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BOOKS
BY
ANNA M. GALBRAITH, M.D.
Four Epochs of Woman's Life i2mo of 260 pages.
3d Edition, Ready Soon
Personal Hygiene and Physical Training for Women
i2mo of 393 pages, illustrated
2d Edition
G .
PERSONAL HYGIENE
AND
PHYSICAL TRAINING FOR WOMEN " "' v
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 Alumnae Association, Woman's Medical College of Pennsylvania ; former Attending Physician, Neurological Department, of the New York Orthopoedic 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
B. SAUNDERS COMPANY
1916
Copyright, 191 1, 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 acknowl- edgment of the value of her teachings By her former pupil
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 im- portance 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 J&ve 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 ex- ercises. For these excellent descriptions the author t 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 bv. means of fresh air, tonic baths, proper food and clothing, gymnastic and out- door exercise, so that the tissues will be placed in the best possible condition to resist disease.
The spirit of the tunes 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 Associa- tion 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 al- ready accomplished in the short space of fifty years by the eradication of terrible epidemics and many diseases,
5
6 PREFACE
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 oppor- tunity 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 ar- ranged 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 ex- tremely kind as to demonstrate for her benefit.
ANNA M. GALBRAITH. NEW YORK CITY.
CONTENTS
CHAPTER I
PAOB
THE WISDOM OF PHYSICAL EFFICIENCY ..................... 11
Physical Efficiency as an Exact Science; Marks for Phys- ical Efficiency; Statistical Study of the Physical Examina- tions of 160 Young Women; the Physical Status of the Women of Today; the Reflex Action of the Various Impair- ments of the Entire Organism.
CHAPTER II HYDRO-THERAPY .......................................... 23
Description of the Skin; Functions of the Skin; the Phys- iologic 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 Ablu- tion; the Turkish Bath; the Electric-light Bath' Indica- tions 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 Cos- metics 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 Han*.
The Cosmetic Care and Treatment of the Hands; Cos- metic of the Nails; the Care of the Feet; Painful Affections of the Feet.
O CONTENTS
CHAPTER IV
PAGB
THE DIGESTIVE SYSTEM: GENERAL PRINCIPLES IN HUMAN NUTRITION AND DIETETICS 80
The Digestive Tract; Care of the Mouth and Teeth; Controlling Factors of Digestion; Psychic Aspect of Diges- tion; 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 Cir- culatory Apparatus; the Lungs; Hygiene of the Lungs and Its Relation to the General Health; Relation of Res- piration to Body Heat; the Respiratory Functions of the Abdominal Muscles; the Importance of Good Chest Devel- opment, Proper Relation Between the Height, Weight, and Chest Measurements; Chemical Properties of Air; Town and Country Air; Dust and Its Relations to Disease; R61e 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 Ex- ercises; Cure of Chronic Bronchitis by Deep Breathing Ex- ercises; 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 Ph}rsiology of the Brain and Nervous System; the Hygiene of Work; the Tox- ins of Fatigue; Overwork; Signs of Overwork; Nature's Res- toratives; Avocation; the Physiologic Necessity for Laugh- ter; Vacations and Health; Sleep; Insomnia.
The Eyes; Eye-strain; Description of the Visual Appa- ratus; Optical Defects and Their Correction; the Mechan-
CONTENTS 9
PAOB
ism of Eye-strain; Locai Symptoms of Eye^strain; Arti- ficial Lighting; Hygienic Precautions in Reading and Sew- ing; 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; Bal- ance of the Mental Faculties; the Effects of th£ Higher Ed- ucation 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 Occu- pation a Physical Necessity; the Psychology of Success.
