as much water and applied to the scalp with
the tips of the fingers. When enough of the shampoo has been used, add
sufficient water to make a good lather. This must be thoroughly rubbed into
the scalp, going over the whole systematically. After the scalp is cleansed,
the soap must be well rinsed out of the hair. This may require many changes
of the water, but it is most important. Dry the hair with hot towels, the
process being completed by a radiator or stove oven. Fanning the hair will
hasten the process very considerably. The hair should then be loosely
braided and a hot towel wound around the head to insure perfect dryness of
the hair and as a prevention against taking cold. One hour is sufficient for
the entire procedure. In winter the hair should be washed just before
retiring.
Brushing the Hair.—Brushing increases the growth of the hair by
stimulating the circulation in the scalp and by removing the dandruff. To be
effective, the hair should be well brushed at least once a day, when there
must be a deep brushing of the entire scalp. The bristles of the brush must
be stiff enough to warm, but not to scratch, the scalp. Brushing and massage
remove any loose hairs that are ready to fall, but they will soon be replaced
by new vigorous ones.
Combing simply disentangles the hair. The teeth of the comb must be far
apart and have rounded ends. In no case should a fine-toothed comb be

used. It tears out the hair, and often causes an irritation of the scalp which
leads to disease.
From what has been said, it will be seen that every member of the family
should have a brush and comb for her own exclusive use, and that no one
should allow a public brush or comb to be used on her head.
The brush and comb must be washed once a week in water containing a
little ammonia; they must be well rinsed out in pure water; the brush should
be dried quickly, with the bristles down. If the brush and comb are not
cleaned sufficiently often, the scales of dandruff would be sufficient to
reinfect the scalp.
Massage of the Scalp.—The scalp should be thoroughly massaged every
night. Grasp the scalp with both hands laterally, as well as anteroposteriorly,
and with some pressure loosen the tissues from the underlying parts and try
to raise it in folds, or it may be pinched with the forefingers, producing
some vascular flux and a sense of warmth.
If the scalp is too dry, nothing is better than pure vaselin, though some
persons prefer olive oil, applied by means of a dropper. The yolks of eggs
beaten up with lime-water make an elegant shampoo.
Dressing the Hair.—Dragging or twisting the hair from its natural
direction, pulling it into constrained or artificial positions, and even twisting
the hair very tightly is injurious to it.
The curling iron acts by abstracting more moisture on one side of the hair
than on the other. The stronger the hair, the more easily it will curl, and the
longer it will stay curled. The daily use of a hot iron, notwithstanding the
greatest care, will in a short time prove injurious; the hair is apt to become
thin and fall out. Its growth is interfered with. The use of kid curlers is
much less injurious, but even here the tight twisting of the hair around the
kids is said to be harmful.
Shell hair-pins are the best for the hair. If steel ones are used, the points
must be smooth and the pins kept in good condition.
When the hair is dressed for the night, after the scalp has been brushed
and massaged, it should be loosely braided and left hanging down.

Cutting the hair 1 inch, every two or three months, is said to promote the
growth of the hair and prevent its splitting. It does not increase the number
of hairs.
There is no truth in the assertion that the hair is a hollow tube, which
allows the escape of oil, and that if the ends are sealed by singeing much
good will result.
Gray Hair.—Grayness of the hair may be either premature or
physiologic. When the grayness is due to some temporary cause, as anxiety
or some diseased state, the process may cease completely on the removal of
the cause. Usually the whitening is permanent. The grayness of the hair is
caused by obscure changes in the nutrition of the hair-papilla, which
interfere with the production of the pigment. As a rule, the hair whitens first
on the temples, then on the top of the head.
The hair first turns gray at its root. The grayness is due to the loss of
pigment. Prolonged residence in either a very cold or a very hot climate will
cause the hair to turn gray.
A yellowish tinge of the hair is sometimes seen in patients with jaundice,
or gray hair may owe its dull yellow color to the tint of dry albumin of
which it is composed. The glitter of steel-gray or silver-white hair is due to
the high refractive power of the minute air-bubbles that lie in the substance
of the hair.
Treatment.—The color cannot be restored to gray hair. The roots of the
hair are embedded in the hair follicles, and cannot be reached by any fluids
applied to the scalp. Not only is the use of hair-dyes to be deprecated as an
exhibition of poor taste, which happily is going out of fashion, but the use
of hair-dyes is extremely dangerous. Cases are being constantly reported by
physicians, where the use of these supposedly simple vegetable hair-dyes
has been followed by very serious and extensive dermatitis of the face,
neck, and shoulders.
Gray hair is really very beautiful when it is of silvery whiteness, and very
ugly when it is of a yellowish-white color. It must be treated with much
greater care, in order to preserve its silvery whiteness, than was necessary
to keep the hair in good condition before it lost its coloring pigment. It
should never be wet, except when it is shampooed. For this reason, instead

of using hair-curlers, crimping pins should be used. In this way the hair is
waved quite as well and the use of water is avoided.
The Cosmetic Care and Treatment of the Hands.—Of all the members
of the body, next to the face, the hands have the most expression, and serve
as an index of character and refinement.
Not only should the most scrupulous attention be given to having clean
hands and nails, but every precaution should be taken to keep the skin soft
and the nails carefully manicured. This is quite possible for the housewife,
simply by wearing rubber gloves while she does her work. It preserves the
fine sense of touch in the fingers, which aids in sewing and embroidery, at
the same time that it adds much to the beauty of the hands.
Chapped Hands.—To prevent chapping of the hands in cold weather
heavy gloves must be worn or a muff carried. Another aid in the prevention
of the skin of the hands from becoming rough and chapped, and the best
means for curing them if this has occurred, is by the use of a good cold
cream at night, just before retiring. The cold cream should be well rubbed in
the skin, especially about the finger-nails, and after this talcum powder be
dusted over. This forms a thick covering for the hands, the talcum powder
prevents the cream from being rubbed off on the bed-clothes, and, on
getting up in the morning, the skin will be found to be soft. Only in case the
hands are very badly chapped should old kid gloves be worn at night.
Cosmetic of the Nails.—The physiologic function of the nails is to
protect the tips of the fingers against pressure and to give them a firm
support; this increases the delicacy of the tactile sensations.
The nails should be slightly curved from side to side, of a light rose color,
and smooth surface. The lunula should be visible at the root of the nail.
Brittleness of the nails is a defect, which causes them to tear easily; it is
generally due to the condition of the general health.
There is a natural tendency for the dirt to accumulate on the under
surface of the nail, between it and the finger. This is not only unsightly, but
it is often the cause of actual danger, as this forms a lodgment for the germs
of disease. Not only is it necessary for doctors and nurses to give the most
scrupulous attention to the care of the nails, but, when we learn that one
cook has been the cause of spreading typhoid fever through a number of

families, in her itinerary in going from place to place, we must be impressed
with the necessity of more careful oversight being given to the hands of
domestics and housewives who prepare the food.
For the same reason, it is self-evident that the hands should always be
washed immediately before going to the table, and cleaning the nails is
always a finishing touch in the washing of the hands.
For the purpose of cleansing the nails, an orange stick or nail-file should
be used, and never the point of the scissors or the blade of a knife, for either
of these causes a roughening of the under surface of the nails, whereby the
lodgment of dirt becomes only the more securely fixed. After the use of the
nail-file, the nail-brush should be used, followed again by the use of the file
or stick. If there is a tendency to a roughening of the skin under the nail, it
can be obviated by the use of cold cream at night. Just before retiring, the
fingers should be dipped into cold cream, and let the tips take up just as
much as they will retain, and after this dipped into talcum powder.
The small rim of epidermis which laps over the nail should be gently
shoved back with the orange stick every day. This skin, when torn, forms
the so-called hangnails, by which infection easily enters the system; it may
give rise to felons or even to general blood-poisoning.
The Care of the Feet.—In the care of the feet it must be remembered
that the leather of the closely fitting boot allows very little ventilation, and
so more attention must be paid to the airing of the feet as well as to their
bathing. The feet should be bathed twice daily.
On making the toilet for the evening dinner both shoes and stockings
should be changed, the stockings hung up in the room, and the shoes left
out to air and dry, instead of being stuffed into the shoe-bag, to remain there
until the next morning.
An alcohol rub will be found very refreshing to weary feet. For profuse
perspiration of the feet, boric acid or talcum powder may be used, dusting
the powder over the feet both night and morning.
Ingrowing Toe-nails.—The common causes of ingrowing toe-nails are
improper foot-wear and an improper method of cutting the nails. If the nail
is cut too short, especially at the angles, while at the same time the shoe is
too short or too narrow, the skin of the toe is forced over the nail, so that it

necessarily happens that, by the further growth of the nail, the flesh of the
toe is pushed still further over, until a point is reached where inflammation
is set up. There is excruciating pain, which may be accompanied by the
formation of a small tumor, which forms pus and may go on to granulation
—the so-called “proud flesh.”
The preventive measures of the trouble are, first, in cutting of the nails.
The toe-nail should be cut in a concave form, the outer angle projecting
beyond the toe. If there is a tendency for the flesh to grow over the nail, the
flesh should be pushed back from the nail, and fastened in this position with
a strip of oxid of zinc plaster, and a gauze packing should be inserted under
the nail-edge. A saturated solution of boric acid serves as an antiseptic
dressing. It is often possible to cut off the projecting nail, and, by the use of
the boric acid dressing, the trouble disappears in a few days. Attention
should always be given to the toe-nails when bathing.
Corns.—There are two varieties of corns; both are very painful. Soft
corns come between the toes, and unless absorbent cotton is inserted to
prevent the rubbing of the toes together, a second corn appears on the
opposing surface of the adjoining toe. A very effective remedy for this is the
application of blue-stone, or sulphate of copper, to the corn. The stone is
moistened in water and then applied thoroughly to the corn; absorbent
cotton should be placed between the toes. In very severe cases it may be
necessary to stay off the feet for a few days and keep the foot upon a chair.
Hard corns must be cut down with the greatest care. It should be done
directly after the bath, so as to have the skin in as nearly an aseptic
condition as possible. A small scalpel, composed entirely of steel, should be
kept for this purpose. It must be thoroughly cleaned after it is used, and just
before its use be sterilized by boiling for five minutes. The reasons for these
precautions are the possibility of cutting into the flesh and setting up blood-
poisoning by the entrance of germs into the wound.

CHAPTER IV
THE DIGESTIVE SYSTEM: GENERAL
PRINCIPLES IN HUMAN NUTRITION AND
DIETETICS
The Digestive Tract; Care of the Mouth and Teeth; Controlling Factors of
Digestion; Psychic Aspect of Digestion; Importance of Mechanical Factors; Chemical
Changes of Food in the Stomach; Intestinal Digestion; Metabolism; Constipation and
its Treatment.
The Amount of Food Required; the Classification of Foods; Standard Dietaries;
Maintenance Diet; Relations of Diet to Various Conditions of Life; Practical Facts for
Guidance; Dietary in the Tropics; Food Economics; Table of Food Values.
The Physiologic Action of Moderate Doses of Alcohol; the Effect of Alcohol on the
Muscular System; the Effect of Alcohol on the Nervous System.
“If there is anything new of importance in the practice of medicine it is this modern
work in nutrition.”—Mendel, 1914.

The activities of animals are carried on by a certain expenditure of energy
which is set free as the result of a chemical breaking down of the living
tissues of the body. In order to maintain the equilibrium of the body this
waste must be replaced by new material which is taken in the shape of food,
drink, and oxygen.
Digestion is the term applied to those changes in the food-stuffs which
precede absorption; it is a refining process which separates the useless from
the useful, and further prepares the latter to be used as building-stones for
the repair of organs and tissues and to furnish fuel to supply the motor
energy of the body.
In the human body the digestive processes are brought about by
mechanical disintegration; by the action on the food-stuffs of acid and
alkaline fluids; by changes produced by active substances called enzymes;
and, lastly, decomposition is produced by the growth of microörganisms.

The digestive tract, or alimentary canal, begins at the mouth and ends at
the anus. It consists of the mouth, the esophagus or gullet, the stomach, the
small and large intestines. Two large glands, the liver and pancreas, pour
their secretions into the small intestine to aid in the digestion of foods. The
alimentary canal, liver, and pancreas together constitute the digestive
system.

Fig. 4.—General scheme of the digestive tract, with the chief
glands opening into it (Stockton).
Nose, Salivary (parotid) gland, Salivary glands, Pharynx,
Vein, Trachea, Thoracic or chyle duct, Esophagus, Liver,
Gall-bladder, Stomach, Spleen, Pancreas, Duodenum,
Lacteals, Large intestine, Small intestine, Vermiform
appendix, Rectum

The contraction of the muscular walls of the digestive tract is the
propelling power that carries the food downward and brings it into contact
with the digestive fluids. These movements will be referred to later, under
the Mechanics of Digestion.

The digestive tract is lined throughout its entire course by mucous
membrane; that lining the mouth gives some idea of its character. It is from
the mucous membrane lining the stomach and intestines, as well as from the
liver and pancreas, that the digestive fluids are poured forth into its cavity.
In passing downward the food meets with five different digestive fluids:
the saliva in the mouth; the gastric juice in the stomach; and the bile,
pancreatic, and intestinal juices in the small intestine. Each digestive fluid
acts only on some particular kinds of food. This action of the digestive
fluids on food is called the chemical part of digestion.
The Care of the Mouth and Teeth.—It is of the first importance that the
mouth should be kept clean and as nearly aseptic as possible, for as the food
is rolled about in the mouth by the process of mastication it is obvious that
it will carry all the germs and mucus with it into the stomach. A nasal spray
containing some solution of an alkaline or antiseptic nature should form an
essential part of the toilet of the mouth.
The Teeth.—From simply an esthetic point of view well-kept teeth are
beautiful and greatly enhance the charm of the face. But the proper care of
the teeth is also essential to good digestion and good health.
In perhaps the majority of people the teeth are sufficiently far apart for
small particles of food to become lodged between them. If not promptly
removed, the heat and moisture of the mouth, acting on these small
particles, cause their decomposition and set up acid fermentation in the
mouth; and it is this acid which causes the decay of the enamel and finally
of the teeth. The decayed tooth gives still further lodgment to particles of
food, and these, left to decompose, give rise to the most offensive gases,
giving fetor to the breath, poisons the blood, and so injures the digestive
and nervous systems.
Where possible a tooth-pick and dental floss should be used immediately
after each meal; the waxed dental floss between the teeth, and the flat end
of the tooth-pick to remove any particles that may have worked in about the
roots of the teeth and gums.
A tooth-brush with good tooth-powder should be used twice a day. The
brush should not be too broad, and is better if slightly curved. The bristles
should not be too hard. The use of tooth-powder, which must be very fine,

or tooth-paste is needed to produce sufficient friction to clean the teeth well.
Warm water is a better solvent than cold, and, therefore, it is well to use it
for cleansing the teeth.
While it is generally known that decay if neglected will destroy a tooth, it
is not so well known that many teeth are lost as the result of the
accumulation of tartar at the gum margin. There is a great tendency to this,
especially about the necks of the lower incisors and upon the teeth that are
not used in chewing. The deposit of tartar encroaches upon the neck of the
tooth and presses upon the gum; the latter becomes irritated or inflamed,
and recedes from the tooth; malnutrition and loosening of the tooth follows.
With very imperfect or decayed teeth proper mastication is impossible.
The teeth should be examined by a good dentist twice a year, so that
small cavities shall be discovered at an early stage, the tartar removed, and
the teeth kept in their best condition. This will prevent the early loss of the
teeth. Lost teeth must be replaced, so that the teeth shall be opposite each
other, for a very important factor in mastication is that the teeth shall strike
properly.
Digestion.—The factors controlling digestion are psychic, mechanical,
and chemical.
Briefly stated, the process of digestion consists first in the liquefaction of
the solid portions of food and the conversion of the insoluble into soluble
and diffusible, for no nutriment can be assimilated until reduced to a state in
which it can pass through a cell membrane. These chemical changes are
carried on by a series of enzymes.

Fig. 5.—Location of the viscera of the body
and their relation to each other: D, D, Lungs
with air expelled; E, E, diaphragm cut away to
show, F, liver cut to show stomach; 2, gall-
bladder; H, H, large intestine; K, small
intestine; L, vermiform appendix (after Heath).

Enzymes are unorganized ferments which possess the power of producing
chemical changes in certain substances with which they come in contact
under particular conditions without themselves suffering permanent
alteration. The digestion of food is largely accomplished by the specific
action of these enzyme bodies, of which every digestive fluid contains one
or more.
But neither solubility nor diffusibility is adequate. Freely soluble
substances like cane-sugar need to undergo digestive changes just as
definite as those carried out in the case of fats or coagulated proteins. The
changes which they undergo before absorption serve a more fundamental

purpose than the mere hastening of their passage through the lining
membrane of the intestine.
In the light of modern chemical knowledge we can be somewhat specific
in regard to the molecular aspects of the digestive processes. They are
probably always cleavages, large molecules giving rise to smaller ones.
When the original molecule is of extraordinary size, as with proteins and
starches, these cleavages have a serial character, and a number of
intermediary products must accordingly be formed; that is to say, the earlier
products are in turn subjected to digestion. Such cleavages are generally, if
not always, hydrolytic; that is, water enters into the reaction and its
elements are found combined in the products.
The Psychic Aspect or the Effect of the Emotions on Digestion.—The
relation of the emotions to the activities of the alimentary canal are of very
practical importance, because recent investigations have shown that not
only are the first stages of the digestive processes normally started by the
pleasurable smell, sight, and taste of food, but also the pouring out of the
gastric juice.
The importance of the initial psychic secretion of the saliva for further
digestion is indicated when we realize that materials can be tasted only
when dissolved in the mouth, and thereby brought into relation with the
taste organs. The saliva which waters the mouth assures the dissolving of
the dry but soluble food even when it is taken in large amounts.
The importance of the initial psychic secretion of gastric juice is made
clear by the fact that the continued flow of this juice during digestion not
only stimulates the glands of the stomach to pour out the chemical gastric
juice, but by its action on the mucous membrane of the duodenum it also
starts the flow of bile and pancreatic juice.
These facts are of fundamental importance in the cooking and serving of
food, especially when the appetite is fickle. A bright and cheery dining-
room, the daintiness of the table service, the center-piece of ferns or
flowers, all are factors in exciting the pleasurable emotions, and so
stimulate the appetite.
On the other hand, the digestive processes may be wholly abolished by
vexation, worry, and anxiety, or when such strong emotions as anger or fear

are allowed to prevail. This fact has long been known in regard to the
salivary secretion, and it has now been established in regard to the secretion
of the gastric juice. It is necessary to avoid all circumstances likely to
provoke emotional reactions.
The inhibitory influence of excitement on the flow of the gastric juice has
been studied by Professor Cannon, of Harvard University, in an interesting
series of experiments on dogs. And a most important point is that the cat,
which was allowed to infuriate the dog being experimented on, was only in
the room for five minutes, and in spite of the fact that the animal was
hungry and ate eagerly; there was almost a complete suppression of the
flow of gastric juice for a period of twenty minutes.
A similar experiment was tried on a boy with a gastric fistula. Food was
shown to the boy and then withheld. He was so vexed because he could not
eat at once that he began to cry and flew into a towering passion, with the
result that no secretion appeared even after the child was calmed. In both
the case of the dog and boy there was not only a temporary inhibition of the
flow of gastric juice, but it is a noteworthy fact that the effects of the
emotional excitement remained long after its cause had been removed.
The practical point is, that if the digestive processes have been inhibited
by emotional disturbances any food taken will lie stagnant in the stomach;
and not only will there be a suppression of the gastric but of the pancreatic
secretion as well, with the consequence that there is likely to be an
accumulation of unabsorbed organic material in the colon and perhaps
higher up as well. Bacterial decomposition will be fostered and actual harm
may be done the organism.
And just as a single occasion may lead to a passing digestive disturbance,
so continual mental depression, worry, or grief may permanently impair the
working of the tract and so undermine the vigor and capacity of the sufferer.
It is believed that many acute attacks of indigestion in children are due to
sharp rebukes administered at the table.
The Psychic Tone.—Just as there is a psychic secretion, so likewise there
is a “psychic tone,” or psychic contraction of the gastro-intestinal muscles,
as a result of taking food. And just as the secretory activities of the stomach
are inhibited by strong emotions, so also are the movements of the stomach.

And, indeed, the movements of nearly the entire alimentary canal are
almost completely stopped during moments of great excitement.
The condition of mental discord may thus give rise to a sense of gastric
inertia, so that anxiety may be accompanied by a feeling of weight as if the
food remained in the stomach, and every addition of food causes an
increase of the distress.
The Importance of the Mechanical Factor in Digestion.—The
mechanical reduction of food in the alimentary canal is preliminary to its
actual digestion. The first stage of digestion takes place in the mouth, and
this is the only portion of the digestive canal which is under the control of
the will. It is here that the food is ground into fine particles by the act of
mastication, and the more thoroughly the food is pulverized in the mouth,
the more rapidly and easily can it be acted on by the gastric juice, and the
very act of chewing increases the flow of saliva as well as shortens the time
that the food will remain in the stomach.

Fig. 6.—The ribs removed, showing
relation of thoracic to abdominal viscera: A,
Trachea; B, heart; C, C, lungs; D, liver; E,
stomach; F, small intestine; G, large intestine;
H, bladder (after Masse).

The saliva not only protects the mucous membrane of the mouth, but it
keeps it free from small food particles, which if allowed to remain would
decompose, and thus injure the teeth by the action upon them by the acids
produced. It also moistens the dry food, aids in the process of swallowing,
and has some action on the starchy substances of the food. By the process
of mastication, then, the food is divided into small particles and thoroughly
admixed with the saliva until the whole is converted into a fine pulp.
Besides favoring the mechanical part of digestion and its slight chemical
action on starchy foods, saliva, being an alkaline fluid, is a distinct
stimulation to the secretion of gastric juice. After the food has been reduced
into a pulp in the mouth, and the change of starches into sugar has begun, it

is swallowed and passes into the next compartment of the digestive
apparatus, namely, the stomach.
The stomach may be felt at the lower extremity of the breast bone, in the
triangular space formed by the divergence of the ribs. It is a large hollow,
compound gland, the walls of which contain muscular fibers in addition to
the tubules which elaborate the special secretions. Its cavity is lined with a
thick mucous membrane, packed with tubular glands, into which is poured
out a complex secretion called the gastric juice.
The Chemical Changes which Food Undergoes in the Stomach.—
There are two chief phases or periods of gastric secretion: (a) The psychic
or appetite juice, and (b) the chemical juice. Gastric juice is not constantly
poured into the stomach to accumulate there, but is secreted only as it is
needed under the influence of certain stimuli. These stimuli may be
classified as psychic and chemical.
In the second phase, or period of gastric digestion, the exciting agent is
the presence of food in the stomach. It has been shown that a correlation of
the different organs of the body is brought about by hormones or chemical
messengers. The hormones of gastric digestion are produced from proteins
in the early stage of gastric digestion, and this shows the importance of the
psychic or appetite juice. A similar effect is produced by meat extracts or
infusions, which are well-known provocatives of gastric secretion.
Gastric Juice.—The principal active agents of the gastric juice are
hydrochloric acid and the enzymes; pepsin, the proteolytic enzyme; rennin,
the milk-curdling ferment; and lipase, the fat-splitting ferment. The uses of
the gastric juice are digestive, activating, and disinfecting.
Gastric juice does not dissolve and chemically change all food that enters
the stomach, but acts only on that class of foods called proteins, converting
them into peptones.
The changes which food undergoes in the stomach are as follows: food is
disintegrated; meat is broken up, gelatin dissolved; the muscle-fibers fall
apart, and are split into disks and sarcous elements; the framework of fatty
tissue undergoes similar dissolution of cellular membranes; milk is curdled;
the caseinogen is transformed into casein, and the latter broken down by
pepsin. Bread and other starchy foods are disintegrated, some of the starch

being formed into sugar by ptyalin. The other vegetable foods are but little
digested by this viscus. The whole is broken into irregular fragments by the
disintegrating power of the stomach and gradually converted into chyme,
the creamy emulsion which passes through the pylorus into the intestines.
The passage from the stomach into the duodenum is aided by the motor
activity of this organ.
The Mechanics of Digestion in the Stomach.—Recent investigations,
especially those of Cannon, have thrown much light on this subject. The
food introduced into the stomach from the esophagus is lodged first in the
fundus or cardiac end of the stomach; from here it is moved by slow
degrees toward the pylorus, from which it enters the small intestine.
Formerly it was taught that this movement was brought about by a churning
motion of the stomach throughout its entire length. Cannon has shown the
error of this conclusion. From his observations it appears that the stomach is
quiet at first. The waves of peristaltic constriction begin at the duodenal and
middle portions and move the food toward the pylorus. In this way the
constrictions that begin near the pyloric end gradually extend to the cardiac
end. The latter part of the stomach is distended after a full meal, but
gradually diminishes in size during digestion.
Moreover, there is a difference in the character of the gastric juice
coming from the different areas of the stomach; that from the middle
portion being acid, and that from the cardiac and pyloric being neutral or
nearly so. These facts show that the food remains for some time in the
fundus and meets there a neutral liquid; consequently, the alkalinity of the
mass is retained for a time, and the saliva acts upon the starch for a much
longer period than has been supposed.
It is believed that the length of time which food remains in the stomach
varies with its kind. The digesting mass is not forced into the intestine until
it becomes well saturated with the free acid of the stomach, a result that will
be reached later with a meat than with a vegetable diet; for it is plain that
much more acid will be required to combine with the proteins of meat than
with the smaller amounts in the carbohydrate foods, and so free acid is
longer in accumulating.
Digestion is aided by the movements of the food mass through the
contractions of the walls of the stomach, so that anything which lowers the

tone of the stomach or impairs the integrity of its lining membrane seriously
interferes with the digestive processes.
The nature of the food influences the rate of its passage through the
pylorus. It has been shown by means of the x-rays that when the meal
consisted of lean meat, suet, and rice, properly cooked and prepared in such
a manner that the constituents were properly mixed together, the
carbohydrates (rice) began to leave the stomach in fifteen minutes, but the
protein (lean meat) and fat did not begin to leave it under one-half hour, and
were much longer in passing through.
It was further found that in a normal stomach a meal of rice and potatoes
gets out of the stomach rapidly, no trace being left in three hours, while a
meal of protein and fat meat was much slower, some being present six
hours after the meal. Indigestible substances are rejected by the sphincter
and returned to the digestive cavity over and over again, but in the course of
time the sphincter relaxes and the peristaltic contractions increase, until the
force is sufficient to drive through the opening hard substances like peas,
plum-stones, and coins.
The Absorption of Food from the Stomach.—A very wide-spread
misconception prevails in regard to the amount of absorption that takes
place through the gastric walls. This is very limited indeed; some sugar,
alcohol and other fluids, and a small proportion of nitrogenous matter are
taken up, but that is all. The legitimate rôle of the stomach is a peptonizer
and grinder only. Absorption of nutrients is the special work of the
intestines, and occupies but a subordinate place in the duties of the stomach.
Proteins undergo peptonization, but that does not change them
sufficiently. The mere splitting into peptones, formerly thought sufficient, is
now known to be quite inadequate. Recent researches have shown that the
complex protein molecule has to be quite crushed into a heterogeneous
assemblage of fragments, from which those suitable for building up into the
body protein are selected for that purpose, the remainder being used as fuel;
that is, as a source of energy. In the case of the other food principles, fats
and starches, the chemical processes are much simpler.
Intestinal Digestion.—The chemical changes which food undergoes in
the small and large intestines are exceedingly complex. Digestion in the
intestine is due to the combined action of the bile, pancreatic juice, and

succus entericus. The material which enters the duodenum from the
stomach is known as the chyme. The acid chyme provokes a flow of bile
and pancreatic juice. It acts upon the prosecretin in the duodenal mucous
membrane in such a manner that secretin, a hormone, is formed and carried
by the blood to the cells of the pancreas which it stimulates.
Bile is a secretion of the cells of the liver and from the inner wall of the
gall-bladder; after elaboration, bile is stored up in part at least in the gall-
bladder. The secretion of bile is irregular in quantity, as is the case with the
gastric juice, and appears to be induced by chemical excitants, of which
acids, especially hydrochloric, seems to be especially effective. Of the
nutrients, the proteins exert the most influence. Less secretion follows the
ingestion of carbohydrates than of proteins.
Formerly it was supposed that fatty foods checked the secretion of bile,
but later experiments have proved that, to the contrary, they increase its
secretion; and olive oil is a powerful cholagogue.
Bile precipitates the proteins of the chyme, neutralizes the acidity of the
gastric juice, dissolving the fatty acids, and activates the lipase or steapsin
of the pancreatic juice and assists in the absorption of fats. When for any
reason the discharge of bile is retarded and the organism attempts to
eliminate it through the kidneys, the tissues become charged with its
compounds and take on a yellowish coloration.
Pancreatic Juice.—The second action upon the food in the intestine is
that of the bicarbonate of soda contained in the pancreatic and intestinal
juices, which neutralizes its acidity; and pancreatic digestion can only take
place in an alkaline medium.
The pancreatic juice has the most comprehensive action of all of the
digestive fluids; it contains a great variety of enzymes and acts upon all
classes of nutrients. Its flow is intermittent, being induced by the action of
the acids in the partially digested food from the stomach.
The pancreatic secretion attains its maximum pressure about three hours
after a meal, but this varies according to the character of the meal. The
enzymes of the pancreatic fluid are trypsin, amylopsin, lipase or steapsin,
and pancreatic rennin.

Trypsin.—Pancreatic juice alone has but little influence on proteins, but
when mixed with succus entericus its influence is great. Trypsin differs
from pepsin by acting in an alkaline or neutral solution, and a free mineral
acid, like hydrochloric, stops its operations; it acts much more powerfully
and rapidly than pepsin. In conjunction with other enzymes it splits protein
foods into simpler compounds, which may be regarded as the building
stones of the original proteins.
Amylopsin.—The digestion of starch in the intestine is mainly effected by
means of a diastatic ferment or enzyme in the pancreatic juice, called
“amylopsin.” This enzyme has the power of hydrolyzing the starch mostly
into maltose.
Steapsin or Lipase.—The pancreatic secretion acts vigorously on fats, not
only splitting them into fatty acids and glycerin, but, in conjunction with the
bile, also effects their emulsification. This latter result is doubtless aided by
the soaps which form a union of the fatty acids and alkaline bases (mostly
sodium) in the bile. The cleavage of the fats is due to the enzyme steapsin.
The succus entericus is the secretion of the glands of Lieberkühn. It
contains quite a number of enzymes, including four which act on
carbohydrates, namely, amylase, maltose, lactase, and invertase; the
proteolytic enzyme is erepsin, which seems to supplement the action of
trypsin. It has no action on native proteins except casein, but it breaks down
proteoses and peptones into amino-acids.
In other words, the discovery of erepsin in the succus entericus and its
effects has led to the now almost generally accepted view that the digestion
of the proteins is carried further than the stage of proteoses and peptones; in
fact, that this enzyme hydrolyzes them into amino-acids, in which form they
are taken up by the cells of the intestinal mucous membrane.
The Absorption of Food from the Intestines.—It was formerly believed
that the main stream of the nutrient passed out of the intestines through the
lacteals and thoracic duct into the circulation. But it is now known that only
the fats take this course, and that the dissolved proteins, carbohydrates,
some fats and salts find their way into the circulation through the portal
system and the liver.

