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BOOKS

BY

ANNA M. GALBRAITH, M.D.


Four Epochs of Woman’s Life

12mo of 260 pages.

_3d Edition, Ready Soon_


Personal Hygiene and Physical Training for Women

12mo of 393 pages, illustrated

_2d Edition_




  PERSONAL HYGIENE

  _AND_

  PHYSICAL TRAINING
  FOR WOMEN


  BY

  ANNA M. GALBRAITH, M.D.

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


  _SECOND EDITION, THOROUGHLY REVISED_


  PHILADELPHIA AND LONDON
  W. B. SAUNDERS COMPANY
  1916




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

  Copyright, 1916, by W. B. Saunders Company


  PRINTED IN AMERICA

  PRESS OF
  W. B. SAUNDERS COMPANY
  PHILADELPHIA




In Loving Memory

of

HELEN WORTHING WEBSTER, M. D.

Professor of Physiology and Hygiene and Resident Physician at Vassar
College from 1874 to 1881


  An untiring worker of charming and inspiring personality,
  the living embodiment of all that was womanly,
  great hearted, and noble.

  This book is affectionately dedicated as a slight tribute of
  the esteem in which she was held, and in grateful acknowledgment
  of the value of her teachings
  By her former pupil

  THE AUTHOR




PREFACE TO THE SECOND EDITION


Since the writing of this book six years ago the entire subject of
digestion has been revised by scientific research, and thanks to the
same scientists the nutritive value of the various food-stuffs has
been ascertained. The importance of this knowledge is so great that
educators are now making an endeavor to have the nutritive value of
artificial and canned goods placed on their labels; and the New York
Board of Health has requested a large Chain of Restaurants to have
the nutritive value of foods printed, beside the cost of the various
articles, on their bill of fare.

Hence the entire chapter on Digestion and Nutrition has been
rewritten. In Chapter I has been given the result of original
statistical studies, showing the urgent need for every woman to know
and put into practice the principles of personal hygiene.

Dancing has become such a popular form of exercise that a description
of the plates giving the dancing steps has been added, together with
some simple dancing exercises. For these excellent descriptions
the author is indebted to Miss Barbara Blankenhorn, a widely known
teacher of music and dancing of Englewood, New Jersey.

The reason that such a comparatively short space was given in this
work to “pelvic physiology and hygiene” was that this subject had
been treated in extenso, in “The Four Epochs of Woman’s Life.”

  ANNA M. GALBRAITH.

  NEW YORK CITY,
  _November, 1916_.




PREFACE


The aim of this work has been to present in a clear and concise
manner the fundamental physiological laws on which all personal
hygiene is based; together with the practical, detailed directions
for the proper development of the body and the training of the
physical powers to their highest degree of efficiency by means of
fresh air, tonic baths, proper food and clothing, gymnastic and
outdoor exercise, so that the tissues will be placed in the best
possible condition to resist disease.

The spirit of the times demands nothing less than the most perfect
development of body and mind of which youth is capable, and
maintaining the highest degree of efficiency of the adult worker for
the longest possible term of years. The _fiat_ has gone forth from
the American Medical Association for the scientific education of the
public in the laws of hygiene and sanitation. And the great civic
movement inaugurated by that same Association and the Committee of
One Hundred on National Health for the establishment of a National
Department of Public Health, promises to be crowned with success in
the near future. And so it has been deemed superfluous to expound at
length what preventive medicine has already accomplished in the short
space of fifty years by the eradication of terrible epidemics and
many diseases, and what a general knowledge of applied hygiene might
reasonably be expected to accomplish in the near future.

It gives the author great pleasure to have this opportunity of
expressing her deep indebtedness to Miss Ruth Blankenhorn, Vassar
College, A. B., 1909, of Englewood, N. J., a most artistic and
graceful dancer who posed for all the illustrations; and to Miss
Harriet I. Ballintine, the able director of the Vassar College
Gymnasium, who arranged the poses for the very excellent plates
illustrating the free exercises and classic dances. Also to the
Vassar College Athletic Association for 1908-09 for the especially
arranged dances and field sports which they were so extremely kind as
to demonstrate for her benefit.

  ANNA M. GALBRAITH.

  NEW YORK CITY.




CONTENTS


  CHAPTER I

        PAGE

  THE WISDOM OF PHYSICAL EFFICIENCY                                 11

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


  CHAPTER II

  HYDROTHERAPY                                                      23

  Description of the Skin; Functions of the Skin; the Physiologic
  Effects of Water, Hot and Cold; the Chief Varieties
  of Baths; Ablutions; the Tub Bath; the Alcohol Rub; the
  Cold Dip; Alkaline and Saline Baths; the Rain Douche or
  Shower Bath; the Hot Foot-bath; the Sitz Bath; Salt Ablution;
  the Turkish Bath; the Electric-light Bath; Indications
  for the Use of Turkish Bath, and Contraindications;
  the Douche; Rationale of the Douche; Contraindications.

  The Internal Use of Water; Its Action on the Heart and
  Blood, on the Digestion; Therapeutic Indications for the
  Use of Water; Contraindications for Drinking Cold Water.

  Enemas; Vaginal Douche; Douching the Ear.


  CHAPTER III

  THE CARE OF THE SKIN AND ITS APPENDAGES                           57

  The Complexion; the Action of the Bath in Health; the
  Proper Time to Bathe; the Care of Wash-cloths; Cleansing
  the Face; Protection of the Face; the Use of So-called Cosmetics
  for the Face; Facial Blemishes, Freckles, Liver Spots,
  Sallow Complexion, Pimples; Acne, Eczema, Wrinkles and
  Their Treatment; the Relation of Diseases of the Skin to
  Internal Disorders.

  The Hair; Dandruff; Causes and Treatment of Premature
  Thinness of the Hair and Baldness; the Care of the Hair;
  Gray Hair.

  The Cosmetic Care and Treatment of the Hands; Cosmetic
  of the Nails; the Care of the Feet; Painful Affections
  of the Feet.


  CHAPTER IV

  THE DIGESTIVE SYSTEM: GENERAL PRINCIPLES IN HUMAN
  NUTRITION AND DIETETICS                                           80

  The Digestive Tract; Care of the Mouth and Teeth;
  Controlling Factors of Digestion; Psychic Aspect of Digestion;
  Importance of Mechanical Factors; Chemical Changes
  of Food in the Stomach; Intestinal Digestion; Metabolism;
  Constipation and Its Treatment.

  The Amount of Food Required; the Classification of
  Foods; Standard Dietaries; Maintenance Diet; Relations
  of Diet to Various Conditions of Life; Practical Facts for
  Guidance; Dietary in the Tropics; Food Economics; Table
  of Food Values.

  The Physiologic Action of Moderate Doses of Alcohol;
  the Effect of Alcohol on the Muscular System; the Effect of
  Alcohol on the Nervous System.


  CHAPTER V

  THE RESPIRATORY AND CIRCULATORY SYSTEMS: THE KIDNEYS             137

  The Mechanics of Circulation and Respiration; the Circulatory
  Apparatus; the Lungs; Hygiene of the Lungs
  and Its Relation to the General Health; Relation of Respiration
  to Body Heat; the Respiratory Functions of the
  Abdominal Muscles; the Importance of Good Chest Development,
  Proper Relation Between the Height, Weight, and
  Chest Measurements; Chemical Properties of Air; Town
  and Country Air; Dust and Its Relations to Disease; Rôle
  Played by Bacteria; Ventilation; the Injurious Effects of
  Overheated Air; the Proper Degree of Moisture for the
  Air of the House; Ventilation of Bed-rooms.

  Care of the Nose, Throat, and Ears; Impediments to
  Respiration; Ventilation of the Lungs and Breathing Exercises;
  Cure of Chronic Bronchitis by Deep Breathing Exercises;
  Relation of Colds to Pneumonia and Tuberculosis,
  and Their Prevention.

  The Kidneys and Their Functions; the Physiology of
  the Female Pelvic Organs.


  CHAPTER VI

  THE NERVOUS SYSTEM AS THE BALANCE OF POWER IN THE
  BODY                                                             184

  The Brain the Master Organ of the Body; the Functions
  of the Brain; Habit and Automatism; the Physiology of the
  Brain and Nervous System; the Hygiene of Work; the Toxins
  of Fatigue; Overwork; Signs of Overwork; Nature’s Restoratives;
  Avocation; the Physiologic Necessity for Laughter;
  Vacations and Health; Sleep; Insomnia.