CHAPTER VIII
DRESS THE FUNDAMENTAL CAUBE 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 Ancientfj the Influence of Physical Training on the Health and Life of the Individual; the Effect of Exercise on Brain Develop- ment and Character; the Physiology and Pathology of Exercise; the Relative Proportions of a Perfect Female Form; Table of Standard Weights for Women; the Muscu- lar System; the Benefits of Exercise; Passive Exercise; Mas- sage; the Balance and Carriage of the Body; Common
10 CONTENTS
PAO»
PHYSICAL TRAINING THE KEY TO HEALTH AND BEAUTY (Con- tinued)
Defects in the Carriage of the Body; the Heart's Need of Exercise; the Gymnasium in the Campaign Against Dis- ease; 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 THROUGH GYMNASTICS AND ATHLETICS 323
Gymnasiums, Baths, and Athletic Associations: A Fun- damental 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 Exer- cises for Back, Thighs, and Abdomen; Rope-pulling Exer- cises 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; Box- ing and Fencing; Classic and ^Esthetic Dancing an Essen- tial 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; Horse- back 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 Today; 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 high- est standard of efficiency a most rigid physical examina- tion 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
11
12 PERSONAL HYGIENE FOR WOMEN
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 Com- mission 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 re- main 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 em- ployer 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 se- riously take up the framing of laws for eugenic marriages, •based on fixed standards of physical efficiency of the con- tracting parties. And the day is not far distant when women as well as men will have to undergo physical ex- aminations 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 pos- sess 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 de- manded.
13
Physical Efficiency as an Exact Science. — Physical efficiency is growing to be an exact science; it is demon- strable 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 illation be- tween 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; quick- ness 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 con- sidered best to modify these tests to meet the require- ments 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 sys- tem, including the blood-pressure; lung and chest develop- ment; digestive and nervous system; the kidneys and gen-
14 PERSONAL HYGIENE FOR WOMEN
erative 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 in- tegrity 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 ex- amination 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 de- cided 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 il- luminating as to the physical condition of women who call themselves well, to say nothing of what the medical pro- fession 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 1 See page 330.
THE WISDOM OF PHYSICAL EFFICIENCY 15
the kind made for the first decade after leaving college; but also because it is very fairly representative of the aver- age 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 properjJiys- ical 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.
/. Acute Diseases Since Childhood and Number of Days Lost Through Illness. For Classes of 1913 and 1914 Only, Consisting of 100 Women.1
History negative — t. e., no history was given of any
acute illness after the children's diseases 30 per cent.
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 postopera- tive treatment, would equal entire time of one woman for 8| months.
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 ap-
1 Similar records for the rlnnnrn of 1915 and 1916 were not pre- served.
16 PERSONAL HYGIENE FOR WOMEN
pendix 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 mur- murs 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
///. Lungs and Chest Development.
Examination of lungs negative, with normal frequency
and character of respiration 97.0 per cent.
Subnormal chest girth in relation to height and weight,
of 51 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.
Castro-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 " "
THE WISDOM OF PHYSICAL EFFICIENCY 17
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 ova- ries in 12.0
Hemorrhoids 3.0
Fibroid tumors 1.5
Dermoid cyst 75
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. 3 J 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, mus- cles 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.1
X. General Impression of Working Efficiency. Class average 8.2 per cent.
1 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. 2
18 PERSONAL HYGIENE FOR WOMEN
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 under- mine the whole system.
Aside from tuberculosis, life insurance companies re- ject 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 examina- tions 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 subnor- mal condition of the vital organs of the body as to be ap- palling 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
THE WISDOM OF PHYSICAL EFFICIENCY 19
by physicians or surgeons were discovered in a class of women who considered themselves well.
The Physical Status of the Women of Today. — The strong presumption that the above statistics are very fairly representative for the average woman of today is strongly borne out by data furnished by the absence on account of illness of the teachers of New York, and by correspond- ing 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 16$ 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 tabula- tiori 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 dis- eases 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 Impair- ments on the Entire Organism. — In the normal erect posi- tion of the body the trunk is given its greatest length, the head is held erect, the shoulders thrown back flat against
20 PERSONAL HYGIENE FOR WOMEN
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 fac- tors in the breaking down of the human organism:
/.; 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 vis- cera 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
THE WISDOM OF PHYSICAL EFFICIENCY 21
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.
///. 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 exer- cises.
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
22 PERSONAL HYGIENE FOR WOMEN
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 activ- ities. 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 tune 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.
