Rural Hygiene Part 18

But the tendency nowadays is to build better houses, to cover the walls with paper, to put on double windows, and even to paste up the cracks to make the room as air-tight as possible. To sleep in such a room without a window open may not be committing suicide, but it is a deliberate method of reducing the vitality, of insuring a headache or a numbed and stupid mental condition, and of loading up the system with poisons which ought to be eliminated by the oxygen which fresh air supplies. It would add many years to the lives of the people of this country if, from childhood up, the habit was formed of sleeping with the window open. Nor need one fear that a cold would result from such exposure. A cheesecloth screen in the window prevents any draft and yet allows perfect ventilation. The face is trained to all kinds of exposure without any danger of catching cold, and there is no reason why, if the bed clothing be sufficient, the night air should not be thoroughly enjoyed without danger. Of course, the bed clothing must be sufficient; two lightly woven blankets are always better than one heavy one. Wool is better than cotton; if a cotton quilt is used, it should be loose and not tied tightly.

_Bathing._

An important function of the skin is to expel objectionable elements coming from the breaking down of the cells and from digestive processes; the skin is quite as important a factor in getting rid of this waste matter as those other processes more commonly considered in this connection. This action goes on most energetically when the secretion of perspiration is abundant and when the temperature of the surrounding air is so high that perspiration does not evaporate as rapidly as discharged. All these secretions contain more or less solid material which, unless removed, acc.u.mulates on the surface of the skin to clog up the glands and, in some cases, to putrefy and decay. It is this decay of organic matter on the surface of the skin which causes the odors plainly noticeable in a crowd, particularly in the winter time. This acc.u.mulation can be prevented only by frequent bathing and by wearing clean clothes, and there is no surer indication of a proper self-respect than the habit of cleanliness, both as to one's person and one's clothes. There is also the very practical feature that cleanliness is an effective method of discouraging infection and disease, partly by the removal of scurf and partly by the greater healthfulness of the skin thereby induced.

Baths have always served as therapeutic agents, and evidences of their use may be found in Roman paintings and in Egyptian sculpture to-day.

But from our standpoint it is their hygienic importance that is insisted upon. Ordinarily, the temperature of the bath should be between 90 and 100 degrees, and enough soap should be used to counteract the oily nature of the deposits on the skin.

Unfortunately, facilities for bathing, except in summer, have not been generally supplied to detached houses in the country. Plumbing in most houses has been lacking, but in these days bath-rooms are being installed with surprising rapidity, and the conveniences resulting are enjoyed as soon as they are understood. Only a few days ago, the writer was told of a small village of perhaps two or three hundred persons where this last summer one house, the first in the village, was provided with a bath-room, to the great interest of all the villagers. The convenience and comfort involved were immediately appreciated, and the plumber, who came in from a neighboring city twenty miles away, secured contracts for and installed twelve bath-rooms in twelve houses before he was allowed to leave the village. This same interest is everywhere noticeable, and the lack of bathing throughout the winter, formerly, alas, so common, is now giving way to a greater cleanliness, thereby improving the health and character of the inhabitants.

A great deal has been written about the value of a cold bath, particularly in the morning, and many people, from a sense of duty, suffer what is almost torture taking a shower bath or a cold plunge bath on rising. When a cold bath (which should not last more than a few seconds) is followed by a good reaction, that is, when after drying, a distinct glow is felt, there is no objection to its use, and undoubtedly it has a tonic effect for those whose vitality is able to endure the shock. But cold baths for their tonic effect are desirable only when the individual is a.s.sured of their lasting benefits. Nor must one judge of the effects by the immediate results, inasmuch as the splendid feeling which follows may be succeeded by a period of depression lasting the rest of the day; in which case, the total effect of the cold bath is bad rather than good. Baths for cleanliness are everywhere desirable, and their frequency should depend upon the individual, his const.i.tution, habits, and work; upon the season and temperature; and on the conveniences for bathing in the house. Baths for tonic effect are not necessary, and if not a pleasure, may very properly be omitted.