  The Eyes; Eye-strain; Description of the Visual Apparatus;
  Optical Defects and Their Correction; the Mechanism
  of Eye-strain; Local Symptoms of Eye-strain; Artificial
  Lighting; Hygienic Precautions in Reading and Sewing;
  Injuries to the Eyes; Symptoms and Treatment of
  Conjunctivitis; Trachoma; Styes.

  Functional Nervous Disorders; Headache; Neurasthenia.


  CHAPTER VII

  THE HYGIENE OF THE MIND AND ITS RELATION TO THE PHYSICAL
  HEALTH                                                           224

  Heredity; Temperament; Social Instincts; Fear.

  Mental Development; Self-control, the Moral Sense, the
  Religious Instincts; the Advantages of College Life; Balance
  of the Mental Faculties; the Effects of the Higher Education
  of Women.

  The Environment; the Choice of Friends; Literature.

  The Power of the Will or Inhibition; the Effect of the
  Mental Attitude on the Physical Health; A Definite Occupation
  a Physical Necessity; the Psychology of Success.


  CHAPTER VIII

  DRESS THE FUNDAMENTAL CAUSE OF WOMAN’S PHYSICAL
  DETERIORATION                                                    252

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


  CHAPTER IX

  PHYSICAL TRAINING THE KEY TO HEALTH AND BEAUTY                   283

  The Ancient Greeks the Most Perfect Type of Beauty;
  the Cause of the Inferior Physique of American Women; the
  Physical Training of the Japanese Women; Improved
  Physique as the Result of Physical Training; Increasing
  Stature and Improved Physique of American Men; Report
  of the Royal Commission of Great Britain on Physical
  Training; Physical Training Among the Ancients; the
  Influence of Physical Training on the Health and Life of
  the Individual; the Effect of Exercise on Brain Development
  and Character; the Physiology and Pathology of
  Exercise; the Relative Proportions of a Perfect Female
  Form; Table of Standard Weights for Women; the Muscular
  System; the Benefits of Exercise; Passive Exercise; Massage;
  the Balance and Carriage of the Body; Common
  Defects in the Carriage of the Body; the Heart’s Need of
  Exercise; the Gymnasium in the Campaign Against Disease;
  Gymnastic versus Athletic Training; Exercise After
  Eating; Effect of Brain Fatigue on Body Fatigue, and
  vice versa; Marks for Physical Efficiency; Advantages
  Derived from Athletic Sports; Ethical Value of Sports for
  Women; Forms of Athletic Games Best Suited to Women.


  CHAPTER X

  SYMMETRIC DEVELOPMENT: GOOD CARRIAGE AND GRACE OF
  MOTION THROUGH GYMNASTICS AND ATHLETICS                          323

  Gymnasiums, Baths, and Athletic Associations: A Fundamental
  Part of a Woman’s College and a Model Woman’s
  Club; the Vassar College Gymnasium; the Standardized
  Percentage Table for Physical Efficiency; Special Medical
  Blank for Women; Self-made Good Physique through
  Physical Training; Rules for Taking Exercise; Gymnastic
  Dress; the Configuration of the Foot; Correct Attitude in
  Standing.

  Corrective Exercises: Exercises for Developing the
  Various Regions of the Body; Shoulder-blade Exercises;
  Respiratory Exercises; Exercise for Forward Projection of
  Chest and Retraction of Abdomen; Shoulder and Back
  Exercises; Leg Exercises; Squatting Exercises for Muscles
  of Spine and Abdomen; Alternate Kneeling; Abdominal
  Exercises; Balancing Exercises for Poise and Carriage;
  Balancing Exercises for Extending Depth of Chest; Lateral
  Trunk and Waist Exercises; Exercises for Muscles of
  Back; Exercises for Muscles of Abdomen; Swimming Exercises
  for Back, Thighs, and Abdomen; Rope-pulling Exercises
  for Back, Chest, Waist, Legs, and Arms; Exercises in
  Trunk Flexions for Back, Abdomen, and Legs; Exercises
  with Chest Weights for Chest, Shoulders, and Arms; Boxing
  and Fencing; Classic and Æsthetic Dancing an Essential
  Feature in Physical Training; Figures of the Dance with
  Some Simple Exercises.

  Outdoor Exercises: Effect of Walking on the Heart and
  Lungs; Running; Mountain Climbing; Swimming; Horseback
  Riding as an Exercise; Rowing.

  Athletic Sports: Croquet; Lawn-tennis; Golf; Hockey;
  Basket-ball.


  INDEX                                                            375




PERSONAL HYGIENE

AND

PHYSICAL TRAINING FOR WOMEN




CHAPTER I

THE WISDOM OF PHYSICAL EFFICIENCY

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

  “Circumstances,” said Napoleon, “I make circumstances.”


Physical efficiency stands for initiative, endurance, success; it is
the very keynote of modern life and has become one of the burning
questions of the day. West Point and Annapolis have always recognized
this, and in order that their graduates should measure up to the
highest standard of efficiency a most rigid physical examination
was and is demanded as a prerequisite for admission; and during the
whole of the four years’ course physical training is systematically
carried on so as to insure the most perfect physique possible, with
the result that in addition to their great powers of endurance and
initiative, is their distinguished carriage and elegance of bearing.

To increase the safety of their passengers the railroad companies
were the next to demand these same physical examinations to determine
the efficiency of their applicants and employees. Other large
corporations followed.

So long as _women_ remained in the home, or were willing and content
to accept any small wage that was doled out to them, the public did
not seem especially interested in their physical condition. But when
women, as a large teaching body or in any other public service, began
to demand equal pay for equal work, the situation was materially
altered, and in 1914 the English Royal Commission summed up the
following conclusions: “Where the character and conditions of work
performed by women approach those of the work of men, the pay of
the women should approximate that of the men, but in so far as the
_efficiency_ of men is higher, the salaries of men should remain
higher.” This at once changed the complexion of the matter, and
physical efficiency for women became a matter of paramount and equal
importance to both employer and employee.

Again, from the standpoint of social science, the physical efficiency
of women is demanded because they are the mothers of the race,
and on them, equally with the fathers, does the welfare of future
generations depend, since it is believed that a child inherits
equally from its parents—one-fourth from father and mother each,
one-fourth from its grandparents, etc. The states are beginning to
seriously take up the framing of laws for eugenic marriages, based on
fixed standards of physical efficiency of the contracting parties.
And the day is not far distant when women as well as men will have
to undergo physical examinations to secure or hold any positions of
importance.

Then, too, one of the results of the present terrible European war
has been to demonstrate that women possess a large amount of latent
powers and endurance which only needed for their development the same
general physical training that the state gives her sons. Women are
now being employed in these countries in all branches of the civil
service, as well as in agriculture and the making of munitions,
engaging in a vast number of employments and trades hitherto
considered unfit for women, because of the great physical strength
and endurance which they demanded.

=Physical Efficiency as an Exact Science.=—Physical efficiency is
growing to be an exact science; it is demonstrable in figures. We
have standardized percentage tables for measuring the capacity of the
lungs, the strength of the heart and muscles, and, added to these,
must be a normal condition of the digestion, kidneys, generative
organs, sight, and hearing. If the sum total of these amounted to
100 per cent., that would mean capacity for the greatest possible
endurance under strain, and so the most effective worker; for there
is a direct relation between the percentage standard of physical
efficiency and the output of work, both as to quantity and quality.

_Marks for Physical Efficiency._—Sir Francis Galton, the great
English scientist, was the first to conceive the idea of assigning
marks for physical qualifications. They were as follows: Breathing
capacity, strength tests, both to be regarded with reference to the
height and weight; quickness of response to a signal, made either to
the eye or ear; the sense of sight and hearing, and the color sense.

Realizing the usefulness of these tests in measuring the physical
efficiency, Professor Sargent included them in the physical
examinations of the Harvard students. The strength tests consist of
that for each forearm, of the back and legs, the dip, the pull-up,
and the lung capacity. The combination of these seven tests is what
is known as the intercollegiate strength test, and is the best means
as yet devised for measuring the general muscular strength and the
respiratory power.

It is obvious that many of these tests would be needed only by men
going into the army or navy, or qualifying for civil engineers or
professional athletes, etc. So it was considered best to modify these
tests to meet the requirements of physical efficiency for women.

For the large number of measurements of the arms, legs, etc.,
included in the Sargent system have been substituted the rating of
the condition of the heart and circulatory system, including the
blood-pressure; lung and chest development; digestive and nervous
system; the kidneys and generative organs; the muscular system;
tests of endurance; ocular and aural tests; with a final impression
of the working efficiency.