The blood contains a constant proportion of serum-albumin and serum-
globulin, which are constructed out of the amino-acids resulting from the
digestion of protein foods. The reconstruction of proteins takes place
chiefly in the cells. Fuchs believes that the amino-acids from the food are
carried to all the tissues; and that the cells of the muscles and glands pick
out from the blood the “building stones” necessary for the construction of
their special proteins.
Fat is absorbed for the most part in the form of an emulsion and as a
solution of soap. Only about 60 per cent. of the fat in the food is absorbed
by the lacteals; the remaining 40 per cent. gets directly into the blood. The
fat is carried directly by the blood-stream to the tissues all over the body; it
is oxidized in the tissues to produce heat and energy; what is not
immediately used for this purpose is stored up in the cells for future use.
Carbohydrates.—Practically all of the carbohydrates digested are
absorbed in the form of sugar. The absorption takes place more rapidly in
the upper than in the lower bowel. A portion of the ingested carbohydrates
is destroyed in the alimentary canal by bacteria, whose enzymes transform
them into various acids and gases.
The Absorption of Sugar.—The sugars pass into the blood through the
portal circulation, and not through the lymphatic vessels. The question is,
Where does sugar go after it gets into the blood? The proportion of sugar in
the general circulation is not greater after a meal than before it. It is
necessary that there should be some means of storing it, for it cannot all be
immediately used for the production of energy. Is it stored as glycogen?
Bunge believes that a considerable amount of carbohydrate is stored as fat,
since the total amount of glycogen in the liver never exceeds 150 grams,
and there is a similar store in the whole mass of muscles. It is evident,
therefore, that only a small proportion of carbohydrates is laid down as
glycogen, and we must assume that the greater part of it is converted into
fat. That fat accumulates in the body on a purely carbohydrate diet is proved
beyond a doubt, and the formation of fat from sugar is considered proved
by experimental evidence.
Sugar is an important source of energy for the muscles, and provision is
made for a sufficiency of it always to be in the blood circulating through
them, and the storehouse from which it is derived is the liver. When the

liver and muscles contain enough glycogen to keep the blood supplied with
it, the excess of sugar is converted into fat, and is reconverted into sugar
when there is a demand for it.
Mechanics of Digestion in the Intestines.—The intestinal movements,
like those of the stomach, have recently been studied by means of the x-
rays. There are three kinds: A pendulum-like motion, consisting of a gentle,
swaying, rhythmic movement occurring in all parts of the intestines. These
movements do not affect the whole of the gut at one time, but occur in
successive segments of it, and are more obvious in those parts which are
distended with food, at a period of three or four hours after a meal. They are
most energetic in the upper and least so in the lower part of the gut, and
proceed from above downward with the course of the food.
The movement consists in lengthening and narrowing, followed by
shortening and widening, of the canal; the contraction involves both the
longitudinal and circular muscular coats, and in the course of its progress
divides the bowel into many segments. This movement breaks up the food,
sways it backward and forward, diffuses the digestive fluids through it, and
drives chyle into the lacteals.
The second kind of movement consists of peristalsis, or wave-like
propulsive movements; also localized dilatation, followed by contraction of
the canal, progressing from above downward at the rate of 1 or 2 inches per
second, and is from three to four hours traveling the entire length of the
intestines.
Under pathologic conditions a third movement is observed, consisting of
a swift venicular movement, starting at the pylorus and traveling the entire
length of the gut in about one minute. It is produced by toxins, gases, and
other irritants.
Digestion is practically completed in the small intestine.
The colon consists of a proximal portion, consisting of the cecum,
ascending colon, and one-half of the transverse colon; a mesial part, formed
by the other half of the transverse colon and part of the descending colon
and a distal portion, formed by the remainder of the descending colon and
of the rectum. The contents of the proximal portion are fluid; food
accumulates in this portion; it is gradually concentrated by the absorption of

water. It has been shown by the x-rays that a meal reaches the cecum in four
or five hours; the hepatic flexure in six or seven hours; the splenic flexure
in nine hours; and the rectum in about eighteen hours.
The feces consist of the residue of the food, digestive secretions, etc. The
contents of the alimentary canal become altered in character as they
descend its course. The mass attains a greater density as it descends, more
and more nutrient being absorbed from it, and even in the colon it becomes
more solid; its color is brownish and its odor characteristic. The amount of
feces from an average mixed diet represents from one-seventh to one-eighth
of the food consumed.
Defecation.—The waste matter which collects in the lower bowel must
be evacuated every day. Allowed to remain longer than this, the digestive
system is clogged by the non-removal of worn-out material, and the blood
is constantly absorbing matter which is poisonous to the body.
Decomposition goes on without being suspected by the sufferer.
Intestinal bacteria or organized ferments are present throughout the
entire intestinal canal and play a part in the food changes. They are most
abundant in the lower part of the small intestine and the upper part of the
large. They act upon the proteins, causing putrefaction, dissolve cellulose,
and cause a decomposition of the carbohydrates. The products of these
fermentations include indol and skatol, which have the characteristic fecal
odor; volatile fatty acids and gases, some of which are carbon dioxid,
hydrogen, marsh-gas, and hydrogen sulphid.
Fermentations of this character up to a certain extent are normal and may
be beneficial, but they may proceed so far as to be deleterious to health.
Anything which retards digestion, such as imperfect mastication, excessive
eating, abnormal amounts of meat in the diet, and failure of the organs
secreting the digestive fluids to supply these secretions in sufficient
quantity, gives these bacteria a better opportunity to act on the food residues
and so increases their bad effects.
Some foods, especially vegetables of the leguminous class, appear to be
provocative of excessive intestinal fermentation. Flatulence and even toxic
poisoning may be the result of great bacterial activity in the digestive tract.
It is hardly possible to check this by administering septics, but purging is of
value by removing the fermentative material. Particular foods, especially

soured milk and kephir, have been shown to have a preventive action on
putrefaction.
Influence of Food on Secretion.—The more recent investigations reveal
the fact that the kind of food has an influence not only on the abundance,
but also on the kind of digestive secretions; this is most important because
an abundant supply of digestive juices is necessary for good digestion.
Broths, meat extracts, and milk stimulate the secretion of the gastric juice,
which makes rational the taking of soup or bouillon as the first course at
dinner, or the eating of toast or zwieback by persons with weak digestions.
Fats, on the other hand, tend to inhibit gastric secretion, so that an excessive
proportion of fat in the meat might hinder digestion in the stomach.
Food may exert an indirect influence on the pancreatic secretion. The
acid in the chyme stimulates the flow of pancreatic juice. One is almost
inclined to speak of the physiologic education of the digestive glands, and
to conceive them as being trained for fat, protein, or carbohydrate digestion.
Metabolism.—Life consists, so far as material phenomena are
concerned, in the transformation of matter into energy. To these
transformations the term metabolism is applied. In the metabolism of matter
the changes are chemical; in energy the changes are physical. It is
commonly assumed that the laws of conservation of matter and energy are
conformed to or obeyed in animal bodies.
The body converts potential into kinetic energy by metabolism in the
body. The potential energy of food is transformed into the actual energy of
heat and mechanical labor. In this respect the only difference between man
and other vertebrates is the nervous and intellectual processes, which are
not yet understood.
Metabolism is anabolic and katabolic. Anabolism is constructive; it
includes growth and the act of the tissues in selecting, appropriating, and
making substances absorbed from the alimentary canal a part of themselves.
The body is never stable; while growth and nutrition progress, destruction
or demolition takes place, and this is called katabolism. To ascertain the
exact amount of matter and energy used daily by the body a balance sheet
of the exchange of material is necessary. The income consists of (a) matter
—food, drink, and the oxygen of the air; (b) energy, the potential energy of
the food and drink. The outgo consists of (a) matter in the feces, urine,

perspiration, and breath; (b) energy—the potential energy of feces, urine,
products of respiration, and perspiration. A complete account would show
the amount of C, N, H, O, P, S, Cl, Na, Ca, K, Mg, and Fe in the income
and outgo, it would also show the compounds in the excreta, including
proteins, carbohydrates, water, and carbonic acid.
Experiments show that the body requires a given quantity of given
energy producing substances for sustenance, and something more to meet
the demands for muscular work.
The metabolism of nitrogen is usually measured by the amount of urea in
the urine, taking into account the small proportion of uric acid and other
nitrogenous bodies. In fasting the organism lives on its own flesh and fat.
The Effects of a Nitrogenous Diet on Metabolism.—The most striking
effect of a purely nitrogenous diet is a large increase in the nitrogenous
metabolism, but it also increases the metabolism of the non-nitrogenous
elements of the body. With an ordinary mixed diet the normal excretion of
urea varies from 33 to 37 grams a day, while with a meat diet the urea may
rise to 50 or even 80 grams daily.
Carbohydrates as a Protein Protector.—It has long been observed that
when there was a deficiency of protein in the food the metabolism of
nitrogen will be spared and the tissues protected if the food contains plenty
of carbohydrates and fat. The subject was fully investigated by Lusk. When
the diet contains an abundance of protein, carbohydrates, and fat the
organism gains a little nitrogen; when the diet contains the same amount of
protein but no carbohydrates, the body loses considerable nitrogen. Again,
when the food was the ordinary mixed kind, and contained a sufficiency of
energy, but was of a low protein character, the excretion of nitrogen was
normal. These results led to the conclusion that the carbohydrates were a
protein protector.
Fat as a Protector of Proteins.—The metabolism of nitrogenous tissue
and elimination of nitrogen is not prevented by the consumption of fat, but
the consumption of fat reduces the metabolism of protein so much that one-
quarter or one-third as much meat will suffice to maintain the nitrogen
equilibrium as would have to be consumed if only lean meat was used.

The nutritive value of meat extracts is comparatively small; their chief
value is in promoting digestion and metabolism of other foods.
Water and Metabolism.—The body consists of 530 parts of water per
1000. It is of greatest importance as a component of the tissues to assist in
the exchange of nutritive substances, the discharge of the products of
metabolism, the regulation of temperature, and other vital functions. If the
supply of water is stopped the body will die, and it may die sooner from the
deprivation of water than from starvation.
A reduction in the amount of water consumed accelerates the
decomposition of protein and fat to replace the water essential for the
bodily functions. As the result of experiments it has been found that the
average income of water is 4 pints, and the excretion is 4½ pints; so that at
the lowest estimate ½ pint of water is formed in the tissues by the oxidation
of hydrogen in the food and tissues; and during ordinary work it was found
that 17 ounces of water was excreted daily in excess of that consumed in
food and drink.
The intense suffering entailed by prolonged thirst is to be accounted for
by the absolute necessity for preserving the normal aqueous dilution
throughout the body.
Water is also essential for removing the effete materials arising from
metabolism, cell growth, and other disintegration.
Chlorids.—About 15 to 18 grams of sodium chlorid (common salt) are
excreted daily in the urine, and smaller quantities in the feces and
perspiration. It is, therefore, a most important food. The tissues retain
common salt most tenaciously, and when there is none in the food it
gradually disappears from the urine. It facilitates the absorption of the
protein foods and increases tissue metabolism. And, further, an
insufficiency of common salt is followed by a diminution of hydrochloric
acid from the gastric juice, and consequently a failure of nutrition. There
can be no doubt that the hydrochloric acid of the gastric juice originates
from the chlorids of the blood.
On the other hand, a very large number of people consume more salt than
they require. Salt is not only a food, it is a condiment, and as such it is
liable to abuse. It has been estimated that from 2 to 4 grams of salt a day is

sufficient, whereas most people take from 20 to 30 grams daily in one way
or another. The kidneys have to excrete the excess of salt, which they seem
to do in health without any difficulty; but in nephritis the kidneys do not
excrete it so readily, and this may lead to a retention of salt in the body.
Iron is essential to the human body. It is taken into the body in the form
of food, and is excreted from the body in the bile and feces. It has been
estimated that typical food contains 10 mgm. of iron daily. The hemoglobin
of the blood contains 0.04 per cent. of iron.
Constipation.—It must be remembered that the intestine is a permanent
source of poisons, which, under certain conditions, cause grave alterations
in the principal organs, notably in the liver, kidneys, and skin, and serious
functional disturbances of the nervous system.
Normally, the organism manages to protect itself against the
microörganisms which are found in the intestines; given, however, certain
conditions, the toxic products can be generated in excess of the powers of
the organism to dispose of them, such as errors of diet, quantitative or
qualitative, atony of the muscular walls of the intestine, and, above all,
constipation. The higher up in the intestine the stasis occurs, the more
serious is the result. Constipation is considered by many surgeons as the
most important factor in the production of appendicitis.
There is frequently a condition present which is known as
semiconstipation, and which is most deceptive to the patient. There may be
a bowel movement every day, but the bowel is never emptied; only the
lower portion of the hardened fecal matter is broken off. This is repeatedly
found to be the case in examining women for some form of pelvic trouble,
and in a woman who says that she has a daily evacuation of the bowels, and
has had one that very morning, the sigmoid flexure will be found to be
packed with hardened feces.
Besides the clogging up of the digestive system by the non-removal of
the waste-products of digestion, the formation of hemorrhoids, which is
caused by the mechanical pressure on the veins, and so interferes with their
emptying out in the normal way, and the general autointoxication of the
entire system, there are also caused in women serious displacements of the
pelvic organs together with their congestion and inflammation.

The general symptoms of autointoxication are: headache, vertigo,
palpitation of the heart, a feeble and irregular pulse, irritability of temper,
melancholia, numbness and tingling in the hands and feet, and the
emaciation and loss of weight are sometimes so marked as to lead to the
suspicion of malignant disease.
Treatment of Constipation.—This should always be preventive, and the
diet is a most important factor. The food should be of a coarse quality, that
is, such as directly stimulates the walls of the intestine to contraction by
their constitutents, or by the large amount of the indigestible bulk. Corn and
Graham bread should be substituted for white bread. Toast is always
constipating. Plenty of fresh fruit and vegetables should be eaten. For those
who can digest them, raw apples, eaten just before retiring, are a great aid.
The drinking of a sufficient quantity of water daily is also essential, and this
quantity must be 3 pints. A glassful of cold water, taken the first thing in the
morning on rising, is often very effective. If this is insufficient, the
phosphate of soda, one teaspoonful to one tablespoonful, may be added.
Habit.—Nowhere is the effect of habit more conspicuous than in the
matter of a daily evacuation of the bowels. There should be a fixed time
every day for this, and the very best time is in the morning, directly after
breakfast. Such a habit, once established, will enforce itself upon the
attention and make regularity a necessity. It not infrequently happens that
constipation is the result of irregularity in going to the toilet. The school-
girl or woman gets up a little late, and, although she may feel the inclination
to empty the bowels, she is able to defer it.
If the movement is sufficiently large, one stool daily is sufficient, but
where the stool is slight in quantity, there may be two or three during the
day, entirely consistent with health, and in a run down state of the system
there are apt to be several small movements rather than one full stool. So
long as the stools are not watery, the individual may rest assured that there
is no looseness of the bowels.
Constipation should never be allowed to become chronic. It is, as has
already been shown, the progenitor of myriads of the most serious diseases;
and, after the bad habits of years have been established, it is one of the most
obstinate of diseases to cure. In every case a good physician should be
consulted at once, and the treatment should be persevered in until the cure

is complete. It is a well-known fact that all medicines for this trouble lose
their effect, the dose has to be increased, and a frequent change made from
one laxative to another. When everything else fails, electricity may be
resorted to. It is one of our most valuable remedies, since it brings about a
cure through the toning up of the muscular walls of the intestine.
The constant use of hot clysters to empty the rectum is one of the most
pernicious habits; in this manner the bowel becomes overdistended and
loses its tone, and the fecal mass is not sufficiently large to cause the
distention of the rectum, which is the normal stimulus leading to the desire
to defecate.
The Amount of Food Required.—Food is required for growth and for
repair; that is, to build up the organism and make good the loses sustained
by physiologic processes, to maintain the heat of the organism, and to
supply it with mechanical energy.
It has become an established custom to compare the human body to a
machine. Both derive their power from fuel; in both instances the potential
energy of the fuel is transformed into kinetic energy or mechanical power
which works the machine; in both cases the energy which is not used in
work escapes in the form of heat.
The human body uses the mechanical power chiefly in muscular work;
the heat is used in warming the body and causing the evaporation of
moisture from its surface. The animal organism is much superior to the
mechanical engine. It is more economic in the use of fuel; it has a nervous
organization rendering it sensible to impressions and capable of directing its
energies. The human machine is capable of adapting itself to many
circumstances and changes in the demands upon it.
But to enable the body to continue to perform these functions indefinitely
it must be properly fed, and a proper feeding of the body requires a
knowledge of its composition and the exchanges which are constantly going
on. This knowledge is to be derived from a study of its metabolism, the
analysis of foods, and a determination of their heat values.
The Classification of Foods.—Foods are divided into proteins,
carbohydrates, fats, mineral salts, and water. The body is composed of
materials belonging to the same groups. Proteins form the principal part of

muscles, bones, and many other tissues of animal bodies; they also
constitute some of the most important vegetable structures.
Proteins are probably the most complex compounds in nature; all contain
carbon, hydrogen, oxygen, and nitrogen, generally sulphur, and sometimes
phosphorus also. They are, with rare exceptions, colloids, that is, glue-like,
non-crystalline bodies, which even in solution cannot pass through animal
membranes.
The building stones of the body are the amino-acids. All proteins contain
them, but the kinds and proportions are not always the same. It has been
shown by biologic experiments that life and growth cannot be maintained
when certain amino-acids are deficient.
Proteins are of use to the human body as tissue formers, and, secondly, as
producers of energy, but they also have a food value as flavoring agents,
rendering the food appetizing, and so are to a certain extent stimulants. The
palatability of meats and soups are due to their presence. The amino-acids
have decided heat value.
The necessity for proteins in the diet has been abundantly demonstrated.
Many investigations have shown that when the food contains no protein the
waste of nitrogen continues, no matter how abundant the supply of
carbohydrates and fats. In other words, a continuous protein cleavage is
demanded by the animal organism, and no other nutriments can serve as a
substitute for protein to meet this demand. If the food contains no protein,
the body tissues will be depleted. It cannot be said that carbohydrates or fats
are an essential part of the diet in the sense that protein is, because it is
possible to substitute one for the other to produce energy, or to substitute
proteins for both.
In spite of these facts, it is safe to assert that the welfare of the human
organism is best promoted by a mixed diet, including all three classes of
food. The larger part of man’s food is used for the production of energy, and
it is physiologically economic that this energy be supplied by the non-
nitrogenous nutrients, particularly the carbohydrates, and to allocate to
protein, so far as practicable, its special rôle of building material.
Nitrogenous Waste Products.—The end-product of proteins is urea,
which is formed from protein decomposition products in relatively large

amounts in the liver cells, and, being readily soluble and diffusible, is easily
eliminated by the kidneys. Besides urea there are other smaller quantities of
nitrogen compounds, the one most deserving of notice being uric acid.
When the proteins are broken down to supply energy, there is always a
definite proportion of urea and uric acid residue that must be eliminated
through the kidneys. An excessive protein diet would burden these organs
beyond their accustomed habit, and flooding the system with these
nitrogenous wastes increases the tendency to rheumatism and gout.
Uric acid is of general interest, and when present in the system in
abnormally large amounts, as in gouty persons, has a pathologic
significance. It is more complex in its composition, and, what is of
particular importance, is that it does not readily dissolve. It forms very
insoluble salts which have unpleasant tendencies to settle in the joints,
causing great pain. Did its metabolism proceed properly, it should be
resolved into urea and carbon dioxid. The quantity of uric acid that appears
in the urine is the residue that has escaped this oxidation.
Uric acid is built up from purin bodies in the food, so that it would be
well for those with a gouty diathesis to abstain, at least when an attack of
gout threatens, from all aliment in which purin is at all abundant. The most
valuable of the purin-free foods are eggs and milk, and to these the uric-
acid sufferer has to turn in times of trouble.
Carbohydrates Physiologically Economic.—This group of compounds
comprises starches, sugars, and gums; the elements of which they are
composed—namely, carbon, hydrogen, and oxygen—are so balanced that if
all of the carbon were removed the residual hydrogen and oxygen would be
in the proportions to form water.
Carbohydrates are usually characterized as the fuel portions of the food,
or, in other words, that part which is burned to produce the various forms of
energy. They are also essential for the well-being of the organism; reduction
of the intake below the essential point frequently leads to acetonuria.
When the metabolism is perfect, any carbohydrates consumed in excess
of the ordinary requirements are converted into glycogen and fat and stored
for providing fuel at a future date. When stored as fats they are completely
oxidized in the simplest compounds, carbon dioxid and water, and are

eliminated through the lungs and skin, possibly part of the water so formed
acting as a solvent for the urinary compounds. Investigations seem to prove
that the body has a preference for the carbohydrates over fats or other
nutrients as a source of energy. There is every justification for the
abundance of starches in man’s diet.
Fat is essential in the food of mankind; it is absorbed ready formed from
the food, or manufactured in the body from the proteins and carbohydrates.
Neutral fats and fatty acids are valuable foods; their primary function is to
supply the body with fuel for heat and energy.
The mineral substances form 5 or 6 per cent. by weight of the human
body, and are constantly leaving it by different channels; they are
indispensable elements of food. They give solidity and stability to the
organism, constituting a considerable proportion of the bones. They keep
various proteins in solution and confer upon them the property of electric
conductivity. They are necessary for all of the secretions and assist in the
general metabolism. The carbonates of soda, potash, iron, and other
minerals render the blood and secretions alkaline. The removal of carbon
dioxid is performed mainly by the alkaline carbonates, which take it from
the blood and surrender it to the lungs. We have already considered the need
of sodium chlorid. The total daily requirements of salts is estimated at about
360 grains.
Vitamins a New Factor in Nutrition.—But recent investigation has
proved that something more is essential for the maintenance of growth and
well-being than protein, carbohydrates, fats, and salts; that food contains a
minute portion of accessory bodies, and that when they are deficient or
absent from the diet the immature body does not grow, the mature body
does not maintain its condition, and there are manifestations of more or less
serious disease. These accessory bodies have been called “vitamins,” and
they are essential to maintain the normal metabolism of the body.
It is recognized that although vitamins are undoubtedly widely
distributed in food products, they occur for the most part in very minute
amounts, and the various foods differ in the proportion which they contain.
If the diet is made up of substances which are poor in vitamins, or rendered
so by their mode of preparation, abnormal metabolic processes have been
found to follow.

The study by many scientists during the past few years of the enzymes
and their striking specificity; of the salts; of the insufficiency of many
proteins, and of the vitamins is epoch making, and has caused a
corresponding advance in dietetics. These discoveries are so important as to
raise the question whether nutritive failure or success does not depend as
much on the accessory bodies—the vitamins, the enzymes, and lipoids—as
on the primary element of the diet.
In addition to these food principles, there exists in our food a number of
compounds which, while not indispensable, act beneficially as flavorings,
stimulants to digestion, etc.; these are termed food adjuncts, and comprise
such bases as caffein, essential oils, organic acids, etc.
Standard Dietaries: The Maintenance Diet.—There is great need of
standardization and of knowledge regarding the maintenance diet, first
among physicians and then among the people in general, or scientific
dietaries based on the nutritive value of foods. These are given in terms of
proteins, carbohydrates, and fats, together with the aggregate energy of the
nutritive value in each. This is the corner-stone of dietetics.
Dietetics is the science of feeding. It has to do with the necessities of the
body and the ability of the food to meet these necessities in the various
circumstances and conditions of life. The ultimate scientific knowledge
concerning human nutrition should be to promote the healthful and
economic use of food.
The problems to be dealt with are quite complex. These are: (1) changes
in the economic conditions of the population; (2) changes in food
production and food supply; (3) changes in the methods of preparing food.
In regard to the influence of the economic conditions of the people on the
composition of their diet, it might be expected that a considerable decrease
in the earning capacity of the poorer people, or an increase in the cost of
foods, would be followed by a change in their diet. Everyday experience
teaches that under such conditions the more expensive foods—meat, eggs,
and milk—are reduced in the diet. These same foods are also rich in
vitamins, so that a reduction here would, therefore, reduce the vitamin
content of the dietary unless other dietary complements rich in vitamins,
such as legumes, were introduced.

The value of any food as a source of heat and energy is measured by a
bomb-calorimeter. The heat given off during the combustion is a measure of
the latent or potential energy of the food. The kinetic energy of the food is
the amount of heat developed by the proportion which is digested. The unit
commonly used is the calorie, or the amount of heat which would be
required to raise the temperature of 1 kilogram of water 1° C., which is
about equal to that required to raise the temperature of 1 pound of water 4°
F.
Heat Value and Digestibility of Foods.—One of the chief functions of
food is to supply the body with heat and energy; the food must be capable
of digestion and absorption. Herein lies the exact value of any food to the
consumer. In science the figures that are given for the digestibility of the
various foods refer to the completeness or extent to which the food is
dissolved and transferred to the circulation, and an indigestible one is that
of which a considerable portion passes out of the system into the feces
without being disintegrated and absorbed.
Animal food is more completely digested than vegetable food, as shown
by the difference of nitrogen in the feces. In meats 97 per cent. of the
protein and 98 per cent. of the fat are absorbed. Lean meat is more rapidly
digested than fat, and the flesh of young animals than that of older ones.
The breast of chicken, fresh beef, and mutton are among the most
digestible of the solid foods. Raw and rare meats are more easily digested
than well-done meats; in other words, cooking lessens the digestibility of
meats. Steak should be broiled and never fried; all fried foods are difficult
to digest. Veal and pork are both difficult to digest.
Eggs are almost as nutritious as meat; their digestibility is unsurpassed
and only equalled by a few foods, such as milk and oysters. They are most
easily digested when soft boiled or poached. Dry toast finely broken up and
mixed with a soft-boiled egg aids in its digestion. Soft-boiled eggs are more
easily digested than raw eggs, but the latter are less irritating to the
stomach, probably because they are digested in the intestines. It has been
found that two poached or soft-boiled eggs leave the stomach in from two
to three hours; that is, in the same time as milk, oysters, white bread, and
light fish.

Milk.—Although one of the most completely digested of foods in a
mixed diet, milk is not quite so completely digested as meat and eggs.
When milk is the sole food (milk diet) the proportion digested depends
partly on the amount consumed. With the consumption of 3½ pints of milk
daily the loss of milk solids varies from 10 to 11.16 per cent. Young
children digest milk more completely than adults.
The addition of aërated waters or crackers broken up in the milk prevent
the formation of tough clots, and hence render it more digestible. Hot (not
boiled) milk is more digestible than cold. Boiling increases the toughness of
the curd, but it destroys the bacteria. Buttermilk and koumiss are more
easily digested than cows’ milk.
Wheat flour enters largely into the diet of every family. In producing it
the outer coating of the wheat kernel is removed, thus throwing into the
milling offals that part of the kernel which is most heavily charged with
mineral ingredients and vitamins. The proportion of digestible proteins in
white flour is not less than in whole wheat flour, as is so often claimed, but
because the latter is richer in mineral ingredients its use is recommended.
Bread is readily digestible; white bread digests more rapidly than brown
or black; and crackers more rapidly than either.
Rice is another cereal of great economic importance. As a food for
invalids it possesses a high value on account of its digestibility, especially
in intestinal diseases. Ordinarily polished rice contains only 0.5 per cent. of
cellulose, and almost all of the substance of the grain is absorbed.
There is a perfect analogy between the well-known relation of the
polishing of rice to its nutritive value, and the milling of wheat and corn to
the nutritive value of wheat, flour, and cornmeal; that is, it loses the mineral
ingredients and vitamins.
Potatoes.—In European countries potatoes rank next to bread; this arises
from the ease of their digestion. From 92 to 95 per cent. of the starch is
absorbed, but there is a loss of 23 per cent. of the protein.
The manner of preparation of vegetable foods determines the proportion
of loss. When potatoes are baked or boiled in the skins the loss is negligible.
The greatest amount of loss occurs when the skins are removed, the
potatoes then allowed to soak in cold water, and placed in cold water to

boil. The potatoes should be pared just before cooking, and the water should
be boiling hard before they are put in. Mealy potatoes digest more rapidly
than waxy ones, and mashed quicker than unmashed.
Oatmeal, barley meal, and other cereals which are not ground very fine
do not digest so easily as wheat flour, but much depends on the mode of
cooking. When oatmeal-gruel is consumed with a sufficient amount of milk
it forms a complete diet.
Nuts are valuable as a source of protein and fat, but they are rather
difficult of digestion.
Fats.—As a rule, children do not thrive whose diet is deficient in fats,
and even adults are prone to tuberculosis and nervous diseases when fat in
the body is deficient.
Cheese is one of the most indigestible of foods. All fried foods are highly
indigestible because the fat envelope of the foods has to be melted off
before the gastric juice can act on the food substance itself. Pastry is also
very indigestible. Of the vegetables, beans, while highly nutritious, are
exceedingly difficult of digestion; also boiled cabbage, cauliflower, hot
breads, iced drinks, ice-cream, and water-ices.
The Relation of Diet to Various Conditions of Life.—The chief factors
influencing bodily needs are age, height, weight, occupation, idiosyncrasies,
and atmospheric conditions.
All activity of the human body, whether in the maintenance of its
functions or in the performance of labor, is work. These two forms of work
may be classified as physiologic and mechanical. Nothing in nutrition is
more important than the relation of food to work.
Children are practically in constant motion during their waking hours,
and their demand for food energy is from two to three times as much per
unit of weight as that for adults.
Sex.—Men and women of the same age and weight, doing the same kind
and amount of work, require the same amount of food. The fact that men
usually require more food than women is because, as a rule, they weigh
more, are more active physically, and perform more external work.

Temperament.—Persons of a nervous type, being more active, use more
energy than the phlegmatic, and, therefore, require more food.
Brain Workers.—A man whose work is sedentary and chiefly mental
does not need so much food as a man doing muscular work. The amount of
carbohydrates required is less, and the amount of fat rather more than for
the man doing light muscular work.
Ranke’s diet for the brain worker is: Protein, 100 grams; fats, 100 grams;
carbohydrates, 240 grams; giving an energy value of 2310 calories.
The diet should not be bulky, but light and easily digestible. Excess of
food and heavy foods are especially bad for brain workers because they
produce heaviness, dulness, and drowsiness. Spiced and rich foods upset the
alimentary functions, whereby the circulation is flooded with the products
of imperfect metabolism to the detriment of the brain.
Trained workmen will do a given amount of labor on less food than
untrained, because when persons take up mechanical operations with which
they are unfamiliar, or undertake work which exercises a new set of
muscles, a unit of work accomplished costs more in food energy than when
the muscles have been trained to do a particular thing.
Very strenuous exercise, like athletic contests and unnaturally slow
movements, are both wasteful of food energy.
Again, a continuance of the same labor for hours, and a state of fatigue,
whether it comes after a longer or shorter time, causes an increase in the
energy expenditure per unit of work performed.
Economy in the use of energy that food supplies to the body is most fully
secured when the movements of the body are at the natural rate; when
periods of intense effort do not occur, and when the labor is not too long
continued and is not carried to the point of fatigue.
Standard for Daily Dietaries (American)—Atwater.
Fuel
Protein. Nutritive
value.
Grams. ratio.
Calories.
Woman with light muscular exercise 90 2400 5.5
Woman with moderate muscular work
Man without muscular work } 100 2700 5.6

Man with light muscular work 112 3000 5.5

Man with moderate muscular work 125 3500 5.8
Man with hard muscular work. 150 4500 6.3

The Relation of Food Economics to Social Welfare.—A virile nation is
one whose citizens are of a good physical type, which means that they are
well nourished. A well-fed people, other conditions being favorable, is a
strong people. Food is the physical basis not only of the individual activity,
but also of social energy. Any causes, therefore, which limit the food supply
or increase the burden of securing adequate nourishment strike a blow at the
nation’s vital power.
We must constantly keep in mind that the energy output is practically the
energy requirement, under given conditions, of course; and the expenditure
caused by the muscular activity of a particular individual cannot be reduced
without affecting the work done or causing the loss of body substance.
Investigation has shown that there is a necessary daily protein minimum
use. When insufficient protein is taken in the food, the necessary balance
will be supplied by drawing on the tissues of the body. The food standards
which are based on the observation of practice call for not less than 100
grams of protein daily for professional men and 175 grams for men at
severe labor.
It is held to be significant that communities holding leading positions in
the world consume a liberal amount of protein, or, conversely, that
communities with an inferior physical and mental status use a low
proportion of proteins in the diet. Again, if we argue from the analogies in
feeding farm animals, generous protein feeding is desirable for the growth
and maintenance of vigorous organisms and a satisfactory rate of
production.
On the other hand, the well-known experience of the ages has shown that
the poor who live on a low protein diet are the most liable to disease. It
cannot be gainsaid that the meat eater has greater stamina and energy than
the one whose diet is poor in protein.
The conclusion is, that while a minimum of protein is essential to the
organism, a greater proportion is advantageous by acting as a stimulant to
the metabolism and as a ready source of energy; that people are better for
the consumption of proteins in quantities greater than in Chittenden’s

standard, and possess greater resistance to disease, probably because the
body is stimulated to manufacture antibodies.
Practical Facts for Guidance.—The housewife who keeps the following
facts in mind may combine foods in an approximate way that will fully
meet the demands of the human organism.
The proper ratio is 1 part of protein to 5 parts of non-protein; and the fat
should equal one-half of the weight of the protein. This gives the following
normal dietary:
Energy
Weight. supplied.
Grams. Ounces. Calories.
Protein 100 3½ 410
Carbohydrates 400 14½ 1640
Fats 50 1¾ 465
2515
Proportion of Proteins in Foods.—Foods Rich in Proteins.—Lean
meat, dried peas, beans, and lentils, 18 to 25 per cent.; fat meat, 12 to 18 per
cent.; eggs, 12 per cent.; oatmeal, 10 to 15 per cent.; cheese, 25 to 35 per
cent.
Foods with Moderate Amounts of Proteins.—Milk averages 3½ per cent.;
fresh peas, beans, and lentils, 3 to 8 per cent.; white bread, 6 to 7 per cent.;
fine wheat flour and barley, 8 to 10 or 12 per cent.
Food with Usually Less than 3 Per Cent. of Proteins.—Green vegetables,
potatoes, and roots, such as carrots, turnips, and onions, etc.
Legumes and certain nuts supply relatively more protein than other
vegetable foods, so that when the cost of meat, fowl, fish, eggs, or milk is
prohibitive, the freer use of beans, peas, lentils, and nuts is strongly
recommended.
The unmodified foods, such as grain, vegetables, fruit, meat, eggs, and
milk, may be depended upon to amply supply all the necessary elements to
sustain growth, functions, and waste of the human body. On the other hand,
foods which it is proper to designate as “artificial” are not only not essential

to an adequate diet, but when they are used freely may render a diet very
one-sided or deficient.
Foods may be so selected as to furnish an abundant supply of mineral
ingredients. For instance, the dry substance of certain vegetables like
asparagus, lettuce, spinach, and such animal foods as eggs, and beef
extracts are relatively rich in iron compounds, and the dried substance of
leguminous seeds, carrots and other vegetables, milk, and cheese are
relatively rich in calcium compounds.
Variety of foods is necessary, for monotony of even the best kinds leads
to satiety, loss of appetite, loathing of food, and subsequent ill-health.
Vegetables and fruits are absolutely essential, but raw fruits are not so easily
digested as cooked. Salads, lettuce, water-cress, green onions, celery,
tomatoes, etc., are so valuable for the juices contained in them that they
cannot be too strongly recommended to those who can digest them. Similar
juices are contained in cabbage, cauliflower, spinach, etc., but these are lost
to a very great measure in the cooking.
Oranges, lemons, grapes, strawberries, and bananas contain equally
valuable juices, and may be eaten raw with advantage to the consumer; but
apples, pears, plums, gooseberries, and many other fruits are better cooked
before being eaten.
The simpler the meals, the less work will be expended in their
preparation, and there is no advantage in an elaborate meal. The main thing
is that the table should furnish a sufficient variety from day to day.
The following specimen dietary has been found to be most satisfactory
for women with sedentary occupations. On it women have maintained good
health and other women have regained their health:
Breakfast.—Fruit, bacon and eggs, breakfast hominy, rolls or toast and
butter, a glass of milk, and one cup of coffee.
The fruit may be any raw fruit in season except apples or bananas; apples
should always be cooked for breakfast because they are more easily
digested; bananas are too heavy and indigestible to be served for breakfast.
Stewed prunes are good and especially laxative.
Bacon is not a necessity, though it is an appetizer. Eggs may be served in
any way, though they are most digestible when soft boiled or poached.

The hominy is boiled in water and served as a vegetable, with a little salt
and butter, but no sugar.
For women with good digestion and taking more active exercise, oatmeal
and cream may be substituted for the eggs, hominy, and glass of milk.
Luncheon may be served in a very appetizing way from the cold meat
and vegetables which have been left from the previous day’s dinner in the
form of stews, baked hash, etc. Stewed fruit should always be served, and
oysters always make a nice dish for lunch.
The criticism of the ordinary lunch for women is that it is too light. The
food served for lunch should furnish about 1000 calories; 90 per cent. of
these should be in the form of starches and fats.
Dinner.—The following is a balanced ration given in the Educational
Lunch Room of the New York Department of Health:
Proteins.
Price. Quantity. Calories. Grams.
Vegetable soup 5 cents. ½ pint. 150 5
Roast beef 20 cents.4 oz. lean. 140 30 or
Roast beef with 4 oz. fat. 460 27
Mashed potatoes, creamed Av. helping. 110 4.0
String beans 5 cents. 2 h. tbsp. 10 .5
Salad a la Sauté 8 cents. Av. helping. 370 2.0
Whole wheat bread 2 slices. 140 5.5
Butter ½ ounce. 120
Apple pie 5 cents. ⅙ pie. 300 4.0
Black coffee 3 cents. 1 cup.
Sugar 2 squares. 60
46 cents. 1760 or 50 or
1440 53
One glass of water is served with each meal; it should be taken when the
meal is finished.
The mineral waters promote digestion by promoting an earlier and more
abundant secretion of the gastric juice.

Lemon juice should be substituted for vinegar in all salad dressings. For a
French dressing the correct proportions are 1 tablespoonful of lemon juice
and water each to 2 of olive oil. Mix well, and pour over the salad just
before serving.
Three meals a day has been found to be the best arrangement, and there
should be an interval of five hours between the meals. If possible dinner,
which is the principal meal, should be taken at the end of the day, after its
work is over, so that comparative repose may be enjoyed after it. It is of
extreme importance that the meals be served at the same hour every day.
The perfectly healthy woman should never take anything to eat between
meals.
A hearty meal should never be eaten when one is exhausted or greatly
fatigued. Half an hour’s rest before dinner is a great aid to digestion. Sleep
directly after a hearty meal is injurious and sometimes proves fatal because
there is a depression of the circulation, and the digestive processes may stop
absolutely during sleep.
Preparation of Food.—Fresh meats are highly nutritious, but in order
that the nutritive properties may not be lost in the cooking, they must be
eaten “rare,” that is, beef and mutton should be at least pink.
A roast should be done in a quick oven, so that the albumin shall rapidly
coagulate on the surface and prevent the escape of the nutritive juices. Or if
the meat is boiled, it should for the same reason be plunged into boiling
water.
On the other hand, in treating meats in order to obtain “stock” for soup,
the meat after having been cut up into small pieces should be allowed to
stand in cold water for twenty minutes and then be put on to simmer for six
hours or more.
Plenty of bones with gristle should be gotten with the soup meat; these do
not add to the cost, and add materially to the value of the stock; for, while
the gelatinoids are not flesh formers, they are admirable protein sparers.
The same thing holds true of gelatin and its preparations.
Indigestible Combination of Foods.—The acid of vinegar being a
fermentation acid renders the digestion of many foods with which it is taken
more difficult, while vegetable acids, such as citric and tartaric, do not

cause that objectionable effect. Vinegar also retards salivary and gastric
digestion.
Strong tea taken with any meat meal converts the albumin of the meat
into a dense precipitate that is absolutely indigestible. The tannin of tea
inhibits the salivary and gastric secretions and so retards digestion.
Indigestion, atony, or catarrh of the stomach is frequently due to excessive
tea drinking, and the artificial stimulation of the nervous system may be
carried so far as to produce insomnia, palpitation, muscular tremors, and
other signs of nervous irritability.
Claret and coffee both delay digestion.
Water is the best beverage to be taken with meals; but the moderate use
of tea and coffee is commendable because they have an invigorating effect
arising from the caffein and the essential oils, but their use should not be
abused.
The Proper Way of Making Tea.—The water should be freshly boiled; the
tea-pot heated so that the water will be maintained at the boiling-point; one
teaspoonful of tea is allowed to the cup. The tea is measured out, put into
the tea-pot, and the requisite amount of boiling water poured over it. It is
then allowed to stand on the kitchen table, not the range, for from two to
three minutes; it should then be strained into the tea-pot for the table.
Unless the tea is strained off the leaves the infusion continues for some
time; this extracts the tannic acid and bitter principles. In addition, the
prolonged infusion dissipates the volatile oil, to which much of the
fragrance of a good cup of tea is due.
As it is almost impossible to have the requisite amount of care exercised
in the making of tea in the kitchen, it is much better that it should be made
on the table. Sugar detracts from the healthfulness of the beverage.
Coffee.—Most that has been said about tea is true of coffee. It is aromatic
and refreshing, stimulates the mental activity, invigorates the muscular
system, and removes the sense of fatigue. The excessive use of coffee often
leads to insomnia. Its use retards gastric digestion, but less so than tea; but
strong coffee or café noir has a still greater inhibitory effect. It has a slightly
aperient effect on the intestines by increasing the peristaltic action. It is also
slightly diuretic.