One other point to be noted is that no practice is of more value in reducing the ravages of contagious diseases than a frequent and conscientious was.h.i.+ng of one's hands. For germs are most certainly transmitted from one person to another, and it is accomplished more frequently by the hands than by any other part of the body.

The invitation, therefore, to a guest to wash his hands before dinner is really an invitation for him to disinfect himself or to get rid of the germs which he is carrying, in order that the host and his family may not be infected during the meal. The guest owes it to his host always to accept the invitation, whether he thinks he needs it or not. Doctors recognize the necessity, and it is surprising to observe how many times during the day a doctor washes his hands, even though he may not come in contact with any particularly infectious disease. An ordinary man, on the other hand, washes his hands only when he thinks they are dirty, although his daily occupation may expose the skin of his hands to infection many times worse than that which the doctor experiences.

_Mouth breathing._

Children have sometimes wondered why they were made with both mouths and noses, since they could breathe equally with either, and many years have gone by before they realized that breathing through the mouth was not intended, but that the exclusive province of the nose was to furnish air to the lungs. The reason for nose breathing rather than mouth breathing is twofold. In the first place, no provision for removing or filtering out germs from the air is made in the mouth, whereas in the nose the crooked pa.s.sages, the moist surfaces, and the hairlike growths all tend to strain out any germs normally in the inspired air.

Further, breathing through the mouth has a tendency to induce inflammation in the tonsils and in the air pa.s.sage connecting with the ear. This inflammation develops into those growths known as adenoids, which, when enlarged sufficiently, close the nostril entirely and prevent its normal use. A recent examination made by the New York Board of Health of 150 school children, all in some way abnormal, showed that 137 had either adenoids or enlarged tonsils. Example after example could be given of school boys and girls whose mental and moral development has been markedly r.e.t.a.r.ded because of mouth breathing. One need only look at a child or adult who constantly keeps his or her mouth open to be impressed by the listless, vacant, inert appearance of the face thus disfigured. Figure 74 shows a photograph of a schoolgirl just before an operation and the characteristic expression due to adenoids is plainly marked. Earache is largely due to adenoids or to inflammation that rapidly leads to adenoids, and Mr. William H. Allen, Secretary of the Bureau of the New York Munic.i.p.al Research, reports that in 415 villages of New York State, 12 per cent of the children living there were found to be mouth breathers. Whenever a child is unable to breathe through his nose, is slow in talking, and then speaks with a stuffy accent, calls "nose" "dose," has a narrow upper jaw, and is either deaf or has inflamed eyes, it is practically certain that enlarged tonsils and a well-developed growth of adenoids are present and should be removed. Not merely do these growths interfere with the mental and physical development of the child, but they also make him more susceptible to contagious diseases, particularly those of the lungs and bronchial tubes.

[Ill.u.s.tration: FIG. 74.--Schoolgirl with adenoids.]

The removal of adenoids is a simple operation, lasting not over a minute, and the result of the operation is in some cases almost miraculous. The medical inspectors of the New York City schools consider the removal of adenoids as a most important part of their work, and groups of children are regularly taken from the schools by the princ.i.p.al to the clinic at the hospital, where one after another tonsils are cut off or adenoids are removed, all fright and commotion being avoided by the gift of five cents as a reward.

_Eyes._

Another evidence of advancing knowledge in matters pertaining to sanitary hygiene is shown in the greater attention given to the eyes, particularly of children. Such incidental troubles as headache, sleeplessness, or biliousness are frequently due to weak or strained eyes, and in the case of school children a great deal of the alleged insubordination, backwardness, and truancy of the children is caused by their being unable to see written instructions or explanations.

It is not likely that this increased difficulty with the eyes is a new thing, but rather that both physicians and laymen are more careful as well as more expert in diagnosing the trouble. The New York State Board of Health in the fall of 1907 sent out cards for testing the eyes of school children to 446 incorporated towns. The results of using these cards in 415 schools were returned and showed clearly that nearly half the children of school age in the state had optical defects. A similar test in Ma.s.sachusetts recently discovered 22 per cent of the school children with defective vision, and this knowledge in itself is an advance inasmuch as it suggests to each individual or to all parents that deficient vision is common and that good eyesight is not a thing to be a.s.sumed.

