3. By means of objects (drinking cups, tableware, etc.) that have been handled by consumptives.

4. By infectious material a.s.sociated with houses or rooms in which consumptives have lived.

These methods of spreading consumption suggest the necessity for the greatest care, on the part of both the patient and those having him in charge.(133) The material coughed up from the lungs and throat should be collected on cloths or paper handkerchiefs and afterwards burned. The house where a consumptive has lived should be disinfected, repapered or calcimined, and thoroughly cleaned before it is again occupied. The inside woodwork should also be repainted. The approaches to the house where the patient may have expectorated should be disinfected and cleaned. Since the germs are able to live in the soil, fresh lime or wood ashes should be spread around the doorsteps and along the walks.

*Typhoid Fever*, one of our most dangerous diseases, is caused by germs (bacteria) that enter the body through the food ca.n.a.l. They attack certain glands in the walls of the small intestine, where they produce toxins that pa.s.s with the germs to all parts of the body. Typhoid fever germs spread from those having the disease to others, chiefly through the discharges from the bowels and the kidneys. The germs contained in these, if not destroyed by disinfectants, find their way into the soil, or into sewage, where they may be picked up by water and widely distributed. Finding suitable places, such as those containing decaying material, the germs may rapidly increase in number, and from these sources find their way into the bodies of new victims. They are likely, on account of manures, to get on vegetables; on account of uncleanly methods of milking, to get into the milk supply; and from sewerage outlets, to get into the oysters that grow in bays and harbors near seaboard cities; but they are most frequently introduced into the body through the drinking of impure water.

*Diphtheria*, also known as "membranous croup," is caused by germs that attack the membranes of the throat. This most dangerous of children's diseases is spread chiefly by discharges from the mouth and throat. These should be collected on cloths and burned, or rendered harmless with disinfectants. The disease may be spread also by objects brought into contact with the mouth, such as cups, toys, pencils, etc. Children are known to have diphtheria germs in the mouth for some time after recovering from the disease, and should, for this reason, be kept away from other children until p.r.o.nounced safe by the physician.

The _ant.i.toxin method_ of treating diphtheria has robbed this disease of much of its terror, yet it not infrequently happens that the physician is called too late to administer this remedy to the best advantage. Since certain cases of diphtheria are likely to be mistaken for croup, the parent frequently does not realize the serious condition of the child. A croupy cough _that lasts through the day_, or a sore throat which shows small white patches, are indications of diphtheria.

*Scarlet Fever, Measles, Chicken Pox, and Smallpox*, on account of the eruptions of the skin which attend them, are cla.s.sed as eruptive diseases.

As the eruptions heal, scales separate from the skin, and these are supposed to be the chief means of spreading the germs. Attention must be given to the destruction of these scales by burning or thoroughly disinfecting all objects, such as clothing, bedding, etc., that may serve as carriers of them. Those having eruptive diseases should be confined to their rooms as long as the scales continue to separate from the body.

*Vaccination.*-The method of preventing smallpox known as vaccination, which has been practiced since its discovery in 1796 by Jenner, has always proved effective. In some instances the sore arm causes considerable inconvenience, but this generally results from neglect to cleanse the arm thoroughly before applying the virus, or from contact of the sore with the clothing later. The virus should be applied by a physician and the wound should be protected after the operation. If discomfort is felt when it "takes," medical advice should be sought.

*Isolation*, or quarantining, is a most important method of combating contagious diseases. By removing the sick from the well many outbreaks of disease are quickly checked. Isolation of individual patients, and sometimes of infected neighborhoods, is absolutely necessary; and while this works a hardship to the few, it is frequently the only safeguard of the many. The community, on the other hand, should make ample provision for the care of the afflicted in the way of hospitals, or sanitaria, and if it is deemed necessary to remove people from their homes, they should not be subjected to unnecessary hardship.

Where one is sick from some contagious disease in the home and there is liability of communicating it to the other members of the family, _room isolation_ should be practiced. Infection cannot spread through solid walls, and where the doors, and the cracks around the doors, are kept completely closed and the usual precautions are observed by those attending the patient, the other inmates of the house can be protected from the disease.

*The Physician and His Work.*-In combating disease the services of the physician are a prime necessity. The special knowledge which he has at his command enables the conflict to be carried on according to scientific requirements and vastly increases the chances for recovery. He should be called early and his directions should be carefully followed. Everything, however, must not be left to the physician, for recovery depends as much upon proper nursing and feeding as upon the drugs that are administered.