This standardized percentage table for physical efficiency of
women was worked out and the ratings made with the able assistance
of Dr. David Bovaird, Associate Professor of Clinical Medicine,
Columbia University, and Dr. George A. Meylan, Associate Professor
of Physical Education, Columbia University; and it has seemed to us
that this combination of tests is of greater practical value, since
the maintenance of physical efficiency depends upon the integrity of
all of the organs of the body. These ratings were made to cover the
Special Medical Blank for Women,[1] gotten up for the examination of
the women candidates of the Presbyterian Board of Foreign Missions.

For many years the various Boards of Foreign Missions, which are the
great church corporations, have required that candidates for this
work should pass a physical examination similar to that demanded by
the life insurance companies, and so similar blanks were sent out to
be filled by the local examining physicians; but because of the many
breakdowns of the women on the field, and the great detriment to the
work and the expense thus entailed, four years ago the Presbyterian
Board of Foreign Missions decided to have all of their women
candidates re-examined in New York by a woman physician especially
appointed by them for this purpose.

The results of these examinations have been most illuminating as to
the physical condition of women who call themselves well, to say
nothing of what the medical profession in general seem to consider as
standards of good health in women who will be obliged to do very hard
work under most trying climatic conditions, which all Life Insurance
Companies rate as extrahazardous.

The composite picture thus obtained by the statistical study of the
physical examinations of these 160 young women is of great value,
not only because it is the first of the kind made for the first
decade after leaving college; but also because it is very fairly
representative of the average physical condition of the great masses
of women who are engaged in teaching, social service, secretarial
work, etc.; and, further, it demonstrates the striking difference in
physique of women who call themselves well, and that of the normal
standard of physical efficiency to which most of these women could
have attained by proper physical education.

=Statistical Study of the Physical Examinations of 160
Candidates.=—This study is made from the records of four successive
classes of young women coming from all over the United States, city
and country, including college and non-college graduates, whose
occupations were physicians, teachers, students, nurses, social
workers, housewives, etc. All had passed a preliminary physical
examination. The average age was twenty-eight years, when woman
should be physically at her best.


  _I. Acute Diseases Since Childhood and Number of Days Lost Through
  Illness. For Classes of 1913 and 1914 Only, Consisting of 100
  Women._[2]

  History negative—_i. e._, no history was given of any
      acute illness after the children’s 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
      postoperative treatment, would equal entire
      time of one woman for                                 8½ 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 appendix and diseased right ovary;
and 2 per cent. for the removal of the appendix and ovarian cyst. The
recovery was not only complete from the operation, but the general
health was greatly improved in every respect.

Of the cases of tonsillitis, 4 per cent. were operated on not only
with complete recovery, but also with the cure of rheumatism from
which these women had previously suffered.


_II. Heart and Circulatory System._

  Examination of heart negative, with absence of murmurs 97.5 per cent.
  Action of heart weak                                   54.0  ”    ”
  Pulse weak and rapid                                   50.0  ”    ”
  Subnormal blood-pressure                               63.0  ”    ”
  Anemia present                                         55.0  ”    ”
  Normal condition of veins                              95.0  ”    ”
  Subnormal temperature                                  40.0  ”    ”
  Class average                                           7.5  ”    ”


_III. Lungs and Chest Development._

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


_IV. The Digestive System._

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


_V. The Kidneys._

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


_VI. The Generative Organs and Menstrual Function._

  Pelvic organs normal                                   33.0 per cent.
  History, menstrual periods normal                      38.5  ”    ”
  Displacements and inflammation, uterus                 67.0  ”    ”
   Accompanied by falling and inflammation of ovaries in 12.0  ”    ”
  Hemorrhoids                                             3.0  ”    ”
  Fibroid tumors                                          1.5  ”    ”
  Dermoid cyst                                           75    ”    ”
  Operations advised for retroflexed uterus and curetage  1.5  ”    ”
  Dilatation and curetage                                 1.5  ”    ”
  Class average                                           7.5  ”    ”


_VII. The Nervous System._

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


_VIII. The Muscular System._

  The average height                                     5 ft. 3½ in.
  Normal weight                                             126 pounds.
  Normal relation of weight to height and age            33.0 per cent.
  Averaged 17 pounds underweight                         47.0  ”    ”
  Posture good in sitting and standing                   33.0  ”    ”
  Posture bad, round shoulders, stooped position,
     muscles flabby                                      67.0  ”    ”

  Strength tests taken only for class of 1915 (30 women):
    Highest                                             802 points.
    Lowest                                              338   ”
    Class average                                       570   ”
  Class average estimated                                 7.2 per cent.


_IX. Tests of Endurance._

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


_X. General Impression of Working Efficiency._

  Class average                                           8.2 per cent.


_General Summary._

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


_Ocular Tests_

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

The most striking points of weakness in the entire class were the
bad postures in sitting and standing, consisting of round shoulders,
a stooped position, and flabby muscles, 67 per cent.; a deficiency
of one-seventh of the normal chest and lung development, accompanied
by a deficiency of one-third of the normal chest expansion, 85
per cent.; weak hearts with weak and rapid pulse, subnormal
blood-pressure, and anemia in over 50 per cent.; over 66 per cent.
had some form of pelvic trouble which was acting to undermine the
whole system.

Aside from tuberculosis, life insurance companies reject applicants
who fall more than 20 per cent. below the normal standard of weight,
and because of this 16 per cent. would have been rejected. The cause
of this great loss of weight was due to malnutrition and overwork,
and had it seemed practicable to adhere to Professor Meylan’s wise
advice that anyone who fell below 7.5 per cent. in any one series of
tests, or below 75 per cent. in the general average, 20 per cent. of
the entire class would have been turned down.

It must be taken into consideration that these examinations were made
during the first week of June, at the end of a hard year’s work; but,
making due allowance for this, the results of these examinations
have revealed such a subnormal condition of the vital organs of
the body as to be appalling even to those of us who have long been
familiar with these subjects. In addition to this was the fact that
many unsuspected ailments needing immediate attention by physicians
or surgeons were discovered in a class of women who considered
themselves well.

=The Physical Status of the Women of To-day.=—The strong presumption
that the above statistics are very fairly representative for the
average woman of to-day is strongly borne out by data furnished by
the absence on account of illness of the teachers of New York, and
by corresponding statistics recently published by the Life Extension
Institute of New York City.

Statistics compiled during the year 1913-14 showed that more than 20
per cent. of the teachers of the New York public schools were absent
at some time on account of illness, and that these absentees averaged
16½ school days. The data obtainable showed four prevalent ailments:
diseases of the respiratory organs, 35 per cent.; acute contagious
diseases, 16 per cent.; nervous diseases, 15 per cent.; and digestive
disorders, 11 per cent. And on the health of the teachers ultimately
depends the efficiency of the entire educational system of the
country.

The Life Extension Institute of New York, in its tabulation of 2000
examinations of young men and women clerks between the ages of thirty
and thirty-five years, showed _only_ 3 per cent. normal, _i. e._,
free from bodily impairments and from habits of life which were
leading to such impairments; and showed 59 per cent. sufficiently
impaired to justify their recommendation to the definite care of
their family physician. “These statistics were compiled at an age
when the human being is supposed to be at the very prime of life. The
results prove that the majority of young men and young women in New
York City begin to die as soon as they are grown up. Deaths due to
degenerative diseases have increased 86 per cent. in the past thirty
years; this means an increased death-rate whereby between 100,000 and
200,000 lives are lost every year.”

=The Reflex Action of Some of These Various Impairments on the Entire
Organism.=—In the normal erect position of the body the trunk is
given its greatest length, the head is held erect, the shoulders
thrown back flat against the ribs, the chest is high, and the
abdomen flat. (See Plate III, Senegalese woman.)

In the bad postures noted in 67 per cent. of the entire class, of
round shoulders with a stooped position and flabby muscles, we note
four distinct and prominent factors in the breaking down of the human
organism:

_I. The Effect on the Chest and Lung Development and on the Action
of the Heart._—In this malposition the upper part of the body is
inclined forward, with the result that the chest is flattened to
the extent of 1 inch. The restriction which this must mean to the
expansion of the lungs is evident; and when it is realized that in
the erect position the heart occupies the space between the breast
bone and the spine, with practically no space to spare, the resulting
interference with the heart’s action is evident.

It is a very serious matter when we have superadded to a deficient
chest development a deficient chest expansion. For these are the
very women in whom because of their general run-down condition and
undeveloped muscles the breathing is very superficial; the apices
of the lungs, the favorite site of tuberculosis, and the deeper
portions are seldom expanded; and not only does the body suffer from
a deficient oxygen supply, but there is an equally defective suction
power on the part of the heart, which means a poor circulation and a
lowered general nutrition of the whole body.