CHAPTER II
HYDROTHERAPY
Description of the Skin; Functions of the Skin; the Physiologic Effects of Water, Hot and Cold; the Chief Varieties of Baths; Ablu- tions; 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 Contraindica- tions; 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 hydro therapy 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 preser- vation 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 ia obtained by the mode of application.
Again, the skin is not a mere covering for the body, but
23
24
PERSONAL HYGIENE FOR WOMEN
one of its most important organs, with well-defined func- tions ; 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, epider- mis; 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 com- plicated structure is supplied with blood-vessels, lym- phatics, 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
HYDROTHERAPT 25
homy 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-ves- sels, lymphatics, sweat-ducte, 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 dis- tinct functions, first, as an organ of sense; second, as an organ of excretion; and third, as an organ of heat regula- tion.
26 PERSONAL HYGIENE FOR WOMEN
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 dis- sipated 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 perspira- tion.
The amount of perspiration produced daily is about two pints, or in the neighborhood of -fa of 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 out- side 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 accom- panied by a corresponding increase in the heat dissipa- tion; the functions are reciprocal, and this equilibrium
HYDROTHERAPY 27
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 consider- able 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 tempera- ture will continue to decline, to a greater or less degree; in the former it will remain constant.
28 PERSONAL HYGIENE FOR WOMEN
The role played by the skin in maintenance of the nor- mal 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 \ 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 ex- ternally. 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 pro- duced, 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 pos- sible may be secured by either the electric light or sun bath.
HYDROTHERAPT 29
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 applica- tions 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 mus- cles, 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 con- gestion, 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,
30 PERSONAL HYGIENE FOR WOMEN
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 gooseflesh appear- ance 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 respira- tion.
When the cold application is considerably prolonged, the tendency to reaction is suppressed. There is an ex- haustion of the nerve-centers as well as of the heat- producing powers of the body. Thus, the system grad- ually 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 tempera- ture. 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; red- ness 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,
HTDROTHERAPY 31
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 ex- haustion, 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 pro- portion 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,
32 PERSONAL HYGIENE FOR WOMEN
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 applica- tions cause a fall of temperature and decrease of metabo- lism.
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, in- deed, 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.
HYDROTHERAPY 33
Cold water is a physiologic tonic, and the cold bath, prop- erly 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; hori- zontal 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 ap- plication 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.
3
34 PERSONAL HYGIENE FOR WOMEN
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 ablu- tion, 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
HYDROTHERAPY 35
may be classified according to the amount of water in the tub as half or full tubs; and again, according to the tem- perature 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 min- utes 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 cham- ber 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
36 PERSONAL HYGIENE FOR WOMEN
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 faint- ness. 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 bod}7 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 applica- tion.
The Cold Dip.— For the dip, the tub is filled with water at a temperature of from 65° to 55° F. The dura- tion 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 notice- able 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
HYDROTHERAPY 37
decided exhilarating effects in those who are strong enough to react after it. When employed for this pur- pose, the immersion should not be more than from three to fifteen seconds. The bather must rub herself vigor- ously 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 pre- ceded 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 bes.t means of fortifying the system against both acute and chronic diseases.
Contraindications. — The use of the cold dip is contra- indicated 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 inflamma- tions, as inflammation of the bowels, peritonitis, or in- flammation 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 $ to i pound of solids to the gallon of water. The principal ingredients are common salt, magnesium chlorid, and magnesium sulphate. These substances have a decidedly
38 PERSONAL HYGIENE FOR WOMEN
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 ap- plication, 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.
HYDROTHERAPY 39
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 meta- bolic 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 imme- diately before retiring.
40 PERSONAL HYGIENE FOR WOMEN
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 com- fortably in it, without undue pressure being made on the under side of the knees.
The tub is half filled with water of the prescribed tem- perature. 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.
In giving all hot baths a thermometer must be used, and a word of warning must be given about adding hot water
Fig. 2. — Sitz-bath tub made of tin (Ash ton).
in case of sickness, as well-authenticated cases of paral- ysis 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.
HYDROTHERAPY 41
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- mdche' 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 ahould 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 tem- perature 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
42 PERSONAL HYGIENE FOR WOMEN
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
HYDROTHERAPT 43
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., fol- lowed 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
44 PERSONAL HYGIENE FOR WOMEN
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 ad- vanced 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 con- trolled. 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 over-stimulation of the nervous system and an excessive elevation of tempera- ture.