Of great importance is _the saving of the energy of the patient_, and to accomplish this visitors should, as a rule, be excluded from the sick room.

*Precautions in Recovery from Disease.*-Many diseases, if severe, not only leave the body in a weakened condition, but may, through the toxins which the germs deposit, cause untold harm if the patient leaves his bed or resumes his usual activities too soon. Especially is this true of typhoid fever,(134) diphtheria, scarlet fever, and measles. Rheumatism and affections of the heart, lungs, kidneys, and other bodily organs frequently follow these diseases, as the result of slight exposure or exertion before the body has sufficiently recovered from the effects of the toxins. To guard against such results, certain physicians require their patients to keep their beds for a week, or longer, after apparent recovery from diseases like typhoid fever, diphtheria, and scarlet fever.

*Relation of Vocation to Disease.*-With a few exceptions, the pursuit of one's vocation, or calling in life, does not supply either the quant.i.ty or the kind of activity that is most in harmony with the plan of the body.

Especially is this true of work that requires most of the time to be spent indoors, or which exercises but a small portion of the body. The effect of such vocations, if not counteracted, is to weaken certain organs, thereby disturbing the functional equilibrium of the body-a result that may be brought about either by the overwork of particular organs or by lack of exercise of others. Herein lies the explanation of the observed fact that people of the same calling in life have similar diseases.

*A Special Problem for the Brain Worker.*-Farthest removed from those forms of activity which harmonize with the plan of the body, and which therefore are most hygienic, is that cla.s.s of workers known as the professional cla.s.s, or the "brain workers." This cla.s.s includes not only the members of the learned professions-law, medicine, and the ministry-but a vast army of business men, engineers, teachers, stenographers, office clerks, etc., a cla.s.s that is ever increasing as our civilization advances. It is this cla.s.s in particular that must give attention to those conditions that indirectly, but profoundly, influence the bodily well-being and must seek to obviate if possible such weaknesses as the occupation induces.

*The Remedy* lies in two directions-that of spending sufficient time away from one's work to allow the body to recover its normal condition, and that of counteracting the effect of the work by special exercise or other means. In many cases the first symptoms of weakness indicate a suitable remedy. Thus exhaustion from overwork suggests rest and recreation. The diverting of too much blood from other parts of the body to the brain suggests some form of exercise which will equalize the circulation. If feebleness of the digestive organs is being induced, some natural method of increasing the blood supply to these organs is to be looked for. And effects arising from lack of fresh air and sunlight are counteracted by spending more time out of doors.

*Exercise as a Counteractive Agent.*-In counteracting tendencies to disease and in the maintenance of the functional equilibrium of the body, no agent has yet been discovered of greater importance than physical exercise, when applied systematically and persistently. This may consist of exercises that call into play all the muscles of the body, or which are concentrated upon special parts. When general tonic effects are desired, the exercise should be well distributed; but when counteractive or remedial effects are wanted, it must be applied chiefly to the parts that are weak or that have not been called into action by the regular work.

Unfortunately, health is sometimes confused with physical strength and exercise is directed toward the stronger parts of the body with the effect of making them still stronger. Not only is health not to be measured by the pounds that one can lift or by some gymnastic feat that one can perform, but the possession of great muscular power may, if the heart and other vital organs be not proportionally strong, prove a menace to the health. This being true, one having his health primarily in view will use physical exercise, in part at least, as a means of building up organs that are weak. Since the body, like a chain, can be no stronger than its weakest part, this is clearly the logical method of fortifying it against disease.

*Value of Work.*-Although there may exist in one's vocation certain tendencies to disease, it must not be inferred that work in itself is detrimental to health. Health demands activity, and those forms of activity that provide a regular and systematic outlet for one's surplus energy and compel the formation of correct habits of eating, sleeping, and recreating best serve the purpose. Work furnishes activity of this kind and serves also as a safeguard against the unhealthful and immoral habits contracted so often from idleness. Even physical exercise which has for its purpose the reenforcement of the body against disease may frequently consist of useful work without diminishing its hygienic effects.

*The Mental Att.i.tude.*-While a proper thoughtfulness and care for the body is both desirable and necessary, it is also true that over-anxiety about, or an unnatural attention to, the needs of the body reacts unfavorably upon the nervous system. Observance of the laws of health, therefore, should be natural and without special effort-a matter of habit. The attention should never be turned with anxiety upon any organ or process, but the mental att.i.tude should at all times be that of _confidence in the power of the body organization to do its work_. Fear and morbidity, which are disturbing and paralyzing factors, should be supplanted by courage, cheerfulness, and hopefulness.