The main function in metabolism is oxidation, and scarcely a step in
the series of chemical changes proceeding within the body is possible
in the absence of an abundant supply of oxygen, constantly renewed.
Living in close rooms lowers the vitality to an extent little dreamed
of by most persons.

_II. The Effect on the Abdominal Viscera._—In the normal erect
position the abdominal muscles remain taut and afford proper support
and pressure to the abdominal viscera and the great splanchnic
circulation of large blood-vessels; whereas in the stooped position
the muscles of the abdomen, not being properly used, become weakened
and sag forward, causing the downward displacement of all of the
abdominal viscera, with consequent disturbance of their circulation
and function. Many cases of indigestion, congestion of the liver, and
constipation can be explained in this way.

_III. The Effect on the Circulation of the Spinal Cord._—The
circulation of the spinal cord is very largely dependent on the tone
of the muscles of the spine; hence the weakness of these muscles
interferes with its circulation. In the spinal cord are large
nerve-centers which have to do with the control of the arms and
legs as well as of the organs of the trunk, so that anything which
lowers the tone of these centers depresses the vitality of the organs
supplied by them; and this is believed to be the cause of many cases
of so-called nervous indigestion.

_IV. The Waste of Energy which Results from Faulty Posture._—Weak
foot, in its final stage flat-foot, is more common in women than in
men because it is not purely a local condition in the arch of the
foot, but primarily due to a weakened condition of the leg muscles
that support the arch. Weak feet are gradually converted into
flat-feet by faulty standing and walking and lack of leg exercises.

Many cases of nervous prostration are to be traced not merely to
overwork or worry, but to the waste of energy which results from
the faulty posture of the body and with the interference of the
circulation in the spinal cord, and the consequent weakness of the
nerve power which results. In other words, it is not the load which
breaks the bearer down, but the way in which the load is carried.

Good chest and lung development, a strong heart, well-developed and
firm muscles are the tripod on which rests physical endurance and
resistance to disease. And this was just where the entire class was
found to be gravely subnormal.

Physical training consists primarily of heart training; in increasing
the breathing capacity; in strengthening and developing the heart
and other muscles of the body. As the muscles become stronger the
body is held more erect, and this favors, as we have seen, all of its
functions.

And it is not generally understood how great is the effect of
physical training on the brain and mental activities. With a strong
and vigorous action of the heart there is a feeling of courage and
general exaltation; whereas with a weak heart and feeble circulation
fear and impaired mental activity predominate.

The charge is constantly laid at the door of women that they seldom
rise above the mediocre, and have never been leaders in the world of
art, literature, the drama, science, or the learned professions; that
it is men who have invented devices for the home!

According to statistics, of the 25,000,000 wage earners in the United
States, 8,000,000 are women, of whom 1,250,000 are over forty-five
years of age and 637,000 under fifteen years of age. From an economic
point of view, anything which will raise the working efficiency of
one-third of our producing population, whose average wage is now the
paltry sum of $6 per week, must be welcomed, because it not only
prevents loss of time from work, but also the cost of illness. The
study of the above statistics demonstrates the fact that the physical
efficiency of women can easily be doubled; that should mean that the
average wage should be raised to $12 per week, which would be a vast
economic gain to the individual, the home, and to the state.


FOOTNOTES:

[1] See page 330.

[2] Similar records for the classes of 1915 and 1916 were not
preserved.

[3] As the physical examinations are made during the time of the
Annual Conference, in order to shorten the time as much as possible
the Board requested that the tests of endurance be omitted.




CHAPTER II

HYDROTHERAPY

  Description of the Skin; Functions of the Skin; the Physiologic
  Effects of Water, Hot and Cold; the Chief Varieties of Baths;
  Ablutions; the Tub Bath; the Alcohol Rub; the Cold Dip; Alkaline
  and Saline Baths; the Rain Douche or Shower Bath; the Hot
  Foot-bath; the Sitz Bath; Salt Ablution; the Turkish Bath; the
  Electric-light Bath; Indications for the Use of Turkish Bath,
  and Contraindications; the Douche; Rationale of the Douche;
  Contraindications.

  The Internal Use of Water; Its Action on the Heart and Blood,
  on the Digestion; Therapeutic Indications for the Use of Water;
  Contraindications for Drinking Cold Water.

  Enemas; Vaginal Douche; Douching the Ear.


The term hydrotherapy will be used here in its broadest sense, and
may be defined as the hygienic and systematic use of water, both
externally and internally, for the preservation and restoration of
health and the prevention of disease.

The hygienic and therapeutic value of the systematic use of water is
just beginning to be appreciated by the medical profession. When this
newly acquired knowledge is put to practical use by the great masses
of the people, there will be a greatly diminished necessity for the
use of drugs. Indeed, water has been pronounced by a high medical
authority to be, and probably is, more nearly a panacea for all human
ills than any other known agent.

The bath is generally considered merely as a cleansing procedure,
whereas this is only one of its beneficial effects. There is, in
addition, the stimulation of all the functions and organs of the body
obtained through the temperature of the water, and the mechanical
stimulation which is obtained by the mode of application.

Again, the skin is not a mere covering for the body, but one of its
most important organs, with well-defined functions; so that, in order
to obtain a clear understanding of the subject, it is necessary first
to consider briefly the functions of the skin; and, secondly, the
physiologic action of water.

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

[Illustration: Fig. 1.—Vertical section of skin. _sbg_, Sebaceous
glands; _ep_, epidermis; _h_, hair; _d_, derma (Fox).]

The skin is composed of three distinct layers—the epidermis, the
corium or true skin, and the subcutaneous connective tissue.
The appendages of the skin are the hair, nails, the sebaceous
and sweat-glands. This complicated structure is supplied with
blood-vessels, lymphatics, and nerves.

_The Epidermis._—The outer layer of this is the horny layer; when a
blister is formed, its fluid raises the entire epidermis from the
true skin. The flat scales forming the horny layer are continually
being thrown off; this process of desquamation is increased by the
friction of the clothes, of bathing, massage, and so forth, and is as
constantly being replaced by new cells from underneath.

The _corium_, or true skin, is the most important part of the
integument. This is a thick, felt-like tissue which is pierced in
all directions for the passage of the blood-vessels, lymphatics,
sweat-ducts, and nerves, and affords lodgment for the hair follicles
and sebaceous glands. The tension of the skin is produced by its
muscular structure and elastic network, and is subject to temperature
changes. This power of contractility is known as the tone of the skin.

The skin has two kinds of glands, the sebaceous and sweat-glands. The
sebaceous glands consist of a gland structure, with a short excretory
duct, which opens upon the epidermis or into the hair follicles.
These glands secrete an oily substance, which keeps the hair and skin
soft and protects them from the sweat.

There exists in the sebaceous glands of the skin an infinite number
of vulnerable points for infection, and the greater part of the
process of cleanliness is directed toward their protection. If in any
part of the skin there is an accumulation of bacilli, their toxins,
or excretions, and, at the same point, a collection of sebum, the
friction of the clothes, caused by the movements of the body, becomes
an active agent in effecting their absorption by the skin. Hence, the
scientific basis for the necessity of the daily bath.

In the _subcutaneous tissue_ we find the fat; it is this part of the
skin that contributes to the roundness and beauty of the body. It is
increased by abundant fatty food, sedentary habits, and freedom from
care.

=Functions of the Skin.=—The skin exercises three distinct functions;
first, as an organ of sense; second, as an organ of excretion; and
third, as an organ of heat regulation.

Next to sight, the sense of touch is the most important of all the
senses. Through this sense the human organism is made conscious of
its contact with the outer world. The cutaneous nerve-endings stand
guard, as it were, over most of the functions of the human body.

The importance of the action of the skin as an organ of excretion
will be better understood from the well-known fact that the skin is
one of the most important aids to the kidneys. That the perspiration
and the urine are to a certain extent vicarious excretions has been
proved.

The blood is the circulating medium which not only serves to convey
nutritive materials from the stomach to the tissues, and the
excrementitious materials from the tissues to the excretory glands,
but also to equalize the body temperature. It conveys the surplus
heat from the interior of the body to the surface, where it may
be dissipated by conduction, radiation, and evaporation. Nearly
nine-tenths of the daily heat-loss takes place through the skin;
and of this, one-seventh is due to evaporation, which is enormously
increased by perspiration.

The amount of perspiration produced daily is about two pints, or
in the neighborhood of 1/64 the body weight. This is double the
amount of water thrown off by the lungs. The watery portions of the
perspiration are readily evaporated, and the solid constituents are
deposited upon the skin. Urea and uric acid, together with more
subtle poisons, are found in the sweat.