The aromatic oils are dissipated by boiling, and the best temperature of
the water is 210° F., or just below the boiling-point.
Defective Methods in the Preparation of Breads which Reduces the
Vitamin Contents, Especially of Corn Bread.—By resorting to artificial
methods for procuring the lightness of breads, baking soda (sodium
bicarbonate) is used. In order to prepare bread in this way the cornmeal is
mixed with milk or water to which baking soda has been added, and put in
the oven to bake. The high temperature of the oven liberates the carbon
dioxid (CO2) from the baking soda, causing the bread to rise, and the
sodium bicarbonate is transformed into sodium carbonate, a strong alkali.
Recent experiments have clearly demonstrated the destructive action of the
alkalies on the vitamins, this being especially true at high temperatures.
It should be strongly emphasized that the old-fashioned way of
combining baking soda with sour milk in the preparation of bread is an
entirely harmless procedure, provided that sufficient sour milk is added to
perfectly neutralize the alkalinity of the soda. The label on some brands of
baking soda clearly states that sour milk, or tartaric acid, should be added in
order to obtain the best results.
Dietary in the Tropics.—Sir R. Havelock Charles says, “It is impossible
to form exact rules for dietary in the tropics because there are differences in
climate which require modifications.” He says nothing about limiting the
amount of meat, but he does say, “no cold meat whatever should come on
the table.” It is important that everything should come straight from the fire
to the table. It cannot then cause bacillary mischief, and there should be no
fear of cholera or dysentery.
Boiled water only should be drunk. No salads of any kind should be used
except in the greatest moderation.
Fruit.—Every fruit which possesses a rind that can be removed may be
eaten raw with impunity by a healthy man at any time of the year. Fruits
which do not possess a rind are incapable of being thoroughly cleansed;
such fruit may be contaminated and dangerous to the consumer, and, at any
rate, ought only to be eaten after it is cooked. Therefore oranges, grape-
fruit, pears, apples, bananas, mangoes, pineapples, custard-apples,
mangosteen, tomatoes, etc., may be eaten raw after peeling them. But it

would be unsafe to eat grapes, currants, strawberries, and other fruits which
cannot be peeled until they are cooked.
As regards proteins, some fish, fowl, or meat may be taken for breakfast;
animal food ought not to be taken in the middle of the day. It is better to
take dinner in the evening. Beef, mutton, pork, kid (goat-flesh), venison
(deer and antelope), poultry, many kinds of birds, eggs, and fish are
obtainable in one place or another. Tinned meats and fish should be
avoided; indeed, the importance of fresh meat is so great that hunting,
shooting, and fishing should be strongly recommended as exercise.
Fat is obtained in the form of meat, dripping, butter, ghee, nuts, and
various oils used in cooking. The pure oil from peanuts, palm-nuts, and
cocoanuts is salutary; but many samples are adulterated with sesamé oil,
poppy-seed oil, and colza oil, which are deleterious by causing dyspepsia or
other gastro-intestinal troubles. These in turn render the subject susceptible
to dysentery, sprue, and other tropical disorders.
Food Economics: Regulation of Diet with Reference to Minimum
Expenditure.—The cost of a meal for an individual or a family is made up
of two factors—the money cost of the raw materials, and the time, cost of
labor, and other expenses required for the preparation and serving of the
food.
The Cost of Raw Food Materials.—Meats of all kinds, poultry, and fish
are the most expensive articles of diet. Then, too, the waste has to be
considered—the bones and legs of a dressed fowl and the bones and skin of
fish.
At the present time the dairy products supply the cheapest nutriment
among animal foods, but the price of butter and eggs are apt to soar
enormously during the winter months.
Leguminous Food.—The dried pea, bean, or lentil are especially rich in
protein, and are thus fit to take the place of a part of meat in the dietary.
Their price is low in comparison to their value, and must be considered next
to bread in importance. They are less completely digested than cereals if
eaten in any quantity; and, highly nutritious as these are, it cannot be denied
that in large quantities they are very indigestible for any but persons with
strong constitutions and leading an active outdoor life.

Great care is needed in their preparation. Dried legumes should be
soaked in cold water for eight hours, and then boiled for one hour and a
half. They are then sufficiently soft to be pressed through a sieve. The skin
of peas and beans that have been dried should be removed, for they pass
through the intestines unchanged. Soft water should be used in preference
to hard, as insoluble lime compounds are formed by the latter with the
protein “legumin.”
Outside Preparation Expensive.—From the standpoint of food value,
white bread is more than twice as costly as the wheat flour from which it is
made. A barrel of flour of 196 pounds will make on the average 315 5-cent
loaves of bread. The bread costs the consumer $15.75, whereas the flour
can be bought at the time of writing for $6.50.
Breakfast foods ready for the table, instead of the cheaper cornmeal,
oatmeal, and hominy cooked at home, and bread, cake, and other pastry
cost double the amount of the raw materials.
There are, however, other factors which complicate and increase the cost
of living. At present the exorbitant cost of labor, cost of fuel, etc., and the
amount of the housewife’s time consumed are all important factors to be
taken into consideration.
The size of the family, the number of small children demanding the
mother’s attention, the kind of labor in which they are engaged, whether
hired help has to be depended on for all the work, etc., are all factors which
must be taken into consideration as to whether the outside preparation is
more expensive than when the labor is performed in the home. This is a
matter for every housewife to work out in making her monthly and yearly
budgets.
TABLE OF FOOD VALUES[4]
Percentage composition.
Heat value Food values
Kind of food,
Water. Protein. Fat. Carbohydrate. Ash. calories per comparison of 1000
edible portion only.
ounce. grams.
Meats.
Beef:
Roast, average 48.25 22.25 28.55 ... 1.25 160 1868
Roast ribs, fat 45.20 19.14 39.04 ... .82 122 2057
Boiled, average 39.10 26.30 35.00 ... 1.00 175 2268

Broiled steak 44.25 23.45 26.50 ... 1.43 100 1942
Corned 51.19 26.32 18.65 ... 4.10 80 1810
Veal: Cooked,
51.88 32.20 11.40 ... 1.50 68 1896
average
Mutton:
Roast, average 51.00 26.00 22.60 ... 1.19 90 1805
Boiled leg 57.67 27.60 14.38 ... 1.05 67 1738
Lamb:
Roast leg 67.10 19.70 12.70 ... .80 66 1318
Various parts 47.25 23.80 28.50 ... 1.25 100 1966
Pork: Roast,
45.00 32.00 20.00 ... 1.76 90 2122
various parts
Organs:
Heart, cooked,
62.60 16.60 20.00 ... 1.00 70 1370
average
Kidney, ox,
76.15 16.50 4.90 .40 1.20 32 940
cooked, average
Liver, ox, cooked,
71.00 20.60 4.60 1.80 1.50 38 1150
average
Sweetbread, ox,
71.00 16.80 12.00 ... 1.60 51 1157
cooked, average
Tongue, ox,
71.00 19.00 9.00 ... 1.00 46 1188
cooked, average
Soup, etc.
Beef-tea 93.00 4.30 .50 1.10 1.10 8 234
Bouillon 96.50 2.30 .10 .20 .90 3 116
Chicken broth 94.00 3.80 .10 1.80 1.00 6 200
Consomme 95.50 2.40 .10 .30 1.10 3 120
Meat hash 80.00 6.50 2.00 9.00 2.40 24 560
Meat stew 84.50 4.60 4.30 5.50 1.10 23 420
Oxtail soup 89.00 4.00 1.50 4.30 1.50 13 278
Pea soup 87.00 4.00 .80 8.50 1.30 15 291
Soup stock, beef 89.10 5.80 1.50 ... 3.60 11 324
Tomato soup 89.00 2.00 1.50 5.50 1.30 12 158
Meat juice
90.00 5.37 .19 ... 1.36 7 269
(natural), average
Fowl.
Domestic, average 64.00 19.00 16.00 ... 1.00 65 1130
Chicken 67.00 22.70 10.00 ... 1.00 62 1395
Capon 56.00 21.80 21.00 ... 1.30 91 1656
Duck 55.75 17.50 25.00 ... 1.00 95 1554
Goose 52.00 16.50 35.10 ... 1.20 110 1800
Turkey 55.50 21.10 23.00 ... 1.00 85 1679
Roast 52.00 27.80 18.50 ... 1.30 82 1872
Roast capon 59.00 27.00 11.50 ... 1.30 60 1677
Chicken 66.90 22.00 8.10 ... 1.70 58 1298

Boiled fowl 57.60 27.00 12.80 ... 1.90 80 1708
Eggs.
Chicken eggs:
Raw 73.70 13.40 11.50 ... 1.00 45 983
Boiled, white. 86.30 12.80 .20 ... .70 16 633
Yolk 50.00 14.80 33.70 ... 1.20 106 1883
Fish and Shell-fish.
Bluefish 78.50 19.10 1.20 ... 1.20 27 935
Haddock, fresh 81.40 17.20 .30 ... 1.10 21 922
Halibut steak 74.80 18.50 5.30 .... 1.40 35 850
Mackerel 74.80 18.50 6.50 .... 1.10 40 1086
Oysters 80.00 10.60 2.60 6.50 1.30 25 655
Perch 75.70 19.00 4.00 .... 1.20 33 1049
Salmon, Atlantic 63.60 21.60 13.90 .... 1.40 64 1445
Sardines 56.30 24.80 12.70 .... 5.00 79 1560
Shad 70.60 18.50 9.50 .... 1.30 47 1170
Roe 71.20 21.00 3.80 2.50 1.50 38 1252
Trout:
Brook 77.70 19.30 2.10 .... 1.20 28 995
Lake 69.30 18.30 10.60 .... 1.20 48 1190
Salmon 70.80 17.80 10.20 .... 1.20 48 1156
Calf’s foot jelly 77.50 4.50 .... 17.40 .70 26 210
Milk Products.
Cows’ milk,
87.30 3.50 3.70 4.60 .73 20 320
average
Skimmed 90.30 4.00 .20 4.60 .83 11 245
Condensed milk,
full cream,
unsweetened 62.40 10.60 10.80 14.10 2.00 52 973
Full cream,
20.00 10.50 9.90 57.50 2.10 100 1368
sweetened
Skimmed and
26.40 10.40 .90 60.20 2.10 40 1232
sweetened
Cream, hand
74.00 2.50 18.50 4.50 .50 56 210
skimmed
Buttermilk 90.00 3.20 1.20 5.00 .60 10 238
Cheese from
45.30 32.00 16.50 2.00 4.20 85 2140
skimmed milk.
Butter:
Best quality 13.00 1.00 82.50 1.50 2.00 225 2371
Second quality 16.00 2.00 73.00 4.00 5.00 203 2235
Margarine 16.00 1.10 76.70 .... 6.30 220 2210
Cereal Foods.
Wheat flour,
10.50 11.90 1.60 75.40 .50 114 1283
superfine, white.
Entire wheat 10.80 12.20 2.20 73.60 1.00 114 1300

Graham 8.60 12.60 2.40 74.50 1.70 116 1330
Maize 10.90 10.20 4.80 71.00 1.30 .... 1242
Meal 12.50 7.10 1.30 78.30 .60 108 1106
Rice 12.40 6.90 .40 79.40 .50 102 1084
Boiled 72.50 2.80 .10 24.50 .20 45 258
Oatmeal, boiled 84.50 2.80 .50 11.50 .70 18 244
Macaroni, cooked 78.40 3.00 1.50 15.80 1.30 26 558
Bread.
White, best 44.10 7.70 .90 46.90 .30 71 793
Entire wheat 49.10 7.40 1.10 41.70 .50 65 770
Brown (Graham) 47.20 7.70 1.20 42.80 .90 67 780
Gluten bread 38.20 9.30 1.40 49.80 1.30 72 910
Toasted bread 24.00 11.50 1.60 61.20 1.70 90 1126
Zwiebach 5.80 9.80 9.90 73.50 1.00 125 1399
Pies and Puddings.
Apple pie 42.50 3.10 9.80 43.00 1.80 80 866
Cornflour blanc
66.00 2.60 3.10 27.00 1.00 36 456
mange
Custard with crust 62.40 4.20 6.30 26.10 1.00 52 604
Maize pudding
60.00 5.50 5.00 28.00 1.40 51 628
(Indian meal)
Rice pudding 60.00 4.00 4.70 32.00 .60 52 608
Tapioca pudding 64.50 3.30 3.20 28.50 .80 45 505
With apples 70.10 .30 .10 30.00 .20 36 289
Roots and Tubers.
Carrots, boiled 92.50 .50 .20 4.50 .80 8 70
Beets, boiled 91.70 1.40 .10 5.13 1.00 11 102
Parsnips, boiled 92.10 1.30 .30 6.50 .70 11 126
Potatoes, boiled 75.50 2.50 .10 21.00 1.00 26 312
Mashed, with
75.10 2.60 3.00 17.80 1.50 31 364
cream
Fried in fat 2.20 6.80 39.80 46.70 4.50 166 1807
Vegetables.
Asparagus, cooked
91.60 2.10 3.30 2.20 .80 30 200
and buttered
Brussels sprouts,
93.70 1.50 .10 3.40 .20 6 98
boiled
Cabbage 85.50 2.30 .70 5.10 1.70 9 89
Boiled 97.00 .60 .10 1.40 .20 3 41
Cauliflower, boiled 97.30 .60 .10 1.40 .50 .... 41
Celery, boiled 97.00 .40 .07 1.00 .50 .... 26
Green peas, boiled 73.80 6.70 2.50 14.60 1.50 34 588
Beans, string,
89.20 2.30 .30 7.40 .80 12 176
boiled
Salads.
Celery 94.50 1.10 .10 9.70 1.00 13 144

Cucumber 94.90 .70 .20 3.10 .50 4 64
Endive 93.00 1.00 .10 3.00 .60 8 73
Lettuce 93.80 1.80 .60 4.80 1.20 9 138
Onions 87.60 1.60 .30 9.50 1.10 13 167
Radishes 91.80 1.20 .10 5.60 .70 5 107
Tomatoes 91.80 1.20 .10 5.60 .70 5 107
Watercress 92.80 .70 .40 4.00 1.20 6 79
Dried Legumes.
Peas 9.50 23.80 1.80 60.30 2.60 104 1544
Haricot beans 12.60 22.50 1.90 59.60 3.50 100 1654
Butter beans 10.50 20.60 2.00 62.60 4.20 102 1519
Nuts.
Almonds, dried 4.80 21.00 54.90 17.30 2.50 189 2645
Brasil nuts 5.40 18.00 66.00 8.00 2.70 204 2606
Butter nuts 4.50 28.00 61.00 3.50 2.90 192 2956
Chestnuts 4.80 11.60 15.30 65.70 2.60 117 1537
Cocoanut, fresh 19.20 5.40 51.00 10.00 1.20 108 ....
Hazel and filbert
48.00 8.00 28.50 11.50 1.50 160 ....
nuts
Peanuts 9.20 26.00 38.60 24.20 2.00 160 2071
Walnuts, dried 4.90 15.50 62.70 7.50 1.90 190 2364
Fruits.
Apples:
Raw 85.20 .40 .50 12.60 .30 18 149
Cooked and
66.10 .20 .80 37.20 .70 46 395
sweetened
Dried 28.10 1.60 2.20 66.10 2.00 84 753
Apricots 85.00 1.10 .... 13.40 .50 18 176
Canned 81.40 .90 .... 17.30 .40 21 208
Bananas 75.70 1.30 .50 21.70 .70 29 276
Blackberries 86.30 1.30 1.00 8.40 .50 17 120
Cherries 82.00 .90 .80 14.30 .60 23 197
Cranberries 88.90 .50 .60 4.00 .20 14 76
Dates, dried 20.00 3.50 2.30 69.00 1.30 101 885
Figs, dried 22.70 4.30 .70 62.50 1.30 80 805
Grapes, fresh 80.50 .90 .80 14.70 .50 28 201
Dried, raisins 18.60 3.00 2.80 70.50 2.70 100 870
Jam, or preserve,
30.50 1.50 .... 60.00 .50 70 744
average
Melon 89.50 .60 .30 7.20 .60 11 103
Oranges 82.80 .90 .20 10.60 .70 15 146
Peaches 88.80 .50 .20 9.20 .60 12 117
Canned 88.10 .70 .10 10.80 .30 14 128
Pears 80.90 .90 .50 15.70 .40 18 203
Canned 81.10 .30 .30 18.00 .30 22 195

Pineapples 89.30 .40 .30 10.00 .90 13 112
Plums 74.50 .90 .20 19.10 .50 24 200
Prunes:
Dried 22.30 2.10 .20 73.30 2.30 86 724
Stewed 76.60 .50 .10 22.30 .50 27 243
Raspberries 86.20 .50 .... 5.60 .50 16 76
Strawberries 94.00 1.00 .60 8.80 .60 12 144

The Physiologic Action of Moderate Doses of Alcohol.—The result of
a series of experiments by Dr. Parke were as follows: “By quickening the
action of the heart, it shortens the interval of rest, and, therefore, interferes
with the nutrition of the heart. It also produces palpitation and
breathlessness. Even small doses of alcohol, by increasing unnecessarily the
action of the heart, are injurious. It acts on the nervous system by lessening
the rapidity and the delicacy of the impressions, as well as by lessening the
power of control of a train of thought. Further, by this same blunting of the
nervous system, voluntary muscular power is impaired, and the finer
combined movements are less perfectly made. It causes a lowering of the
temperature of the body, and, although it is taken to overcome the effects of
exposure to cold, it has been learned that persons who take it are less able to
resist the exposure to cold.”
As the result of modern scientific investigation and experimentation,
alcohol with its compounds has been taken out of the list of beverages,
where it has heretofore been classified with tea and coffee, and out of the
list of foods, to which class it had been admitted because of the known
oxidation of alcohol in the body, and has been placed in that list of drugs
known as narcotics, alongside of ether, chloroform, opium, and cocain—all
of them, the most deadly drugs in the Pharmacopeia, yet, when used by
skilled hands, the most beneficent.
The first effect of this class of drugs is a short temporary stage of
exhilaration, more or less rapidly followed, according to the amount taken,
by a stage of sleepiness or actual insensibility, which lasts longer than the
stage of excitement, and this in turn is followed by a long period of
depression.
Like other members of its class, alcohol has a cumulative action, the
residual quantities habitually taken accumulate and gradually affect the
efficiency and well-being of the individual.

A point that must always be borne in mind in giving any medicine is that
not a few drugs have a curious tendency to induce a craving for their
repetition.
The amount of alcohol contained in some of the most commonly used of
the alcoholic beverages is as follows: beer, 4 to 5 per cent.; hard cider, from
5 to 10 per cent.; claret, 8 to 11 per cent.; port, 9 to 22 per cent.;
champagne, 10 to 15 per cent.; rum, gin, and strong liquors, 40 to 50 per
cent.; whisky, 44 to 50 per cent.; brandy, 48 to 56 per cent.
These alcoholic beverages are often made still more harmful by
adulterations by ingredients in themselves harmful.
A large percentage of alcohol is also found in bitters and patent
medicines.
We will consider the subject of alcohol under the following aspects: First,
the question of alcohol as a food; second, the effects of alcohol on the
digestive system and the metabolism; third, the effects of alcohol on the
heart and the muscular system; and fourth, the effects of alcohol on the
nervous system.
First, Is Alcohol a Food?—The substances used as foods act in providing
energy for muscular work, in maintaining the heat of the body, in building
up of the tissues, and in saving the waste of the tissues. Moreover, a food
which does harm to any organ, or to the system as a whole, when taken in
moderate repeated quantities, becomes a poison for that individual.
A food may be defined as any substance which, when absorbed into the
blood, will nourish, repair waste, and furnish force and heat to the body,
without causing injury to any of its parts or loss of functional activity. From
any one of these four standpoints alcohol cannot be regarded as a food.
The physiologic effects of alcohol and real food-stuffs are totally
different. Fats, carbohydrates, and nitrogenous foods after mastication at
once begin to be digested and assimilated, and to fulfil the true functions of
a food by maintaining a natural temperature, pulse-rate, and tissue repair of
the body, without any disturbance of its mental and physical functions and
activities.
Alcohol, on the contrary, is absorbed from the stomach unaltered by the
digestive processes; circulated in the blood in its original form, it at once

interferes with the ordinary activity of the brain and other organs, and, by
its anesthetic action, hampers the mental and physical activities and
interferes with the processes of metabolism.
The Effects of Alcohol on the Digestive System and Metabolism.—The
local action of alcoholic liquids is particularly destructive on an empty
stomach; and when taken in strong solution, but it is also known that
smaller doses, taken continuously, are liable to effect the digestive organs in
a slower though similar way.
The injurious effects of alcohol are that it acts as a local irritant,
producing dilatation of the blood-vessels of the stomach and subsequent
gastritis; it leads to hyperacidity, by stimulating the secretion of
hydrochloric acid; the tartrates and malates contained in wine are
decomposed in the stomach, setting free organic acids, and thus producing
acidity; the acetic acid and yeast in beer set up an acetic acid fermentation
in the stomach-contents.
Whether taken alone or with food, the tendency of alcohol throughout is
to lessen the churning movements of the stomach, and leads to atony of that
organ, which in turn leads to dilatation of the stomach.
Alcohol appears to have a particularly deleterious effect on the digestion
of women. This is explained by the fact that men lead a more active outdoor
life, and consequently retain their appetite for food longer than women. For
the same reason, they are able to work off the effects of drinking more
easily and start afresh the assimilation of food. The indoor life led by
women, their clothing, worn tight around the stomach, are added causes for
lack of appetite. Catarrh of the stomach results; this is followed by
insufficient food and an increased amount of stimulants. There follow
nausea, irregular and insufficient nutrition, indigestion, and a faulty
elaboration of the food.
By its action on the liver alcohol interferes with the amount and quantity
of bile, and so inevitably leads to indigestion and constipation, and a similar
interference with the action of the liver-cells and their chemical changes set
up in many cases gouty conditions, accompanied by mental depression and
irritability.

Diseases of the liver occur more frequently as the result of taking
frequent small doses of alcohol, though never reaching the stage of
intoxication, than as the result of indulging more freely, but at longer
intervals.
The Effect of Alcohol on the Blood.—The blood is a mixture of
corpuscles and a fluid known as the blood plasma. The corpuscles are of
two kinds—red and white. The red blood-corpuscles are the oxygen
carriers; they carry the oxygen to the tissues, where they readily give it up.
They are constantly being destroyed by the liver and spleen, and are
replaced by new ones, which come from the red marrow of bones. The
white corpuscles are much fewer in number, but they play a most important
part in protecting the body against disease. It is now about twenty years
since Professor Metchnikoff, of the Pasteur Institute of Paris, announced to
the world his discovery that the white corpuscles have the power of
destroying the microbes to which so many diseases are due. These white
blood-cells form the standing army or policemen of the body, and their duty
is to attack, and, if possible, to destroy, any foreign matter, such as dust or
disease germs.
The plasma of the blood contains various kinds of salts, and include
sodium chlorid or common salt, the phosphates, and chlorids of calcium and
potassium.
The way which the body fights disease is partly by means of the white
blood-corpuscles, which totally destroy the germs, and partly by the
increase in the blood of those chemical substances which are antidotes for
the poisons given out by the germs.
Alcohol taken into the stomach is quickly absorbed and reaches the blood
in two minutes. The maximum of alcohol is found in the blood in fifteen
minutes after it is swallowed.
The blood is the medium by which food and oxygen are conveyed to the
tissues, and by which the refuse material from the tissues is carried away;
alcohol interferes with both these processes.
The red cells are liable to become damaged and anemia results. It has
now been proved that even tiny doses of alcohol paralyze more or less the
white cells, and thus interfere with their power of destroying microbes.

Chemical substances tend to exert a delaying or inhibitory influence over
the chemical processes of the body. These chemical processes are oxidation,
the storing up of nutriment, the manufacture of secretion, the production of
energy and muscular movement, and the excretion of waste materials.
The greatest possible difference exists as to the rate at which oxidation
goes on. When there is nothing to hinder its occurrence, the poisonous
toxins and waste matters are rapidly burned up and eliminated and health
prevails. Alcohol, by its affinity for oxygen, robs the tissues of oxygen
which they would otherwise use for combustion. Hence the tissues are kept
starving for oxygen, metabolism is interfered with, and they cannot get rid
of their waste material.
This delayed oxidation tends to increase the body weight. The cells in an
intermediate stage of fatty degeneration clog the body, and, of course, add
to its weight. The natural effect of taking alcohol is to make the body obese.
On abstaining from alcohol, the superfluous tissue is often burned away,
and the weight of the body reduced, and a look and feeling of youth is
recovered.
The Effect of Alcohol on the Heart and Circulation.—By the circulation
we understand the driving of the fluid blood around the body, through the
blood-vessels, such driving being maintained by the pumping power of the
heart, which is practically a hollow muscle.
In consequence of this pumping power of the heart, the blood in the
vessels is under considerable pressure, which is naturally increased if the
blood-vessels are narrowed or contracted, and diminished if the blood-
vessels are expanded or dilated.
Gradual deterioration in the heart power is a cause of premature death.
One of the early indications that the foregoing changes may be occurring in
a heart is a sense of fatigue and breathlessness on slight exertion, or a
feeling of disinclination for normal effort. The result of such depression of
the efficiency of the heart is often seen when the individual is attacked by
some disease; she succumbs to heart failure, instead of being able to resist
the disease. This probably accounts for a great many deaths between forty
and sixty years of age.

Further, it must be remembered that all the nutritive action of the blood
depends on its power of rapidly filtering through the walls of the blood-
vessels to the tissues, and, conversely, its power of drawing off the waste-
products of the tissues depends on the facility with which such products can
penetrate its walls.
As soon as degeneracy sets in, the walls of all vessels tend to become
thickened, and the active transference through them, more and more
prevented; the nutrition of the body is thus gravely hampered, and, with the
advance of this thickening of the walls, the vessels are less able to adjust
themselves to the variations in pressure from within; and, finally, when
unable to withstand the pressure, they rupture, causing hemorrhage and
apoplexy, which, when occurring in the brain, cause paralysis and mental
decay.
A similar degeneration takes place in old age, but the point is, that many
persons, instead of waiting until old age comes to them, deliberately
precipitate these senile changes.
The Effect of Alcohol on the Kidneys.—The elaborate mechanism of the
kidneys consist of a filtering system of thousands of tubules, arranged
closely side by side, whose function it is to carry away from the body the
waste material, which otherwise would interfere with the vitality of the
different organs.
The part played by the kidneys in rapidly eliminating effete material
cannot be too carefully safeguarded. Anything which interferes with its
work will sooner or later cause a retention of waste-products in the system,
and will also permit of the escape of valuable albuminous materials of the
substance of the blood through the filtering apparatus. The effect of alcohol
upon the kidneys can only be described as disastrous. In proportion as the
kidney shrinks, there is a diminution of the excretion of urine, and, finally,
the condition known as Bright’s disease is established.
The Effect of Alcohol on the Muscular System.—The muscular tissue
forms 43 per cent. of the body weight. It has been proved that under the
moderate use of alcohol the muscles become flabby and less vigorous and
effective; that troops cannot work or march on alcohol; that in training for
athletics, for races, or for other sports, total abstinence is always practised;
the true sportsman depends quite as much on his brain as on his muscles for

success. In England it is recognized that total abstinence is a necessity
where great exertions are concerned, and it is now beyond all question that
alcohol, in even so-called dietetic quantities, diminishes the output of
muscular work, both in quantity and quality, and that the best physical
results are obtained under total abstinence from its use.
Alcohol actually lowers the temperature of the body from three-fourths
of one degree to three degrees. This depression of temperature is not
transient, but lasts for several days, so that its use, when the person is
exposed to intense cold, is extremely hazardous to life.
The Effects of Alcohol on the Nervous System.—Kraepelin has carried out
a series of experiments to prove the effects of small doses of alcohol on the
output of work. In all mental work there are two elements to be considered,
namely, quality and speed. Now, all observers are agreed that the quality of
mental work is affected even before speed, more mistakes being made.
Tests were made in reading aloud; in adding figures in various
combinations; in type-setting; and in memorizing; in all these instances it
was found that, after taking moderate doses of alcohol for a number of
consecutive days, the work done was less, was less accurate, and that there
was a decrease in the power of memorizing.
Another series of investigations, made by Rudin to determine how long
the intellectual abilities continue to be depressed after the effects of alcohol
pass off, showed that the effects of a single dose of alcohol persisted until
noon or evening of the next day.
Von Helmholtz, one of the greatest observers and thinkers of the
nineteenth century, noted on himself the effect of alcohol in interfering with
the highest powers of thought and conception. Describing the conditions
under which his highest scientific thoughts had matured and come to
fruition, he said: “As far as my experience is concerned, they never come to
a wearied brain or at the writing-desk; they were especially inclined to
appear to me while indulging in a quiet walk in the sunshine or over the
forest-clad mountains, but the smallest quantity of alcohol seemed to drive
them away.”
Professor Sikovsky’s testimony is that “alcohol diminishes the rapidity of
thought, makes the imagination and the power of reflection commonplace
and deprived of originality, acts upon fine and complex sensations by

transforming them into coarse and elementary ones, provokes outbursts of
evil passions and dispositions, and in this predisposes men to strife and
crime, and upsets habits of work and perseverance.”
Self-control is one of the highest functions of the brain, and the racial
power which results to a people as a consequence of the individual practice
of self-control cannot be too highly estimated. Therefore, children are
trained as far as possible to control their emotions and actions. Alcohol
diminishes and breaks down this power of acquired self-control, undoing
the work of parents and educationalists. Quite small doses are often
responsible for reckless and self-pleasing actions, which are far reaching in
their results in loss of moral tone and self-respect. The ideals of duty are
lost sight of, and, at best, leave the individual in a laissez-faire attitude.
Among the depressant effects of alcohol are intellectual lethargy and a
sense of fatigue, which, combined with the other factors, lessen the capacity
for genuine enjoyment and pleasure.

FOOTNOTES:

[4] Compiled from Tibbles’ “Dietetics, or Food in Health and Disease.”

CHAPTER V
THE RESPIRATORY AND CIRCULATORY
SYSTEMS: THE KIDNEYS
The Mechanics of Circulation and Respiration; the Circulatory Apparatus; the
Lungs; Hygiene of the Lungs and Its Relation to the General Health; Relation of
Respiration to Body Heat; the Respiratory Functions of the Abdominal Muscles; the
Importance of Good Chest Development; Proper Relation Between the Height,
Weight, and Chest Measurements; Chemical Properties of Air; Town and Country Air;
Dust and Its Relations to Disease; Rôle Played by Bacteria; Ventilation; the Injurious
Effects of Overheated Air; the Proper Degree of Moisture for the Air of the House;
Ventilation of Bed-rooms.
Care of the Nose, Throat, and Ears; Impediments to Respiration; Ventilation of the
Lungs and Breathing Exercises; Cure of Chronic Bronchitis by Deep Breathing
Exercises; Relation of Colds to Pneumonia and Tuberculosis, and Their Prevention.
The Kidneys and Their Function; the Physiology of the Female Pelvic Organs.

It is said that diseases of the lungs are the cause of four-fifths of all
indispositions, ill health, and actual disease among civilized people, and
that, between the age of fifteen and twenty-five, almost one-half of the
mortality is due to pulmonary tuberculosis.
This almost universal weakness of the lungs, as it may be styled, is a
product of modern civilization, and is caused by our unhygienic mode of
life. Too little importance is attached to physical development, and well-
developed lungs can only be found in a well-developed chest; too little time
is spent in outdoor exercise; and private houses, public conveyances, and
public assembly rooms are not properly ventilated.
Good development of the chest and lungs, and thorough and systematic
ventilation of the lungs, are essential to a strong heart, a vigorous
circulation, and power of the tissues to resist disease.
The Mechanics of Circulation and Respiration.—In order to
understand the mechanics of circulation and respiration, it is necessary to
appreciate four fundamental facts—that the thorax is a distensible, air-tight
cage; that it contains and is filled by the heart, lungs, and great blood-

vessels; that the exchange of gases in the blood takes place in the lungs; and
that, on the development of the chest and respiratory muscles, depend the
development of the lungs and the force of the circulation.

Fig. 7.—The bony thorax, anterior view (Ingals).

The Thorax.—The chest or thorax is a cone-shaped, distensible cage,
formed of bones, elastic cartilage, and muscles. The spinal column forms
the fixed part of this living cage, and the ribs are attached to this in such a
way as to allow of their being raised in inspiration, thus increasing the
anteroposterior and the lateral diameters of the chest.
The thorax is converted into an air-tight cavity by means of muscles. The
base is made up of one huge muscle, the diaphragm. This is attached at its
border to the ribs and posteriorly to the backbone. It is the diaphragm which
separates the cavity of the thorax from that of the abdomen. When the
diaphragm is relaxed, it has a concavoconvex form, the convexity being
directed toward the chest, and the heart and lungs rest directly on it, while
the concave surface covers or rests on the liver.

The Circulatory Apparatus.—This consists of a central force and suction-
pump, the heart, and a series of elastic tubes that grow smaller the further
from the heart they are situated; they divide and subdivide, like the
branches of a tree. The smallest arteries, called capillaries, from their hair-
like size, are so minute that they only allow the passage of a single
corpuscle at a time and their walls are transparent.
The heart is a somewhat cone-shaped organ, placed between the two
lungs; it is situated more or less obliquely in the chest, immediately back of
the breast-bone. Roughly speaking, the base of the heart corresponds to the
right edge of the sternum, while the apex lies a little below and to the right
of the left nipple.
The heart is divided into a right and left side. The left side forms the
force pump, whose motive power is supplied by the contraction of its own
muscle-fibers. The bright red blood, with its fresh supply of oxygen—hence
its color—flows from the lungs into the left heart, which then contracts
automatically and forces the blood into the arteries of the body.
The arteries consist of a series of elastic tubings; hence, the smaller the
tubing, the greater the resistance which has to be overcome by the force of
the heart’s beat, so that during violent exercise, when the contraction of the
muscles causes a pressure on the minute arteries and capillaries situated in
them, the more forcible must be the beat of the heart to overcome this
additional resistance. Likewise, when the surface of the body is suddenly
chilled, as by a plunge into cold water, all the vessels situated here contract,
and, again, more work is thrown on the heart.
The three chief factors in the mechanics of the circulation are the force
and frequency of the heart’s beat, the peripheral resistance, and the
elasticity of the arterial walls. Any disturbance between these relations
brings about abnormal conditions.

Fig. 8.—Front view of heart and lungs, showing relations to other thoracic organs (Ingals).