In the country it is more difficult, perhaps, to realize these deficiencies, because the constant outdoor life acts as an offset to the strain during the time when close work is required, and perhaps the distance from a competent oculist serves to postpone the time of consultation, but no greater folly can be indulged in than to suffer inflamed eyes, persistent headache, and imperfect vision, if it is possible in any way to secure the services of an oculist.

Never is it worth while to buy from a jeweler, a grocer, or a hardware store a pair of spectacles, much less to buy them from an itinerant peddler, since an oculist, with his particular apparatus, can measure the seeing ability of each eye and fit each eye with the necessary lens to restore normal vision. It is better to have no gla.s.ses than to have gla.s.ses that are wrong.

_Teeth._

A curious result of the recent studies among school children with defective eyes and ears has been the discovery that bad teeth were quite as important in their relation to general health as either bad eyes or ears. One eye specialist went so far as to say that the teeth of school children should be attended to first, because thus many of the eye troubles would disappear.

As has already been pointed out, the first, step in digestion is taken in the mouth, and careful chewing is not less important than the other parts of the digestive process. If one's teeth are not adapted to chewing, if they are bunched, crowded, loose, or isolated, the appearance of the teeth is the least objectionable feature. The real importance comes from the fact that with such teeth perfect mastication is impossible. The teeth themselves harbor germs which actually infect the food and favor its putrefaction. With decayed teeth, infectious diseases find a ready entrance to the lungs, nostrils, stomach, glands, ears, nose, and membranes. At every act of swallowing, germs are carried into the stomach. Mouth breathers cannot get one breath of uncontaminated air, and dental clinics, organized and conducted in the interests of the health of school children, have been altogether too little inaugurated. The use of a toothbrush should be encouraged in children as soon as they are four years old, and its habitual use twice a day is most desirable for every one.

Only regular examination by the dentist can keep the teeth in good condition, and periodic visits at least once a year to a dentist's office, not to the kind advertised by Indians where they are willing to extract teeth without pain, free, but where a regularly qualified dentist practices, should be the habit. Armenian children, who prize and covet beautiful teeth, are taught to clean their teeth always after eating, if only an apple or a piece of bread between meals, and while probably our American customs would hardly make this possible, there is no question but that a persistent and frequent use of the toothbrush will help much in reducing dentist bills.

_Sleep._

From many standpoints sleep is the most wonderful attribute of the human body. Our familiarity, from our earliest years, with sleep, closes our eyes to its strange, its awful power. We know that every human being, once in twenty-four hours, will normally close his eyes and for a certain length of time be as oblivious to things present as if already in the sleep of death. It is a common belief that sleep is nature's provision for restoring tired muscles and jaded nerves, and for building up new tissue in cell and corpuscle. Excessive exertion produces a numbness and exhaustion so that the body becomes "dead tired," and sleep brings back life and elasticity. And yet some parts of the body, some muscles and some organs, do not stop work during sleep, and apparently feel no bad results for their continuous lifelong exertion. Thus, the lungs, whose muscular action is estimated at the rate of one thirtieth of a horse power, have no rest day or night, seemingly without weariness. Similarly, the heart is continually forcing blood under a pressure of about three pounds through the arteries without cessation from birth to death.

Why do the muscles of the arm and leg tire and need sleep as a restorer, while those of the heart and lungs are independent of sleep? Dr. W. H.

Thomson, in his book on "Brain and Personality," finds an answer to this question in the fact that the latter do their work independently of the human consciousness, while the former are stimulated and directed by the will. He points out that fatigue comes in proportion to the intensity of the mental effort expended. A baby, to whom everything is strange, whose consciousness is absolutely zero at birth, however well developed his body, sleeps five sixths of the time because of the mental efforts needed in his simplest bodily acts. Brain work, the most absorbing task of consciousness, is always the most compelling in the matter of sleep.