_Animal Heat._—The heat of the body is wholly derived from foods,
which, when completely oxidized within the body, produce practically
the same amount of heat and energy that would be generated by their
combustion outside the body.

But it is essential, in order to keep the body of warm-blooded
animals at a constant or normal temperature, that an increase in the
heat-production should be accompanied by a corresponding increase
in the heat dissipation; the functions are reciprocal, and this
equilibrium is regulated and maintained by a special nervous and
functional mechanism.

The automatic protective measures against the effects of heat are:

_First._—Dilatation of the cutaneous vessels and an acceleration
of the circulation through the skin and the subcutaneous tissue.
By this means the dissipation of heat is increased; the sweat at
the temperature of the blood, deposited upon the surface of the
body, evaporates under favorable circumstances, and in this way
considerable amounts of heat are abstracted from the body. In
consequence of sweating and its evaporation, the blood circulating
through the skin is cooled, and returning to the internal organs at a
lowered temperature, prevents their overheating.

_Second._—Should the action of heat be continued for a greater length
of time, a large amount of blood will be retained in the skin in
consequence of the loss of tonicity of the cutaneous vessels; the
cutaneous circulation will be slowed, and thereby the blood, heated
at the surface of the body, is prevented from returning to the
internal organs and so overheating them.

_Third._—In consequence of the accumulated amount of blood in the
skin, a diminished amount of blood will remain in the internal
organs; thus their activity, and thereby also the production of heat,
will be lessened.

In these processes will be found a safeguard against the excessively
rapid penetration of heat to the internal organs, and against the
unduly rapid elevation of the body temperature through thermic
influences.

As a result of the stimulating influence of cold, there first occurs
contraction of the skin and its vessels. This, by restricting the
dissipation of heat, brings about perfect compensation if the
abstraction of heat be but slight; and but partial compensation, if
the abstraction of heat is more marked. In the latter event the body
temperature will continue to decline, to a greater or less degree; in
the former it will remain constant.

The rôle played by the skin in maintenance of the normal temperature
of the body is indispensable.

The normal temperature of the adult human body is 98.6° F. in the
mouth, and that of the rectum and vagina is one degree higher.

Fasting, sleep, and short applications of heat all decrease
heat-production; during sleep the temperature of the body falls half
a degree or more.

Respiration by the skin varies from ½ to 1 per cent. of the total
amount of oxygen taken into the body, and a somewhat lower percentage
of carbonic acid is thrown off through this channel.

The skin absorbs substances in watery solutions with difficulty,
on account of the oil lying upon and in the epidermis; substances
dissolved in oil and rubbed in are more rapidly absorbed; absorption
takes place rapidly after the skin has been washed with ether,
chloroform, or alcohol.

=The Physiologic Effects of Water.=—These depend on whether the water
is taken internally or applied externally. If applied externally,
the effects will depend upon the temperature, whether hot, tepid, or
cold; also on the manner of application, but, most of all, on the
length of time which it is applied and the state of health of the
individual.

The temperature of water is classified as very cold, from 32° to 55°
F.; as cold, from 55° to 65° F.; cool, from 65° to 80° F.; tepid, 80°
to 92° F.; warm, 92° to 98° F.; hot, 98° to 104° F.; very hot, 104°
F. and above.

_Heat._—A general hot bath produces dilatation of the vessels of
the skin and contraction of the vessels of the brain; a general
activity of the glands of the skin, both perspiratory and sebaceous.
Perspiration may be produced, either to the degree of slight moisture
or of profuse sweating, according to the length of time and the
intensity of the application made. In a very hot bath the rate of
perspiration may be increased from fifty to sixty times the ordinary
amount. The most pronounced effect possible may be secured by either
the electric light or sun bath.

Loss of fluids from the body has a depressing effect similar to,
though somewhat less marked than, that produced by bleeding, so that
there is a vital necessity for administering water internally before,
during, and after the bath.

Prolonged and repeated perspirations induced by artificial
means weaken the skin, and thus lessen its power to resist cold
impressions, unless counteracted by frequent cold applications.

The general and usual reactions following the applications of heat
are atonic and depressing in character. For the most part, the
reactions following cold applications are to be preferred to those
following hot ones.

The three great vascular areas of the body are the muscles, the
portal system, and the skin. Each of these parts may be regarded as
a great reservoir, capable of retaining a large part of the entire
amount of blood of the body. When one of these areas is in a state of
congestion, the others must be in a comparative state of anemia.

The restorative effects due to the application of heat are due partly
to the elimination of fatigue poisons which is thereby encouraged,
as well as by the reflex stimulation of the nerve-centers. The good
effects are much more decided and lasting, and the exhausting effects
neutralized, if the hot application is followed by a short cold one.

The effects of a neutral bath, 92° to 95° F., is sedative,
diminishing nervous irritability.

A hot-water bottle or fomentations, placed over the stomach for an
hour or two after eating, increase the gastric secretions, and, when
placed over the liver, increase the flow of bile.

=The Physiologic Effects of Cold.=—In suitable cases a short
general application of cold is a powerful heart tonic. Cold causes
a contraction of the vessels of the skin and of those of the brain,
with a dilatation of the internal vessels. There are pallor and
coldness of the skin, and an almost instantaneous suspension of
perspiration, which is dangerous only when the body is in a state of
fatigue.

If the application of cold is long continued, the surface becomes
blue, the temperature of the muscles beneath the skin is lowered,
thus checking heat-production in these muscles; the circulation is
slowed, and the heart’s action is diminished in frequency. There is
a goose-flesh appearance of the skin; a sensation of chilliness,
trembling, shivering, chattering of the teeth; at first a quickening
and then slowing of the pulse, and deep gasping respiration.

When the cold application is considerably prolonged, the tendency to
reaction is suppressed. There is an exhaustion of the nerve-centers
as well as of the heat-producing powers of the body. Thus, the
system gradually loses its power to resist the depressing effects of
cold. The repeated chillings of the body increase the length of time
required to return to the normal temperature. Applications of water
below the temperature of the body always lower the temperature.

_Reaction._—If the application of cold is of very short duration, of
very low temperature, and given under high pressure, the phenomena of
reaction begin immediately on its cessation.

The reaction consists in a dilatation of the surface capillaries,
with contraction of the internal vessels; redness of the skin; the
skin is smooth, soft, and supple; there is a sensation of warmth,
comfort, and well-being; respiration is slower and deeper; there are
a fall of the internal temperature and increase of perspiration.

Certain measures to favor reaction should be taken before the bath,
such as exposure to the air of a warm room, drinking hot water, and
short exercise of a rather vigorous kind.

During the bath the measures which favor reaction are short, sudden
applications of cold, friction while in the bath with the hand, and
pressure effects in the douche.

After the bath reaction is favored by vigorous rubbing, a thorough
drying of the body, warm clothing, warm air of the room, and as
vigorous exercise as the strength of the individual will permit.

Conditions which are unfavorable to healthy reaction are: old age,
infancy, exhaustion, either temporary or from an excessive loss of
sleep, or extreme nervous exhaustion, obesity, rheumatic diathesis,
unhealthy or inactive skin, profuse perspiration when accompanied
by a state of fatigue, extreme nervous irritability, a very low
temperature of the skin, an immediately preceding or impending chill,
and extreme aversion to cold applications.

The average temperature of the human nude skin is in the neighborhood
of 90° F. The difference between the temperature of the skin and
water is the chief element in determining the reaction of the
individual. It is evident that water at a temperature of 90° F. would
be neutral or indifferent; the difference of intensity of effect
is in proportion to the difference of temperature of the water and
skin. The duration of the cold procedure is an important element in
the production of reaction. It may be laid down as a rule never to
give any cold-water application without friction. The physical and
psychic state of the individual exerts more or less influence upon
his reactive capacity. An anemic, or otherwise depressed individual
must be managed with great circumspection, because she bears heat
abstraction badly. The hydriatic procedure must always be adapted to
the reactive capacity of the bather.

The woman must be thoroughly rubbed after the bath until a good
reaction has occurred. Especial attention must be paid to the feet
and legs. The bather should first be rubbed with a warm towel or
sheet, and then with the bare hands of the attendant, as the warm
hand greatly facilitates the reaction. The bather is by no means dry
when the skin ceases to feel wet. So long as the skin is soft and
spongy, it still contains moisture which has been absorbed by the
superficial layers of the epidermis. The absorbed moisture, being
left to evaporate after the bath, the individual is liable to become
chilly and contract a cold, which is erroneously attributed to the
bath itself.