The average frequency of the heart’s beat, or the pulse, is 72 times a
minute. It is increased by exercise; it is quicker in the standing than in the
sitting posture. It is quickened by meals, and, on the whole, it is quicker in
the evening than in the early morning hours. Independent of muscular
exertion, it is quickened by great altitudes. It is said to be quicker in
summer than in winter. Its rate is profoundly influenced by mental
conditions.
The whole of the blood of the body passes through the heart in 32 beats
—that is, in less than half a minute. The greatest part of this time is spent in
the capillaries. There the tissues are obtaining their fresh supplies of food
and discharging their waste matter into it.

Fig. 9.—Relation of heart and great vessels to the wall of the
thorax. The collapsed lungs are drawn slightly aside (after Heath).

The heart, great blood-vessels, and the lungs are placed in the air-tight
cavity of the thorax, and are subjected to the pumping action of the
respiratory movements. The inspiratory muscles elevate the ribs, at the
same time that the diaphragm, by its contraction, pushes the contents of the
abdomen downward. The cavity of the chest, so enlarged, causes the
pressure around the heart and the great blood-vessels within the chest to be
less than that on the blood-vessels outside the chest; hence, during each
inspiration the venous blood is sucked back into the right side of the heart.
The tissues deprive the blood of its oxygen, so that which flows back to
the heart in the veins is blue. The right heart then sends this blue blood to
the lungs, that it may get rid of its carbonic acid, which is not only not
needed, but is actually injurious to the body, and to receive a fresh supply of
oxygen, which has been carried into the lungs in breathing.

The blood is the great medium of exchange between all parts of the body.
It is, at the same time, the nourisher and the scavenger of all the tissues.
After the food has been liquefied and converted into new substances in the
digestive system it is poured into the blood. From the blood all the tissues
draw material to renew their own worn-out parts and other material which
they store up as latent force, which, when it unites with the oxygen of the
blood, becomes active force, such as heat and motion.

Fig. 10.—The diaphragm (after Kitchen).

The blood holds in suspension a vast number of minute cells or
corpuscles; the red corpuscles give its color to the blood, and are the
oxygen carriers, while the white are the phagocytes or the protective agents
of the body against disease.
The blood constitutes about one-thirteenth of the body weight. Of this,
one-fourth is distributed to the heart, lungs, and great blood-vessels, one-
fourth to the liver, one-fourth to the skeletal muscles, and the remainder to
other organs.
In order that the blood may be a satisfactory medium of exchange
between all the tissues of the body two things are necessary—first, there
must be through all parts of the body a flow of blood of a certain rapidity
and general constancy; and, second, this flow must be susceptible of general
and local modifications.

The lungs are the essential organs of respiration or ventilators of the
body. They are two in number, separated from each other by the heart, are
placed in a semi-distended state in the air-tight thorax, which we have seen
they, together with the heart and great blood-vessels, completely fill. The
lungs ultimately consist of air-cells, surrounded by dense plexuses of
capillaries and nerves. The air-cells communicate with the exterior through
the bronchial tubes, trachea, larynx, throat, and nose.
The larynx is the organ of voice. It is situated between the trachea and the
base of the tongue, at the upper and back part of the neck, where it forms a
considerable projection in the middle line, called Adam’s apple.
The trachea is a cylindric tube, which extends from the larynx downward
about 4½ inches, when it divides into the right and left bronchial tubes. The
bronchial tubes, on entering the lungs, divide and subdivide, until finally
they terminate in a lobule which is composed of air-cells and intercellular
passages.
In inspiration the cavity of the thorax is enlarged by an active contraction
of the muscles, in consequence of which the pressure of air within the lungs
becomes less than that of the air outside of the body, and this difference of
pressure causes a rush of air through the trachea into the lungs, until an
equilibrium of pressure is established between the outside air and that
within the lungs. This constitutes inspiration. Upon the relaxation of the
respiratory muscles, the elasticity of the chest-walls and lungs, aided
perhaps, to some extent, by the contraction of certain muscles, causes the
chest to return to its original size. In consequence of this, the pressure
within the lungs now becomes greater than that outside, and the air rushes
out of the trachea, until the equilibrium is once more established—
expiration.
During quiet respiration all parts of the lungs are not equally expanded; it
is chiefly the apices of the lungs, reaching up into the region of the neck,
and the central parts of the lungs, which undergo the least change of
volume. This lack of a thorough distention and aëration of every part of the
lungs is a cause of weakness of the lungs as well as of the entire body, for it
is precisely those parts of the lungs which are the least active that are most
prone to become the seat of tuberculosis.

In forced inspiration the cavity of the thorax is increased from 2 to 3
inches, partly by the elevation of the ribs and partly by the descent of the
diaphragm, due to the contraction of its muscular fibers. In contracting, the
diaphragm presses upon the abdominal viscera, pushing them downward
about 3 inches, so that a projection of the flaccid abdominal walls occurs.
The movements of the diaphragm are less extensive in women than in men,
which is believed to be due to the corsets and general manner of dress. A
perfectly free mobility is necessary for change in the size of the chest and
lungs, in which the respiratory movements take place from sixteen to
twenty times a minute.
The amount of air entering and leaving the lungs varies greatly in
ordinary and forced respiration, being often three times as much in the
latter. The volume of air is determined by the spirometer. Mr. Hutchinson,
who invented the spirometer, has defined the vital capacity of the lungs as
that amount of air which can be expelled by the most forcible expiration,
and so the measure of the individual’s respiratory power. The vital capacity
varies according to a number of conditions, as age, sex, weight, but, most
important of all, is the height. It has been found that between five and six
feet the vital capacity increases eight cubic inches for each inch in height.
The vital importance of the rôle which oxygen plays in the health and life
of the individual may be better understood from the facts that about 10,000
liters of air are breathed daily, which makes the amount of food and drink
consumed daily seem almost infinitesimal, and, important as the quality of
the food is, the quality of the air is much more so, and, finally, that one can
live for some days without either food or drink, but dies in a few minutes if
the supply of air is cut off.
Secretion of the Lungs.—Like the lips and mouth, the lungs are invested
on their free inner surface by a delicate mucous membrane, which
constantly secretes a clear viscous fluid, the mucus. The lungs, therefore,
like the nose, are always moist, and just as the nose is cleared by blowing it,
so the lungs are cleared by hawking or coughing. A sense of discomfort or a
feeling of irritation of the windpipe induces a deep inspiration, followed by
an explosive expiration, which quickly brings up the mucus, so that it can
be expectorated. The only difference between the mucus of the lungs and
that of other organs is that the former is mixed with air and has, therefore, a
frothy appearance.

The secretion of the lungs naturally flows down and accumulates, until it
is voluntarily brought up and expelled. Any one with a cold on the chest, or
who is subject to catarrh, will notice that, on moving about in the morning
in making the toilet, especially on raising the arms to dress the hair,
expectoration is greatly facilitated, and that this is followed by a feeling of
clearing out of the throat and lungs.
Because of the great aid given to the lungs in clearing them of mucus,
moderate exercise in the open air is a much better treatment of an ordinary
cold than a prolonged stay in bed. And for the same reason, in the treatment
of lung troubles, so soon as the temperature of the patient is down to
normal, and her strength makes it safe to allow her to move about, the
recovery of the patient is hastened by getting up and moving about the
house.
Hygiene of the Lungs and Its Relation to the General Health.—Two
conditions are essential for the preservation of the health and prevention of
diseases of the lungs—good chest and lung development, and a continuous
supply of fresh air for the proper ventilation of the lungs.
Fully one-third of the whole volume of blood is always circulating in the
lungs, and each corpuscle passes through them 8000 times in the twenty-
four hours. In other words, the lungs are the vitualizing stations of the
corpuscles which unceasingly go hurrying by. If these carbonic-acid-laden
corpuscles arrive in the lungs, and do not find the requisite amount of
oxygen awaiting them, they return to the tissues, carrying part of their
carbonic acid back to them instead of a fresh supply of oxygen, and so the
tissues are weakened instead of being nourished, while the corpuscles
themselves suffer from lack of proper nourishment and deteriorate in form
and color. Imperfect ventilation of the lungs is the most frequent cause of
anemia or thinness of the blood.
It must not be overlooked that the air may be fresh and pure, and yet not
able to penetrate all parts of the lungs because of superficial and improper
breathing.
Relation of Respiration to Body Heat.—The heat of the body is
generated by the oxidation of the tissues. The chilliness experienced by
persons engaged in sedentary occupations is by no means always caused by
the low temperature of the room, as will be proved by the thermometer, but

by the close air of the room and superficial respiration, which causes
internal overheating with imperfect combustion. The correctness of this
statement may be proved if the woman will throw the windows wide open
and take deep breathing exercises for five minutes. She will then go back to
her work thoroughly comfortable. In other words, she has breathed herself
warm.
The Respiratory Function of the Abdominal Muscles.—Well-
developed abdominal muscles play an important part in expiration, hence,
in emptying the lungs of their impurities. Under normal conditions the
pressure in the abdominal cavity is greater than that of the atmosphere;
hence in the elastic recoil following inspiration, the abdominal viscera
constitute a buffer, so to speak, and drive the diaphragm upward.
The chief causes of flabby abdominal muscles, with its consequent low
intra-abdominal pressure, are a sedentary life, the wearing of corsets which
prevent the free play of the abdominal muscles, and the overdistention of
the abdominal walls by repeated pregnancies and by the accumulations of
fat.
As a result of lax abdominal walls, there is very frequently an
enteroptosis or a falling of the abdominal contents far below their normal
position; this includes the liver, spleen, pancreas, the intestines and
stomach, and is the most frequent cause of floating kidney.
Further, the accelerating influence of the diaphragmatic movements on
the circulation is seriously interfered with.
The Importance of Good Chest Development.—The least chest
development of the adult woman—that is, the underarm girth around the
chest—consistent with good health is 28 inches, and this girth must be
enlarged 3 inches on forced inspiration. In ordinary respiration the waist
expansion should be from ½ to 1 inch, while during muscular activity it
should be from 1½ to 3 or 4 inches.
In women the movements of the upper part of the chest are very
conspicuous, the breast rising and falling with every respiration; whereas, in
children and in men the movements are almost wholly confined to the lower
part of the chest, and are called diaphragmatic, in contradistinction to those
seen in women, which are called thoracic. It is now the opinion of many

observers in this country and in Europe that the habit of thoracic breathing
in women has been brought about by constricting the waist and the lower
ribs. Observations made among the Indians and Chinese women show that
the abdominal is there the type of breathing, and civilized women who wore
no corset had relatively good abdominal breathing. Further, that a thoracic
type of breathing can be produced in man by putting him in a corset.
Vital capacity is, as we have seen, the term employed to denote the
amount of air that can be expired after the fullest possible inspiration. The
amount for persons 5 feet in height has been estimated as 174 cubic inches,
with an increase of 8 cubic inches for every inch in height above this. The
relation between height and vital capacity is rather remarkable, since height
is chiefly determined by the length of the legs, and not by the size of the
trunk and thorax. This is due to the fact that mobility of the chest increases
with stature.
The capacity of the chest is determined by the spirometer. A person who
can only blow, say from 180 to 250 cubic inches, has a good pair of lungs,
while, on the other hand, an ability to blow only 100, even where
percussion and auscultation had revealed nothing, is suspicious.
One test by the spirometer is not sufficient to judge of the condition of
the lungs, since the woman may be nervous or may not understand how to
breathe into it, so that a number of tests should be made on different days,
which may give a much better result, though no change has occurred in the
lungs.
Proper relation between the height, weight, and chest measurement:
Height. Average weight. Average chest measurement.
Feet. Inches. Pounds. Inches.
5 120 29.80
5 1 122 30.60
5 2 125 35.00
5 3 128 35.75
5 4 131 36.25
5 5 135 37.00
5 6 139 37.50
5 7 143 38.00
5 8 147 38.50
5 9 151 39.00

The Chemical Properties of Air.—It is of more vital importance that the
air which we breathe should be pure than the food which we eat should be,
although the latter is universally conceded to be a matter of prime
importance. The reason is that the poisons in the air, inspired by the lungs,
pass directly into the blood, whereas, taken into the stomach, the action is
much slower, and there is at least the possibility of their passing through the
digestive tract unassimilated.
The olfactory nerves are the normal guides as to the purity of the air, and,
if they have not been dulled by long usage in breathing impure air, they are
extremely sensitive to impurities in the atmosphere.
Country Air.—In the open air there is a constant, even though insensible,
movement of the currents of air; the result is a constant renewal or
ventilation of the air. There is, in addition, the evaporation from brooks,
rivers, lakes, the dew and rain, which aid in cleansing the air from dust; the
peculiar freshness of the air in the country after a heavy fall of rain is
familiar to all.
The “bouquet” of the air, most noticeable and delightful in the early
morning, especially in the spring of the year, is due to the fragrance given
off from the flowers, plants, and trees, and imparts a feeling of exhilaration
and a sense of the joy of living.
Sunshine increases the respiratory movements.
Wind clears the air of impurities, and is only harmful when it carries dust
with it, or when it is so strong that it impedes the respiration or bodily
movements. Very weak persons get out of breath easily when battling
against the wind.
Town Air.—Even the outdoor air of towns has its full quota of oxygen,—
21 per cent.,—and so is healthier than indoor air. The carbonic acid in the
air varies from 0.2 to 0.6 per cent. Among the impurities of the air are
smoke, fog, and dust.
Dust and Its Relation to Disease.—Dust, consisting of particles of all
kinds of organic and inorganic matter, is a nuisance of indoor as well as
outdoor life. That the dust in cities is the intolerable nuisance and menace to
public health that it is, is due to the filthy condition of the streets.

The specific cause of tuberculosis is the tubercle bacillus. Considering
the prevalence of the custom of spitting on the pavements, streets, floors of
public conveyances, and public halls, that the dust from the streets is carried
into the houses on the shoes and the trailing skirts of women, it is self-
evident that anything which stirs up the dust, as sweeping, stamping on the
floor with the feet, dancing, and on the streets strong currents of air and
high winds are a most serious menace to the health and lives of the
community.
In addition to the fact that dust is the great carrier of the tubercle bacillus,
the particles of dust cause a direct irritation of the mucous membranes
lining the nose, throat, larynx, and bronchial tubes.
That dust is an important factor in the causation of colds may be inferred
from the facts that they are more common in the city than in the country,
and that in the city they are more frequent in the spring and fall, when the
streets are not watered.
The Rôle Played by Bacteria.—Bacteria are distributed nearly
everywhere and in larger quantities than is generally believed. The air in
open spaces in cities contains from 100 to 1000 bacteria per cubic meter,
while the air of an inhabited room contains from 6000 to 10,000.
It can now be definitely stated that microörganisms are the immediate or
exciting cause of bronchitis observed in diphtheria, in influenza, measles,
whooping-cough, pneumonia, etc. These microörganisms are conveyed both
directly from the sick to the well, and from the inhalations of the germs
floating in the atmosphere. Whenever dust is raised, we breathe in a great
number of microörganisms.
In influenza the bacilli are found in the secretions of the nose, throat, and
in the expectorations from the lungs.
The bacilli are not only the cause of the acute infections, but also of
chronic bronchitis.
The bacterial flora usually present in the throat and the respiratory
passages is rich and varied. So long as the mucous membrane lining these
passages remains in a healthy condition, an unfavorable condition is offered
for their growth and development and these microörganisms are harmless.
But just so soon as the general vitality is lowered, or there is an impairment

of the normal condition of the epithelium lining the respiratory tract, a
culture-medium is provided in which these germs flourish and grow.
Anything which will cause an irritation or congestion of the mucous
membrane of the throat and bronchial tubes furnishes the necessary
conditions for the infection to take place. The germs themselves excite an
acute inflammation, and the inflammation extends from the head or throat
to the bronchial tubes, through the spread of the infective agent along the
respiratory tract.
Ventilation.—Very few people in cities spend more than one hour a day
in the open air, which means that they are housed up for the other twenty-
three hours, so that no pains should be spared to bring up the quality of the
indoor air to approximate as nearly as possible that of the outdoor air. The
air of houses contains many more microbes than that of the street.
For dwelling-houses 3000 cubic feet of fresh air is needed every hour. It
is said that in the country the only bad air is in farmers’ houses, whence it
has no chance to escape.
Direct sunlight kills the tubercle bacillus in thin layers of sputum in five
or six hours, and diffused sunlight in several days, and proper ventilation
greatly facilitates this bactericidal action. A large cubic space is of little
avail if the ventilation is inadequate. The windows should be at least one-
seventh of the floor space.
The air of the house must be fresh, pure, and cool, to allow proper
ventilation of the lungs and skin. Colds are prevalent in winter, because that
is the season when people are housed up and breathe impure air.
The commonest causes of impurities of the air in houses are the expired
air and the transudation of the skin; the production of the combustion of
lights or unconsumed gas may come from the burner when lit, if the
pressure is very strong, or the rubber fittings may retain the gas; tobacco
smoke; the effluvia of simple uncleanliness of rooms and persons; and the
products of the fluid or solid excreta retained in the room. In addition, there
may be special conditions which allow the impure air to flow into the room,
as from the basement or cellar of a house, from imperfectly trapped soil and
waste-pipes, or from other impurities outside of the house.

In respiration the air is vitiated by a decrease in the amount of oxygen
and an increase in the amount of carbonic acid; the expired air contains
about 4 or 5 per cent. less oxygen and about that amount more of carbonic
acid than the inspired air. It has been estimated that an individual takes into
her lungs about 500 cubic inches of air per minute and exhales the same
amount of vitiated air. The expired air is of a higher temperature, and is
loaded with aqueous vapor. The organic substances present in expired air
are in part the causes of the odor of the breath; it is probable that many of
them are of a poisonous nature. The air is still further vitiated by the
products of decomposition of persons having decayed teeth, nasal catarrh,
and disorders of the digestive systems, as well as by personal emanations.
When the sensibilities of the sense of smell become dulled, they give no
warning of the sense of danger, and the individual may not feel conscious of
the harm, although the nervous centers may be greatly depressed, and,
because discomfort has not been experienced in a vitiated atmosphere, it
does not follow that harm has not been done. The effects are slowly and
imperceptibly cumulative, but are on this account none the less injurious,
and are now recognized as being among the most potent and wide-spread of
all the predisposing causes of disease.
The physiologic effects of breathing vitiated air are that, owing to the
impurities of the air, the respirations become quicker and shallower, the
heart’s action more rapid and feeble; there is a more or less irritation of the
mucous membranes lining the nose, throat, and larynx. In extreme cases,
where many people are crowded together and the ventilation is totally
inadequate, the air often becomes so impure as to cause headache, lassitude,
nausea, and fainting.
The long-continued action of such impurities on the olfactory nerves may
ultimately induce, through the central nervous system, alterations in the
respiration, circulation, and nutrition. When moderately vitiated air is
breathed more or less continuously, the individual becomes pale and loses
her appetite; after a time there is a decline in the muscular strength and
animal spirits. The aëration and nutrition of the blood is interfered with, and
the general tone of the system falls below par.
It has further been maintained that metabolism is hindered by much-
breathed atmosphere. In addition to the ordinary symptoms of discomfort,

the long occupancy of so-called stuffy rooms so lowers the resistance as to
be conducive to the contraction of colds and even to more serious
infections.
People in this lowered condition of health, which is very common among
those who spend the greater part of the day indoors, in offices, houses,
schools, factories, and workrooms, offer much less resistance to attacks of
acute diseases than do people who lead an outdoor life.
In considering the ventilation of a house, the purity of the air, the
temperature, and the dryness of the air must all be considered.
The test now generally accepted as the standard of purity of the air is not
the chemical one of the estimation of the amount of carbonic acid contained
in the air of a closed space, but that, on entering a room or closed space
from the outside fresh air, no sense of impurity or closeness should be
noticeable.
The so-called natural ventilation of houses, which takes place through the
porosity of the walls, the cracks around the doors and windows, is generally
too inconsiderable to be taken into account.
Where houses are heated by furnaces, a certain amount of ventilation is
furnished by this means, but the air is by no means so pure as the air of a
house heated by hot air or steam pipes. In the latter case, the greatest
drawback is the dryness of the air.
As the air contained in an inhabited room cannot be kept as pure as the
outside air, the object of ventilation is, by the admission of the pure external
air, so to minimize the impurities that the air respired may not be
detrimental to health.
The most effective means for the ventilation of houses and apartments is
the throwing wide open all doors and windows; the windows must be
opened at both top and bottom, as the hot impure air rises and the cold air
falls to the floor. The length of time which the house should be left open
will depend on the outside temperature and the velocity of the winds. This
ventilation of the entire house should be carried out three times a day—in
the early morning, at noon, and again in the evening.
In addition to this, provision should be made for a constant access of
fresh air to the room. A simple and rather primitive method is by raising the

lower sash by a strip of wood several inches in height and the exact width
of the window. The air will then enter the space between the upper and
lower sashes. Some such or any better method of ventilation should be in
continuous use, day and night, when the room is occupied. So soon as the
weather is sufficiently mild, some of the windows should be left open all
the time.
When the air of a room is fresh and pure, the human system is furnished
with all the oxygen it can consume, and heat is thus introduced into the
body, so that a lower external temperature is necessary for comfort. Hence,
supplying a sufficient quantity of fresh air minimizes the amount of coal
consumed, besides increasing the vigor of the body.
The temperature of the house will depend on the occupation, age, and
health of the inhabitants. With a sedentary occupation, a temperature of
from 64° to 70° F. is the most suitable. The temperature of the bedroom at
night should not be allowed to fall below 50° F. Every room in the house
should be furnished with a thermometer.
The Injurious Effects of Overheated Air.—A rise of temperature in the
surrounding air diminishes the amount of oxygen consumed and the amount
of carbon dioxid discharged; a fall of temperature has the opposite effect. In
addition, this overheated air forms a hot jacket about the body, which
prevents the radiation of heat necessary to keep the body in a healthy
condition.
For the same reason, when out-of-doors, furs should not be worn close up
around the neck, and fur coats should only be worn in the extremely cold
weather. Paper and rubber worn about the body act in the same way, by
preventing the radiation of heat and moisture—practically steam jackets are
formed; the skin is rendered very sensitive and susceptible of chilling on the
slightest fall of temperature.
The Proper Degree of Moisture of the Air of the House.—The air
below the freezing-point is deprived of much of its moisture; brought into
the house, and raised from 70° to 80° F., or drawn into the nostrils and
raised to 98° F., it must take up its quota of moisture. This moisture must,
therefore, be provided in the air of the house. In the case of houses heated
by furnaces, some moisture is furnished by the water-pans of the furnace;
but in the case of heating by hot air and steam pipes, there is less circulation

of air, the air is very much drier, and generally of a very much higher
temperature. A satisfactory method of furnishing these houses with the
proper degree of moisture has not yet been invented.
One is only comfortable in a dry air when it is of a low temperature.
When the dry air becomes heated, there is more moisture given off by the
mucous membranes, which causes a feeling of dryness and irritation in the
nose, throat, and larynx; there may also be a sensation of uneasiness of the
chest, and, at the same time, the individual feels chilly.
Persons constantly breathing abnormally dry air lower the resisting
power of the respiratory mucous membranes and become very susceptible
of taking cold.
Since the degree of moisture of the air of a house is equally important as
its temperature, every room should be furnished with a hygrometer, which
should register from 65 to 70 per cent. of moisture.
The Ventilation of Bed-rooms.—The importance of the proper
ventilation of the sleeping-room will be seen from the fact that two-thirds of
the oxygen absorbed in the twenty-four hours is absorbed between 6
o’clock in the evening and 6 o’clock in the morning; and on the state of the
air of the bed-room will depend greatly the vitality of the individual. During
sleep inspiration occupies ten-twelfths of the respiratory period, while at
other times it occupies only five-twelfths of that period. In a closed room
the oxygen would eventually be consumed, the air become filled with
impurities, and the body languish for want of oxygen and incapacity to
throw off its impurities.
The air of the room should be perfectly fresh on retiring; where it has
been used as a sitting-room, it should be thrown wide open and thoroughly
ventilated just before going to bed. The temperature of the room should not
be above 65° F. In the bed-room at night all the air coming into the room
should come from the same side of the room, and the doors opposite should
be closed. If the room is small, and the window is at the head or foot of the
bed, some provision must be made to screen the bed, and to allow the air to
enter the room without falling directly on the sleeper.
In the intense heat of summer, especially if the air is saturated with
moisture, one sleeps much more comfortably on the side, with the face

almost at the edge of the bed; in this way the formation of a stagnant pool
of exhaled air about the face is prevented, which would otherwise be
rebreathed, and greatly increase the feeling of discomfort and malaise.
On retiring at night the clothes worn during the day should be spread out
over chairs to become thoroughly ventilated, instead of being hung up in a
closed press or closet. From a sanitary point of view, it is essential that
every article of clothing worn during the day should be removed at night.
Both clothes and body need ventilation.
In the morning the clothes should all be taken off the bed, and they, as
well as the night-clothes, should be spread out to be aired during the
ventilation of the room. The windows are thrown wide open when one goes
to breakfast.
The Care of the Nose, Throat, and Ears.—It will be most profitable to
consider the care of the nose, throat, and ears together, since the mucous
membrane lining these cavities is continuous, and so there is always great
danger of an inflammation of one extending to the others.
It has been calculated that about one-third of our adult population are
notably deaf in one or both ears. In the majority of cases deafness is the
result of colds and throat troubles, and much can be done to prevent its
occurrence.
The nose communicates through the nasal fossæ with the nasopharynx,
and the mucous membrane lining the nose is continuous with that lining the
throat.
The nose performs four important functions—it serves as a passageway
for the air in breathing, and it warms, moistens, and filters the inspired air;
it is the organ of smell; it aids in phonation; and it affords ventilation to the
ears and accessory sinuses. But by far its most important function is the rôle
which the nose plays in respiration. To supply the large amount of water
necessary to moisten the inspired air, it has been calculated that about one
pint of water must be secreted by the nose daily; part of this amount of
moisture is furnished by the tears. Mouth-breathing always causes dryness
of the throat.
The filtration of the air is accomplished first through the action of the
hairs at the external margin of the nose, which hinder the entrance of large

particles, and, second, by the adherence of small particles to the moist
surface of the intricate passages of the nose and nasopharynx. The microbes
are expelled with the dust; in addition to this, the nose probably has the
power of destroying any bacteria through the action of its germicidal
mucus.
Obstruction of the Nasal Passages.—In adults the commonest modes of
obstruction are the bending of the nasal septum to one side, or by a
thickening of the septum by which one nostril may be completely closed up.
The occlusion may also be due to the swelling of the mucous membrane or
the presence of polypi.
In children the most common form of obstruction of the nose is by the
adenoids and the enlargement of the tonsils; this enlargement may be so
great as to prevent nasal breathing and interfere with the normal ventilation
of the ears.
The Throat or Pharynx.—The throat or pharynx is the upper and funnel-
like portion of the alimentary canal, which is seen at the back part of the
mouth. It extends up back of the nose. The cavity of the throat is somewhat
separated from that of the mouth by the soft palate. This is a membranous
curtain, which is attached to the posterior part of the hard palate. The
pendulous part of the soft palate is known as the uvula. The uvula
sometimes becomes so greatly relaxed that it rests on the base of the
tongue, which causes a constant irritation and slight cough, a condition
which is easily relieved by a few astringent applications.
On looking into a mirror there will be seen, on either side of the throat,
two arches, formed by folds of mucous membrane; these are known as the
pillars of the throat. Between these pillars, on either side, is an almond-
shaped body called the tonsil. In health the tonsil should not protrude
beyond the anterior pillar.
Causes of Diseases of the Nose and Throat.—Exposure to wet and cold,
when insufficiently clad, or, even worse, sitting still with damp skirts or
shoes on. A still more potent factor than exposure to cold is the relative
degree of humidity of the atmosphere; great humidity is frequently
accompanied by epidemics of influenza. Exposure to very high winds;
sudden changes of temperature; the very dry air and the overheating of
houses; insufficient covering at night; the inhalation of irritating vapors and

finely divided mechanical irritants. Also, gastro-intestinal affections and
uric acid.
Chronic enlargement of the tonsils predisposes to tonsillitis and to all the
infective and contagious throat diseases. In addition, the breath is apt to be
fetid, and swallowing the mucus, germs, and toxins has a deleterious effect
on the stomach and general health. Mouth-breathing and anemia often
follow, and there is an increased liability to inflammation of the eyes.
The Importance of a Healthy Condition of the Throat and Nose.—The
nose and throat are the portals of entrance to the bronchial tubes and lungs,
and it depends on the condition of their mucous membranes whether the
germs of disease will find lodgment here and be carried down into the
bronchial tubes and lungs, or whether they will be expelled with the mucus.
Any irritant which destroys the vitality of the epithelium covering the
mucosa, or a local congestion which interferes with the nutrition,
circulation, and secretions of the part, offers favorable conditions for the
culture of bacteria normally present. Also, anything which will cause a
lowering of the general health, and thereby lessen tissue resistance, acts as a
predisposing cause to local inflammation, while the germs themselves
excite inflammation by their active growth in loco.
From these facts will also be seen the importance of having cut short, as
rapidly as possible, any congestion or inflammatory troubles of the nose
and throat.
Prevention of Nasal Catarrh and Sore Throat.—First in importance
comes attention to the general health. Under this must be considered the
clothing, food, ventilation, and exercise.
The clothing should be light, yet sufficiently warm to be a protection
against the cold and winds. Heavy shoes with thick soles are necessary to
protect the feet, and it is not so much the matter of getting wet as it is of
sitting down with damp clothing on.
An atmosphere filled with dust in sweeping should not be tolerated in
any well-kept house.
Local Treatment for the Prevention and Cure of Mild Cases of Nasal
Catarrh and Sore Throat.—The treatment is practically the same. The toilet
of the nose and throat should be made at least as often, and at the same

time, as that of the teeth; certainly, the first thing on getting up in the
morning and again before dressing for dinner. In our seaboard cities and
towns, at least, there is a very general predisposition to some degree of
congestion of the mucous membrane of the nose and throat. This means an
abnormal amount of mucus which collects in the parts during sleep. Again,
on coming in from out-of-doors on a windy day a large amount of dust,
which means microbes as well, has become lodged in the mucous
membranes of the nose and throat.
This toilet of the nose and throat is best carried out by means of a nasal
spray. The spray apparatus consists of a bottle holding some two ounces, a
hard-rubber spray piece, and a bulb with tubing to force the liquid through
the spray piece. The tip of the spray should have the form of a cone; this
should be introduced into each nostril, the bulb squeezed several times,
until the amount of fluid is sufficient to be hawked out, and this process is
facilitated by holding the mouth open during the spraying of the nostrils.
After the nostrils have been thoroughly cleansed, the throat should be
sprayed directly.
The liquids used must be bland and unirritating, and only enough should
be used at one time to cleanse the parts. There are on the market excellent
alkaline and antiseptic tablets; one tablet should be dissolved in a spray-
bottle not quite full of water. This solution keeps in perfect condition, and is
always ready for use.
A solution of boric acid, in the proportion of two teaspoonfuls of boric
acid to one pint of water, may also be used.
If the nose and throat are inflamed, this so-called water spray should be
followed by an oil spray, which will be found to be most soothing and
healing. A separate apparatus for this will be necessary, as an oily solution
would clog an ordinary water-spray, but the principle of the spray is the
same, and it is used in the same way. The following is an excellent formula:
Take of menthol and carbolic acid each two grains; of eucalyptol, six drops;
and of albolene, two ounces. Mix well, and fill the spray-bottle one-third
full; it is to be used in the full strength. Use only enough of this spray to
moisten the nose and throat; by inhaling simultaneously with squeezing the
bulb, the very fine spray is carried into the larynx, and so is very useful
when there is an irritation of that organ, as shown by hoarseness. If there is

only a slight irritation of the parts, the use of the spray twice daily will be
sufficient; the last time should be just before retiring. On windy days it will
be a great protection to the mucous membrane of the throat to use it just
before going out-of-doors, on the throat only. If the inflammation is severe,
the spray may be used as often as every two hours. This prescription should
be put up by a good druggist.
Ear specialists condemn all nasal douches as dangerous, on account of
the possibility of the water being forced into the Eustachian tubes.
General Treatment.—First of all, the system must be toned up by the
systematic use of cold baths, adapted to each particular case, tonics, iron,
and cod-liver oil. It is a grave mistake to allow these cases to become
chronic, as they may be the forerunners of influenza and even general
tuberculosis. They need prompt and scientific treatment, which the
physician alone is capable of giving.
The Ear.—The ear is divided into three parts—the external ear, the
middle ear or tympanum, and the internal ear or labyrinth. The internal ear
is the essential part of the organ of hearing in which the auditory nerve
ends. Its structure is very complicated. The external ear is separated from
the middle ear by the tympanic membrane or drumhead. This is a thin,
small, membranous sheet, which is stretched tautly across the junction of
these two cavities, and vibrates inward and outward between them. The
external ear collects and conducts the waves of sound to the tympanum.
The middle ear, or tympanum, is an irregular cavity, situated within the
bone. It is traversed by a chain of movable bones, which connect the
drumhead with the internal ear, and serves to convey vibrations of sound to
it. The middle ear, or drum cavity, is filled with air, and communicates with
the pharynx by means of the Eustachian tube. The middle ear is lined
throughout with mucous membrane, which is continuous with that of the
throat and nose.
The Eustachian tube is continuous with the middle ear, and extends
downward and forward about an inch to connect it with the pharynx, where
it opens by a trumpet-like expansion, just above the soft palate, at the
junction of the throat and nose. It serves to carry off the excess of fluid from
the middle ear and to preserve the equilibrium of the pressure between the
gaseous contents of this cavity and the atmosphere. The walls of the

Eustachian tube are in close contact, but they are normally opened during
every act of swallowing, yawning, etc., when the air finds its way into the
middle ear. A stoppage of the nose reverses the process, and when the tubes
are not likewise stopped up, every swallowing motion draws air out of the
tubes. If the openings of the tubes become closed, deafness, dizziness, and
subjective noises will result.
The middle ear is the seat of about two-thirds of all aural troubles, and,
since much of this could be prevented, this becomes a matter of great
practical importance.
Causes of Impairment of Hearing.—The majority of the affections of the
middle ear originate from extensions of catarrhal inflammations, from the
nose and throat, through the Eustachian tubes. In children adenoids are the
most frequent cause of deafness. The so-called hereditary deafness is
probably due to an inherited configuration of the septum of the nose, a
bending of the septum to one side, or a tendency to catarrhal affections of
its mucous membranes.
Every cold in the head tends to mechanically involve the ears, and, while
recovery may seem complete, there is likely to be some unrelieved trouble
which insidiously but steadily increases—first one ear, and then the other,
shows signs of defective hearing. If only one ear is involved, the condition
may progress seriously before the patient is aware of the trouble.
Preventive Measures Against Deafness.—From what has been said, it
naturally follows that the preventive measures must be chiefly those already
given against taking cold. If one does take cold, instead of leaving it to run
its course, as is too often done, proper therapeutic measures should be at
once adopted to bring as speedy a cure as possible.
Impacted Ear-wax and its Removal.—A healthy ear should never show
more than enough wax to render the hairs within soft, and the individual
should be unconscious of the wax coming away. Wax does not collect in a
healthy ear. When it does occur, there is a stopped-up feeling in the ears,
due to the occlusion of the meatus by wax.
The only procedure that is safe to follow in order to remove the wax from
the ear is to gently douche the ear with warm water, at a temperature from
105° to 110° F. If this does not suffice, a physician must be consulted, as all

efforts to remove the wax after it has become impacted are dangerous and
futile except in skilled hands.
Earache.—The best thing for the relief of earache is the external
application of heat by means of a hot-water bag. If this does not give relief,
the ear may be douched with warm water. Earache can often be prevented,
by those subject to it, by placing a very small piece of absorbent cotton in
the ear before going out in very high winds or in automobiling.
Impediments to Normal Respiration.—These are, for the most part,
acquired through improper habits of posture, dress, lack of muscular and
chest development. Other impediments to respiration are a deviation of the
septum of the nose to one side, marked curvature of the spine, and
deformities of the chest which may be the results of rickets.
Curvature of the spine is frequently the result of muscular weakness,
combined with faulty position at the desk.
The clothing must be sufficiently loose to admit of the fullest possible
chest expansion; the measurements for the clothing, and most especially for
corsets, must be taken during full chest expansion.
Heavy clothing suspended from the shoulders is also hurtful, because it
renders impossible the expansion of the apices of the lungs. Obviously, all
tight bands around the neck interfere with the respiratory movements.
Bodily position plays a very important part in maintaining the symmetric
development of the chest and in the proper ventilation of the lungs; and this
is a matter of the greatest importance to students, clerks, and writers who
spend a great part of every day at the desk.
The faulty attitude, together with the weak muscles and the poor
muscular development, are fruitful sources of spinal curvatures and flat
chests; and free respiration is interfered with. Writing with a pen is most apt
to be accompanied by a peculiarly cramped position of the body, rendering
normal respiration impossible.
The Correct Attitude at the Desk.—The chair should be of such a height
that the woman may rest her feet firmly and easily on the floor or upon a
foot-rest, the seat being deep enough from before backward to
accommodate about three-fourths of the length of the thighs, while the back

of the chair should be so curved as to support the spine easily in its natural
curves, both at the waist and at the level of the shoulder-blades.
The chair and desk should be sufficiently close together so that the
student may sit erect to read from books, since leaning forward at the desk
causes round shoulders, flat chest, and short-sightedness. When the desk
and chair are properly arranged, two-thirds of the forearm can be rested
upon the desk without raising the shoulders.
In reading, the distance of the book from the eyes should be twelve
inches, and the book-rest should be inclined, sloping downward toward the
reader, at about an angle of 85 degrees.
If the woman has any great amount of writing to do, she should learn to
use a typewriter. In using this machine she not only writes very much more
rapidly and easily, but the position of the body is much more erect than that
assumed when using the pen, and it is not nearly so fatiguing to the muscles
of the hands and arms.
All closely confining sedentary occupations, as writing, sewing, etc.,
should be frequently interrupted to move about for a few minutes, rest the
eyes, and take a few deep breathing exercises before an open window; this
is necessary for the eyes as well as for the ventilation of the lungs.
Ventilation of the Lungs and Breathing Exercises.—Forced respiration
is essential to completely change the air in the lungs, to maintain the
elasticity of the lung tissue, and to expand the chest in every direction. Only
in this way can a thorough ventilation of the lungs take place; a full supply
of oxygen is taken in, which stirs up, disinfects, and cools the stagnant
residual air, and forced expiration expels the respiratory excretions. One of
the frequent causes of foul breath is lack of ventilation of the lungs, so that
the expired air becomes laden with impurities.
In normal breathing the current of air which passes in and out of the
lungs travels through the nose, not the mouth. The ingoing air, by exposure
to the vascular mucous membrane of the narrow and winding nasal
passages, is warmed and moistened, and at the same time the mouth is
protected from the desiccating effects of the continual inroad of
comparatively dry air.