Let it be borne in mind that hygienic living requires nothing more than the application of the same intelligence and practical common sense to the care of the body that the skillful mechanic applies to an efficient, but delicate, machine. And, just as in the case of the machine, care of the body keeps its efficiency at the maximum and lengthens the period that it may be used. This end and aim of hygienic living is best attained by cultivating that att.i.tude of mind toward the body that avoids interference in the vital processes and permits the natural appet.i.tes, sensations, and desires to indicate very largely the body's needs.

*Att.i.tude toward Habit-forming Drugs.*-Among the different substances introduced into the body, either as foods or as medicines, are a number which have the effect of developing an artificial appet.i.te or craving which leads to their continued use. Since the effect of such substances is usually harmful and since they tend to engraft themselves upon communities as social customs, they present a twofold relation to the general problem of keeping well. The individual may be injured through the personal use which he makes of them, or he may be injured through the effect which they have upon relatives or friends or upon society at large. Since our social environment is a factor in health little less important than our physical environment, the conditions that make for their continuance should be more generally understood.

*How Social Agencies perpetuate the Use of Habit-forming Drugs.*-When the use of some habit-forming drug has risen to the importance of a general custom, a number of conditions arise which tend to continue its use, even though the fact may be quite generally known that the substance does harm.

In the first place, those who have formed the habit suffer inconvenience and distress when deprived of its use. In the second place, a number of people will have become interested in the production and sale of the substance, and these will lose financially if it is discontinued. In the third place, those of the rising generation will, from imitation or persuasion, be constantly acquiring the habit before they are sufficiently mature to decide what is best for them. Thus may the use of a substance most harmful, such as the opium of the Chinese, be indefinitely continued-a species of slavery from which the individual finds it hard to escape.

Such is human nature and such are the forces and influences of human society, that the freeing of a people from the bondage of some habit-forming drug cannot be accomplished without strenuous and persistent effort. Education, persuasion, the good example of abstainers, and legal restrictions must be pitted against the forces that make for its continuance. Such a struggle is now in progress in all civilized countries relative to the use of alcoholic beverages.(135)

*How the Use of Alcohol became a Social Custom.*-The general use of alcohol as a beverage may be accounted for by three facts. Alcohol is a habit-forming drug; it has a stimulating effect which many have found agreeable; and being a product of the fermentation of fruit juices and other liquids containing sugar, it is easily obtained. Through the operation of these causes the human family became habituated very early to the use of alcohol. The "wine" of primitive man, however, did little harm as compared with the alcoholic liquors of modern times. It was a weak solution and on account of the crude methods of manufacture and storage could only be produced in limited quant.i.ties. Perhaps the worst effect of its early use was the establishment of a general belief in its power to benefit, since this laid the foundation for excess in its use when the developments of a later period made it possible.

During the eleventh century the method of making alcoholic drinks from starch-producing substances, such as wheat, barley, and potatoes, became quite generally known, and also the method of concentrating them by distillation. This knowledge made possible the manufacture of alcoholic drinks in large quant.i.ties and in considerable variety. Alcoholic indulgence was now no longer the pastime of the few, but the privilege of all. Its evil effects followed as a matter of course; and as these became more and more apparent, there began the struggle to restrict the consumption of alcohol which has continued with varying success to the present time.

*Counts against Alcohol.*-The statements found in different parts of this book relative to the effects of alcohol upon the body may here be summarized as follows:-

1. Alcohol has an injurious effect upon the white corpuscles of the blood and lessens the power of the body to resist attacks of disease (pages 35, 98).

2. Alcohol injures the heart and the blood vessels (page 56).

3. Alcohol causes diseases of the liver and kidneys and interferes with the discharge of waste through these organs (pages 210, 212).

4. Alcohol interferes seriously with the regulation of the body temperature (page 271).

5. Alcohol is one of the worst enemies to the nervous system (pages 326, 332-334. 336, 337).

6. Through its effect upon the nervous system and through its interference with the production of bodily energy (page 195), alcohol greatly diminishes the efficiency of the individual.

7. The taking of alcohol in amounts that apparently do not harm the tissues is, nevertheless, liable to produce a habit which leads to its use in amounts that are decidedly harmful.

*Alcohol and the Social Environment.*-Our social environment includes the people with whom we are directly or indirectly a.s.sociated. The presence in any community of those who are immoral, inefficient, or defective, places a burden upon those who are mentally and physically capable and renders them liable to results which are the outgrowth of weakness or viciousness.