Not the muscles themselves but the attention, the skill, the mental effort required to direct those muscles, Dr. Thomson says, const.i.tute the reason for sleep, a reason which, to those who labor only with their hands, must seem unutterably sad. He says that while muscle work is the commonest and the simplest, so it is also the most poorly paid and the most degrading, and that while brain work is enn.o.bling and the highest type of labor, it is so difficult of attainment and produced only by such grievous toil that most of us s.h.i.+rk it, even while reproaching ourselves at our lack of capacity and purpose. The pathetic burden of unfulfilled possibilities, he says, is the curse of labor, and only in sleep does man have temporary oblivion through which, for a time, he forgets his work and, as it were, uses sleep as an anaesthetic for the pain of labor, to rise therefrom each morning ready to carry his burdens for another day.

Lack of sleep, to those whose brains are active, speedily brings nervous disaster, and the consciousness, from being the active superintendent of the body, becomes inert, and the body drifts like a boat without a pilot. Lack of sleep to those whose work is muscular means a numbness in the nerve cells which guide those muscles, so that they disobey the will or act unreasonably and without direction. But too much sleep, like over-indulgence in any anaesthetic, is only s.h.i.+rking that duty and avoiding that effort to which the higher life calls us, and the sluggard who sleeps more than the tired nerves need is allowing himself to sink deeper and deeper into a slough of despond. He forgets his toil in sleep, but it is only by active, conscious effort when awake that his work may be lifted to the higher plane where the brain is active, where work ceases to be mechanical and a burden, and where that greatest reward of personal satisfaction can be obtained.

CHAPTER XIV

_THEORIES OF DISEASE_

Disease may be defined as an abnormal condition of the human body, and since there is no one condition of the human body which can be satisfactorily described as normal, there is, therefore, no exact definition of disease.

What is disease for one person because of a departure from his normal health might not be recognized as disease in another person of different normal vitality. Nor is it possible to a.s.sign any particular and special cause for disease since the condition recognized as disease is the result, usually, not of one but of a series of causes or circ.u.mstances more or less connected and linked together, and in many cases not obviously a.s.sociated with the resulting disease. Thus, in records of death, it is very common to see reported pneumonia as the cause underlying and fundamental, when the cause was really typhoid fever, the patient yielding to the former disease because of the enfeebled condition due to the latter. Again, many children contract diseases like measles or whooping cough because of reduced vitality due to insufficient nourishment, lack of clothing, and neglect, and their illness is said to be due to measles or whooping cough when under proper conditions of care and attention they would not have the disease at all. The causes of disease therefore may be divided into two cla.s.ses, direct and indirect. In the latter cla.s.s are to be included such causes as environment, heredity, age, and occupation. In the former cla.s.s are to be found such causes as the introduction of disease germs into the system; the action of poisons, whether introduced into the alimentary ca.n.a.l or into the lungs, and such external conditions as excessive heat and cold and accident.

_Effects of dirt._

At one time it was thought that diseases could spring up in the midst of dirt, and one of the strong arguments for keeping houses clean, for removing manure piles, and cleaning up back yards, was the fear that without such care diseases might be induced in those living near by.

This is possible in a certain sense, but unless the seed or germ of the disease is present in a pile of dirt there need be no fear of the disease being developed. There is, however, a probability that by the organic decay and the consequent pollution of the atmosphere the vitality, energy, and resistance of the individual in the vicinity may be weakened.

It is well known, for instance, that prisoners confined in damp dark cells lose vitality, and when released, have but little of their former physical strength. In the chapter on Ventilation, it has been shown that persons confined in a small room and breathing their own exhaled air may in time become unconscious and die, and therefore it is reasonable to believe that persons living in the immediate vicinity of decaying animal or vegetable matter will suffer a loss of vitality and will have less resistance to disease.

_Blood resistance._

It is well known that there are present in the body certain agencies which act as guardians of the body against disease; that there are certain corpuscles of the blood and certain liquids circulating through the system which immediately attack and if in sufficient numbers or strength drive out the advancing enemy, so that "taking a disease" in most cases means that the activity of these resisting organisms is not forceful enough to successfully combat the germs of the disease. These agencies, whether circulating liquids or cells or corpuscles, are most active in the healthy body, and anything that tends to reduce the general health, such as exposure, overexertion, imperfect nourishment, overeating or overdrinking, or lack of sleep, tends to diminish their activity and so makes the individual more susceptible to disease.