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
HYDROTHERAPY 45
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 iden- tically 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 rheuma- tism 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 oxida- tion 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 valu- able 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. There- fore, these hot applications for the reduction of fat should never be too much prolonged, and the bath should always
46 PERSONAL HYGIENE FOR WOMEN
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 metabo- lism 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 dis- proportion 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 seme 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 intro- duced 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 con- sidered— the temperature, pressure, and the mass.
HYDROTHERAPY 47
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 f 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 bor- der 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
48 PERSONAL HYGIENE FOR WOMEN
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 in- creased, 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
HYDROTHERAPY 49
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 4$ 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 stop- pered 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. Further- more, 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
4
50 PERSONAL HYGIENE FOR WOMEN
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 drink- ing water in sufficient quantities, the activity of the kid- neys 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 ob- tain a thorough cleansing of the stomach, and at the same time not to cause its overdistention, not less than \ pint of water and not more than \\ pints should be taken at one time. The water must be taken one hour before meals, in order to insure its removal from the stom- ach 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 regu-
HYDROTHERAPT 51
lated 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, } 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 com- pletion.
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 Salee" should be taken in connection with the first named or alone. The " Source Sal£e " 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,
52 PERSONAL HYGIENE FOR WOMEN
which furthers the passage of the digested food from the stomach into the intestines. The quantity taken must be from \ 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 dis- solving 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 drink- ing 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.
HYDROTHERAPY 53
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.
54 PERSONAL HYGIENE FOR WOMEN
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 flatu- lence. After the discharge of the warm water, 1 pint of cool water should be introduced, beginning with a tem- perature 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
HYDROTHERAPY 55
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 foun- tain-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; some- times 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 essen- tial to test the temperature of the water. The tempera- ture 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.
56 PERSONAL HYGIENE FOR WOMEN
Ordinarily, plain hot water is all that is necessary to use, but if the vaginal discharge is irritating, one tea- spoonful 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; Pro- tection of the Face; the Use of So-called Cosmetics for the Face; Facial Blemishes, Freckles, Liver Spots, Sallow Complexion, Pim- ples, Acne, Eczema, Wrinkles, and Their Treatment; the Relation of Diseases of the Skin to Internal Disorders.
The Hair; Dandruff; Causes and Treatment of Premature Thin- ness 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.
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58 PERSONAL HYGIENE FOR WOMEN
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 out- door 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 indi- gestion 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 in- fluence. 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.
Within twenty-four hours the skin, especially those
PLATE I
THE CARE OF THE SKIN AND ITS APPENDAGES 59
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 lodge- ment 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, con- tinued through the autumn, and by the time midwinter has arrived, the system has become so toned up that noth- ing 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 con- scious of her heart, she will feel at her best in the after- noon. 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 invigorat- ing than the cold ablution, and the reaction at that time of the day is more vigorous than in the early morning.
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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 dis- ease, and are the best preventives against ordinary colds and sore throat.
A hot tub-bath is best taken at night just before retir- ing. In winter it must never be taken immediately before
THE CARE OF THE SKIN AND ITS APPENDAGES 61
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 debilitat- ing, 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 dis- ease has apparently become cured. Further, each mem- ber 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
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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 judg- ment 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 qf 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
THE CARE OF THE SKIN AND ITS APPENDAGES 63
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 dis- eases have followed the use of paints. Of the advertised cosmetics, many are not only worthless, but actually in- jurious.
Certain applications to the skin of the face are permis- sible 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 pow- der on the market are perfectly harmless, and, if there is a
64 PERSONAL HYGIENE FOR WOMEN
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 cer- tainly aggravated by them. They are not only unsightly blemishes on the skin, but sometimes cause great nervous- ness by the intense itching which accompanies them.
Sallow Complexion. — This is generally caused by dis- orders 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 symp- tom of the disordered bodily state, but a cause of its per- petuation. 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.