By means of respiratory exercises the mobility of the chest may be
greatly augmented; there is an increased flexibility of the ribs and sternum,
as well as loosening of the thoracic joints, which may have become stiff,
and these exercises also lead to a development of the respiratory muscles.
In this manner only can the frame work of the chest become thoroughly
inflated from within, and thus all parts of the lungs, which run the risk of
becoming incapacitated from lack of use, be brought into play.
It is highly important that this thorough ventilation of the lungs should
take place at least three times a day—the first thing in the morning, while
making the toilet, again about the middle of the day, and at night just before
retiring.
To obtain the greatest benefit from these exercises they must be taken
without corsets, the clothing must be light and loose, and the body lightly
clad. The air in the room must be fresh, and after they have been learned,
they can, as a rule, be taken before an open window. In the morning they are
best taken just after the cold bath, when, by removing the impurities and
filling the lungs with fresh air, and at the same time starting up a good
vigorous circulation, they cause one to begin the day with energy and zest.
The respiratory movements are diminished during sleep, and at the same
time there is a large accumulation of blood in the splanchnic veins, so that,
particularly when there is any tendency to difficulty with the breathing at
night, the trouble is greatly lessened by filling the lungs with pure air just
before retiring.
It is necessary, first of all, to learn the art of breathing, to be able to
dissociate the clavicular, the costal, and the diaphragmatic. By clavicular
breathing is meant the raising of the collar-bone and shoulders as high as
possible by means of a slow but deep inspiration—this expands the apices
of the lungs; costal breathing is the throwing out and expanding the chest to
its utmost capacity, and so enlarging the chest in its transverse and
anteroposterior diameters; diaphragmatic breathing is the depression of the
diaphragm and the protrusion of the abdomen without raising the lower
ribs. The last is the most readily learned in the supine position; the bed
supports the weight of the body, so that the individual is able to concentrate
her entire attention on fixing the bony thorax, depressing the diaphragm,
and protruding the abdomen at every inspiration and retracting it to the

utmost with every expiration. This, of course, develops and gives tone to
the abdominal muscles.
When the woman has conquered these first principles of respiration, she
is ready to put them into practice in the standing posture. They should be
learned before a mirror, and after that taken before an open window. The
hands should be placed on the hips; first elevating the collar-bones and the
shoulders to the utmost, while still holding the breath, she expands the
chest, always breathing in from above downward, and, lastly, the diaphragm
is depressed. With the lungs thus expanded to their utmost capacity, the
breath is held as long as possible, then the lungs are emptied by an abrupt
and forced expiration.
These exercises should be repeated at first ten times, gradually increasing
to thirty times. It is well to take one or two ordinary respirations between
the forced ones.
It will be found that, as these exercises proceed and the lungs are filled
with purer air, the breath can be held for a longer period of time, and that
with practice the length of time that the breath can be held is greatly
increased; it should be held for half a minute. Public speakers, singers, and
divers are all skilful in this respect.
When these simple breathing exercises have been mastered, breathing
exercises can be combined with other exercises, which have as their aim the
development of the muscles of the chest.
Reading aloud, singing, talking, laughing, are all good exercises for
developing the capacity of the lungs.
The Cure of Chronic Bronchitis by Deep-breathing Exercises.—The
upper part of the body must be nude and the exercises taken before a mirror,
so that the woman can watch the movements of the chest and abdomen, see
that all the hollows of the chest are filled out during forced inspiration, and
that the muscles of the abdomen are properly retracted. For the average
woman this last will be the most difficult; in beginning these exercises she
will find that it will require all her concentrated energy and will power to
cause a retraction of these disused muscles.
Patients with chronic bronchitis do not have the ability to perform forced
respiration properly. The respirations are too superficial, and the respiratory

movements are not properly performed.
As respiration is ordinarily performed, the partial expansion of the upper
part of the chest is accompanied by a contraction of the abdominal muscles,
whereby the diaphragm is forced upward, with the result that the lower part
of the lungs remains very slightly expanded, whereby the circulation as well
as the removal of mucus is imperfectly performed. This lack of forced
respiration is a frequent cause of acute bronchitis running into a chronic
form.
In chronic bronchitis it is especially in the lower part of the lungs that
stagnation of the secretions takes place, and they can only be dislodged
from the mucous membrane by forced abdominal expiration and the ascent
of the diaphragm. This causes a cough which expels the mucus, and forcible
abdominal expiration and cough are the only means of drainage of the
lower and deep-seated parts of the lungs. Further, in forced respiration the
muscle tissue of the bronchial tubes contracts, which certainly does not take
place in ordinary respiration, but, on the contrary, this tissue atrophies.
Other beneficial results from forced respiration are increased
oxygenation, improved nutrition, changes of a mechanical nature,
ventilation, and disinfection of the lungs, massage of the lungs and pleura,
and drainage.
No other method of treatment is so successful in the cure of chronic
bronchitis not dependent on disease of the nose and throat. In from two to
six weeks of treatment, in which there is a profuse discharge of mucus, it
will be found that the bronchial tubes have cleared up, provided that the
patient is supplied with an abundant supply of fresh air day and night.
Methodically practised, deep breathing is not only the surest cure, but also
the safest stimulating expectorant.
Relation of Colds and Influenza to Pneumonia and Tuberculosis and
their Prevention.—We have already seen that bacilli are not only the cause
of acute infections, but also of chronic bronchitis, and that this was
especially true of the bacillus of influenza and the pneumococcus of
pneumonia.
It is well known that influenza is an infectious disease, which rapidly
spreads through the family and the community, but it is not so well known

that the so-called “common colds,” ordinary sore throat, and tonsillitis are
also highly contagious. The infection is carried from one person to another
by direct contagion; the air is being constantly sprayed with the germs of
disease in talking, laughing, sneezing, and coughing. In coughing and
sneezing it is not sufficient to hold the hand before the mouth—a
handkerchief must be used for this purpose.
Colds are among the most frequent of the so-called minor ailments in this
country. The causes are the overheating of the houses, the great dryness of
the air, badly ventilated houses and public assembly rooms, which render
people very susceptible to the great variations in temperature.
Prophylaxis, or the prevention of colds, combine all those measures
which promote the general tone of the system, and may be said to embrace
all the elements of personal hygiene. Good digestion and proper
nourishment of the body with suitable food; the proper ventilation of
houses, all public buildings and conveyances, for in these latter the public
are brought into very close contact with their fellow-men.
Local prophylaxis would consist in the toilet of the nose and throat—the
removing of adenoids and enlarged tonsils.
The individual must remember that she can reinfect herself; for this
reason, an abundant supply of handkerchiefs must be used; they should be
placed in a handkerchief bag and washed separately. Packs of cards should
be thrown away before they become soiled. Sprays and atomizers must be
individual property, and be kept thoroughly cleansed.
With the exception of deep-seated chest colds, in the early stages a cold
may often be nipped in the bud by a few hours of hard sudorific work in the
open air. In half a day the nasal ducts and respiratory system will throw off
irritating matter that would take much longer time if the patient remained
indoors and relied on the action of drugs alone.
Treatment.—Other methods of treatment are a hot tub-bath on retiring, an
active but not too severe cathartic, as two grains of calomel, taken just
before going to bed, and, if the individual is chilly, a hot lemonade should
be taken at the same time. Both the cathartic and the free perspiration will
aid in relieving the internal congestion and thus aid in its abortion. A cold
sponge should be taken the following morning to tone up the system.

Turkish baths are also useful in breaking up colds; again, the precaution
must be taken to avoid chilling on leaving the bath.
The following tablet is a very simple and very efficacious remedy for
breaking up a cold in the early stages: Take of powdered camphor ¼ gr.; of
the sulphate of quinin ¼ gr.; and of the fluidextract of belladonna root ⅛
minim. This should be well mixed, and made up into one tablet or a
capsule. One tablet is taken every half-hour, until four doses have been
taken; after that one tablet every three hours, until the running of the nose
has ceased, which generally occurs within twenty-four hours. If there is not
marked improvement at the end of this time, or if there is any fever, a
physician should be consulted at once.
Quinin, when given alone to abort colds, must be given in sufficiently
large doses to produce cinchonism, the subjective symptom of which is a
slight deafness or ringing of the ears. The natural tendency of cold is to
cause inflammation of the middle ear, and since the use of quinin in large
doses causes a congestion, and so predisposes to inflammation of the
middle ear, its use should be avoided.
The great amount of illness and mortality from pneumonia during and
following epidemics of influenza is too familiar to the public to need more
than mentioning. The patient is so rapidly and extremely prostrated by the
attack of influenza as to be susceptible to the ready action of the
pneumococcus, which, as we have seen, is ever present, and the extension
of the inflammation from the fine bronchial tubes to the air-cells of the
lungs rapidly takes place. In the exhausted condition of the patient she is
not able to resist this invasion, the heart is already weakened, and death
frequently rapidly ensues as the immediate result of heart failure.
The Prevention of Tuberculosis.—The tubercle bacillus is practically
ubiquitous, and the prevalence of tuberculosis is universal. Hence it is
imperative to raise the resistance of the individual in every way possible, as
well as to limit the spread of the infection. This means the employment of
all the resources of public and personal hygiene, public and private
sanitation, and the education of the public in how the disease is
disseminated, and how its spread may be prevented; also the teaching of the
individual, her duty to the family and society, as well as to herself, in order
not to spread the contagion.

Tuberculosis attacks the crippled and poorly developed lung just as
surely as it shuns the one which is fully expanded and in constant and active
service. Numerous observations have established the existence of a constant
ratio between tuberculosis of the lungs and deficient chest expansion.
Diet.—The doctrine has been growing among the laity that the child’s
likes and dislikes should determine what food it should eat. Thus a finical
taste is cultivated and a lack of proper nourishment follows, and it is this
finical diet class of people which forms a large percentage of tuberculous
invalids. It has long been recognized that a proper diet and the tolerance of
it is of the utmost importance in the treatment of tuberculous patients, but
from the foregoing it would appear that a proper diet throughout life is also
of the utmost importance in the prevention of disease; a sufficiency, not
only as to quantity, but also as regards variety.
It is the patient who can eat everything who stands a good chance of
getting well. So, too, it is the individual whose diet for years has been
perverse, who could not eat meat, to whom eggs were distasteful, who
could not stand milk, who was infected with the vegetarian fad, or the two-
meal-a-day fad, who stands a fair chance of falling a victim to tuberculosis,
through a lowered tone of the system, because it offers but a feeble
resistance to a powerful and insidious enemy. And the mode of the
preparation of the food is an equally important factor. It has been shown
that the poor cooking among the lower classes is a powerful predisposing
cause to intemperance and tuberculosis.
Influenza is a frequent and important agent in bringing to light latent
tuberculosis, and must be classed as an important exciting if not
predisposing cause. Low, damp climates predispose to the infection by
lowering the vitality. Tuberculosis is more prevalent in cities than in rural
communities, due to the manner of housing and the character of the
occupation.
Summary of the Present Views of Infection.—The doctrine of inherited
and acquired susceptibility still holds sway; next, that all infants are
susceptible, and that susceptibility lessens with increase in age; that adults
are comparatively insusceptible when free from general and local lowered
resistance and repeated and prolonged exposure.

As to the source of infection, the consensus of opinion and ascertained
facts point to the sputum as of overwhelming importance; cow’s milk is an
important factor; the food may be infected directly by coughing, or the dirt
and dust from the floor and hands; the fingers and many other objects that
find their way into the child’s mouth are sources of danger. To adults, both
dust and moist droplets are more often the source of infection than infected
food.
Expectoration.—Careless expectoration is the chief source of infection.
Laws should be passed and enforced prohibiting the expectoration on
pavements, stairways, in all public conveyances, and all public places.
The danger of infection from tuberculous house servants has not been
sufficiently appreciated. A chronic cough in the case of a servant should be
at once investigated by the family physician. Servants should be taught the
necessity for washing the hands before touching the food or cooking
utensils. The condition of their rooms, clothing, bathing, and other personal
habits should be closely investigated, and personal cleanliness should be
demanded as a sine qua non for obtaining or keeping a situation.
Since it is a well-known fact that tuberculosis can be acquired from the
occupation of houses and rooms formerly occupied by tuberculosis patients,
it has been suggested that a clean bill of health should be demanded of the
owner of the house before renting it; that is, a certificate from the Board of
Health, that no case of infection has existed in the house, or that it has been
properly disinfected since that time. If such a movement became popular,
landlords would be obliged to furnish these bills of health in self-defense.
Since the Boards of Health demand the reporting of all cases of
tuberculosis, this scheme is by no means impracticable or Utopian.
The tubercle bacillus is not destroyed by any degree of cold, but both
light and sunlight are distinctly injurious to these bacteria. The lowest fatal
temperature to the tubercle bacillus is 131° F. of moist heat, acting for a
period of six hours. The thermal death-point of tubercle bacilli in milk is of
great practical importance, and many experiments have been made which
have determined that a temperature of from 140° to 167° F., was sufficient
if continued for one hour. If it is desired to pasteurize the milk, it should be
placed in a closed bottle or stirred and heated for at least twenty minutes at
a temperature of 149° F.

Disinfection.—The use of formaldehyd gas has practically displaced the
use of sulphur for the fumigation of rooms, as well as for the disinfection of
furniture and clothing. For this purpose a moist vapor used in a sealed room
is essential.
At least 8 ounces of the commercial 40 per cent. formalin should be used
for each 1000 cubic feet of air content. The most efficient method is that
used by Biggs, of New York, which is as follows: For an ordinary room,
1000 cubic feet, 1 pound of lime, 8 fluidounces of formalin, and from 2½ to
3 fluidounces of commercial sulphuric acid are required. All openings but
the door are sealed. The formalin is poured into an empty water-pitcher, 4
ounces of water are added, and then the sulphuric acid is poured slowly in.
The lime is placed in a china or earthenware wash-basin on the floor upon
newspapers; all water is removed from the room. All drawers and
cupboards opened; the mattresses stood on end; and the mixture poured
quickly upon the lime, when the door is sealed. The sulphuric acid may be
packed in a tin bucket containing the lime, and, with the formalin in a
separate bottle, may be used by any person of ordinary intelligence. The
room should remain closed from twelve to eighteen hours. It must not be
lost sight of that after disinfection by means of formalin a thorough
cleansing is imperative. A room which has been thoroughly cleaned and
carbolized is safer than a room which has been disinfected with formalin
and not properly cleaned.
After death or removal the entire place should be renovated. Besides
disinfection and scrubbing the painted woodwork with a solution of hot
soda water, the walls should be repainted or repapered, and the woodwork
repainted.
Rugs, bedding, pillows, and clothing should be disinfected by hanging up
in the room while it is undergoing disinfection. Books and all articles of
small value should be burned. All soiled linen should be boiled.
The Kidneys and their Function.—The kidneys are the secretory
organs of the urine; they are two in number, and are the largest tubular
glands in the body. They are deeply seated in the lumbar region, lying one
on each side of the vertebral column; the kidneys extend from the eleventh
rib nearly to the crest of the pelvis. They are usually embedded in a
considerable quantity of fat, which is the chief factor in holding them in

position, aided to some extent by the large blood-vessels with which they
are connected. The kidneys are oblong bodies and measure about 4 inches
in length, 2½ inches in breadth, and over 1 inch in thickness. Their weight
is about 4½ ounces.
As an excretory organ the kidney probably stands second to the
alimentary canal; it surpasses in importance the skin, whose total excretion
of water it equals. The abnormal substances appearing in the urine are often
not the products of disease of the kidneys, but of some other organ or
system.
The kidneys excrete and put the finishing touches upon the urinary fluid;
they act at the end of the metabolic course, both as active and as passive
agents. While to some extent the kidneys are mechanical contrivances, mere
filters, so to speak, they are to a far greater degree active, specific glands.
The renal epithelium has the power of synthesis, and builds up complex
substances that are not apparent as such in the blood or lymph, as well as
the power of analysis or breaking down of substances. These changes are
due to the formation in the tubular cell of an enzyme, which we call
histozyme. The kidney is the end link in the vascular chain, and the daily
performance of healthy kidneys is no doubt a combination of the
mechanical and the vital processes.
The Secretion of the Urine.—In a perfectly normal being the problems of
waste and repair are balanced to a nicety. As we know, the tissues of the
body are bathed in lymph containing in solution the compounds that are
necessary for their nourishment—proteids, carbohydrates, fats, salts, and
gases. Waste follows in direct proportion to the activity of the tissues. The
worn-out, effete material first finds its way into the lymph, and from it into
the blood-stream, to be later eliminated from the economy, else deleterious
results will follow their retention in the body. It is by the selective action of
the cells of the various glands of the body that these useless substances are
removed from the blood, and converted into such forms as can be readily
excreted. In the main, the products to be removed are urea and the allied
nitrogenous bodies—carbon dioxid, salts, and water. These organs are of
vital importance, since nearly all of the waste-products containing nitrogen
are eliminated in the urine.

The most easily understood function of the kidneys is the excretion of the
urinary water; this varies in amount with the rapidity of flow through the
renal vessels and to some extent on the blood-pressure.

Fig. 11.—Relation of kidneys to heart
and great blood-vessels: A, Heart; B,
B, kidneys; C, bladder (after Quain).

The separation of the solid substances of the urine form the next function
of the kidneys, and these substances fall into two groups—inherently useful
materials, which are in excess or which have served their purpose, and
substances which are inherently harmful. The latter class embrace many
end-products of metabolism, which we are accustomed to consider as
normal constituents of the urine.
The analytic study of the urine is of great value to the physician and
surgeon, because of the knowledge which it gives concerning the processes
of metabolism occurring within the body. The nature and amounts of the

various end-products of metabolism are carefully investigated as they occur
in the urine, whether they be normal or pathologic.
The Urine.—The normal human urine recently passed is a clear liquid, of
a straw color, with an average specific gravity of 1020, the specific gravity
indicating the amount of solids contained in the urine. It is acid in reaction.
The quantity for twenty-four hours is 50 ounces, or about 3 pints,
depending on the amount of water ingested. During sleep the amount
secreted is less than at other times. The amount of urine is decreased after
profuse sweating, diarrhea, thirst, diminution in the blood-pressure, and
after severe hemorrhage. When the body temperature is considerably higher
than normal, the amount of urine is again diminished in quantity.
Urea forms nearly one-half of the solids in normal urine and nearly one-
half of the urea is nitrogen. It is the principal representative of the waste of
the nitrogenous tissues. The chief source of urea is from the metabolism of
the muscles; the ingestion of a large amount of proteid food stimulates
metabolism. The quantity of urea passed in the twenty-four hours is about
500 grains.
The uric-acid constituent is very small, and in the human urine scarcely
reaches 0.03 per cent. of the solids. Lack of exercise leads to an increased
formation of uric acid by a lessening of the oxidation of the tissues. In gout
the amount of uric acid excreted is abnormally small, because it
accumulates in the blood and tissues. The brick-dust deposit sometimes
seen in the urine is composed chiefly of the urate of sodium. The average
daily amount of uric acid passed in the human urine is about 7 grains. The
excretion of uric acid may be increased by drinking copious drafts of water.
Toxicity of the Urine.—After the removal of both kidneys the animal dies
of uremia; that is, there is an accumulation of urinary products in the blood.
The removal of one kidney is not necessarily fatal, and women have so
lived very comfortably for many years. A human being excretes enough
poisonous material by the kidneys in two days to cause death.
The Urinary Excretory Apparatus.—After the urine has been secreted by
the kidneys it must be carried away from the body, so that the economy may
not suffer from the resorption of the contained toxic principles. The
excretory apparatus comprises the ureters, the bladder, and the urethra.

The ureters are two cylindric tubes of the diameter of a goose-quill and
about 15 inches long. They make their exit from the inner border of the
kidney, and pass downward and inward toward the median line, to empty
into the base of the bladder by a slit-like orifice.
The bladder is the reservoir for the urine. It is a musculomembranous sac,
situated in the pelvis, and in the female it is in front of the uterus and above
the vagina. It normally contains one pint. It should be emptied four times a
day. If it is allowed to go longer than this, it becomes overdistended, and is
apt to displace the uterus backward, and the bladder-walls themselves
become weakened.
The Physiology of the Female Generative Organs.—The internal and
essential organs of generation are the uterus, ovaries, and the Fallopian
tubes. These organs have to do with the process of ovulation, menstruation,
and reproduction.
The Ovaries.—These are two small bodies of an almond shape, and lie
one on either side of the uterus. The bulk of the organ consists of
connective tissue, in which lie embedded the Graafian follicles, or ovisacs,
in which the ova are contained.
During the child-bearing period, or from about the age of fifteen to forty-
five years, the development of the Graafian follicles and the discharge of
the ova are continually taking place. The liberation of the ova usually takes
place at definite times, which, in general, coincide with the menstrual
epochs, one or more ova being set free at each period, but this is by no
means invariable.
The Uterus.—The virgin uterus is a small, hollow, muscular organ,
somewhat pear shaped, whose cavity is about 1½ inches deep. The uterus is
situated in the middle of the pelvic cavity, between the bladder and the
lower bowel. It is held in position by broad elastic bands, which go to
different sides of the pelvis; it is also in part supported by the structures
below and above it; but so loosely is the uterus held that it is easily pushed
about, as, for instance, by a full bladder or a packed bowel, and persistently
allowing the bladder to become overful, and failure to have a daily
evacuation of the bowels, are prolific sources of displacements of the
womb.

Respiratory Movements of the Uterus.—When no constrictions are
placed about the waist, the uterus moves freely up and down with every
respiration. So distinctly, and with such regularity, do these movements
occur that an operator, by watching the movements of the uterus, can tell
the effect that the anesthetic is having on the patient’s breathing. These so-
called respiratory movements play a very important rôle in the circulation
of the uterus, and in the return of the venous blood to the heart.
Anything which interferes with these movements, as the wearing of
corsets or of tight bands about the waist, prevents the free return of the
venous blood. The uterus becomes congested, and through the constant
abnormal weight of the organ itself, as well as by the pressing down upon it
from above of the superincumbent organs, the uterus is pushed down below
its normal position, the ligaments whose duty it is to hold it up become
relaxed, and the unhappy woman suffers all the agonies that are attendant
on the “falling of the womb.” For this reason the disorder is frequently met
with in women who have never borne children as well as in those who have.
The Functions of the Uterus.—The function of the uterus is to provide a
favorable place for the reception of the product of conception, where it may
be protected and nourished during the period of its development. The
purpose of menstruation is to keep the uterus in suitable condition for the
reception of this product of conception at any time. It is now known that the
menstrual flow is not the whole of menstruation, and that the changes going
on in the uterus are almost as continuous as the process of digestion.
Average Duration of the Menstrual Flow.—The average duration of the
menstrual flow is five days, although the variations are considerable in
healthy women. A flow lasting any place from two to six days is perfectly
consistent with health, but a flow continuing less than two days or more
than six days generally indicates a local or general disease.
Character of the Menstrual Flow.—For the first few hours, or perhaps for
the first day, the flow is usually slight in quantity and light in color; on the
second and third day the flow reaches its height, and is profuse and dark in
color, but it should never be clotted; after this it generally ceases. The
amount of the flow varies from 5 to 10 ounces. If less than 5 or 6, or more
than 18 napkins, are pretty well saturated through, the amount may be
considered abnormal.

Premonitory Symptoms of the Flow.—The premonitory symptoms of the
monthly flow should not be so marked as to cause the individual any
discomfort. The first indication of the return of the period should be the
flow. There is generally a feeling of abdominal fulness, with some lassitude
and sometimes slight headache. The temperature is lower and the pulse is
slower than at other times. This lowered tone of the system is an additional
reason for increased care against exposure in wet or cold weather.
Hygiene of Menstruation.—During the menstrual period all cold baths
must be strictly prohibited, whether tub-baths or cold sponges. The reason
for this is that the application of cold to the surface causes a driving in of
the blood from the exterior of the body to the internal organs, and, at the
time of the menstrual periods, there is already a congested condition of the
pelvic organs, and it must be remembered that congestion is the first stage
of inflammation.
Hot or warm sponge baths may be taken throughout the period, and the
vulva should be bathed with warm water twice a day throughout the entire
period of the flow, as this not only removes the clotted blood before it
decomposes and becomes the source of irritation, but also removes other
irritating matters, and prevents the nervousness that is caused by local
irritation.
Another question which is still sub judice is the necessity for and the
frequency with which vaginal douches should be taken; all physicians are
agreed that a vaginal douche, taken immediately after the menstrual period,
is beneficial, as it removes all of the débris of the flow, which is sometimes
very irritating.
Exercise.—A moderate amount of exercise should be taken every day;
this is needed now quite as much as at any other time, and only good can
result from it, and no harm comes of a woman going out in the rain or the
cold weather. As has been shown, the menstrual process is going on for a
large part of the time, and the flow is only the external appearance, but
during the time of the flow the woman must be unusually careful not to get
her feet wet or sit down with damp clothing on. Violent exercise of all kinds
is to be prohibited at this time, as dancing, bicycling, gymnastics, and walks
of over three miles. The reason for this is very obvious: the uterus has now
reached the height of its turgescence, and is heavier than at any other time,

hence the danger that displacements or a very profuse flow would be caused
by any kind of violent exercise.
Treatment.—If the woman has been so unfortunate as to have been
caught out in a heavy rain, so that her clothes have been wet through, or if
in the cold weather she should come into the house thoroughly chilled, the
best thing to do is to take off her wet things as quickly as possible; be well
rubbed down with hot rough towels; drink a cup of hot tea, and go to bed at
once, with a hot-water bag placed over the abdomen or under the small of
the back. She should remain in bed until the next morning, to the end that
the circulation may regain its equilibrium as quickly as possible by the
immediate relief of the pelvic congestion.
If this exposure should have caused the sudden cessation of the flow, a
hot mustard foot-bath should be taken. One tablespoonful of ground
mustard is used to the gallon of water, as hot as it can be borne; the pail
should be made as nearly full as possible, without running over, and a
blanket wrapped about the pail and woman, so as to cause a profuse
perspiration; this should be kept up for ten minutes; as the water cools off,
hot water may be added.
Profuse menstruation, painful menstruation, and scanty, very slight, or
irregular flow are all abnormal conditions that are due to some abnormal or
pathologic causes, and a good gynecologist should be at once consulted, so
that not only suffering may be prevented, but that serious consequences to
the general health may be averted.

CHAPTER VI
THE NERVOUS SYSTEM AS THE BALANCE
OF POWER IN THE BODY
The Brain the Master Organ of the Body; the Functions of the Brain; Habit and
Automatism; the Physiology of the Brain and Nervous System; the Hygiene of Work;
the Toxins of Fatigue; Overwork; Signs of Overwork; Nature’s Restoratives;
Avocation; the Physiologic Necessity for Laughter; Vacations and Health; Sleep;
Insomnia.
The Eyes; Eye-strain; Description of the Visual Apparatus; Optical Defects and
Their Correction; the Mechanism of Eye-strain; Local Symptoms of Eye-strain;
Artificial Lighting; Hygienic Precautions in Reading and Sewing; Injuries to the Eyes;
Symptoms and Treatment of Conjunctivitis; Trachoma; Styes.
Functional Nervous Disorders, Headache; Neurasthenia.

The Brain the Master Organ of the Body.—The brain is not only the
most important organ in the body, but its essential organ, for the sake of
which all the other organs and tissues exist, and it is the master of the
whole. It not only receives help from every other organ, but it also largely
controls the working of each. By its mental action alone it can hurry the
heart’s beat or slow its pace; it can make the skin shrivel or flush; it can
quicken or stop digestion; it can stop or change the character of all
secretions; it can arrest or improve the general nutrition. Every organ and
every vital process is represented in the structure of the brain, by special
centers and groups of cells that have a direct relation with such organs and
processes, and through which they are controlled.
The Functions of the Brain.—The brain may be said to have four chief
functions; the first is that of motion; it presides over and stimulates all the
voluntary muscular movements of the body, regulating their force, and
coördinating in their working the different groups of muscles needed to
perform them. Mind and muscular movement have the closest possible
connection with each other. The second function of the brain is that of
feeling and sensation; the third is that of nutrition; through this its own
nourishment and that of the rest of the body is regulated. While mind is the

fourth and highest form of nerve force, it is not created in the brain, but is
absolutely conditioned by that organ.
Different groups of brain-cells have different work assigned them; some
have motion, some have sensation, some have nutrition, and some have
mind. For example, special tracts of brain govern inhibition. While every
group does its own work, it is related to and combined with others,
influencing them, and being influenced by them.
Every kind of mental activity uses up the brain energy of the cells. To
think clearly, plenty of healthy blood must be supplied to the cells. In order
to make healthy blood, there must be an abundance of fresh air supplied to
the lungs, and a vigorous heart to pump it up to the brain. It has been
demonstrated that, during intellectual work or emotional feeling, there is an
increased supply of blood to the brain, which may become more or less
congested, and that there is an actual rise of temperature; whereas during
periods of relaxation, rest, or fatigue, the brain is pale and anemic.
The brain-cells generally, but particularly those cells involved in mental
activity, are of such a nature and constitution that they cannot rest
absolutely during the waking hours. They may act slowly or with great
rapidity; different brains have different capacities for energizing, both in
regard to speed and force; and, further, the brain may be pushed to work
greatly in excess of its normal activity, just as an engine may be allowed to
go at the rate of 50 or 60 miles an hour, or may be pushed to go at the rate
of 100 miles an hour. In both cases the danger resulting from speeding are
greatly in excess of going at the normal rate of speed.
In any case, the continuous brain action implies the necessity for
continuous repair. The only complete physiologic rest which the brain
enjoys is during sleep, when the process of repair goes on most rapidly;
during this period the brain-cells absorb their nourishment from the blood in
excess of their needs, and so lay up a store of energy for the waking hours.
Habit and Automatism.—It is one of the innate qualities of every tissue
and of every organ in the body, that when any vital action is performed, any
vital process gone through with, it is easier to do it the second time, and the
continuous exercise of the action makes the performances more and more
easy, until they become automatic.

The physiologic basis of habits consists of the plasticity of the nerve
substance, and in the capacity of nerve substance to receive and retain
impressions. There results the certainty that the nervous system will act
again more easily in those ways in which it has already acted.
On the one hand, the automatic performance of work saves an enormous
amount of brain energy; on the other hand, bad habits may be formed whose
effects may be most pernicious, and which are gotten rid of only with the
greatest difficulty. An example of the first is the young child learning to
walk; at first he accomplishes the feat only by the fixed concentration of
every power of the brain on the act; whereas the healthy adult walks
automatically, without paying the least regard to the movements or the
manner in which they are accomplished. Hysteria and ungovernable
outbursts of passion furnish good examples of the bad habits that may be
formed, owing to the lack of discipline and the powers of inhibition; every
time that a woman gives way to one of these outbursts, so much the harder
will it be for her to prevent or control another outbreak. Inhibition is the
highest and most important function of the brain.
Habits woman must have, but it is for her to choose what they shall be,
provided she chooses quickly; the time limit in habits is one of the strong
evidences of the close connection of body and mind. It is a startling fact to
face, that a woman’s habits are largely fixed before she is twenty; that the
chief lines of her future growth and acquaintance before she is twenty-five;
and her professional habits before she is thirty; yet to something like this
James believes that physiologic psychology points. The woman becomes a
bundle of habits, and her habits settle about her like a plaster cast.
The Physiology of the Brain and Nervous System.—The brain, spinal
cord, and spinal nerves constitute the so-called cerebrospinal nervous
system. The brain is that portion of the nervous system which is contained
within the cranial cavity and which it completely fills. The spinal cord is the
continuation downward, from the brain through the spinal canal, of nerve
substances, and from which the spinal nerves are given off. The nerves may
be described as cords and threads of varying degrees of fineness, distributed
to every tissue and organ in the body.
The nervous system has been likened to the electric telegraph, the brain
being the central station, while, in addition to the special senses, the body is

provided with numerous terminal substations in the skin and internal organs
of the body, which keep the brain informed of what is going on in the world
around it, as well as in the various parts of the body. The nerves simply act
as conductors to transmit the messages. The body is supplied with two
distinct sets of nerves or wires, one of which carries messages from the
outside world and various organs to the brain, while the other set transmits
orders from the brain.
The spinal cord is the center of reflex acts; that is, if the leg of a brainless
frog is touched with acid, he will take the other leg to wipe it off with.
There are, as we have seen, substations in the skin, hence the acid causes
the sensation of a foreign body, word is telegraphed the spinal cord, where
there is a large central station; from here word is sent out by another set of
nerves, to move the leg away from the acid, but this being insufficient, word
is telegraphed to the other leg to wipe off the offending substance. Did the
same thing happen in the body, at the same time that the cord telegraphed
word to the affected member to withdraw it, it would telegraph the brain,
and the sensation of pain would be felt.
A message travels along a nerve at the rate of about thirty-six yards a
second, or a mile a minute. This is about the time made by a lightning
express train. The distance in the body being so short, the time taken is
imperceptible, and we say that movement is instantaneous.
The paths traveled by nerve impulses are made passable by use; the
oftener an impulse traverses a given route, the more adapted such a route
becomes for future traffic.
But all of this has to do with the nerves which are under the control of the
will. There is another set of telegraph wires in the body, called the
sympathetic or vegetative system, so-called because it presides over the
processes of nutrition and is beyond the control of the will.
The Hygiene of Work.—Since the motor centers are located in the brain,
it is natural to expect that all definitely directed movements will directly
affect the brain and the mental development, and so it is. Du Bois Réymond
says that it is easy to demonstrate that such bodily exercises as gymnastics,
fencing, swimming, riding, dancing, and skating are much more exercises
of the central nervous system, of the brain, and spinal cord than of the
muscles.