Other injurious effects following imperfect reaction after the
cold bath are secondary chills or a continuous chill lasting for
several hours. The hands and feet are cold, there is headache, not
infrequently diarrhea, and other evidences of internal congestion,
such as abdominal or ovarian pain, vertigo, etc.

Reaction may be favored by covering the patient with blankets,
surrounding her with hot-water bottles, and giving her hot tea to
drink. Exercise should follow the bath. Walking for from twenty
minutes to an hour is the most usual form of exercise. Very vigorous
exercise for a short time cannot be substituted for moderate exercise
for a longer time.

_The Tonic Effect of Cold Upon the System._—The effect of cold upon
the muscles, when given in the form of a cold bath, douche, or spray,
is to augment muscular energy and tone to a very great extent; this
increased muscular tonicity is the cause of the slight shivering. The
cold douche, if short,—one or two seconds,—and given with a pressure
of from 25 to 30 pounds, is a powerful restorative in fatigue
resulting from severe muscular effort, but it must be immediately
preceded by a short hot bath, and must be followed by vigorous
rubbing and wrapping in a hot blanket.

Short cold applications cause elevation of temperature and increased
metabolism, while prolonged cold applications cause a fall of
temperature and decrease of metabolism.

The tonic effect of cold water is believed to be due to the
stimulation of the sympathetic nerve-centers. The sympathetic nervous
system controls the blood-vessels, heart, the functions of secretion
and excretion; and, indeed, all the vital functions of the body.

The sensation of well-being which accompanies the reaction following
a general cold application is largely due to an increased activity
of the cerebral circulation. Cold water is a physiologic tonic, and
the cold bath, properly employed, increases the vital resistance to
pathologic processes.

All applications of water at a temperature low enough to provoke
vital resistance are tonic; hence, tonic effects are produced by
all temperatures below 90° F., but the most certain and pronounced
results are obtained from the douche in every form, which adds
mechanical impact to the thermic effects of cold. The most durable
tonic effects are produced by the frequent use of very cold and very
short baths.

A tepid bath causes a lowering of the body temperature.

=The Chief Varieties of Baths.=—These, in the order of frequency
with which they are used, are: ablutions; tub; foot-tub; sitz; salt
sponge; shower; Turkish; horizontal jet; needle; fan douche; Scotch
douche; Roman and electric-light baths.

=Ablutions or Sponge Baths.=—These baths are of universal use. The
sponge is one of the dirtiest and most impossible articles of the
toilet to clean and to keep clean. It is a collector of dirt and
germs, and should be banished from every bath-room and from every
house. It is not sufficient that each member of the family should
have her own sponge; it is quite possible for the individual to
become infected or reinfected from her own sponge. Incidentally,
it does not afford sufficient friction, and thus does not favor
reaction. In taking ablutions, the application of water may be made
with the hand, though it is best made by means of a wash towel. The
good effects of the simple ablution will be greatly enhanced by the
use of the hat tub, and this especially where there is no bath-tub in
the house.

When the bath is taken for the purpose of cleanliness, the water
should be warm or hot, and pure Castile soap is one of the best that
can be used. If the skin is rough, a good sand soap will be more
beneficial. The bath should be completed by dashing cold water over
the body with the wash-towel.

The body must be quickly and thoroughly dried by means of a rough
bath-towel. After this, the skin may be still further toned up by a
good alcohol rub.

If the ablution is taken simply for the tonic effect, it is generally
taken on rising in the morning, and the water used is cold. The
ablution may be confined to the upper part of the body, that is, the
chest and back; and consists in friction with a rough wash-towel,
followed by dashing the water over the body; followed by brisk
friction with a rough bath-towel. This procedure causes a marked
stimulation of the heart and lungs, and is followed by a rise of
temperature.

In winter all baths must be taken in a warm room.

There is a decided increase of muscular and mental capacity after the
cold ablution, demonstrating the tonic effect it has produced.

The cold ablution may also serve as an introductory to other and more
heroic hydriatic procedures. If the reaction is not good, water at
a higher temperature should be used, and only small portions of the
body should be attacked each day, followed always by brisk friction.
As the reaction becomes better, the temperature of the water should
be gradually lowered from day to day.

There must be a decided sensation of warmth of the body before
proceeding to take any form of cold bath. This may be induced
by sipping a cupful of hot water before rising, and then being
well covered with the bed-clothes until the body is in a glow. In
conditions of anemia or neurasthenia, where the circulation is
markedly poor, in addition to drinking the hot water, the bather may
stand on hot blankets while taking the cold ablution, and after it be
rubbed briskly with hot towels.

Nothing is gained, and a great deal of harm is done, by trying to
persevere in the daily cold ablution when it is followed by a pallor
of the skin, chilliness, etc.

=The Tub Bath.=—This is much more refreshing, more salutary, and may
be used to produce a much greater variety of effects than the simple
ablution. Tub baths may be classified according to the amount of
water in the tub as half or full tubs; and again, according to the
temperature of the water, as warm, tepid, hot, and cold. The half tub
contains about 30 gallons of water.

In a general way it may be said that the half tub of warm water is
used for the purpose of cleanliness; the hot baths for breaking up
colds, for rheumatism, etc.; the tepid bath to allay nervousness; and
the full cold tub, for the tonic morning dip.

For cleansing purposes the so-called half tub, that is, the tub
contains a sufficient amount of water to reach above the pelvis when
one is seated in the tub, is used. The temperature ranges from 98° to
102° F. Five minutes is as long as the bather should remain in the
tub, as all hot baths are more or less exhausting. After an initial
immersion in the water, the scrub takes place by means of the Turkish
bath-towel, or, better, by the use of the flesh brush. If there is a
shower attached, the hot bath should always be followed by a brief
cold shower; if not, the cold water should be turned on and dashed
over the body by means of the wash-towel. This closes up the pores of
the skin, prevents the profuse perspiration from taking place that so
often follows a hot bath, and greatly diminishes the susceptibility
to taking cold. An alcohol rub completes the procedure. This insures
a further toning up of the cutaneous vessels. A small quantity of
alcohol is poured into the hand and applied to a limited area of the
body. It is well rubbed in with friction until the alcohol has wholly
evaporated. Beginning with the arms, the legs, chest, and back are
successively gone over.

The hot bath is best taken immediately before retiring, and should
not be repeated oftener than twice a week. Retiring to bed at once,
the bed acts as the cooling chamber of the Turkish bath. The hot bath
is most restful, and, except in rare cases, tends to the production
of refreshing sleep.

If the bather has a weak heart, suffers from shortness of breath,
or is weak from any cause whatever, she should only take a half
tub bath, since it has been learned from experience that when the
water covers the entire body, there is increased difficulty in the
respiration, and the heart’s action often becomes embarrassed,
palpitation of the heart is experienced, with a feeling of impending
suffocation. There is sometimes also a feeling of faintness. On
getting into the tub, the temperature of the room should never be
above 68° to 70° F.

_The Full Tub or Immersion Bath._—In this form of bath there is a
complete submersion of the body in the water, so that the water
reaches the under surface of the chin, the head of the bather resting
on a cross strap, being the only portion of the body uncovered by the
water.

If the bath is tepid, that is, has a temperature of from 80° to 90°
F., great care should be taken to have the chest covered, in order to
prevent pulmonary congestion. This is best accomplished by placing a
Turkish towel, wrung out of hot water, about the chest and shoulders
of the bather just after she enters the tub.

If the bath is hot, from 98° to 104° F., before entering the bath
the face and neck are rubbed with cold water, in order to relax the
vessels of the brain and so prevent cerebral anemia. Except when
the hot bath is given for especial therapeutic purposes, as for
rheumatism, cystitis, colic, etc., it should always be followed by a
cold application.

=The Cold Dip.=—For the dip, the tub is filled with water at a
temperature of from 65° to 55° F. The duration of the dip varies from
two or four seconds to one or two minutes. The bather should wet the
face and chest before entering the water. It is best to enter the
bath suddenly, as the sensation of cold is thus far less noticeable
than when the bath is entered gradually. If the stay in the tub is
more than momentary, vigorous rubbing must be kept up during the
entire time spent in the tub.

For persons in good health a cold dip on rising in the morning is
excellent. It creates an appetite, accelerates the circulation,
arouses the nervous system, and produces decided exhilarating
effects in those who are strong enough to react after it. When
employed for this purpose, the immersion should not be more than from
three to fifteen seconds. The bather must rub herself vigorously
while in the tub, and follow the bath with brisk toweling and plenty
of friction. She should then take moderately active exercise for
fifteen to twenty minutes.