THE CARE OP THE SKIN AND ITS APPENDAGES 65
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 affec- tions. 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. WTien 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. 5
66! PERSONAL HYGIENE FOR WOMEN
Treatment of Liver Spots, Sallow Complexion, Pimples, Acne, and Eczema. — First, the general treat- ment. 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 at- tention to the bowels. There must be procured, by some means or other, a free daily evacuation. A hard, consti- pated 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 pa- tients 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 di- gested, 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 vege- tables, 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.
THE CARE OF THE SKIN AND ITS APPENDAGES 67
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 com- plexion 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
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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
Fig. 3. — Muscles of the right side of the head and neck.
being converted into a map of wrinkles and drooping angles at the mouth.
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 in- creased 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
THE CARE OF THE SKIN AND ITS APPENDAGES 69
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 move- ment 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 up- ward 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 follow- ing: Take of the oil of sweet almonds, 2 ounces; of sper- maceti, { ounce; of white wax, $ ounce; and of rose-water, i 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
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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 folh'cle is a cylindric-shaped depression of the skin, whose funnel-shaped mouth opens on the free sur- face. 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 nor- mally shed every day.
In order to have thick, luxuriant, silky hair great atten- tion 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 pres- sure.
The hair has a great tendency to accumulate dirt. It catches the dust flying in the air, and also retains the secre- tion 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 revolu-
THE CARE OF THE SKIN AND ITS APPENDAGES 71
tion in the views of the skin specialists in regard to the cause of dandruff. Previous to that time it was consid- ered as simply a collection of epithelial scales mixed with more or less oily matter. Now, following the investiga- tions that were first instituted by Unna, dandruff is con- sidered 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 walk and the hair.
Seborrheic eczema is a chronic desquamative inflam- mation 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 experi- ment, 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 dis- ease 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.
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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 mem- bers 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 pro- gressive 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 pre- ventive measures to insure the healthy condition of the scalp. And first and most important of these is cleanli- ness. 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 con- trary, 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 in- crease the interval to every two or three weeks.
THE CARE OF THE SKIN AND ITS APPENDAGES 73
Borax in the water cleanses the scalp well, but its con- tinuous use is injurious; the same may be said of am- monia 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 consider- ably. 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
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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 hi 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 press- ure 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 arti- ficial 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
THE CARE OF THE SKIN AND ITS APPENDAGES 75
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 hol- low 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 gray- ness 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 pa- tients 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 derma- titis 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
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order to preserve its silvery whiteness, than was neces- sary 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 care- fully 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, espe- cially 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
THE CARE OF THE SKIN AND ITS APPENDAGES 77
a light rose color, and smooth surface. The lunula shduld 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 scis- sors 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 hang- nails, by which infection easily enters the system; it may give rise to felons or even to general blood-poison- ing.
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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 hi 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 con- cave 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 fast- ened 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
79
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 sur- face 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 pos- sibility 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, decom- position is produced by the growth of microorganisms.
The digestive tract, or alimentary canal, begins at the
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THE DIGESTIVE SYSTEM
81
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,
Nu.se
Large Intes- tine
Salivary (parotid) gland
Vermiform appendix
Rectum
Fig. 4. — General scheme of the digestive tract, with the chief glands opening into it (Stockton).
pour their secretions into the small intestine to aid in the digestion of foods. The alimentary canal, liver, and pan- creas together constitute the digestive system. 6
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The contraction of the muscular walls of the digestive tract is the propelling power that carries the food down- ward 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 suffi- ciently 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
THE DIGESTIVE SYSTEM 83
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 mastica- tion 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 op- posite each other, for a very important factor in masti- cation 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 con-
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version 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 condi-
THE DIGESTIVE SYSTEM 85
tions without themselves suffering permanent alteration. The digestion of food is largely accomplished by the specific action of these enzyme bodies, of which every di- gestive 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 fun- damental purpose than the mere hastening of their passage through the lining membrane of the intestine.
In the light of modern chemical knowledge we can lie 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 reac- tion 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
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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 stimu- late 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 re- moved.
The practical point is, that if the digestive processes have been inhibited by emotional disturbances any food
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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 decom- position will be fostered and actual harm may be done the organism.