It is further urged that healthful energy of will is impossible without
strong muscles, which are its organs, and that endurance, self-control, and
great achievement all depend on muscle habits.
The philosophy of work consists in its necessity. The brain-cell in health
cannot cease to be active, except to a partial extent during sleep. There must
be some output of mind from the mind cell and of motor stimulus from the
motor cell. The proper selection of work for that particular brain to do, and
the physiologic regulations of the work done, is the basis of the hygiene of
work. For health, for happiness, and for efficiency, right work rightly done
is the most important matter in any man’s or any woman’s life.
The physiologic, as well as the moral necessity, has always been
conceded for every man to have a life-work—a vocation; a work for which
he should be fitted, and for which he was capable, sufficiently congenial not
to sink into mere drudgery, and which would, at the same time, afford
ample financial compensation to be remunerative and a stimulus to his
power of endurance.
Important, from a physiologic point of view, as a vocation is for men, it is
equally or even more important for women. It is highly probable that the
unstable nervous system of women and their emotional extravagance and
dissipations, whether of frivolity, wickedness, or grief, is largely due to lack
of mental discipline and muscular development. It is a psychologic
proposition that any woman who has a toothache suffers less if she keeps
busy, and any one will testify that she suffers much less from the intense
heat of summer if she is busily employed.
One of the great objects of a definite and fixed occupation is to turn the
thoughts out from the ego. Work of some kind is indispensable to the health
and happiness of every one, since it necessitates an objective instead of a
subjective attitude of mind.
Experience teaches that the brain, like the muscles, is subject to training;
occasional excessive efforts, with long intervals of repose, are rather
injurious, while a many-sided activity, constantly repeated, interrupted by
sufficient shorter rests and supported by sufficient nutrition, is
strengthening. A healthy training of the brain should be as many sided as
possible.

Symmetric development and training of every function of the brain is as
essential for mental efficiency and sanity as the development of all the
muscles of the body is for bodily vigor, and a one-sided training of the
mental powers is as certain to produce eccentricities of habits of thought
and actions as those occupations which call into play only the action of
certain groups of muscles is to cause bodily deformities. Anything which
will prove injurious to the delicate nerve substance must be avoided, as
laziness, idleness, and, worst of all, any form of narcotics.
Many-sided life work, consistently carried through, not only strengthens
the brain, but also its continued power of adaptation, and one’s whole life is
a continuous struggle for adaptation. The more the brain works, the more
capable it is of receiving new impressions and elaborating old ones, and it
retains its elasticity longer.
Hurry generally implies lack of system in carrying out the routine of
work, or the undertaking of more work than the individual can accomplish
without injury to herself. Few things can more certainly muddle the brain
and produce a sense of physical exhaustion than a sense of hurry. Without
the sense of this insane driver with a lash in his hands standing over one,
she can work more rapidly, with complete self-possession, and do more
accurate and better work. The peculiar sense of being hurried has a direct
benumbing physical effect, that can often be felt in the brain as distinctly
confusing.
The Toxins of Fatigue.—By speeding the machinery to the utmost, a
strain is placed on nerves and muscles, and they are kept keyed up to the
greatest possible tension. There is a natural pace that one can keep up; force
the pace, and weariness results. A man can go for hours at the rate of five
miles an hour; he can run at the rate of six miles an hour for quite a long
while; but if he tries to run eight miles an hour, he will drop out very soon.
The powers of endurance must be gradually developed, but no machine
should ever be run at its utmost speed.
By undue pressure, at any period of life, it is possible to use up energy
that ought to have been spread out over long periods; and this is
emphatically the case during adolescence; too heavy a drain is made on
futurity, which means a serious breakdown, or, at least, premature old age.

It has long been assumed that during the activity of muscles substances
were produced which exerted a poisonous influence upon the muscle
tissues. Exactly what these substances were was not known, but it was
supposed that they were definite products of metabolism or tissue waste. It
is a well-known phenomenon, observed during the training of athletes and
soldiers, that prolonged and disciplined exercise makes it possible for
individuals to support easily an amount of work which would prove
exhausting or even fatal to the untrained. Increased work, under any
circumstances, means increased metabolism, and consequently a more rapid
accumulation of its products.
A German investigator, Dr. Weichardt, has shown that if guinea-pigs
were put upon a miniature treadmill and forced to run it until they dropped
dead from exhaustion, a highly poisonous liquid could be pressed from their
muscles, and that the injection of this liquid or extract into the veins of
healthy guinea-pigs produced, when administered in small doses, rapid
fatigue; whereas, larger doses caused death, accompanied by all the
symptoms observed in the original animal during the process of mechanical
tiring.
On the other hand, liquid taken from unworked guinea-pigs had no such
effect. Further, that if these little animals were put upon a treadmill and
worked to just short of exhaustion, and then were given time to recuperate,
as we say, the liquid or extract from their muscles had no such effect: it was
quite harmless.
From the results of these carefully carried out scientific investigations,
Weichardt has come to the conclusion that fatigue is due to a definite toxin,
analogous to that of diphtheria and tetanus, and he believes that the
explanation of the phenomena of training lies in the fact that in the body of
the athlete there must be a specific “antibody,” which neutralizes the
“fatigue toxin” as soon as it is formed.
In the animals undergoing these experiments of extreme fatigue there was
a fall of temperature. A practical use of this fact could be made for the
individual, by noting the fact that a subnormal temperature was a grave
danger-signal.
Other observers concede that fatigue is due to chemical substances,
produced in the body as the result of brain and muscle activity, and find that

these toxins produce a depressing effect, especially on the muscular system,
and that the sensation of fatigue is in large part the manifestation of this
depression. The action of toxins is not confined to the tissues in which they
arise; excessive activity of one tissue can cause fatigue of others. The facts
of acid intoxication are noticed as analogous to fatigue phenomena, so far
as the latter are due to toxic substances. As antidotes, only rest and sleep
can be relied upon.
Observations in the electric experiments on nerve-cells have shown a
remarkable shrinking of the nerve-cells, and especially of their nuclei. After
five hours’ continuous work, the cell nucleus was only half its normal size,
and twenty-four hours of rest was necessary in order to restore it to its
normal size, but half that amount of work does not require half that amount
of time for its recovery.
The mental symptoms of normal fatigue are loss of memory; the sense of
perception is less acute; the association centers act less spontaneously and
therefore slower; the vocabulary diminishes; the emotional tone is lowered;
the attention is unstable and flickering. All these are marked symptoms that
the individual is far below her best. All kinds of perceptions are more acute
in the morning.
Fatigue is not, therefore, merely physically uncomfortable; it is
intellectually, physically, and morally dangerous.
Overwork.—A surplus nervous energy must be persistently aimed at—
what Emerson calls “plus health.” It must be indelibly impressed on the
intelligence of every one that no fatigued individual can be at her best; she
is doomed to do inferior work, to be mentally depressed, and to be morally
weakened. Hope and courage ooze away, and all sense of proportions and
perspective are lost.
The amount of work that can be performed without fatigue is a matter of
individuality, and the only safe gauge of overwork are the danger-signals
sent out by nature—loss of appetite, insomnia, increasing exhaustion from
day to day without increase in the amount of work done, mental depression,
lack of interest and initiative. No one can afford to disregard these danger-
signals.

Habitual overwork produces fag and a desire for stimulants to act as a
spur to the overworked muscles during the day, and recourse to increased
stimulants or sedatives to act as hypnotics at night. The inert nerve-centers
have no reserve energy to give out, so it is worse than useless to stimulate
them. On the other hand, the nerve-centers are at too low an ebb to react
from the depressing effects of sedatives, which, to the individual, must be
positively injurious. The aim must be to promote nutrition, and to give
complete rest to the exhausted nerve-centers.
Brain work, to be beneficial, must be regulated with the greatest care.
During the exercise of the brain there is always an increased blood-supply
to it. If the exercise is continued too long, there is a tendency for the blood
to remain in too great quantity, due to the exhaustion of the nerve-cells,
which are no longer able to control the vessels.
During sleep the blood-supply to the brain is diminished and the cells
recover themselves, but if this hyperemia be persistently kept up, sleep soon
becomes impossible, the brain-cells have no opportunity to become
repaired, and their activity is diminished.
Richardson says: “Making all allowances for differences, even in the
prime of their mental and physical vigor, few individuals can exceed six,
and for most persons prudence would direct not more than four or five
hours of close mental application, without seriously endangering their
health.”
No real advantage is gained by eight or ten hours of daily study, since the
memory and reasoning powers become so exhausted that the assimilation of
ideas becomes slower and more difficult. When in his prime, Walter Scott
declared that six hours a day was all that he could profitably spend upon his
literary compositions. In later years, because of his pecuniary
embarrassment, he worked beyond this limit, and, as the result of excessive
labor, his last years were spent in hopeless imbecility.
Signs of Overwork.—These show themselves in irritability, with a sense
of exhaustion, the irritability being due to an exhaustion of the nerve-
centers. Work becomes irksome. There are periods of depression and
melancholia, which recur at shorter and shorter intervals and continue for a
longer period of time. There is a slight loss of memory, together with
inability to concentrate the mind upon any given subject for any

considerable length of time, and the power of thought and judgment are
impaired. There are sleepless nights, ringing in the ears, fatigue from the
slightest exertion, an irregular action of the heart, with palpitation and a
frequent desire to urinate. Various forms of pain and neuralgia occur.
There may be as yet no loss of flesh or impairment of the appetite, but
this condition of cerebral anemia furnishes the possessor with a pair of blue
spectacles through which the intelligence must look, and which throw their
own color over everything. Distressing dreams and unrefreshing sleep allow
the brain little opportunity for either rest or repair. The mind becomes as
sensitive as the skin after a blister, and the calm, vigorous mental labor is
superseded by feverish anxiety, wearing responsibility, and vexing chagrin.
When the brain is well supplied with a powerful circulation, and a rich
blood-supply from a good digestion furnishes it with an abundance of
pabulum, the cares of life are borne with equanimity and cheerfulness. One
of the most unerring signs of failing health is the inability to withstand the
pressure of these same daily cares. When the cares that formerly sat lightly
on the shoulders become well-nigh an insupportable burden, a state has
been reached where the mind reacts on the body.
Worry.—It is readily evident that worry is bred of exhaustion, and is one
of the signs of overwork; but, if too often indulged in, it becomes a fixed
habit, and the mind rapidly becomes settled in a state of gloom.
It is most important for overwrought business and professional women,
but most especially for those women whose vocations in life combine three
distinct occupations or callings—namely, wives who act in the capacity of
housekeepers, ministers of finance to the household, and the bringing up of
children—to realize the importance of not undertaking more than they can
accomplish without fret and worry. The overconscientious woman may
object that it is selfish to consider her own comfort when she has work to do
for others, but to expend too freely of the nervous energy, even in a good
cause, is like giving so much of our substance to charity that we ourselves
are in turn obliged to lean on others for support. In properly conserving our
own energies, we may ultimately be lightening the burden of others. There
is a proper balance between the duty one owes to one’s self and to others.
Once bred, worry is an endless chain. Tell such a woman not to worry,
and she worries for fear she may worry. She is afraid that she has decided

wrongly, and regards decisions in regard to the most trivial affairs of life as
though they were matters of vital importance.
The obsession “to arrive” is a fertile source of fret and worry. This habit
of mind leads to frantic and incessant labor and blocks all pleasure at every
point. The person who plays a game only to see who wins, loses half of the
benefit of the recreation.
“The legs of the stork are long, the legs of the duck are short; you cannot
make the legs of the stork short, neither can you make the legs of the duck
long. Why worry?” (Chinese proverb.)
Insomnia.—This is another symptom of overwork. The mind, worried
and harassed all day, retires at night to struggle in the darkness and solitude
with worries, forebodings, doubts, and regrets, which now assume gigantic
and fantastic shapes. In this case the insomnia is due to faulty habits of
mind.
Another form of insomnia is caused by intellectual work being carried on
at night until time for retiring; the mind is then so fully saturated with the
subject that it is unable to throw it off on going to bed.
Whatever be the cause of the insomnia, it soon becomes a fixed habit,
and, whether it is a case of laying awake a long time before sleep comes, or
waking up at a regular hour toward morning,—and it is a curious fact that
the habit of waking up recurs at almost precisely the same hour in the
morning,—the longer this habit of insomnia is indulged in, the more
difficult it is to break it up.
Nervousness.—This is a well-known sign of overwork, which shows
itself in intense nervousness and irritability. Everything jars on the nerves.
The woman gives way to her emotions, over which she loses control.
To keep placid when overworked to the limit of physical endurance
requires a stolidity of soul and lack of nerves only known to the North
American Indians, and perhaps the Japanese, and it matters not what the
kind of overwork is, whether business, pleasure, or charity.
Nature’s Restoratives.—The proper division of the day is eight hours to
be allotted to work, eight to sleep, and the remaining period of eight hours
is to be divided among the various methods of refreshing body and mind—
the toilet, eating, rest, and recreations.

Not only are rest, recreation, and sleep in proper proportions essential to
the health of the body, but they are equally essential to the quantity and the
quality of the output of work. From them result a feeling of physical well-
being, an exuberance of animal spirits which go into the work. The
perspective is more accurate, the judgment is clearer, and the creative power
is greater. Work goes of itself with a swing. Happiness is an expansive
quality, that makes itself felt throughout the entire body, but its effects are
most manifest in the mental power.
The mother who so honestly works and plans for the good of her family
as to give herself no time to rest after her physical efforts is in such an
exhausted condition as only to be able to give them the tired and critical
side of herself for daily association. There are few human achievements
much finer than to make human beings happy, and this power woman is
endowed with to a very large extent.
Rest, to be of value, must be systematically taken. Bearing in mind the
shrinking in size of the nerve-cells after stimulation caused by work, and
that they recovered their normal size in relatively less time if the shrinkage
were less, it becomes obvious that, in order to accomplish the best work,
whether purely mental, or of the more complex mental and physical work
demanded of the mother who is at the same time the housewife, that a break
in the day’s work will aid in securing the best results.
The exact time of the daily siesta must be adapted to the family régime,
but a fixed hour should be set aside for this purpose, and this should be
known as the mother’s hour, and nothing short of a catastrophe should be
allowed to infringe on it.
The woman should retire to her bed-room, undress, and go to bed. The
room should be darkened, and at the same time there must be an abundant
supply of fresh air. One soon forms the habit of taking a short nap, of
perhaps half an hour; one hour should be spent in bed. After this, she gets
up, takes a shower or other bath, dresses, and is then ready to enjoy life and
be a comfort to her family. In this way alone can absolute relaxation, rest of
mind, and body be secured.
Avocation.—Second only to the physiologic necessity for a vocation in
life, is the necessity for an avocation, and this must be in the nature of a
recreation.

It is a well-known fact in farming that any one kind of crop will exhaust
the very best soil, but few people recognize the necessity for a change of
occupation and recreation in order to produce the best mental and physical
results.
Joyless drudgery drains the springs of health. There is a mental
starvation, due to the lack of recreation, as well as the physical, due to the
lack of bread. The French aristocrats, noted for the gaiety of their pastimes,
in spite of their dietetic and other sins, furnish a remarkable list of
longevity. Persons of a cheerful disposition are generally long-lived, and
anything tending to counteract the influence of worry and discontent
directly contributes to the preservation of the health. Despair, which
frequently results from years of overwork, can paralyze the energies of vital
functions like a sudden poison, while hope fulfilled has cured many a
disease.
The nature of the avocation chosen will necessarily depend upon the
character of the vocation. For women whose vocations are intellectual and
sedentary, as writers, teachers, stenographers, etc., some outdoor
employment, which calls into activity the muscles of the body, rests the
eyes and brain, and, at the same time, pleasantly occupies the mind, is the
best, as walking, gardening, lawn-tennis, golf, rowing, etc.
For all women engaged in sedentary occupations, daily exercise in the
open air is the first essential, and let them be assured that their feelings of
fatigue and disinclination to exercise are no safe guide as to their ability to
take exercise.
The first cause of the feeling of fatigue is due to the lack of oxygen in the
lungs and the impure air of the room. On going out-of-doors, the woman
will be surprised at how much stronger and better she feels after an hour’s
brisk walk than she did on starting out.
“Fancy work” and lace-making, instead of being classed with recreations,
must be classed with fine hand-sewing of the most taxing kind. It calls the
same groups of muscles into play, and is productive of the same evils, with
a greater tendency to produce eye-strain and a paralysis similar to writer’s
cramp.

The proper avocation of the tired housewife, who has been on her feet all
the time and whose vocation is manual labor, will be the diversion of the
mind by reading a good book, while comfortably pillowed on a veranda
chair, a drive, a visit to some congenial friend, a game of cards, or music.
Literary clubs for women should be more largely organized through the
country and in country towns. In the cities women have found these clubs a
great boon, not only to the health and happiness, but they are in the highest
degree educational.
Further, women have found that these literary clubs were profitable, as a
means of bringing their minds in contact with other educated minds, and
thus they had not only the additional stimulus to study, but a broadening of
their horizon, which the woman’s heretofore shut-in household life had
precluded. Courses in domestic science would be a boon to the home.
The greater the number of interests which education and culture have
created, the greater will be the diversity of the recreations open for the
woman’s enjoyment.
Care must be taken that the avocation, which is at first an enjoyment and
relaxation, is not turned into hard labor. The moment that any one strains
every nerve, even to excel in a game, that moment it ceases to be a
relaxation.
History shows that the laws of all nations have always provided a certain
number of days of rest, or at least a change of occupation, and that these
days were fixed at more or less regular intervals. This was partly from a
religious and partly from a hygienic standpoint. The necessity for the
interruption of the regular routine work has always been recognized, and
one day out of every seven has been set aside for this purpose.
The custom that is so frequently adopted by city folk of going out of
town over Sunday might very well be imitated by country folk by going
into the town or city over Sunday. For not only is the too continuous
application to one’s employment fraught with danger, but it has been
conclusively shown that a monotonous routine of occupation, such as lived
by the average farmer’s wife, is a severe tax on the sanity of the mind.
Statistics show that the heaviest percentage of insanity falls on farmer’s
wives, and the supposed cause of this is the monotony of their lives.

A horse cannot gallop as many hours as it can walk, and the daily task
should be the sum-total of what man or beast can do compatibly with
health. To combine a day of toil with a second of amusement in one twenty-
four hours does not give the proper allowance for sleep, and cannot be done
without injury to the individual.
Fun and laughter are the most efficacious remedies in the pharmacopeia,
and tired humanity owes a debt of gratitude to the guild of humorists, be
they writers, comedians, or musical composers.
The Physiologic Necessity for Laughter.—The attitude of the individual
varies with age, temperament, and the perspective of life. Grave adults are
apt to think of laughter and smiling as something occasional, a momentary
lapse once in a while from the persistent attitude of seriousness. Healthy
children, on the contrary, consider that a state of laughter is the normal
condition of humanity, and that seriousness is a tiresome necessity, which
must be tolerated from time to time. But very few people have any idea that
there exists a well-defined physiologic necessity for laughter, and the
greater the intellectual labor and the mental strain, the greater is this
necessity.
The deep forcible chest movements increase the rapidity of the
circulation, the force of the heart’s beat, and secures a more complete
oxygenation of the blood.
It is not improbable that this accelerated circulation produces remote
effects on the organism. One of the immediate effects of a good laugh is
that it relieves the brain by the rapidity of the movements of the blood
through the capillary circulation.
In addition to the immediate physiologic effects which result from
laughter it is highly beneficial, by relieving the brain and nervous system
from the intense strain and tension of the daily affairs and occupations of
life, and gives relief to the severely congested capillaries, which otherwise
involve considerable risk to the individual.
Physiologists hold that pleasurable feelings tend to further the whole
group of organic functions, and that laughter produces a considerable
increase of vital activity by the heightened nervous stimulation. There is a
sense of increased energy, of a high tide of the fulness of the life current.

Vacations and Health.—The secret of success of the old Romans in
conquering the world lay as much in their ability to maintain the health of
their troops in their various campaigns as by the courage and organization
of those troops; or, rather it may be said that courage is but the coefficient
of a good physique and a general mental vigor.
A rest one day out of seven, with an occasional outing for the week-end,
is good but not sufficient. If one would keep up to her highest standard of
physical and mental efficiency, she must have at least one month of
absolute change of environment and outdoor life in the year.
The kind of place one chooses for her vacation will depend on where her
home is. To dwellers in cities, the mountains and seaside resorts are the
most beneficial. August is our most trying month, and every one who can
would do well to take her vacation at that time, always selecting some
resort north of her own home, so that she may have the additional
advantage of a more bracing climate.
Maine furnishes many of the most beneficial of our health resorts,
combining as it does so many attractions—its bracing atmosphere of pine
forests, its beautiful scenery with vast expanses of water, and the great
variety of diversions which it affords.
It is always wise to send an advance scout to investigate the place in
which you contemplate spending your vacation. Avoid low and swampy
land; investigate the character of the water-supply and the nature of the
plumbing, together with the sewerage system, for it is all too frequent that
an attack of typhoid fever follows an outing in the country. Every good
summer resort should furnish facilities for a variety of outdoor sports—golf,
tennis, boating, swimming, etc.
During the vacation needless exposure to the direct rays of the sun must
be avoided. There is probably nothing which lowers the vital resistance, and
so prepares the way for disease as much as exhausting exposure to the hot
rays of the sun.
Long hours of sleep should be indulged in. The morning air is the most
beneficial; it is, therefore, a good habit to retire early and to rise early.
If the vacation is not properly spent, it may be the means of doing more
harm than good. On the other hand, if properly spent, vacations prepare one

as nothing else can to meet and resist the vicissitudes of the following
winter. It is the people who go off on long vacations who have the least
need of the doctor’s care.
Sleep.—During sleep all the bodily functions are in abeyance and the
secretions are diminished; respiration is slow and confined to the chest, so
that the amount of inspired air is only one-seventh of that during the waking
hours; the temperature of the body falls; less blood circulates through the
brain; and the sensibility of the nerves to external stimuli is diminished.
Sleep is not only par excellence the time of repose and recuperation of the
brain and nerve substance, but it is the only time when, by the diminution of
waste caused by the incessant activity of the brain, that the organ can be
properly nourished, the deficit in nerve force canceled, and the surplus of
energy stored up.
Without this absolute remission of brain activity every twenty-four hours
an actual destruction of substance would occur, which, if persisted in,
would be so depressing to the nervous functions as to be inconsistent with
life, and this is the case in the concluding stages of fatal diseases.
The sleepy feeling caused by fatigue is due to the circulation in the blood
of toxins resulting from tissue waste, which benumb the brain-cells; while
the feeling of freshness and bien-être with which one awakens in the
morning is due to the elimination of the fatigue products from the blood
during sleep. If the blood of a tired dog be transfused into the veins of a
perfectly fresh animal, the latter will immediately show symptoms of
somnolence and seek a dark corner for sleep.
The medical authorities of to-day are pretty well agreed that eight hours
of sleep is the minimum required for the maintenance of health, and all
concede that the brain-worker requires more sleep than the manual laborer.
Every moment after the feeling of languor presents itself is a strain upon the
nerves and muscles which will sooner or later invalidate for life, and finally
bring the victim to a premature grave. Habitual deficiency of sleep will
undermine the strongest constitution.
It is a matter of great importance to train one’s self in the habits of sleep,
regularity in the hour of retiring, abstinence from active brain work for the
hour immediately preceding going to bed, since, if active brain work is
continued until one goes to her room for the night, the chances are that the

brain will continue its activities after getting into bed, and sleep may be
banished from the pillow for several hours.
A few minutes spent in breathing exercises, the vigorous use of the flesh
brush or hair glove, a hot plunge or foot-bath are no mean hypnotics.
A sound sleep is dreamless. Dreams require a certain expenditure of
nerve force and mental energy, so that dreamless sleep is the most restful.
Disagreeable dreams and “night-mares” are generally associated with
indigestion and biliousness, which also occasion a general restlessness. All
this can be overcome by taking some medicine for the liver. Two grains of
calomel taken just before retiring often works like a charm. The dose must
not be repeated under a month. In case of tendency to insomnia, no coffee
should be taken after breakfast.
Treatment of Insomnia.—The mechanical measures for the relief of
insomnia have for their purpose the withdrawing of the blood from the
brain to the surface of the skin. Hot foot-baths; general warm baths; cold
douches to the spine, brisk exercise; light massage, and cold rooms. Mental
work should be laid aside several hours before retiring; late suppers
avoided; coffee, if taken at all, should only be taken for breakfast, and then
only one cup. Reading or amusement should be selected that does not excite
the nerves.
To woo sleep the woman should put herself in a position of rest, which of
itself physiologically induces sleep. Avoid irritations, noises, bad air, cold
feet, overloaded bowels, all of which tend to wakefulness and to prevent the
proper physical rest. Then sleep usually comes of itself.
The Eyes: Eye-strain.—Of all the misfortunes that could befall a human
being, the loss of sight is probably the greatest, and yet no organ of the
body is so constantly abused as the eye.
The trouble is that the possessor of the normal eye does not take into
consideration that in all near work, as in reading, writing, sewing, etc., the
eye is actively engaged as well as the hands and brain, and that the eye only
is at rest when looking into space or when closed.
Description of the Visual Apparatus.—The eyeball is contained and
protected in a bony cavity, formed by the bones of the face and skull, and is
supported by a cushion of fat and other tissues. It is held in place by its

membranes and muscles, by which it is also moved. It is further protected
by the eyelids, the eyebrows, and the eyelashes. The eyebrows protect the
eyes from dust and perspiration and shade the eyes.
The eyelids are lined by a very delicate mucous membrane, called the
conjunctiva. They are maintained in close apposition to the eyeball by
atmospheric pressure. The tears are secreted by the lacrimal gland, which is
at the upper and outer angle of the orbit. The lubrication by the tears and the
mucus secreted by the conjunctiva cause them to move smoothly and
without friction. An important function of the lids is to distribute the tears
over the front of the eyeball, and by incessant winking to free the front of
the eye from dust and to keep it moist.
The conjunctiva is continuous with the mucous membrane of the nose
and mouth. Hence, in inflammation of the nasal mucous membrane, as in an
ordinary cold in the head or influenza, the conjunctiva is liable to become
very much congested or inflamed.
The eyeball is spherical in form, having the segment of a smaller and
much more prominent sphere ingrafted on its anterior part. The segment of
the larger sphere, which forms about five-sixths of the globe, is opaque, and
forms the sclerotic coat, the so-called “white” of the eye. The smaller
sphere, which forms the remaining sixth, is transparent, and is formed by
the cornea.
The iris is a circular contracting membrane, suspended from the edges of
the cornea, in front of the eye like a curtain. The iris gives color to the eye,
and when we say that an eye is blue or brown, we mean that is the color of
the iris. The iris is freely movable, and, according as to whether it dilates or
contracts, there is an alteration in the size of the central aperture, called the
pupil.
The chief function of the iris is to regulate the quantity of light admitted
to the interior of the eye. In a very strong light the pupil quickly contracts,
shutting out the excessive light, while in a subdued light the pupil dilates,
thus allowing more light to enter. When looking at a distance or when
looking languidly into space, the pupil dilates.
The Formation of the Image.—The eye is a camera, consisting of a series
of lenses and media arranged in a dark chamber, the iris serving as a

curtain. The object of the apparatus is to form on the retina a distinct image
of external objects.
The Mechanism of Accommodation.—In the passive condition of the eye,
when it is adjusted for far objects, the anterior surface of the lens is
somewhat flattened. Accommodation for near objects consists in a
contraction of the circular ciliary muscle and an increase in the convexity of
the anterior surface of the crystalline lens.
The light enters the eyeball through the pupil, falls upon the retina, which
has often been compared to the sensitive plate of a camera, is received and
transmitted by the optic nerve to the visual centers of the brain. The eyeball
does not see. It is only a sensitive end-organ, which receives and transmits
the impressions to the higher centers of sight. The act of vision is performed
in the brain.
The focusing power of the eye is the property of bending nearly parallel
rays of light from distant and divergent rays or from close range so that they
meet exactly on the sensitive retina; this is called refraction. In the normal
eye these rays are focused exactly on the retina.
Optical Defects and their Correction.—In the normal eye the near limit
of accommodation is from 4 to 5 inches, and the far limit may be put at an
infinite distance.
Myopia or Near-sightedness.—This is one of the most common
refractive defects of the eye. In this condition, because of the greater length
of the eyeball or increased refractive changes of the media, rays of light
from a distance are focused in front of the retina, producing an indistinct
image.
The near-point is brought much nearer—from 2 to 2½ inches—and the
far limit is at a very short distance.
In reading, the myope is obliged to hold her book very close to the eyes
in order to see. In doing so, she strains her muscles of convergence,
producing ocular congestion and compression of the eyeball.
The predisposing causes of myopia are heredity; it is said that half of
myopics are descended from near-sighted parents; uncorrected astigmatism,
and the effort to read very fine print or figures, entails severe strain on the
eyes, which may result in myopia.

Myopia is corrected by a concave lens, which diverges the rays of light,
prolonging the focal distance, so that the rays of light are focused exactly
on the retina.
Not only are myopic eyes not injured by wearing suitable glasses, but, on
the contrary, are often preserved from injurious pressure on the globe, due
to the indulgence of the habit to nearly close the lids in order to see better,
as is commonly done when glasses are not worn.
Hyperopia or Far-sightedness.—In this condition the eyeball is too short,
and the rays of light from a distance are focused behind the retina. Instead
of being distinct, the image is blurred. Hyperopia is corrected by a convex
lens, which converges the rays of light, bringing them sooner to a focus. In
the hyperopic eye the near-point of accommodation is at some distance, and
a far limit of accommodation practically does not exist.
Presbyopia.—This is a loss of the power of accommodation, by which
reading, writing, sewing, and other near work is accomplished. This power
of accommodation is greatest in early life, and gradually diminishes until
about the age of forty years, when reading at the ordinary distance becomes
uncomfortable. At about seventy-five years of age the power of
accommodation is practically lost.
Every person over forty-five years, with normal or far-sighted eyes,
should wear glasses to perform near work.
Astigmatism.—Astigmatism does not depend on the length of the eyeball,
but on the curvature of the cornea, and rarely on that of the lens.
Uncorrected astigmatism necessitates the expenditure of more muscular
effort in the attempt to see distinctly than is necessary when refraction is
normal. This is accompanied by early fatigue and more or less congestion
of the vascular tunics of the eye. Astigmatism is corrected by a cylindric
lens, which has a plane surface in one axis and a concave surface in the axis
at right angles to it.

Fig. 12.—Astigmatic chart.

In simple astigmatism, on looking at the accompanying astigmatic chart
with each eye separately, certain lines in the defective meridian seem very
much blurred, while those at exact right angles appear clear and black. This
furnishes a test for astigmatism, since to the normal eye the lines appear of
equal distinctness and clearness. Astigmatism is a very common ocular
defect.
The Mechanism of Eye-strain.—Comparatively few eyes are perfect.
Far-sighted or astigmatic eyes can secure perfect vision by means of
accommodation. By constant strain on the ciliary muscle, the crystalline
lens is so increased in curvature as to exactly counterbalance the optical
defect of the eyes.
Healthy eyes should do their work without the consciousness of the
owner, and this is a safe test as to the kind and amount of work demanded
of them.

Perfect rest for the eyes is impossible in the waking state—distant vision
represents rest for the eyes and near vision exertion.
Near work is the chief cause of near-sightedness. Distant vision should
alternate with near work, and in near work the object should not be brought
nearer to the eyes than 12 inches.
The Local Symptoms of Eye-strain.—There may be a sense of fatigue
in the eyes after reading for a short time, and this may be followed by a
constant sense of discomfort in the eyes, which is increased on using them,
and which may be accompanied by severe pain in the back of the head.
There is a sensitiveness to light, and inflammation of the eyelids and
conjunctiva. There may be twitching of the eyelids, and in extreme cases
difficulty in keeping the eyes open on account of drowsiness. The eyes may
smart, itch, or burn, and continually “water.”
As the trouble becomes more pronounced, reading for a short time may
be followed by a blurring of the type, and finally the lines may run together.
There is a constant sense of the eyes feeling for the lines, and, perhaps one
of the first things to call attention to the condition of the eyes may be the
losing of the lines in reading.
The general or reflex symptom of eye-strain is headache, which
frequently takes the form of migraine. This is increased on reading, sewing,
riding in the cars, etc. The headache is usually over the region of the
temples or just above the eyes, but it may be on the top of the head or at the
base of the skull.
Vision is so fundamentally related to all the brain functions that eye-
strain, or anything which interferes with normal sight, may cause the most
varied disturbances of bodily functions.
The Prevention of Eye-strain.—Persons whose work necessitates much
ocular labor should vary their duties with intervals of rest. In continued
reading or sewing it is well to desist at short intervals and fix the gaze on
some distant object, and to frequently close the lids.
Lace work, very fine needle work, working on black goods, reading very
fine print, or print on an inferior quality of paper, or attempting to read in a
dim light, are all a severe tax on the eyes, and should be avoided, as they
are certain to cause them permanent injury.

Defective vision is so common in school-children, it is so often present
without being suspected, and so much harm is done to the eyes and the
general health of the individual before it is discovered, that there should be
a compulsory law requiring the examination of all school-children; and,
again, before boys and girls enter the normal schools and colleges.
Clear vision gives clear judgment; defective vision in its various
manifestations gives different warps and bents to the mind of their
unfortunate possessors.
Veils.—The wearing of veils is responsible for not a little deterioration of
vision, particularly when they are thick or dotted. Unless the meshes of the
veil are very large, it holds a layer of impure air close to the face, so that the
wearer is breathing vitiated air. It hinders clearness of vision, because the
external world is viewed through a narrow lattice.
The best veil for the eyes is one with a single mesh, either without dots,
or the dots so far apart that none shall come over the eyes.
Protection of the Eyes from the Glare of the Sun.—In very hot weather
the eyes should always be so protected that the rays of the sun do not shine
directly into them. This protection may be afforded by the brim of the hat or
by a parasol. At the sea-shore, or on an ocean voyage, where the glare of the
sun is constant and particularly trying, the eyes should be protected by
wearing slightly tinted smoked glasses.
Artificial Lighting.—The main sources of artificial lighting are
kerosene, gas, and electricity. The principal questions of importance are the
quantity and quality of the light, its steadiness, the vitiation of the
atmosphere by the products of combustion, and the expense; also the proper
arrangement of the light.
Kerosene is the most extensively used means for artificial lighting. The
principal objections are—the heat, the trouble of filling and keeping the
lamps in order, and the danger of explosion and fire if upset; the odor and
the great vitiation of the atmosphere.
The modern lamp gives a brilliant light, and if properly shaded by a
slightly bluish chimney, so as to absorb the excess of yellow rays, it is very
satisfactory.