For any one just beginning to take the cold dips, the temperature
of the water should be just 1 degree below that of the body, and
gradually lowered by a drop of 1 degree every morning or two. Or, the
dip may be preceded by a preliminary warm bath or warm shower.

The salient point in connection with bathing is not to allow the skin
to lose heat too rapidly. To apply this as a warning in the case of
cold baths: it has been estimated that the heat loss from the body
immersed in cold water at the temperature of 86° F. is double the
normal; at 77° F., three times, and at 68° F., five times, the normal.

The daily use of the cold dip for those who are able to react after
it is one of the best means of fortifying the system against both
acute and chronic diseases.

_Contraindications._—The use of the cold dip is contraindicated for
young children, the aged, and in run-down conditions of the system;
in all cases where the action of the heart is weak, in Bright’s
disease, or in any acute or chronic congestion of the kidneys; in all
acute inflammations, as inflammation of the bowels, peritonitis, or
inflammation of the uterus and ovaries.

=Alkaline Baths.=—For these baths from 4 to 12 ounces of the
carbonate of soda should be used to 30 gallons of water. The water
should have a temperature of from 92° to 96° F. This bath is useful
in many forms of skin disease, and relieves the itching of jaundice
and urticaria.

=Saline Baths.=—The typical saline bath is the salt-water bath.
Sea-water contains in solution from ⅓ to ¼ pound of solids to the
gallon of water. The principal ingredients are common salt, magnesium
chlorid, and magnesium sulphate. These substances have a decidedly
stimulating effect upon the skin and encourage reaction. For an
artificial sea-water bath, 8 pounds of sea-salt should be used to 30
gallons of water.

Ordinary coarse salt is purer, contains from 97 to 98 per cent. of
the chlorid of sodium, is cleaner, and makes a clearer solution, and
it dissolves in about one-third of the time required for sea salt,
and can be obtained for about one-third of the cost.

As a cleansing agent, a 5 per cent. brine is equal or superior to
soap. Further, the axilla and hairy parts remain clean and sweet for
a much longer time than after the use of soap. These brine baths,
taken three times a week, are followed by a great improvement in the
general health.

=The Rain Douche or Shower Bath.=—The shower is the most tonic of
all the baths that can be taken at home, and no bath-room should be
considered complete without it. In this form of douche the water
is projected through a perforated disc, falling upon the bather in
a number of fine streams. It is necessary for the bather to wear a
rubber cap in order to keep the hair dry. In taking the shower bath
the bather stands up; the disc is generally placed about 3 feet above
the head. The water should be allowed to fall first upon the feet,
then the hands, arms, shoulders, back, and, lastly, upon the chest
and abdomen. The bather should keep in active motion during the
application, flexing the limbs, and rubbing the chest with the hands.
At the beginning of the shower the hands should be placed over the
chest, in order to protect the precordial region from the impact of
the water.

The cold shower should be preceded by some kind of a heating
process—either a hot plunge or a hot shower bath. A shower of from
100° to 104° F. may be applied for one to three minutes before the
cold application. A cool shower of 75° to 65° F. is an excellent
training for persons who are sensitive to cold. The neutral shower,
92° to 97° F., given for three to five minutes, is sedative in its
effects.

The cold shower, 60° to 70° F., duration from five to thirty seconds,
is useful in phlegmatic neurasthenics and dyspeptics; sedentary
people in whom the general metabolic activity is diminished; also in
obesity and in all cases after a sweating process. By standing in hot
water the bather is much more tolerant of cold.

The neutral shower is one of the most effective measures for the
relief of insomnia; especial attention should be given to the back
and legs. The action is quicker than that of the neutral immersion
bath.

As a hygienic measure, the shower bath offers a most agreeable and
rapid means of cleansing the whole surface of the body.

Since the effect of the douche depends on the pressure, it will
be readily understood that the hose attached to the faucet of the
domestic bath-tub is merely a sprinkler, and not a douche, in the
proper sense of the word. Such a procedure can only be tolerated
by the most robust. In the upper stories of most city houses the
pressure is probably not more than from 3 to 10 pounds; the stream
of water from the sprinkler is really only a drizzle; the mechanical
effects being so slight, there is no reaction produced; the result is
that its use is followed by a feeling of chilliness and depression.

=The Hot Foot-bath.=—The temperature of this bath should be at the
beginning from 102° to 104° F., and the duration from three minutes
to half an hour. The pail is nearly filled with water, care being
taken that it shall not be so full as to overrun when the feet and
legs of the bather are put in. A blanket, closely wrapped about the
patient and the pail, should come up above the knees. As the water
cools off, hot water should be added.

This form of bath is most commonly used to relieve congestion and
inflammation. The dilatation produced in the blood-vessels of the
feet and legs relieves congestion of the brain and the organs of the
upper half of the body, as well as of the pelvic viscera. It should
be taken immediately before retiring.

=The Sitz Bath.=—The sitz or hip bath requires a tub made for that
particular purpose. The back of the tub, which is most commonly made
of tin, is cut high, while the front must be sufficiently low for the
patient to sit comfortably in it, without undue pressure being made
on the under side of the knees.

The tub is half filled with water of the prescribed temperature. It
is well to begin with water at a temperature of 102° F., and increase
the temperature while the patient is in the tub, making it as hot as
is comfortable.

[Illustration: Fig. 2.—Sitz-bath tub made of tin (Ashton).]

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

During the sitz bath the patient keeps on her stockings and bedroom
slippers, and, unless friction is ordered, the entire body, as well
as the feet and legs, are enveloped in blankets.

The duration of this bath is from three to ten minutes. This bath
is especially useful in restoring the menstrual function when it has
been suspended as the result of chill or other causes; also, for
relieving hemorrhoids, uterine colic, neuralgia of the ovaries, and
inflammation of the bladder.

To prolong the effect of the bath the patient may be put to
bed wrapped up in her blankets. In cold weather it is a good
precautionary measure to have the bed heated with hot-water bottles,
in order to prevent chilling.

=Salt Ablution.=—As the name indicates, this is a salt-water bath,
and the best results are obtained by using a saturated solution,
which is in the proportion of 1 pint of salt to 1 gallon of water.
Sea-salt is the best, but, if that cannot be obtained, ordinary salt
may be used.

If there is no bath-tub in the house an ordinary wash-bowl may be
used, but the bath is most effective when taken in the tub. The salt
and water are put in a papier-mâché pail, which is placed at the foot
of the tub. The chilliness which might be caused by sitting on the
cold porcelain is avoided by placing a heavy folded bath-towel on
the bottom of the tub. In cold weather the tub should be previously
heated by allowing the hot water to run in.

The salt water feels very much colder than plain water at the same
temperature. It is well to begin with a temperature of from 90° to
85° F., and gradually lower the temperature until 70° F. is reached.

The water is applied by means of a Turkish wash-towel, accompanied
by vigorous friction, beginning with the face and neck, arms, legs,
back, and, lastly, the chest and abdomen are gone over. After that,
the water is dashed over the entire body, and is followed by a brisk
toweling and friction with the hands or hair glove. The salt water
should not be washed off, except in those rare cases where it causes
a disagreeable sensation; it is then removed by the use of the hot
followed by the cold shower, as previously directed.

_Indications for Its Use._—It is an excellent nerve tonic in cases
of depression with loss of appetite, insomnia, etc., also in anemia
and neurasthenia. In this class of cases it is best taken in the
afternoon, on rising from the siesta, and just before dressing for
dinner. It is especially refreshing in the hot weather.

Its use is contraindicated under the same conditions that other cold
baths are, and must never be taken when the bather has a tendency to
chilliness.

The various kinds of baths previously described can all be obtained
in the home, but the Turkish bath, with its various accessories, can
only be taken in a properly equipped bathing establishment.

=The Turkish Bath.=—This form of bath dates back to the time of
the Romans. The essential features of a modern establishment are:
dressing-rooms; a warm room, with a temperature of from 110° to 130°
F.; a hot room, temperature of 150° to 170° F.; a steam room; a
shampoo room; a douche apparatus; a plunge bath, and a cooling room.
In many establishments there is only one hot, dry-air room. The air
of the room may be heated by steam-coils.

The bather, having disrobed, is enveloped in a sheet, and enters
the hot room, where she reclines on a steamer-chair. A towel wrung
out of cold water is placed on the forehead and changed as often
as it becomes hot. The bather should drink a glass of cold water
immediately before or on entering the hot room, and several glasses
should be taken at intervals during her stay in this room.

The skin is highly stimulated and profuse perspiration results. The
profuse sweating promotes absorption from the alimentary canal, and
so is a powerful stimulant to nutrition. It also emphasizes the
necessity for copious water-drinking.