The fact that alcohol causes pauperism, crime, and general inefficiency, thereby rendering the social environment less conducive to what is best in life, is plainly evident. To realize how alcohol harms the individual through its effects upon society in general, one has only to take into account his dependence upon society for intellectual and moral stimuli, for industrial and economic opportunity, for protection, and for general conditions that make for health and happiness. As we strive to improve our physical environment, so should we also strive for the betterment of social conditions.

*Industrial Use of Alcohol.*-Interesting and instructive in this connection is the fact that alcohol is, after all, a substance capable of rendering great service to humanity. The injury which it causes is the result of its misuse. Though unfit for introduction into the human body, except in the most guarded manner, it is adapted to a great variety of uses outside of the body. A combustible substance which is readily convertible into a gas, it may be subst.i.tuted for gasoline in the cooking of food, lighting of dwellings, and the running of machinery. As a solvent for gums, resins, essential oils, etc., it is used in the preparation of varnishes, extracts, perfumes, medicines, and numerous other substances of everyday use. Through its chemical interactions, it is used in the manufacture of ether, chloroform, explosives, collodion, celluloid, dyestuffs, and artificial silk. In fact, alcohol is stated by one authority to be, next to water, the most valuable liquid known.(136)

Opposed to an extensive use of alcohol for industrial purposes is the guard which the government must keep over its manufacture on account of its use in beverages. Though alcohol may be profitably manufactured and sold at thirty cents per gallon, the government revenue stamp of $2.08 per gallon practically prohibits its use for many purposes. A step toward a wider application to industrial purposes has been taken by the law permitting the sale of so-called "denatured"(137) alcohol without the tax for revenue. This law has proved beneficial to some extent, though the practical solution of the problem is still remote.

*Nicotine and Social Custom.*-The influences which brought about a general use of tobacco are similar to, though not identical with, those that engrafted alcohol upon society. The drug nicotine is a habit-forming substance and the plant producing it is easily cultivated.(138) Its immediate effect upon the user is generally agreeable, acting as a stimulant to some, but having a soothing effect upon the nerves of others.

Moreover, a strong deterring factor in its use is lacking, since its harmful effects are not readily discernible and by many are avoided through moderation in its use.

As with alcohol, tobacco is conveniently used to promote sociability among men, a fact which has much to do with its very general use. If it could be limited to social purposes, it would likely do little harm, but the habit, once started, is continued without reference to sociability-a matter of selfish indulgence. In fact, one effect of tobacco is to cause the user to become less sensitive to the rights of others, this being evidenced by smokers who do not hesitate to make rooms and public halls almost unbearable to those unaccustomed to tobacco.

*Counts against Nicotine.*-The physiological objections to the use of tobacco, as already stated (pages 56, 92, 326, 333, 336), are the following:-

1. The use of tobacco before one reaches maturity stunts the growth. The boy who uses it cannot develop into so strong and capable a man as he would by leaving it alone.

2. Tobacco injures the heart.

3. Tobacco injures the air pa.s.sages, especially when inhalation is practiced.

4. Tobacco injures the nervous system and by this means interferes in a general way with the bodily processes. For the same reason it interferes with mental and moral development, the cigarette being a chief cause of criminal tendencies in boys.

5. In some cases tobacco injures the vision.

6. The tobacco habit is expensive and is productive of no good results.

*Tobacco and the Rising Generation.*-The problem of limiting the use of tobacco to the point where it would do slight harm, in comparison to what it now does, would be solved if those under twenty years of age could be kept from using it. But few would then acquire the habit, and those who did would not be so seriously injured. In our own country it lies within the province of the home and the school to bring about this result. The fact that parents use tobacco is no reason why the boys should also indulge. The decided difference in effects upon the young and upon the mature makes this point very clear. Laws protecting boys from the evil effects of tobacco, not only cigarettes, but other forms as well, are both just and necessary.

*Social Custom and the Caffeine Habit.*-By suitable processes a white, crystalline solid, easily soluble in water, can be separated from the leaves of tea, and from the berry of the coffee plant. This is the drug caffeine, the substance which gives to tea and coffee their stimulating properties, but not their agreeable flavors. Less injurious, on the whole, than either alcohol or tobacco, caffeine has come into general use in much the same way as these substances. In a sense, however, caffeine is more deceptive than either alcohol or nicotine, because the usual mode of preparing tea and coffee gives them the appearance of real foods. The housewife who would feel condemned in purchasing caffeine put up as a drug somehow feels justified when she extracts it from plant products in the regular preparation of the meal.