Illuminating gas, as furnished in cities, has a great excess of yellow rays,
which are very injurious to the eyes, and the vitiation of the atmosphere is
very considerable. Gas-light is modified by the Argand and Bunsen burners.
Of these, the Bunsen burner, a patented composition burner, heated to
incandescence, is the best. It gives a white light, resembling daylight, and,
under proper adjustment, a far greater volume than any other burner. It is
not so hot, does not consume as much gas, and so there is less vitiation of
the atmosphere. It is intensely brilliant, and must be shaded by ground glass
or a proper shade.
Electricity gives the very best light, with a minimum amount of heat and
vitiation of the atmosphere. For individual use 16-candle power is
sufficient.
The lamp-shade should be opaque, of a dark-green color, and lined with a
white, reflecting surface. Transparent lamp-shades, especially when
patterned, are always bad, whatever their color; because of the different
degree of illumination thrown upon the work, the light is irritating to the
eyes.
Hygienic Precautions in Reading and Sewing.—There should be free
access of open daylight. Near the window is obviously the best place for
working, and the seat should be so selected that the window is to the left of
the worker. This prevents the work from being shaded by the hand, and
protects the eyes from being fatigued by the light falling directly into them.
Any room will have too much light into which the sun shines directly.
Even if the worker’s face is not turned directly toward the sun, yet the light
reflected from the book or other work will be so intense as to be dazzling.
The softest and most pleasant light to work by is the diffused light from the
northern sky. An excess of light may be easily regulated by a shade.
Reading.—Very fine type should always be avoided, it is a very
unnecessary strain on the eyes, as are also books printed on a poor quality
of paper with improper spacing. The paper should be unglazed.
Length of Line.—The length of the printed line should not be more than 4
inches, nor less than 2¾ inches; that is, not more than 10 or less than 7
centimeters. If the line is too long, the effort to find the succeeding line is
too great. If, on the other hand, the line is too short, the lateral movements

of the eye are so frequent that the muscles concerned in these movements
soon become fatigued.
The position of the reader should be sitting upright, with the back toward
the light, which should fall over the left shoulder, and the book held nearly
on a level with the eyes. The book should be held at a distance of about 12
inches from the eyes. The light should be on a level with the head or
slightly above it. In desk work, a shade should always be worn to protect
the eyes.
Reading in the recumbent position is a pernicious habit, and is
particularly bad when convalescing from an illness or when very tired.
Reading in carriages or cars is injurious to all eyes, but especially so to
myopic eyes; because of the constant jolting, the distance between the type
and the eyes is continually changing, necessitating the frequent and abrupt
adjustments of accommodation; besides, the illumination is apt to be very
poor. Reading in a dim light or the twilight is also very bad for the eyes.
Sewing and embroidery require the most trying ocular labor and the best
conditions for illumination. Working on black goods by artificial light
should be absolutely forbidden.
Injuries to the Eyes.—The most common injuries to the eyes are the
entrance of small particles of dust, cinders, steel filings, etc., into the
conjunctival sac, or into the substance of the cornea. Frequently, with the
aid of a little winking, the tears wash away these foreign substances, but if
the substance lodges in the lining membrane of the upper or lower lid, or is
imbedded in the cornea, it may be necessary to resort to other means in
order to remove them.
The lining membrane of the lower lid is brought into view by simple
tension of the lower lid downward by one finger. If the offending particle is
not seen, the upper lid should be averted. This may be easily effected by the
fingers alone. The patient is told to look down, the edge of the upper lid and
the lashes are seized by the thumb and forefinger of the right hand, and the
lid is drawn at first forward and then downward away from the eye, then
upward over the point of the thumb or forefinger of the left hand, which is
held stationary on the lid and acts as a fulcrum. The foreign body should be

removed with the handkerchief, but, if it is imbedded, it may be necessary
for a competent physician to remove it.
The habit of opening the eyes when dipping the face into a basin of
water, or when diving, produces congestion and inflammation of the
conjunctiva.
Symptoms and Treatment of Conjunctivitis.—The eyes may be blood-
shot and the lining membranes of the lids intensely red. There is a sense of
irritation about the eyes and an intolerance of light, with a constant sense of
discomfort. The sensation produced is that of having sand in the eyes. The
eyes are heavy, and tire after using them for a short time.
The best treatment for acute conjunctivitis, which is so often caused by
the penetration of dust or other foreign bodies into the conjunctival sac, is
the application of cold water. A folded handkerchief is wrung out of ice-
water and laid on the closed lids. It must be changed every few minutes, so
that it shall not become warm; two cloths are necessary. When the acute
symptoms have begun to abate, the patient will no longer find these
applications grateful, and they must be discontinued.
For chronic conjunctivitis hot applications are the best. For these, one
teaspoonful of fine table salt may be dissolved in a pint of hot water, or two
teaspoonfuls of boric acid may be used instead; the last named is a mild
antiseptic. The boric acid dissolves very slowly, so that it is well to prepare
enough in the morning for the entire day. One tablespoonful of boric acid
may be put into a quart bottle of hot water, and be well shaken from time to
time, until there is a perfect solution.
When ready for use, half a pint may be heated, poured into a tumbler,
which is then placed in a basin of hot water; this latter serves as a water-
bath to keep the solution in the glass hot. The application should be made
with a rather thick wad of absorbent cotton or a piece of fine cheese-cloth.
The absorbent cotton should be picked up with all the water it will hold, and
be placed over the closed eyes just as hot as can comfortably be borne, and
held there until it begins to cool, when the procedure should be repeated.
The two eyes can be treated simultaneously. These hot fomentations should
be kept up for ten minutes, and be repeated four times a day.

Trachoma.—This malady, of which so much is heard now, is another
name for granular conjunctivitis or granular lids. The affection is very
contagious. It comes on slowly, and is frequently accompanied by redness
and an appreciable degree of secretion in the early stages. Presence of
secretion or of interference of the vision should always attract attention.
Strict precautions must be taken that the patient’s handkerchief, towel,
and wash-basin are not used by other members of the family. Further, the
other members of the family should bathe their eyes several times a day
with a solution of boric acid.
Styes.—Styes are a very painful species of small boils that generally
form on the edges of the eyelids. They are apt to appear in succession.
Certain persons are liable to them if the system is run down from general
causes. Like boils in other parts of the body, they give evidence of impaired
nutrition.
Hot fomentations of boric acid solution will sometimes abort them if
used early. If pus has formed, the stye must be opened by an incision
parallel to the edge of the lid. This should not be attempted by any one
except a physician.
Color-blindness.—As a rule, about 4 per cent. of males and about one-
half of 1 per cent. of females are color-blind. The part of the color sense that
is most often deficient is that for green and red.
Cataract.—This is a disease in which the crystalline lens or its capsule,
or both, lose their transparency and become opaque. Eventually total
blindness is the result. Senile cataracts appear after the forty-eighth year.
The only remedy for the disease is the surgeon’s knife.
Functional Nervous Disorders.—Evidences of sound health are: first,
individual adaptability or capacity of the individual to easily adapt herself
to extremely opposite conditions of existence; second, endurance, or the
capacity to do a considerable amount of mental work for a short time
without suffering fatigue, or to be able to quickly recover from the fatigue;
third, to be able to control the emotions; fourth, to be able to resist morbific
influence; that is, the capacity on the part of sound organs of excretion to
quickly eliminate all poisons from the system.

The signs of debility are just the reverse: first, deformity, obesity, or
leanness; second, personal inadaptability, that is, when physical or mental
discomfort is caused by such slight provocations as change of food,
clothing, or climate; third, lack of endurance, so that a long rest is required
to repair the fatigue incident to slight exertion; fourth, lack of control of the
emotions; fifth, a proclivity to morbific influences, so that the individual
succumbs to every contagion or miasm that she encounters.
Nervousness is a disease of civilization, coupled with overwork and
indoor life. The more complex the environment in which the individual
finds herself, and to which she must adjust herself, the greater the demands
made on the nervous system.
The extreme dryness of our climate, together with the great variations of
temperature between winter and summer and the rapid fluctuations of
temperature, predisposes to nervous disorders.
Headache.—Headache is a symptom rather than a disease, but there is
no symptom which requires more careful investigation of its cause than that
of headache. It occurs at all ages, but is most common from ten to twenty-
five years and from thirty-five to forty-five years. Women suffer from
headache more than men, in the proportion of about three to one.
Headaches are most common in the spring and fall of the year and in the
temperate climates.
Causes of Headache.—These may be classified into those in which the
blood is at fault; reflex causes; various nervous disorders; and organic
diseases.
The blood may be impoverished, as in the case of anemia, where there is
a deficiency in hemoglobin; but by far the most frequent cause of headache
is where the blood is disordered, as in gout, rheumatism, kidney diseases,
diabetes, and the infectious fevers and malaria.
Among the more common reflex causes are eye-strain, especially errors
of refraction; disorders of digestion, particularly constipation; and pelvic
disorders, as in inflammation of the pelvic viscera.
Functional diseases of the nervous system causing headache are
overwork, neurasthenia, hysteria, epilepsy, and neuritis.

Among the most common of the organic diseases is arteriosclerosis; other
diseases are meningitis and brain tumors.
Symptoms.—The pain is often dull in character and rendered worse by
stooping; the location of the pain depends on the cause of the headache. The
most common variety is over the forehead or eyes. In eye-strain the pain
may either be in the front or back of the head. In indigestion, the pain is
most frequently over the eyes, but it may also be on the top of the head. In
anemia the pain may be either frontal or diffuse. In pelvic disorders the pain
is generally at the base of the brain, though it is sometimes in the top of the
head.
Neuralgic headaches are generally characterized by sharp paroxysmal
attacks, located in the temporal regions, and associated with pain in other
parts of the body. It is perhaps most frequently caused by anemia.
In hysteria the headaches are characterized by a circumscribed pain—it
has been likened to the driving of a nail into the head.
In migraine the pain is paroxysmal and intensely severe; it is frequently
caused by some poison in the blood, as in autointoxication, due to failure of
proper regulation of the bowels, also by pelvic disorders.
Treatment.—The treatment is constitutional, and is based on the removal
of the cause. First, there should be a regulation of the diet, a free evacuation
of the bowels, and their proper regulation. In every case of headache there
should be an examination of the urine. Often there is some congestion of
the kidneys where it is least suspected. If the headache is persistently made
worse by reading or sewing, the patient should be referred to a competent
oculist. An inquiry should always be made into the condition of the
menstrual function, backache, and leukorrhea. Any marked disorders here
will necessitate a gynecologic examination.
For the immediate relief of migraine, the patient should go at once to bed
and drink a glass of hot water; sometimes a cup of hot tea gives great relief.
No food should be taken for from six to twelve hours, according to the
severity of the case. The room must be kept dark and quiet and the head
high.
A strip of prepared mustard leaf, 5 inches wide by 8 inches long, should
be cut, and a piece of cheese-cloth, 6 or 8 layers thick, should be folded the

same size. The cheese-cloth is then wrung out of hot water, and the mustard
leaf is quickly dipped into the same. The cheese-cloth is placed on the back
of the neck, between it and the mustard leaf. The clothes should be kept dry
by a folded napkin. In this way the mustard may be kept on from six to
eight minutes, until it begins to burn and the skin get red. If left on too long,
the mustard may produce the most painful kind of a blister. When taken off
the neck, the mustard may be put on over the stomach.
The medicinal treatment must be directed by the physician, but a
perfectly safe prescription, and one which may be kept on hand, is the
following: Take of sodium bromid, 15 grains; of essence of peppermint, 10
drops; and of water a sufficient quantity to make 1 dram. Mix well. The
dose may be repeated in three hours if necessary. This prescription should
be put up by a good druggist, in a three-ounce quantity. Sometimes relief is
afforded by 1 teaspoonful of the aromatic spirits of ammonia, taken in four
tablespoonfuls of water, and this is about the right quantity of water to take
any liquid medicine in. At night 2 grains of calomel should be taken, so that
the patient shall not be disturbed through the night, and it is not so apt to
cause nausea as when taken through the day.
Neurasthenia or Nervous Prostration.—This disease first saw light in
the United States, and was christened by Beard as an American disease that
was absent from no household in which the inhabitants used their brains. It
is certainly much more prevalent in this than in any other country.
Americans scarcely treat their bodies with more consideration than their
automobiles; they put on high pressure and speed them to the utmost. Add
to the high pressure under which we live that other fact of heredity, that
many persons are born with unstable nerve-cells, and may be nervously
bankrupt, and it is not difficult to understand that 50 per cent. of Americans
are suffering in some degree from lowered nerve tone.
Causes of Neurasthenia.—All classes of men and women who use their
brains severely, and who have seasons of excessive anxiety and
responsibility, are subject to neurasthenia. We have seen that fatigue was
caused by the accumulations of toxins in the body, due to muscular activity,
but these toxins may also be caused by intellectual overwork or anxiety
over domestic or business affairs.

Other causes are the intemperate amount of intellectual work which is
forced on the brain, and the excessive indulgence of the emotions and the
passions. Combined with the strenuousness of life is the large element of
uncertainty, the intense anxiety, and the restless energy which is the price of
success. Added to these may be lack of suitable and sufficient recreation
and short hours of restless sleep; the restrictions of a narrow lot, loneliness,
and isolation, the frequent repetitions of uninteresting tasks, added to the
burdens of maternity, domestic cares, and worries.
In cities the ear-strain caused by the incessant noises of the street, the
amount of work done by insufficient and improper lighting, the unsanitary
mode of life, the improper diet, the monotonous and infertile work, the
unhappiness and discontent bred of a life of idleness, or one given to
society and gambling, whether bridge, whist or poker, the senseless
bolstering of shattered nerves with alcoholic stimulants and beverages,
patent medicines, and hypnotics, all add their quota to the breaking down of
the nervous system.
A man can do a prodigious amount of work if he only varies it with play
which really amuses him, or if he substitutes for mental occupation those
which involve bodily exercises.
In so-called latent gout insomnia is a frequent symptom, or insomnia may
develop as the result of bad nervous habits. Insomnia from whatever cause
is followed by the impairment of nerve substance and an overloading of the
body with toxins. This continued nerve exhaustion leads to oxaluria, uric
acid, gout, anemia, gastric and intestinal dyspepsia, muscular insufficiency,
and precordial distress.
Whatever enfeebles the body by overtaxing the nervous system the waste
is in excess of the repair, in all overwork the destructive metamorphosis is
greater than the reparative processes, and so there is an accumulation of
toxic products and a more or less severe and permanent injury is done the
nervous system.
Other causes of neurasthenia, not so generally recognized as overwork,
are to be found in the pathologic conditions of the intestinal canal, which
becomes a veritable culture tube, and absorption from this into the blood
constantly takes place. And this condition of putrefaction has to be

overcome before relief can be afforded, and in many cases this condition is
associated with an insufficiency of the elimination of urine.
The large intestine is the seat of an enormous bacteriologic flora; they are
not there by millions, but by billions. Some of them are harmless, but not all
of them, and if these pathogenic bacteria are present in sufficient quantity,
they, too, may produce symptoms of mild poisoning. So, too, may mere
indigestion, or the malfunction of any other organ, torpidity of the liver, a
deficiency of the excretion of bile, which is generally accompanied by
constipation.
The Symptoms of Neurasthenia.—The symptoms are essentially those of
chronic fatigue, which has become exaggerated and pathologic. They may
be classified as sensory, motor, psychic, and somatic. The sensory
symptoms first noticed are those of generalized fatigue, with such localized
sensations as headache, backache, and limbache. The motor symptoms are
muscular fatigue, muscular weakness, and muscular exhaustion on slight
exertion. The psychic symptoms are manifested by a diminution in the
capacity for sustained mental effort and the spontaneity of thought and
exhaustion after slight mental effort. The somatic symptoms show
themselves in atony of the digestive tract and the circulatory apparatus, with
disturbances of the secretions.
Headache is one of the most common symptoms of localized fatigue,
and, associated with this, may be a sense of constriction about the head, and
there may be either a sense of lightness or fulness of the head.
A woman who is chronically tired loses all her personal vigor, force,
aggressiveness, and, above all, will power. Associated with this lack of will
power are hesitation, indecision, a marked irritability, and timidity.
Neurasthenic patients are subject to spontaneous attacks of fear, causeless in
origin, and generalized in character. These attacks may be accompanied by
pallor of the face and palpitation of the heart, just as in normal fear. The
tired woman is a cross woman. The irritability shows marked impairment of
the power of inhibition.
The Rational Treatment of Neurasthenia.—First of all, there must be a
removal of the cause which has produced it. There are two distinct classes
of cases—the overworked and the idle. The first class, and the most
important to the world, are the overworked. We may have to deal with the

intellectually overworked, in which the mental overwork was combined
with financial anxieties, domestic difficulties, or lack of success in their
work, or the cause may have been the tremendous responsibilities of their
positions, which involved the lives or fortunes of many people. Added to
this great strain and overwork, has been a lack of proper intervals for rest,
recreation, and sleep, and the body has become a storehouse for various
toxins, and so is suffering from both acute and chronic poisoning.
This class of patients must have the most rigid rest treatment, such as was
prescribed by Weir Mitchell years ago. It is most important that the patient
should be removed from her old surroundings; if this is not possible, she
should be isolated on the top floor of the house with a good nurse. The
room selected must be bright and cheerful, with plenty of sunshine and
fresh air; a window should be open practically all the time, for oxygen and
sunshine are two of the best restoratives. The diet must be easily digested
and very nutritious. The patient should be urged not to use her mind at all.
Carefully selected short stories may be read aloud by the nurse; the reading
should not be continued for more than half an hour at a time.
A great deal may be done to eliminate these toxins from the system by
the proper use of electric-light baths, followed by the shampoo and the
percussion douche; massage with salt water, salt rubs, and electricity.
In most cases a month of this absolute rest is as long as is beneficial to
the patient. And for most of them the sea-shore is the best. There should be
enough going on to be diverting without being overtaxing, and a climate
should be selected which is warm enough for the patient to live out-of-
doors. There should be short walks, drives, sails, etc., and this outdoor life,
with a contemplation of nature, is the most powerful restorative. The
grandeur of nature, whether it is the mighty forests, with their refreshing
shade and quiet, or even stretched in a hammock watching the sky and
trees, or the constant surging of the vast sea, bringing rest in its unceasing
restlessness, with the ships sailing lazily along, until the whole fades away
in the distant horizon. In the vastness of the universe, the ego becomes
contemptibly unimportant and insignificant.
After several months spent in this way the body has gotten rid of its
toxins, nerves and muscles are rested, and through the soothing influence of
nature the neurasthenic is gradually trained back to a healthier habit of

thought and a more rational frame of mind. There is substituted for the
morbid emotional complex a feeling of pleasure and energy. Reason and
judgment reassert their sway; outdoor life quickens the perceptions, and
forms tranquilizing memory pictures on the brain that return later to solace
and refresh the individual.
There is another, and a very large class, of cases among women of leisure
who have suffered all their lives from a lack of a vocation; they have
nothing to think of except themselves. They do not know what it is to be
quite well; they travel from one part of the country to another, and from one
country to another, but they never rise above a certain level of invalidism.
They are self centered, and what they need is the work cure. In the majority
of cases, before these patients can be restored to health, powerful habits
must be eradicated, new interests in others must be supplied to supplant the
most intense egotism, new paths must be hewn out in the brain, the will
must be recreated, and character can only be imparted by those who possess
it.

CHAPTER VII
THE HYGIENE OF THE MIND AND ITS
RELATION TO THE PHYSICAL HEALTH
Heredity; Temperament; Social Instincts; Fear.
Mental Development; Self-control, the Moral Sense, the Religions Instincts; the
Advantages of College Life; Balance of the Mental Faculties; the Effects of the
Higher Education of Women.
The Environment; the Choice of Friends; Literature.
The Power of the Will or Inhibition; the Effect of the Mental Attitude on the
Physical Health; A Definite Occupation a Physical Necessity; the Psychology of
Success.

The solidarity of brain and mind is an axiom of modern medicine, and it
is a fundamental principle that must be kept constantly in view in all
physical and mental training. Hitherto unsoundness, inefficiency, and
weakness of mind have only been lightly touched upon in preventive
medicine, but the importance of the mind as the chief factor in health and
disease is so paramount that it can no longer be ignored.
The problems that present themselves to the mother and the educator to-
day are practically the same, and the mother is one of the most potent
educators that we have—how the mind can best be strengthened,
broadened, and be made the most efficient working instrument possible
through the application of modern scientific and physiologic knowledge.
These are questions of vital importance to the human race.
Heredity.—Holmes says: “Each one of us is only the footing up of a
double column of figures that goes back to the first pair. Every unit tells,
and some of them are plus and some of them are minus. We are mainly
nothing but the answer to a long sum in addition and subtraction. Slight
obliquities are what we most have to do with in education.”
There are certain hereditary predispositions that will develop under
certain conditions; some of them are good, some are evil; that is, with the

natural development of the mind, certain peculiarities of the ancestors will
be reproduced. The problems suggested are how the mind can best be
developed, educated, and trained, so that hereditary weaknesses may be
counteracted or held in abeyance, and that latent hereditary talents may be
discovered and developed.
The first proposition that we have to face is that like produces like. There
are modes of education, of conduct in life, and of occupation that should be
avoided where a boy or girl is handicapped by a bad heredity. There are
special precautions and attention to physiologic laws which would save the
minds of many young men and women with a bad heredity from passing
into a state of inefficiency and actual disease. Heredity implies only
potentiality toward good or evil, and the latter may be averted by
knowledge and the proper practice.
Temperament.—This comprises the general make up of the individual,
the shape of the head, the appearance of the eyes, the mobility of the
features, the texture of the hair and skin, and the kind of movement. The
recognition of the kind of temperament, and a suitable training for its best
development, is of the greatest importance in attaining good health and
success in life.
There are four general types of temperaments—the nervous, the
phlegmatic, the arthritic, and the scrofulous or lymphatic.
The nervous temperament has certain marked characteristics, as the
small, wiry figure, the well-shaped head, the bright, restless eye, nervous
bearing, highly strung and sensitive nerves, feeling pain keenly and bearing
it badly. This woman is imaginative, sensitive, fond of intellectual work,
often artistic and ambitious. In her the brain and mind are dominant above
all else. When run down, this woman will be difficult to bring up again to
the normal level. She will grow thin, dyspeptic, irritable, and often
neuralgic. She will be peculiarly liable to nervous disorders.
This temperament has its special temptations—alcohol and sedative
drugs are two of them. Alcohol is not taken steadily or for social reasons,
but for the effect of alcohol on the brain, and there is the greatest danger of
becoming addicted to alcoholic habits, and finally of becoming an
uncontrollable dipsomaniac.

The phlegmatic or bilious temperament relates more to the training of the
body, since in this class of cases the mind is not exposed to the same
dangers, but the oversanguine temperament has its own dangers, which may
lead to lack of effort, speculation, and financial ruin.
The arthritic have a predisposition to both rheumatism and gouty
disorders, to which they are distinctly more liable than others, and the fact
that there is this latent tendency should be taken into consideration during
childhood and youth.
Social Instincts.—Social instincts lie at the foundation on which the
family and community is based. It may be said that any individual who is
destitute of them is in an abnormal condition, hence a right training of the
social instincts is, beyond doubt, one of the most important means of
securing happiness to the individual and order to society. The child’s or
youth’s relation to others, her affection for others, and her altruistic
practices, all go for the making of society, good citizenship, and patriotism
in the race.
At the school age the social instincts are one of the strongest elements in
life, and one of the most powerful adjuncts in developing mind and body.
The cravings of young women for social amenities are stronger, and her
deprivation of them more hurtful, than in the case of young men. There are
few girls in whom it does not require some regulation. The strain of too
much social life is injurious; social dissipation cannot be combined with
school life without wrecking the health of the young woman; nervousness,
anemia, and mental depression follow.
That individual cannot be said to be healthy mentally whose social
instincts are poor and perverted. Commonly one of the first symptoms of a
disordered mind is the diminution of the social instinct. The insane are
notoriously asocial.
Fear.—This is one of the most elemental and primitive of the emotions.
Biologists assure us that fear and surprise were the first of the emotions to
be developed, and that the feeling of the ludicrous was the last. Darwin says
that the earthworm knows fear, and darts into its burrow like a rabbit when
alarmed. So we see that fear is common to all forms of animal existence,
even to the lowest. This universality of fear has come about through the
working of the laws of natural selection, which prescribe that only those

creatures shall survive that can best adjust themselves to their environment.
Within limits, fear as a primary instinct has been and is eminently useful. It
is the cry of alarm raised by the senses which act as guardians of the body,
and, at a signal, in virtue of the nervous automatism, the organism is put in
a position of defense. On the other hand, fear may serve to paralyze, as has
been observed in the case of birds, many of which, though scarcely
wounded by the small shot, fall to the ground as if struck by lightning,
panting with wide-open eyes. In human life, while fear incites to activity, it
may also paralyze that activity.
Mosso says that the fear that young children have of cats and dogs,
before they have learned why they are to be feared, is a consequence of
heredity. We are born to a heritage of fear. If we fear ghosts and demons
less, we fear microbes and bacteria more. The professional or business man
fears failure, but fear should be a guardian, not a jailer. A healthy fear of
indigence will lead to thrift, industry, and such measures as will secure
one’s personal independence. Up to a certain point, fear is a protection, but
beyond that it paralyzes.
Mental Development.—We note that at birth the brain is mindless, and
that the brain-cells, which are the vehicle of the mind, undergo their greatest
development during childhood from stimuli coming from without the body.
The brain-cells possess infinite possibilities and potentialities. They are
developed from the stimuli from without through the eyes, ears, touch,
taste, and smell. There is another series of constant impressions which are
received from within the body, and these come from the muscles.
These impressions, conveyed to the brain-cells from the body, and from
the outer world beyond the body, leave a fixed registration, the writing on
the brain-cells has begun, and this constitutes memory; and the imprint on
these cells is similar to that which type leaves of letters and words on the
page of the printed book. These printed impressions on the cells can be
revived and seen and heard by the mental consciousness, just as a printed
book can be opened and seen and read by its owner.
The natural qualities of the mind are imitation, acquisitiveness,
emotionalism, and imagination.
The force of example in the home, at school, and in the book world is
among the most potent influences in molding character. The young girl

instinctively imitates her mother, her friends in real life, and in her book
world, and the woman will be the composite production, combining traits of
all of these, which will be ingrafted on the ancestral traits which have been
inherited.
In young children it is difficult to decide where the imagination leaves off
and the spirit of untruthfulness begins. In any case, the tendency to
exaggeration and untruthfulness are so prevalent in childhood that it must
be checked at the earliest signs of its appearance. The vice becomes so deep
rooted that it affects the mind in all its workings and the entire life as well.
It follows men and women into their business careers, their scientific life,
and their professions.
Professor Swift, in a very interesting study of the development of the
mind, invokes the aid of biology to show that all children are but little
animals, having no inborn notions of right and wrong, inheriting no sense of
justice; savage, by nature, and predatory by instinct.
He finds a psychic justification for fighting among boys. “Fighting in
some form,” he says, “is one of the first means by which the mind becomes
accustomed to intense action. To fight well, a boy must be capable of severe
concentration of attention.”
And he has found the age at which boys come to think that laws and the
recognized rules of right conduct should be voluntarily respected varies
from fifteen to seventeen years and older. These figures are approximately
correct for girls.
Absolute truthfulness, square dealing, honesty, honor, and an esprit de
corps should be demanded. Hitherto these principles have not been
sufficiently inculcated in girls as the fundamental principles on which life
must be met. The discipline has been too lax in the home and in the school;
it is that of implicit and prompt obedience on the word of command; the
proper subjection to and respect for those placed in authority; the kind of
discipline given in business life, the hospital, and the army, and the lack of
which has cost so much happiness and so many thousands of lives.
Self-control.—The perfect capacity for self-control in all directions and at
all times is the ideal state at which we aim. It is the standard aimed at by
developing the power of the will and the strength of inhibition. The great

difficulties, the magnitude of the task, may be conceived of from the saying
of the wisest of all men: “He who conquers his own spirit is greater than he
who taketh a city.” The reason is plainly evident—all the hardest battles of
life must be fought out alone, there is a feeling of isolation, as if one were
struggling alone against the combined forces of the universe, and, at the
same time, there is going on the struggle for the mastery between the two
conflicting natures, “When I would do good, evil is present with me.”
Whereas, in concerted action there is a feeling of sympathy, of
reinforcement from outside help, and the pleasant stimulation of
competition.
If youth were taught that certain enemies were going to present
themselves on the field, that they come for the most part in the first instance
single handed, and if grappled with one at a time, and the contest between
right, and perhaps inclination, be then and there fought to a finish, each
successive time the conflict would be easier and the victory more certain;
that in losing such a battle there must always be a certain loss of self-
respect, a feeling of moral weakness, it may be even so slight a fault as the
exaggeration of facts; while, on the other hand, a victory always gives
something of the same feeling of exultation that one has in any fairly won
contest or game. A feeling of pleasurable superiority, of having one’s self
well in hand. In the moral habits every gain on the wrong side undoes the
effects of many conquests on the right. The training of the will becomes the
most vital of all problems. Nothing that is learned in youth is really so
valuable as the power and habit of self-restraint, of self-sacrifice, of
energetic, continuous, and concentrated effort.
The Moral Sense.—From fifteen to twenty-five years of age is the most
crucial period of life in regard to the hygiene of the mind. It is during this
period that the brain first exhibits some of its strongest hereditary
tendencies. While such mental factors in human life as conduct and
character are being consolidated, as they now are, hereditary predispositions
manifest themselves, telling for good or evil, for success or failure.
The acquisitions then made are critical in the extreme and often final.
The real love of right, hatred of wrong, duty, conscience, religion, become
solid and effective in forming character.

The emotional nature instinctively shows a leaning toward the opposite
sex; love between the sexes toward the close of adolescence is the most
intense and most unreasoning of human passions. The sense of right, wrong,
and duty become active principles, dominating the character. There are
yearnings after the ideal, an intense scorn of and hatred of evil. The
purposes in life are then shaped. The impressions and resolutions then
formed affect the whole tenor of the woman’s life, as a rule, more than at
any other time.
The capacity to feel pleasure reaches its greatest intensity. The sex
relations are built up on safe and natural lines, regulated by family life,
social feelings, and the carrying of the thoughts and the emotions into other
channels, controlled by certain instinctive natural tendencies, by morality
and religion. To think and feel properly should mean to act rightly as a
physiologic corollary.
Music, literature, and art, imaginative works of all sorts, mix themselves
up with the sex feeling, so that the two help to form the emotional nature.
Far-away glimpses of poetic feeling, pleasurable altruism, citizenship, and
patriotism show themselves in the earlier stages and give direction to life in
the later. The whole period is one of immense importance for the health and
happiness of the remainder of life, and the risks to the body and mind are
then very great. A fact which is of great importance, and which is especially
true of adolescence, is that it is possible by undue pressure to use up stores
of energy that should have been spread out over very long periods. Through
such overexertion in study or in games too heavy a drain is made on
futurity, and mental disorders at this time are by no means infrequent,
mental depression being generally the first to appear. This is more
especially true in the descendants of neurotic families. The subjects are
troubled with neuralgias, insomnias, and there is a pessimistic view taken of
life.
The Religious Instincts.—Möbius says, “We reckon the downfall of
religion as one of the causes of mental and nervous diseases. Religion is
essentially a comforter. It builds for the man, who stands amid the evil and
misery of the world, another and fairer world. Besides his daily careful life,
it lets him lead a second and purer life. The consciousness of being within
the hand of Providence, and the confident hope of a future redemption, is a
support to the believer in his work and care, for which unbelief has no

compensation. Meditation calms and refreshes him like a healing bath.
Worship breaks in upon the daily drudgery of his days with rest and
meeting.” The morality of a nation suffers most severely through the
downfall of its religion, as experience has always and everywhere proved.
The religious instinct has a very close relation to the emotions, morals,
esthetic feelings, to social instinct, and to sex. The feelings of reverence and
awe, and the consciousness of the infinite in man are vague, but are the
most powerful parts of his nature.
Religion furnishes the only pure ideals that half of the world has access
to. It has proved an intellectual stimulus, and roused a metaphysical frame
of mind in some of the most vigorous nations, such as the German and
Scotch. It leads more toward refinement of life than any other agency. It
stimulates the benevolent and altruistic feelings, and leads to their practical
demonstrations; it fights vice and immorality; it seizes on the best that is in
man and transforms the character.
The Advantages of College Life.—College life is of the greatest
possible advantage to girls in many ways: it is broadening to the mind;
discipline is maintained, and, at the same time, the girl is thrown on her
own resources; adequate means are provided for developing both mind and
body to their greatest capacity.
Whether the girl comes from the country, a country town or city, her
social group is comparatively limited; her world is very little and the ego is
very large. The discipline that any large body of students bring to bear on
the conduct and behavior of the individual is one of the important
advantages of a college training. The insignificance of the ego, who is only
a unit in this large community, is quickly impressed on the gray matter of
the brain, and the rough and unpleasant angles are soon smoothed off. This,
in addition to the discipline afforded by the college officers, and the total
lack of discipline is the weakest point in the average girl’s education. To be
brought into intimate relation with the members of a large and educated
community is in itself a liberal education. To learn to respect the rights and
the opinions of others, to perceive that any given subject has a great number
of points of view, is attaining toward a healthy mental balance that will
make the woman broader minded, more sympathetic, more companionable,
and more charitable in her views of life.