_Cell disintegration._

Although disease is caused by the attacks of germs, another and far more important cause of disease is the breaking down or overstimulation of some particular organ. This is very plainly seen in diseases involving the stomach or intestines, where habitual excesses in eating lead, sooner or later, to consequent inflammation, disease, and death. This is also true of the lungs; merely living in an atmosphere full of dust will irritate the lungs to such a degree as to cause inflammation. Cancer is presumably the result of local inflammation, although the cause of the original suppuration is unknown. Similarly, appendicitis starts from some irritating cause, resulting in inflammation and the formation of pus. In very many cases the cell-disintegration seems to be a matter of heredity.

_Heredity._

Heredity, the second of the indirect causes of disease seems to be a.s.suming less importance as it is more studied. Probably in but few cases is heredity more than a chance factor in the causation of disease.

Heredity, formerly considered to be the most important cause of consumption, is now understood to have little to do with this widespread epidemic, although it is agreed that children brought up in the family with a consumptive mother and father are more likely to contract the disease than if they were segregated.

It is a providential arrangement that children inherit the tendencies of both father and mother, and that the good qualities of one parent are known to offset the bad qualities of the other; probably for this very important physiological reason marriage between near relatives, where both parents would be inclined to the same weaknesses, has always been proscribed. However, even with the characteristics of the father offsetting peculiarities of the mother, it is possible for the traits of a parent to be reproduced in children, and this applies to mental traits as well as to physical. In some families there exist tendencies toward nervous diseases, such as epilepsy and insanity, although it is not accurate to say that either disease is naturally inherited. It has been observed that a tendency to cancer, to scrofula, and to rheumatism runs in certain families, but this is hardly more than saying that in certain families, where the predisposition in this direction by one parent is not offset by the tendencies of the other parent, the physical condition of the child is such as to encourage the development of diseases.

_Age and s.e.x._

As indirect causes of disease, age and s.e.x cannot be overlooked. It is well known, for instance, that certain diseases belong essentially to childhood, measles and scarlet fever being markedly prevalent among children under ten years of age. In fact, it has been said by experts that if measles could be kept from children under five years old, the disease would be practically stamped out, since beyond that age they are less susceptible and the course of the disease is much milder. No greater mistake can be made than in exposing children to so-called "children's diseases" because of a desire "to have it over with." Not only is such exposure foolish, since it is quite possible to escape the disease altogether if in the first few years of life it is avoided, but also inviting death, since the mortality of the disease becomes markedly less and less as the age of the patient advances.

Many of the diseases of children are due to imperfect and incomplete development; either the lungs or the stomach or some other organ is not equal to its work, and the child remains an invalid or dies. Many children die from imperfect nutrition, especially in the second summer, when teething is at its height, on account of the ignorance of the mother and on account of unsanitary surroundings. No movement is more promising in the way of prolonging the lives of children than that recently inaugurated in New York which undertakes to teach mothers, of foreign nationality in particular, how to dress, bathe, feed, and bring up their children.

Another reason why disease occurs more frequently among children is, as will be seen later, that one attack of a disease frequently confers immunity upon the patient, so that, for example, a child having scarlet fever is not likely to have the disease later on in life; but this is no argument for exposing one's self to contagion, since it is quite possible that even the first attack may be avoided. Tuberculosis or consumption is preeminently a disease of youth, as is also typhoid fever. It is very rare for the latter disease to appear in children or in adults over forty-five, and for the former to develop until maturity.

In old age, diseases occur due to the gradual failure of the different organs to perform their normal functions. Some of these diseases are connected with the heart and the circulation, others with the liver or with the mucous membranes, so that among those advanced in life, rheumatism, gout, cancer, and diseases of the kidneys are very apt to occur.

One of the objects of sanitation is to eliminate disease due to bacteria and to prolong the normal life, so far as is possible, past the early period when diseases are easily contracted. It is not hoped that death can in any case be prevented, but hygiene will have done its utmost when death occurs only among the aged and when the diseases then causing death are only those which are consequent upon the wearing out of the body.