And just as a single occasion may lead to a passing diges- tive 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 in- hibited 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 accom- panied 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 par- ticles 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.
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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.
Fig. 6.— The ribs removed, showing relation of thoracic to ab- dominal viscera: A, Trachea; B, heart; C, C, lungs: D. liver; E, stomach; F, small intestine; G, large intestine; H, bladder (after Masse).
It also moistens the dry food, aids in the process of swal- lowing, 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
THE DIGESTIVE SYSTEM 89
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 compart- ment 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 diverg- ence 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 secre- tion 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 (6) 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 mes- sengers. 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 gas- tric juice are digestive, activating, and disinfecting.
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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 pep- tones.
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 in- vestigations, 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 f undus 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 conr striction begin at the duodenal and middle portions and move the food toward the pylorus. In this way the con- strictions that begin near the pyloric end gradually extend to the cardiac end. The latter part of the stomach is dis- tended 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 stom-
THE DIGESTIVE SYSTEM 91
ach; 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 f undus 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 com- bine 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 carbo- hydrates (rice) began to leave the stomach in fifteen min- utes, 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 gete 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 ovrr again, but in the course of time the sphincter relaxes and the peristaltic contractions increase, until the force is
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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 r61e of the stomach is a peptonizer and grinder only. Absorption of nutrients is the special work of the intestines, and occu- pies but a subordinate place in the duties of the stomach.
Proteins undergo peptonization, but that does not change them sufficiently. The mere splitting into pep- tones, formerly thought sufficient, is now known to be quite inadequate. Recent researches have shown that the com- plex protein molecule has to be quite crushed into a hetero- geneous 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 ex- ceedingly complex. Digestion in the intestine is due to the combined action of the bile, pancreatic juice, and suc- cus 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 secre- tion of bile is irregular in quantity, as is the case with the gastric juice, and appears to be induced by chemical ex- citants, of which acids, especially hydrochloric, seems to be especially effective. Of the nutrients, the proteins exert
THE DIGESTIVE SYSTEM 93
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 gastic 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 color- ation.
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 pan- creatic fluid are trypsin, amylopsin, lipase or steapsin, and pancreatic rennin.
Trypsin. — Pancreatic juice alone has but little influ- ence 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 com- pounds, which may be regarded as the building stones of the original proteins.
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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 vigor- ously 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 al- kaline bases (mostly sodium) in the bile. The cleavage of the fats is due to the enzyme steapsin.
The sweats entericus is the secretion of the glands of Lieberkuhn. It contains quite a number of enzymes, in- cluding four which act on carbohydrates, namely, amylase, maUase, 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 gener- ally 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 for- merly 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-albu- min and serum-globulin, which are constructed out of the amino-acids resulting from the digestion of protein foods. The reconstruction of proteins 4&kes place chiefly in the cells. Fuchs believes that the amino-acids from the food
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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 emul- sion and as a solution of soap. Only about 60 per cent, of the fat in the food is absorbed by the lacteals; the remain- ing 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 absorp- tion 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 en- zymes 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 lymph- atic 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 for- mation of fat from sugar is considered proved by exper- imental evidence.
Sugar is an important source of energy for the muscles, and provision is made for a sufficiency of it always to be in
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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 re- converted 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 arrays. There are three kinds: A pendulum-like motion, consisting of a gentle, sway- ing, 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 con- traction involves both the longitudinal and circular mus- cular 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 ob- served, 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
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cecum, ascending colon, and one-half of the transverse colon; a mesial part, formed by the other half of the trans- verse 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 be- come 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 aver- age 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 7
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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 in- creases their bad effects.
Some foods, especially vegetables of the leguminous class, appear to be provocative of excessive intestinal fer- mentation. 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 inves- tigations reveal the fact that the kind of food has an influ- ence 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 di- gestions. 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 con- ceive them as being trained for fat, protein, or carbohy- drate digestion.