In addition to the regular college curriculum are the opportunities
afforded, not only to special students, but to the entire body of students, for
a liberal education in music and art, and so a broad foundation for general
culture is laid that will greatly increase the opportunities for pleasure all
through life.
So that, in addition to the actual knowledge acquired by a college
education, there are also the advantages of the discipline of and
development of mind and body; the knowledge of how and what is worth
while to study; the power to study and solve life’s greatest problems for
herself and those dependent on her; the firm muscles, the clear brain, the
steady nerves, the power of judgment, the control of the will, and the
formation of character—on all of which the ultimate happiness and success
in life depend.
Dr. Beard gives to brain workers a value of life of fourteen years above
the average. The brain-working classes are less apt to worry, less
apprehensive of indefinite evils, and less disposed to magnify minute trials
than those who live by the labor of their hands.
Spinoza says that every advance toward perfection gives us happiness,
and it is safe to say that the buoyancy which characterizes contemporary
thought, the hopeful outlook amidst the dangers which threaten us, the
sense of the added cubit to the man’s stature, are due largely to the
recognition of the power for good within his soul of which he was not
formerly aware.
Balance of the Mental Faculties.—There must exist a certain balance
between the various faculties of the brain in order to insure sanity. A high
order of intelligence without much will, or keen emotions without a
corresponding power of inhibition, and overmastering will and slight moral
sense, vivid imagination without common sense, intense social instinct
without much conscience, fervid religious instinct without much sense of
duty or altruism, must invariably produce one-sided and unbalanced
individuals, and the results would be bad for society; and too many of these
one-sided or unbalanced people would impair if not endanger the safety of
the State.
Excessive ambition, misdirected energy, longing for the unattainable,
regret for the unalterable, anticipation of future unhappiness, lack of a sense

of perspective, fretting over non-essentials, indecision, reopening of
troublesome questions already settled, avarice, selfishness, excessive
emotions, uncontrolled passions, and the actual cultivation of the
melancholic state are some of the causes of mental anguish and subsequent
physical suffering.
Well-balanced mental faculties give a philosophic view of life; guard the
mental and hold the emotional in check; grasp the true relationships in life,
and view it in the proper perspective.
The Effect of the Higher Education of Women.—Nothing is so convincing
as actual experience and statistics;[5] and nothing is so broadening to the
mind as the study of history.
Never before in the history of the human race has any such large body of
young women been given the educational advantages for the development
of body and mind which they enjoy to-day. From antiquity there have been
exceptional women, who were highly educated and cultured, as in
Alexandria, Athens, and in the old European universities, but up to the
present day any tendency toward the education of the masses of women has
been looked at askance, and in this respect the position of the people of the
United States was long peculiarly provincial.
To two men belong the great credit and honor of conceiving the idea of a
liberal college education, and a medical college training, for women in this
country.
In 1865 Mathew Vassar, “having recognized in woman the same
intellectual constitution as in man,” founded a college for women only, and
thus gave women the opportunity for the same education that young men
enjoyed at their colleges.
In 1850 the Woman’s Medical College of Pennsylvania was incorporated.
The idea of establishing a college for the medical education of women
originated with Dr. Bartholomew Fussel, of Chester County. The query
arose in his mind, “Why should women not have the same opportunities in
life as men?”
Just how strong the public sentiment was against these movements, and
the leaders of the opposition comprised the most prominent educators and

physicians of the day, and what impediments they placed in the way, it is
now difficult to realize.
The opponents of the higher education of women urged three final
objections: First, women were mentally incapable of receiving the same
kind of intellectual education as was given to young men at college.
Second, they lacked the physical endurance to bear the strain of mental
work. And, third, such an education would render the young woman
masculine—she would no longer be willing to look after the ways of her
house, her natural affections and power to love would vanish, she would
become unwilling to marry and bear children.
Ex-President Eliot, of Harvard University, who has so long been the great
educational leader in this country, in his paper on “The Higher Education of
Women,” says: “During the past thirty-five years three distinct
apprehensions concerning the effect of the higher education of women seem
to me to have been removed. In the first place, there was a perfectly sincere
doubt (because there was little experience to go upon) whether young
women were so capable as young men of receiving what was then called the
higher education; or, in other words, whether the young woman had the
capacity to master by study the traditional subjects of the higher education.
That doubt has been completely removed.
“Secondly, it was feared that if the young women studied in the colleges
three or four years, beginning at about eighteen years of age, that such study
would have serious effect on their health and on their fitness for their
natural functions in after-life. This apprehension was felt by many
physicians and was warmly expressed. For a whole generation we have
been trying the experiment, and the result is perfectly clear. These
apprehensions have not been justified. It is apparent that young women can
do much mental work for three or four years between the age of eighteen
and twenty-two, not only without impairing their physical vigor, but all the
time improving it, if they live wisely and under right conditions.
“And thirdly, there was the strong apprehension felt by many excellent
people, lest in the process of the higher education young women would be
denatured. They admitted that young men were not denatured in any way by
the higher education at college, but they thought that there was a serious
chance that young women would be altered in their feminine nature by the

process of education. It has turned out that a young woman who studies in
college, from the age of eighteen to twenty-two, is no more altered in her
nature than a young man is who goes through a similar process. It takes a
great deal more than that to alter the nature of a woman.
“I suppose that this apprehension was based on the fact that women
seem, to men at least, more tender, fragile, and delicate than men, and,
therefore, more liable to be bruised or coarsened than men; it was feared
that the kind of public life, so to speak, in large groups would have some
tendency to deprive them of their natural delicacy, refinement, and
tenderness. It has not turned out so, and everybody recognizes that it has not
turned out so.”
When higher education, the professions, and industrial pursuits are all
unquestioningly thrown open to women, then it can be reasonably supposed
that they will come to possess those traits of mind—judicial, logical,
creative, etc., now generally considered as masculine traits, and they will
not only be more attractive and companionable for their husbands, but will
be far more competent teachers for their children, their enlarged range of
thought and vision inspiring greater confidence in their sons, and
stimulating higher ideals in both sons and daughters.
The Environment.—As we have seen, the brain registers every
impression from within and from without; if the impressions are those of
discomfort, gloom, darkness, ugliness, those things, being inharmonious to
the constitutional working of the brain, do harm and tend to set up bad
habits. First, the body must be healthy, and the environment good in order
to insure a healthy, vigorous mentality. Too much thought and care cannot
be given to the environment of the child, youth, and adult.
Careful attention must be given to the toilet. The quality and condition of
the underlinen, the cut and fit of the clothes, all tell on the mind. It has been
said that a man tries to live up to his clothes; hence, the uniform of the
soldier and the cassock of the priest. Clothes are not only an index of the
character, but they help to make it. The clothing that comes into intimate
contact with our bodies has a soothing or irritating effect upon the mind. It
has also been said that for a woman to know that she was properly dressed
had a soothing influence on the mind, second only to that of religion itself.

In the evening, laying aside the business suit of the day with all the
anxieties and dust of toil, and replacing it by a tasteful house-gown, brings a
sense of freshness that brightens the mind and stimulates the appetite. The
clothing should always be suitable to the employment, to the purse, and to
the surroundings, or good taste is violated, and, again there is an unhealthy
reaction on the mind.
To live in a gloomy house, with a dull ugly wall-papers, and no sunshine
entering the room, may produce in their inhabitants want of appetite,
interfere with nutrition, make them gloomy, unhappy, and hard to live with.
While esthetic surroundings render life happier, brighter, and higher.
If one cannot afford expensive paintings to hang on her walls, she can
select photographs of the old masters, neatly framed, which, placed in
harmonious surroundings, elevate the mind, cause a love of the beautiful,
develop the taste, and lay the foundation for a broad culture that will
increase the enjoyment of nature as well as of art.
The Choice of Friends.—We have seen that the impressions conveyed to
the brain-cells leave a fixed registration and are indelibly stamped there.
These may be called the sensitive plates of the mind, and it is because of
this writing on the brain that the selection of our friends and associates is a
matter of such vital importance.
The subconscious mind, of which we hear so much to-day, does not
originate thought; it can only elaborate and develop it, and the most
important fact which has as yet been discovered in regard to the
subconscious mind is that it is suggestible; that is, it is subject to moral
influence and direction. A few words of commendation and praise brighten
the whole day; if we can forget our pain for a little while, it is apt to cease.
All our greatest intellectual leaders, from time immemorial, have been
unanimous in their teachings that one of the most important elements in the
molding of the mind and character was the nature of our friendships.
Tennyson says, “I am a part of all that I have met.” “A man’s friendships
shape his life more than aught else, or more than all else.” The immortal
bard puts it, “It is certain that either wise bearing or ignorant carriage is
caught, as men take disease of one another; therefore, let men take heed of
their company.” And again, “’Tis meet that noble minds keep ever with
their like, for who so firm that cannot be seduced?”

Certain requirements and standards should be met, and the girl or woman
should be sure that the individual, whether man or woman, comes up to the
standards of her own clan.
A friend should be congenial, with similar tastes, opportunities, and
training; frank in criticism, yet sympathetic in spirit; loyal and staunch in
adversity, and one who disseminates an atmosphere which is broadening,
elevating, and uplifting. Such a friend is to be desired and to be sought after.
Literature.—Not one of the least of the great molding influences on the
mind and the social life of to-day is its literature, and the form of this which
reaches the greatest masses of the people are the daily press, the literary
magazines, and the modern novel. It is scarcely possible for the young to
conceive the great impression which is made on the mind and character by
the kind of books which they read. Carlyle said, “We cannot look however
imperfectly upon a great man without gaining something from him.” And to
this statement might well be added, it is impossible for the mind to be
brought into intimate contact with the lives of dissolute men and women, so
vividly portrayed in many of the novels of the day, without being smirched
by it. It is no more safe to read such a class of books, hoping to escape
contamination, than it would be to live in the malarial districts of Africa,
and hope to escape contracting that insidious disease.
However limited the geniuses may be in our immediate circle of friends,
each of us may have for her most intimate friends the greatest geniuses the
world has ever known, and have them at their best.
Two axioms should always be kept in mind—a real love for books is
formed in early life or not at all, and to have books for friends one must
own them, have them on her own shelves, to take down and put up at will,
to mark, to compare, and study. So whatever else one lacks, she should
always have her own library, even if it is a limited one.
Next in importance to the recognition of good reading must necessarily
be a recognition of the limitations of one’s reading. Whether in the capacity
of student, housewife, mother, or business woman, the time that can be
devoted to general literature is very limited.
A careful study of history and biography should always precede fiction. It
is a fundamental part of a liberal education to know something of the

world’s history, and the history of the English nation, as well as the
biographies of the men and women who were such important factors in
making its various epochs.
This should be followed by a study of the classics, and that education has
not been liberal which has not included a study of the modern classics.
German literature opens up a new and delightful world. A study of the
classics forms the taste, elevates the mind, broadens the vision and the
power of judgment, and it is a profound help in the formation of character.
After such reading as this, who would be willing to spend her time on the
cheap and trashy novels of the day.
Good modern fiction should be taken up as a recreation by the woman
whose life is laborious, its questions perplexing, and its complications
tiresome; in other words, after the woman has left the high-school or
college and has entered on her life’s vocation. For young girls, not only is
too much time apt to be given to fiction which should be devoted to other
and more important matters, but it is apt to do much harm by giving them a
wrong impression of life.
The Power of the Will or Inhibition.—The conduct of mankind is
chiefly governed by the emotions, instincts, and impulses. Spencer traces all
human action to the desire for pleasure in the large and philosophic sense of
the term. If this be so, then the education and hygiene of the emotions and
impulses must be of the very highest importance in the life of each
individual and in the social world. The question arises, and it is all
important, can those inhibitory centers be so developed in youth, and so
cultivated in life, that they can act as antagonists to what is morbid? Can
they be used as direct preventive and curative agencies against tendencies
and impulses which are foolish and hurtful? And the answer of educators, as
the result of large experience and observation, is emphatically, yes.
But the training, to be efficient, has to be systematic, persistent, and
along well-defined lines. The first step in this training must be the strict
avoidance of all that has a tendency to lower the standards of morality,
whether this is in the line of companions, literature, the stage, music, or art.
To do otherwise is not brave, but as foolhardy as it would be for a weak
army to advance against a powerful foe; it means annihilation or to be taken
prisoners of war.

To overcome obsessions and delusional beliefs by volitional effort, the
effort should be made to direct the mind to other subjects which have
nothing whatever to do with the obsession, rather than to make a direct
stand of the will against it, since the will may put forth its utmost strength
in the way of direct repression of the temptation to any immoral action, and
may entirely fail, while, by directing the same amount of force in changing
the direction of thought, complete success may be attained.
The influence of the will upon the emotions is a matter of the highest
importance in regard to the direction of the current of thought and the
determination of actions. Control your passions; govern your temper. We
can no more avoid feeling mentally hurt than we can feeling physical hurt,
but we have exactly the same power of the withdrawal of the attention from
the mental hurt as from the bodily pain, by determinately fixing it upon
some other object.
“I am, I ought, I can, I will,” are, as has been well said, the only firm
foundation-stones upon which we can base our attempts to climb into a
higher sphere of existence. The first implies a faculty of introspection, the
second a moral judgment, the third a consciousness of freedom to act, the
fourth a determination to exercise that power.
The influence of the will on the conduct is first automatic, through
previously acquired habits; second, through the emotional state, and third,
by our notions of right and wrong. In the fundamental principles of living
must be included a genuine consideration of the right of others. The
memory is an automatic reproduction of ideas, the mechanism of recording
processes.
The education of the will, the power of breasting the current of the
desires, and doing for long periods of time what is distasteful and painful,
all tend to increase the power of inhibition and strength of the will. Nothing
that is learned in youth is really so valuable as the power and habit of self-
restraint, of self-sacrifice, of energetic, continuous, and concentrated effort.
Seneca claims that difficulties strengthen the mind as labor does the
body. Plato said, that “self-conquest is the greatest of all the victories.”
Character lies preëminently in the sphere of the will, and anything which
weakens the will saps the worth of life at all points. The strength of will

bears not only on character, but on happiness and influence as well. The
leader must show reserved power, and make it plain that she has herself
well in hand, to secure confidence. “Will makes men giants.”
The Effect of Mental Attitude on the Physical Health.—The ordinary
operations of the mind have little effect on the physical condition, but such
emotions as fear, worry, anxiety, grief, despair, anger, hatred, and the like
depressing emotions act directly upon the muscular and nervous
mechanisms, profoundly affecting the secretions and the excretions, and
stamp themselves upon the very tissues of the organism.
Of all the mental attributes the emotions are the most exhausting. A
woman can spend more of her strength in five minutes of unnatural
excitement than in a day of calm, steady brain work.
A perfect temper is not only a prime requisite for a club president, but for
every man and woman in this hard workaday world, with its fierce
competitions, its petty jealousies, and the stiletto practices of the cowardly,
and it is one of the greatest preventives of indigestion, insomnia, and
nervous prostration.
Forget your grievances. Every time that one repeats them to herself or to
a friend she lives them over again, and the original trouble was but the
merest moiety of suffering compared to a wound torn open afresh every
day. To cherish a vindictive spirit does a vast amount of injury to the
possessor of that spirit. In view of the facts of the beneficial effects of
fighting upon small boys, and that the combative propensities of the Irish
peasant commonly evaporates with his shillelagh, it would seem
commendable to introduce boxing matches among women as a way to settle
their differences.
From the standpoint of health, the intense excitement attendant on
playing for high stakes, the loss of sleep, the unnatural life, the loss of
money that one can ill afford to lose, must eventually lead to a serious if not
to a fatal breakdown.
It is not the natural and reasonable intellectual work that injures the brain,
but the various emotions—ambition, anxiety, disappointment, the hopes and
fears, the loves and hatreds of our lives—that wear out the nervous system
and endanger the balance of the brain.

Powerful emotion is like concentration attended with dissociation, it
occupies the mind to the exclusion of all else, even to the dictates of self-
preservation and reason. The will is more or less suspended and held in
abeyance during the emotional states.
The too great concentration of the attention on one’s business or
occupation is a self-indulgence that often ignores the importance of the
lighter side of life and the legitimate claims of family and friends.
Less ambition and more philosophy would greatly lessen the number of
cases of nervous prostration and allied neuroses. All of one’s fortune is not
staked on one throw of the dice; if the woman fails in one direction, there
are other resources left.
Concentration of the mind on the physical suffering leads to the so-called
habits in disease; there may have, in the first place, been a real physical
cause. For example, in case of injury to a limb followed by severe pain in
that member it has happened that after amputation of the limb the
consciousness of pain persisted in the brain. In the functional neuroses, the
first cause may have been a real physical one, but the individual becomes so
self-centered, it is with difficulty that the mind can be withdrawn from the
ego, and a cure can only be effected by supplanting the intense egotism by
new interests.
Medical literature contains numerous observations of ailment caused by
fright, and even of death itself so caused. It is not uncommon for medical
students to contract the disease about which they are studying. In the old
small-pox epidemics it was a very generally observed fact that those who
feared contracting the disease were the most apt to get it. The reason is very
easily explained—fear so suppressed the functional activities of circulation
and nutrition, as to predispose the individual to take any disease to which
she was exposed.
Autosuggestion is the predominant element in the concentration of the
thought on one particular subject, and of the narrowing of the perspective to
a single point of view.
Prolonged anxiety or grief will cause an emaciation, second only to that
of tuberculosis itself, by the depression of the heart’s action and the

circulation, the loss of appetite, the interference with nutrition, and the loss
of sleep.
Worry is, as we have seen, in the first instance most frequently bred of
exhaustion, but, if indulged in, it readily becomes a fixed habit, and the
mind rapidly settles into a state of fixed gloom.
Worry is a type of fear. It is a futile regret over past mistakes and the
miserable forecasting of the future. It has been called the great shortener of
life under civilization—of all forms the financial one is the most frequent
and, for ordinary minds, the most distressing.
Anxiety and the anxious frame of mind is in readiness to take fright in
connection with our most vulnerable points on all occasions of
apprehension or uncertainty. As no one’s future can be clear throughout,
there is never wanting the matter of anxiety to a mind susceptible of this
state.
It is a significant fact that our asylums are recruited from the classes who
spend their lives amid narrow monotonous surroundings; hence the large
proportion of women, especially of farmers’ wives, whose lives are
probably the most narrow and the most monotonous. From this result the
fixed ideas, the obsessions, and all the absorbing egotism of insanity.
With a variety of valuable and permanent interests, the mind is well
safeguarded against attacks of worry. The overworked woman should
increase her recreations, leave home for short intervals, travel, and have
entire rest and change of scene. With increased vigor of body will come
increased power of the will and the capacity to abolish worry.
Anger floods the brain with blood, and if the arteries are brittle, as they
are in old age, and the individual is just as old as her arteries, the rise in
arterial tension may result in the rupture of a blood-vessel, and the
subsequent hemorrhage into the brain may cause an attack of apoplexy,
paralysis, or even death. Attacks of anger hasten the deterioration of the
arteries; in this way anger has been known to cause death.
Every violent physical sensation will react on the lungs; every powerful
normal emotion, whatever its cause, will also make its influence felt on the
respiratory functions. An exercise which is performed with tranquil
breathing if the mind is free from care, quickly produces respiratory

disturbances if the mind is brooding and preoccupied. Those who have
acted as seconds in a duel to men accustomed to the use of the sword know
that they become breathless in the duel much more quickly than they do in
the fencing school.
Depressing emotions make themselves felt in the respirations of animals
as well as of man. A sensitive horse, which is badly used at its work, or
even roughly spoken to, rapidly becomes breathless.
The dog is incomparably less swift than the hare, but is able to catch it;
the fright of the hunted animal disturbs its breathing and robs it of much of
its strength.
In fright the disorder of the respiratory movements destroys the regularity
of the interchange of gases which takes place in the lungs, between the
venous blood and the atmospheric air, and thus profoundly hinders the
function of the aëration of the blood.
The more impressionable the subject, the more easily do the emotions
influence his respiratory actions. Hence, the superiority in certain bodily
exercises of men whose minds are calm and masters of themselves.
Emotional causes, such as worry, anxiety, and grief, as well as the more
tangible physical factors, cause softening and disease of the tissues, which
frequently accounts for the arteriosclerosis and premature senility. Alienists
have long found abundant evidence that abnormal physical conditions are
capable of producing mental diseases, but the reverse is quite as true.
And not only the imagination, but the intellect, the emotions, and the will
have or may have a powerful influence over the sensations and organic
functions.
It is not only profoundly true that mental attitude has much to do with
bodily function, capable of producing changes in its nutrition and secretion,
but we may go further and say that healthful and hopeful habits of thought
do much to put the body on the defensive against the assaults of disease.
Mental attitude refers not to the will or the emotions, but to the mind in
its entirety. The trend of a woman’s thoughts, the use she makes of her
intellect, the strength of the volition, the sense of responsibility, and the
objects of her life are all questions that have a distinct bearing upon the
bodily functions and the health of the individual.

A Definite Occupation a Physical Necessity.—It is now generally
conceded by the leading sociologists of the day that women who are not
engaged in the duties of maternity need the same intellectual and industrial
activities as men. Many go further, and it is their opinion that there is no
reason for excluding women, who are fulfilling the duties of maternity,
from exercising full intellectual and physical activities in other directions.
And the proof that this is not a mere theoretic assumption is to be found in
the fact that many women have not only given birth to a family of children,
but have successfully reared them, and, in addition, have been eminent in
other pursuits and callings. Well-known illustrations of this fact are to be
found among the most noted sovereigns that Europe has ever had—
Catherine de Medici, Maria Theresa, Catherine II of Russia, and Queen
Victoria.
Pleasure seeking, as the end and object of life, leads to ennui, disgust,
and physical and mental deterioration, while the slavery of housework, the
childish vanities, and petty cares and vexations are most injurious to the
nervous system, so that for the life of the housewife the education preceding
it should be broad; and the more highly educated the woman is, so much the
more effectually can she free herself from attaching too much importance to
every little detail, and so neglecting what is higher and more important, and
it will be a great preventive of irritability of temper, quarrelsomeness, and
even melancholia and mental derangement, from which so many of these
women suffer in consequence of the monotony of their lives.
Every girl when she leaves school, which she should consider the very
alphabet of her education, should prepare herself for some definite
occupation, just as her brother does.
Clouston, in answer to the question as to how the powers of the mind can
best be developed, conserved, and made the best use of for life’s work,
says: “It is a most fortunate thing, if, during the later period of adolescence,
an occupation in life has been selected which really suits the capacity of the
individual and goes with his innate tendencies. The seriousness and the
settledness of the life of the period, with the bracing of every nerve and
sinew to do the work, to gain a reasonable position in society, and to enjoy a
fair amount of happiness, is in itself a tonic of no mean value, while
overtaxing of body and mind is always a risk, as well as an ambition which
overreaches itself. The repressions of woman’s life in civilized society

constitute one of her serious strains and dangers. The life and conditions of
a working woman who has six or seven children in a few years, who has
small means, and but little help, is in my judgment the very hardest of any
human being in our modern social system.”
Thomas[6] thus sums up his views as to the evils resulting from the non-
occupation of women of the better classes. “Human nature was made for
action; and perhaps the most distressing and disconcerting situation which
confronts it is to be played on by the stimulations without the ability to
functionate. The mere superinducing of passivity, as in the extreme case of
solitary confinement, is sufficient to produce insanity, and the emotion of
dread or of passive fear is said to be the most painful of the emotions,
because there is no possibility of relief by action.
“The American woman of the better class has superior rights and no
duties, yet she is worrying herself to death; not over specific troubles, but
because she has lost her connection with realities. Many women, more
energetic and more intelligent than their husbands or brothers, have no more
serious occupation than to play the house cat, with or without ornament. It
is a wonder that more of them do not lose their minds; that more of them do
not break with the system entirely, is due solely to the inhibitive effect of
early habits and suggestions.
“The remedy for the irregularity, pettiness, ill health, and
unserviceableness of modern women seems, therefore, to lie along
educational lines. Not in general and cultural lines alone, but in a special
and occupational interest and practice for women, married or unmarried.
This should preferably be gainful, though not onerous or incessant. Normal
life without normal stimulation is impossible, and the stimulation best
suited to the nervous system is some form of interesting work.”
The Psychology of Success.—Success has been defined as the
accomplishment, the realization of what has been willed or wanted, the ripe
fruition of the well-tended tree. The achievement of fame or fortune is what
the world generally regards as success.
Before entering on an enterprise, all the premises in the case must be had
in order to form correct judgments, otherwise incomplete and imperfect
knowledge of the case will lead to error in judgment, in which there could
be said to be “no chance of failure, it was a certainty.”

An element that always makes for success is to be able to supply a want
of the public; it is partly a question of demand and supply. It is sometimes
possible to create a demand. But, as a rule, success is the fruition of
patience and well-directed energy.
There is nothing which tends so much to the success of volitional effort
as the confident expectation of its success, while nothing is so likely to
induce failure as the apprehension of it. Since the tendency of the cheerful
and joyful emotions is to suggest and keep alive the favorable anticipations,
while that of the depressing emotions is to bring before the view all the
chances of failure, the former will increase the power of volitional effort
and the latter will diminish it.
The mental condition also exerts a direct influence upon the physical
powers, through the organs of the circulation and of the respiration, the
heart’s impulse being more vigorous and regular, the aëration of the blood
being more efficiently performed, in the former of these conditions than in
the latter.
Success too easily won, or won early in life, may really be a cause of
failure, because, having been once achieved, the individual may be content
with what she has and not proceed to higher development. And so a very
inferior success may be the tomb of energy and the satisfied goal of
ambition, instead of a stimulus to higher things.
Lack of success may also be caused by indulgence or lack of courage, the
individual preferring to sail along the chartered course of mediocrity rather
than to strike out a new path for herself, involving risk, anxiety, and endless
work.
And perhaps jealousy in the rank and file of the lazy, indifferent, and
mediocre far more often impedes effectually the road to success than is
dreamed of, so that a greater degree of secretiveness, warding off the scent,
of the intentions, the aspirations, and the methods of work, until the object
shall have finally been achieved.
Another and most important secret of success is to recognize failure as
only a stepping-stone to higher things. Eggleston says, “Persistent people
begin their success where others end—in failure.”

The people who succeed in this world are the people who get up and look
around for the circumstances they want; if they cannot find them, make
them. “Circumstances,” said Napoleon, “I make circumstances.”
There are four mental requisites necessary to the achievement of success,
namely: a clear view of the end; a judicious indifference to the sentiment
around by the sweeping away of obstacles; an indomitable energy; and the
power to resist the temptation to rest on the soporific plane of mediocrity.

FOOTNOTES:

[5] “Education as the Controlling Factor in the Physical Life of Woman,” Four
Epochs of Woman’s Life.
[6] “Sex and Society.”

CHAPTER VIII
DRESS THE FUNDAMENTAL CAUSE OF
WOMAN’S PHYSICAL DETERIORATION
The History of Woman’s Dress; the Corset in History; the Crusade Against the
Corset; the Influence of the Corset on the Female Body; the Curved Front Corset; the
Relation of Corsets to Abdominal and Pelvic Disorders; the Effects of Corsets on the
Muscles; the Straight Front Corset; the Abdominal Corset; the Wearing of Corsets by
Young Girls; What Style of Corset is the Least Injurious; the Shoe; the Stockings; the
Essential Qualities for Winter Underclothing; the Length of the Walking Skirt; the
Winter Street Dress.

A careful study of the history of woman’s dress affords a forcible
demonstration of the fact that the fundamental cause of the inferior
physique and lowered vitality of the modern woman of civilization is to be
found in not only her own, but also in her female ancestors’ unhygienic
mode of dress for many centuries.
Study the physique and dress of the ancient Greeks, then follow the
history of dress down through the Middle Ages and the Renaissance to the
present time, and, if further proof be needed, visit, as has been done, the
savage races of the earth to-day, and behold women of powerful and classic
physique still exist in lands where the body is not molded according to the
barbarous decrees of the “modiste of fashion.”
The History of Woman’s Dress.—The history of Greek costume is for
the most part free from what is known as change of fashion, for the reason
that the Greeks did not attempt to reconcile the two opposite principles of
covering, and at the same time displaying the figure; that is to say, of
cutting the dress to fit the body.

PLATE II
Greek costumes. “Queen and two attendants.”

The dress of the Greeks, when at the height of their civilization—and that
of the Assyrians, Egyptians, and ancient Romans was not essentially
different—was very simple. It often consisted of a simple garment, the
tunic, which pleased the eye by the gracefulness of its drapery, and at the
same time was comfortable by reason of its looseness.
The chief and indispensable article of female dress was the chiton, or
tunic, consisting of one piece of material, sewed together in the form of a

sack, open at top and bottom, in height reaching from the neck to the feet of
the wearer, and in width equal to that of the extended arms. Within this
stands the figure, and first it is girt around under the breasts by a girdle, to
keep it from falling; next the upper edges are fastened together on the top of
the shoulders by a brooch, and the arms are either left bare, pressing down
into folds at each side the masses of material, or these masses may be
gathered around each arm, and fastened down the outside with buttons and
loops, so as to form sleeves.
To secure greater warmth on the breast and shoulders the chiton was
made long enough to be doubled back at the top, and this part reached to the
waist. Underneath the chiton was worn a band of cloth, to support the
breasts, and, in addition to this, a cord was sometimes crossed round the
breasts outside the chiton, to assist either in supporting them or in bringing
out their form. Round the loins was sometimes worn either a short petticoat
of thick woolen stuff or a sort of bathing drawers, such as acrobats wore.
This was all of the essential dress for indoor wear. The chiton was made of
a variety of fabrics, though generally of linen.
For outdoor wear was the himation, a garment also worn by men; it was
made of woolen stuff and was worn like a plaid.
The chiton and himation, as above described, continued to be the
standard dress from 450 B. C. onward.
The hair was most usually worn gathered back from the temples, and
fastened in a knot behind by hair-pins of ivory or bone, either plain or
mounted with gold.
For the feet, sandals were usually worn, in exceptional cases shoes, and
for hunting, high boots. Gloves were never worn by the Greeks, except to
protect the hands in working.
From the time of Pericles, the great European distinction between male
and female dress consisted in the length of the skirt, old men, priests, and
officials being allowed the privilege of wearing long or women’s skirts, and
young girls being permitted to wear the short or man’s skirt. Among the
Romans, this single garment, worn by both sexes, was called the toga.
As time rolled on, this loose cord, which had formed the girdle, was
reinforced by a broad belt or band to support the breasts. Among the

Assyrians this belt was made of stiffened linen or thin metal; the Egyptians
wore a folded belt; a broad belt for supporting the breasts was also worn by
the Roman ladies. But whatever the material used, this stay-belt does not
show any signs of tight laces or of vertical ribs of iron or bone. It was,
however, the forerunner of “stays,” and when the moral fiber of the Greeks
grew lax, the courtesans set the fashions, and dress was used to display
rather than to conceal the figure, and, in order to make the hips more
prominent, the waist was constricted by a many-layered belt. At the same
time, the use of cosmetics was introduced.
The Mediæval or Middle Ages.—From the end of the fifth century to
the beginning of the seventeenth there was a singular resemblance in many
marked particulars between the dress of the two sexes. It now became the
object of dress in both sexes not merely to clothe the person, but also to
display the figure and adorn it. In the temperate climates there are always
greater changes in fashion than in the very hot or very cold.
Subjugation by the Romans in the first centuries of the Christian era was
followed by a general conformity to their mode of dress, so that the Roman
dress may be considered to have become European.
In marked contrast to the loose, flowing robes worn by the southern
nations of Europe in their decadence were the short skirts and jackets
clinging to the limbs, which were worn by the hardy nations of the North,
who were given to constant fighting and the pursuit of the chase. The
Norman lords, following the fashion of the south, swept about in long
tunics and flowing robes.
In the twelfth century the Anglo-Saxon women, dressed in their loose
garments, were indebted to the Norman ladies for the introduction of
“stays,” and the fashion of tightly lacing the body with a robe, laced down
in front in order to show its undulations, as well as the use of cosmetics.
In the household register of Eleanor, Countess of Leicester, which bears
the date of May 24, 1265, is one of the earliest places in which the word
corset occurs. The word is again found in reference to the wardrobe of
Richard King of the Normans, and Edward his son. Corsets were at this
time worn by men as well as women.

The author of the life of St. Thaïs, who lived in the twelfth century, tells
us that the French were so tightly laced that they could bend neither their
bodies nor their arms.
Peter the Great wrote that the robes are so tightly stretched over the body,
that the ladies can scarcely breathe in them, and often suffer very great pain
in order to make their bodies slender.
It was in the thirteenth to the fourteenth century that the last trace of the
Roman drapery gradually disappeared: the women adopted for the most part
the robes with the tightly fitting corsage, leaving ordinarily uncovered the
neck and the skin of the breast; this closely fitting corsage was closed in the
back by lacing.
Boots and shoes of this period had their pointed toes made two or three
times the length of the wearer’s foot. The fashions of England were the
same as those of France, though apparently they were not carried to quite
the same excess as on the continent. The singular aim of each sex was not
only to emulate the other in the sumptuous style of dress and its profuse
adornment, but also to imitate the form and fashion of the other’s attire; this
obtained in both countries.
The Renaissance.—In the sixteenth century a distinct separation
between ancient and modern dress took place, and our present fashions took
their origin from about that time. It was during this century that men
adopted clothes closely fitting about the body, overcoats with tight sleeves,
felt hats with more or less rigid brims, and closed boots or shoes. The
women also wore their dresses tightly fitting to the figure, with tight
sleeves, low-crowned hats, and richly trimmed petticoats. These garments,
which differ wholly from antiquity, constitute, as it were, the common type,
from which has risen the endless variety of modern male and female dress.
At this time the general resemblance between the clothing of the two
sexes, which may be traced to the earliest times, became decided. After the
accession of Queen Elizabeth in 1558, the well-known costume, associated
with herself from about the middle to the close of her reign, gradually
became established. The long-peaked and tight stomachers of the ladies,
and the padded quilted doublets of the men—it might truthfully be said that
each garment was a parody of the other.

Ruffs of an exaggerated amplitude and of a painfully severe stiffness
were worn by both sexes.
At the beginning of the seventeenth century the dresses were tight at the
waist, but begun to be made very full around the hips, by means of large
padded rolls, which were still more enlarged by a monstrous arrangement of
padded whalebone and steel. To both boots and shoes high heels were
added, in place of the flat heels previously worn.
About 1710 the hooped petticoat was introduced, and about 1740 they
obtained enormous dimensions.
When traced to their original sources, we find that all of the extremes of
fashion were made to conceal some deformity of the figure, or to give to a
part of it undue prominence, as in the case of the corset, which was first
introduced when clothes were not wanted for the concealment of the
person, but to make more prominent the curves and undulations of the
figure. The ruff grew out of a scrofulous complaint on a royal neck; the
hoop-skirt, to conceal the enceinte condition of a French queen.
The Corset in History.—Dr. Bouvier divided into five epochs the
transformations undergone by the corset, or by that part of the clothing
which took its place from earliest antiquity to 1853.
The first epoch is that of antiquity; in this, as we have seen, the band or
girdle, which was worn by the Greek and Roman ladies, was the forerunner
of the corset.
The second epoch comprises a great part of the Middle Ages. This was a
period of transition which partook of the styles which preceded and
followed it. At first there was an abandonment of the narrow Roman band,
and later the introduction of the corsage fitting tightly about the body.
The third epoch embraces the end of the Middle Ages and the first part of
the Renaissance, which was marked by the general adoption of robes with a
very tightly laced corsage.
The fourth epoch is that of the whaleboned corset, which extended from
the middle of the sixteenth century to the end of the eighteenth.
The fifth epoch is that of the modern corset.

The busk, known since the fourth century, was introduced into France in
the sixteenth century; men also wore busks or stomachers. The busk relates
closely to the history of corsets. The middle of the sixteenth century is the
epoch of transition from the corsage to the whaleboned waist, which
constituted a sensible approach to the modern corset.
We find that the reign of Queen Elizabeth was marked by the first use of
the whalebone stays. These were much affected by her successor James,
who insisted that all his courtiers, male as well as female, should cultivate
the appearance of the wasp.
The corset of George II, represented in Hogarth’s pictures, is said to have
been one of the most harrowing forms of screw torture. We are told that the
doughty warriors of Gustavus Adolphus wore stays almost to a man.
To Catherine de Medici is generally attributed the introduction of the
closely whaleboned waist into France, and the corset which she invented
resembled in more than looks that instrument of torture—“The Machine
Virgin of the Inquisition.” This corset was made of steel, and was as
inflexible as a suit of armor, and, like a warrior’s breast-plate, consisted of
two pieces. It opened longitudinally by hinges, secured by a hasp and pin,
made like an ordinary box fastening. In the front and back a rod or bar of
steel projected in a curved direction downward, and on their bars depended
the adjustment of the long-peaked body of the dresses and the set of the
skirt behind. During the forty years in which she ruled at court a thirteen-
inch waist measure became the accepted standard.
Madame de Sévigné, born thirty years after the death of Catherine de
Medici, formulated the axiom which has since been a law to the French
modiste, “Les hommes ont la permission d’être laid; les femmes ne l’ont’
pas; aussi n’en est-il aucune qui consente à l’être.”
The idea of the waist was unfortunately that which concerned the
execution. Instead of being adapted to the body or figure, in accordance
with its form, to bend with its movements, as the supple corsage which
preceded it had done, this new garment became an inflexible mold, which
distorted the natural contours and imposed upon them a conventional mold,
and prevented the least variation of size or situation of the contained organs,
as well as their continued integrity and the proper performance of their
functions.

The use of the whaleboned corset prevailed even among infants scarcely
out of their swaddling clothes. This was the natural consequence of the
pretended necessity to mold the human form in order to obtain beautiful
proportions, to reform nature, and prevent her mistakes, and one could
never take too much care to obtain such laudable ends. Mothers would have
been considered culpably indifferent of their children who had neglected
these first indispensable cares for the regulation of the formation of their
bodies.
The Crusade Against the Corset.—From the time of Galen, 130 A.D.,
to the present day, in spite of the anathemas hurled against it by the state
and medical profession, denouncing this great injury which woman does
herself, has the corset still prevailed.
In the thirteenth century, Henry III, having permitted its use for some
time, proclaimed a very severe edict against the wearing of corsets, which
was considered so pernicious to the health of women, but of no avail.
In the fourteenth century an edict was issued by the Emperor Joseph of
Austria, forbidding the use of corsets in all nunneries and places where girls
were educated, and calling upon the Church to aid him, threatening
excommunication to those evil-disposed damsels who should persist in
operating upon their waists. The College of Physicians of that day took up
the subject with activity and zeal, and dissertations upon the evils of tight
lacing were scattered broadcast.
Professor Virchow, that eminent pathologist, wrote, “What is the use of
introducing the principles and appliances of hygiene into the huts of the
poor and ignorant, when the scions of wealth and pretended intelligence,
especially of the gentler sex, show their contempt of hygiene by their dress
and general wearing apparel. In days gone by I have battled against that
diabolical invention called the corset, but this crusade has been given up by
me as absolutely futile.”
The modern hygienist has taken the stand that, since the corset cannot be
suppressed, it must be reformed. About 1880, for the first time, some
attention began to be given to the hygienic consideration of the style of the
corset.