Metabolism. — Life consists, so far as material phenom- ena are concerned, in the transformation of matter into energy. To these transformations the term metabolism is
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applied. In the metabolism of matter the changes are chemical; in energy the changes are physical. It is com- monly 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 beteen 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 ab- sorbed from the alimentary canal a part of themselves. The body is never stable ; while growth and nutrition pro- gress, 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; (6) energy, the potential energy of the food and drink. The outgo consists of (a) matter in the feces, urine, perspira- tion, and breath; (6) energy — the potential energy of feces, urine, products of respiration, and perspiration. A com- plete 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 quan- tity 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
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increase in the nitrogenous metabolism, but it also in- creases the metabolism of the non-nitrogenous elements of the body. With an ordinary mixed diet the normal ex- cretion 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 carbohy- drates 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 nitrog- enous 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 com- ponent 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. •
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A reduction in the amount of water consumed acceler- ates 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 4$ pints; so that at the lowest estimate \ pint of water is formed in the tis- sues 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 disintegra- tion.
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 metabo- lism. 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 con- sume 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 R so readily, and this may lead to a retention of salt in the body.
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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 hemo- globin of the blood contains 0.04 per cent, of iron.
Constipation. — It must be remembered that the intes- tine 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 func- tional disturbances of the nervous system.
Normally, the organism manages to protect itself against the microorganisms 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 in- testine 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 repeat- edly 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 mechan- ical pressure on the veins, and so interferes with their emptying out in the normal way, and the general auto- intoxication of the entire system, there are also caused in women serious displacements of the pelvic organs to- gether with their congestion and inflammation.
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The general symptoms of autointoxication are: head- ache, vertigo, palpitation of the heart, a feeble and irreg- ular 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 morn- ing on rising, is often very effective. If this is insufficient, the phosphate of soda, one teaspoonful to one tablespoon- ful, 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 infre- quently happens that constipation is the result of irregu- larity in going to the toilet. The school-girl or woman gets up a little late, and, although she may feel the inclina- tion 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.
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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 every- thing 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 in- testine.
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 cap- able of directing its energies. The human machine is
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capable of adapting itself to many circumstances and changes in the demands upon it.
But to enable the body to continue to perform these func- tions indefinitely it must be properly fed, and a proper feed- ing of the body requires a knowledge of its composition and the exchanges which are constantly going on. This knowl- edge 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 consti- tute 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 appetiz- ing, and so are to a certain extent stimulants. The palat- ability 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 abun- dantly demonstrated. Many investigations have shown that when the food contains no protein the waste of nitro- gen continues, no matter how abundant the supply of car- bohydrates and fats. In other words, a continuous pro- tein cleavage is demanded by the animal organism, and no other nutriments can serve as a substitute for protein to
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meet this demand. If the food contains no protein, the body tissues will be depleted. It cannot be said that car- bohydrates 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 wel- fare 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 carbohy- drates, and to allocate to protein, so far as practicable, its special role of building material.
Nitrogenous Waste Products. — The end-product of proteins is urea, which is formed from protein decompo- sition 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. rheu- matism 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.
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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, hy- drogen, and oxygen — are so balanced that if all of the car- bon were removed the residual hydrogen and oxygen would be in the proportions to form water.
Carbohydrates are usually characterized as the fuel por- tions 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 con- sumed 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 oxi- dized 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
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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 car- bonates of soda, potash, iron, and other minerals render the blood and secretions alkaline. The removal of carbon di- oxid 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 in- vestigation has proved that something more is essential for the maintenance of growth and well-being than pro- tein, 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 fdr 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 ren- dered 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.
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In addition to these food principles, there exists in our food a number of compounds which, while not indispen- sable, act beneficially as flavorings, stimulants to diges- tion, 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 condi- tions 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 sup- ply; (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 capac- ity 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 con- tent 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 poten- tial energy of the food. The kinetic energy of the food is
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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 tem- perature 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 en- ergy; 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 circula- tion, and an indigestible one is that of which a considerable portion passes out of the system into the feces without be- ing 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 be- cause they are digested in the intestines. It has been found that two poached or soft-boiled eggs leave the stom- ach in from two to three hours; that is, in the same time as milk, oysters, white bread, and light fish.
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MUk. — 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 3^ 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 aerated waters or crackers broken up in the milk prevent the