Great harm often results from a too prolonged stay in this room.
Ordinarily, the bather should leave the room as soon as free
perspiration is established; that is, in from fifteen minutes to half
an hour.

From this room the bather next enters the Russian bath or steam
room. It is very much more agreeable to have very little steam
in the room on entering; when the steam is very dense, a feeling
of suffocation may occur. Any one with a weak heart should avoid
the steam room altogether, as it is apt to cause a sense of great
oppression. For the complexion, bronchitis, or laryngitis, it is
excellent.

From the hot room the bather goes to the shampoo-room, where, lying
upon a marble slab, she is first gone over from head to feet by the
wet hands of the attendant. This manipulation removes the layer of
cuticle which has been loosened by the free perspiration. These
rubbings and strokings are continued until the skin feels smooth and
polished.

The bather is next shampooed with soap and water, applied with a
bath-brush. This may in turn be followed by a salt rub. After this
comes a douche, given with a horizontal jet, at a temperature of 104°
to 106° F., followed by a cold douche.

If the bather is a strong woman, she may now enter the cold plunge.
The temperature of this should be from 70° to 60° F.; this must only
be a quick dip. She is then vigorously rubbed and dried. After this
she lies down in the cooling room and has an alcohol rub, which
completes the procedure. She should rest here for half an hour at
least before dressing. The pulse should be normal and the skin
perfectly dry before she dresses and goes out on the street.

In winter, instead of the ordinary alcohol rub which is given, it is
much better to have a thorough massage with cocoa-butter or almond
oil—the so-called Roman bath. Just following the Turkish bath much of
this oil will be absorbed, which is beneficial for thin people, and,
in any case, it will lessen the danger of getting chilled on going
out into the cold air.

The woman unaccustomed to these baths should under no circumstances
go to a Turkish bath without consulting her physician, as great harm
might result. The bath should not be taken oftener than twice a week,
unless by special orders of the physician. Care must be taken not
to overuse them, as frequent and prolonged exposures to the sedative
influence of heat is very debilitating. The wise woman will provide
her own bathing cap, bath-brush, and straw sandals.

The use of the Turkish bath is indicated in rheumatism, toxemia,
chronic dyspepsia, biliousness, obesity, sciatica, and lumbago.

The contraindications to its use are, in Bright’s disease of the
kidneys, in most pulmonary affections, in the advanced stages of
arteriosclerosis, and in diabetes with emaciation.

=The Electric-light Bath.=—This is now frequently used instead of the
hot-air room of the Turkish bath, and possesses many advantages. A
cabinet is lined on three sides with mirrors, on which are arranged
50 or 60 electric-light bulbs; the mirrors multiply the number of
lights by reflection. A stool is placed in the cabinet for the
patient to sit on, while the head protrudes above the top, which is
closed. By means of switches and a proper, grouping of the lamps
in wiring, the number of lights, and so the temperature, can be
instantly and perfectly controlled. The heat is derived by radiation,
so that it is not necessary to have the air confined. In this form
of light bath the body is directly exposed to the effects of radiant
light and heat.

The incandescent electric-light bath is superior to every other form
of heating procedure in which the only object is the preparation for
the cold bath. The time required is not more than from three to five
minutes. When it is desired to produce profuse perspiration, the
patient may remain in from eight to fifteen minutes. A longer stay
than this is apt to produce an overstimulation of the nervous system
and an excessive elevation of temperature.

The electric-light bath possesses the distinct advantages that, while
the body is exposed to a high degree of heat, the air of the room
in which the head is, and which one is breathing, may be cool, and
unique advantages in the exactness of the dosage as regards time and
intensity. It can also be used in a much greater number of diseases
than the hot-air room of the Turkish bath.

The finishing treatment on leaving the cabinet is identically the
same as that for the ordinary Turkish bath.

_Indications for Its Use._—While the electric-light bath is not a
complete substitute for sweating produced by exercise, it comes
nearer to that than any other heating procedure, and, when followed
by some vigorous cold application, it possesses a hygienic value
which cannot be overestimated.

It is especially valuable in cardiac disease and diabetes. It
stimulates oxidation, and is thus valuable in obesity and the toxemia
of chronic dyspepsia; also in malarial cachexia, syphilis, neuritis,
neuralgia, sciatica, habit chorea, hysteria, rheumatism, and anemia.

It is superior to all other treatment in chronic rheumatism and all
diseases dependent on uric-acid diathesis or diminished metabolism,
by the combined action of the elevation of temperature and the
vigorous cutaneous activity. The elevated temperature stimulates the
oxidation of the proteid wastes and augments vital combustion, while
the increased skin activity carries off all waste-products prepared
for elimination.

As a prophylactic, this form of bath is especially valuable for all
persons leading a sedentary life; it is the best substitute for
exercise in the open air, and, where there are no contraindications
to its use, should be taken once a week.

In cases of obesity, sweating may be used to reduce the weight;
but, in order to obtain the best effects, it must be combined with
exercise, and it must be borne in mind, that in obesity there
is great danger of overheating the blood, in consequence of the
obstacles to heat elimination presented by the thick layers of
non-conducting fat. Therefore, these hot applications for the
reduction of fat should never be too much prolonged, and the bath
should always be finished by vigorous applications of cold. These
cold applications have also a tonic effect upon the nervous system,
and increase the muscular disposition for exercise, and this is the
most rational treatment for obesity.

_Loss of Weight._—There are many cases in which metabolism has
been so sluggish, allowing an accumulation of imperfectly oxidized
matters in the body, that the first active stimulation of the
nutritive processes is in disproportion to the increased destructive
metabolism. Under these circumstances there is necessarily a
decrease in weight. The rubbish must first be removed and old
defective structures before new and highly organized tissues can be
deposited. A slight loss of weight need, therefore, give rise to no
apprehension, but if the loss is considerable, or continues for some
time, especially if accompanied by loss of strength or appetite, it
is a matter for investigation.

Palpitation of the heart and fulness of the head are an indication
that the applications have been too hot or too long continued.
Vertigo and fainting are apt to occur when hot applications have
been continued too long, but they are quickly relieved by cold
applications, especially by cold affusions to the chest and
shoulders. Headache may result, either from excessively hot or cold
procedures. Deficient reaction is generally the result of a too
prolonged application of cold.

On entering the electric-light cabinet, a wet towel wrung out of
ice-water is placed around the neck and another around the forehead;
or an ice-bag may be placed on the top of the head.


=The Douche.=—A douche consists of a single or multiple columns of
water directed against some portion of the body. The apparatus is
complicated, and it is essential that an accurate pressure-gauge and
thermometer should be introduced into the circuit of the douche. It
can only be properly administered in a hydriatic establishment. In
the employment of the douche three factors must be considered—the
temperature, pressure, and the mass.

The range of temperature employed varies from 45° to 125° F. The
pressure ordinarily employed varies from 10 to 60 pounds. The mass
varies according to the effect desired, and may be regulated by means
of the finger, placed in the water column near the nozzle.

The douche is applied by means of the rubber hose, which is connected
at its proximal end with the water-supply, and at its distal end
is attached a nozzle, the average diameter of which varies from 2
inches to ⅜ inch. From these a fine or coarse jet or a fan douche
may be produced. The latter is formed by placing the index-finger
of the hand holding the nozzle upon the lower border of the outlet,
producing an expansion of the otherwise solid jet into a fan-shaped
stream.

The mechanical effects of the douche are derived from atmospheric
pressure, and this is of more importance in the effects produced than
the temperature.

The Scotch douche consists of alternate streams of hot and cold
water. The general cold douche is the most powerful of all the
tonics; the warm or neutral douche is sedative; the very hot douche
is frequently followed by atonic reactions.

_Rationale of the Douche._—The douche is a thermic massage. Since
the douche is a sorbefacient of pathologic products, the French have
availed themselves of its use to aid the body to throw off an excess
of uric acid, fatigue toxins, etc.

It has been demonstrated that a rain douche of 50° F., under a
pressure of two atmospheres, increases threefold the work that the
muscles are capable of doing, while the Scotch douche, oscillating
between 98° and 53° F., doubles the working capacity of the muscles.
Even tepid douches increase the working capacity of the muscles,
while a tub-bath of the same temperature is without decided effect.
The pressure under which the douche is given adds a powerful element,
which is absent in other hydriatic procedures. The percussion and
vibration affect the vasomotor system much more powerfully than any
form of still bathing.

The power and action of the heart are greatly improved by the use of
the douche, the capacity of the lungs is increased, and the digestion
is improved.

Brief douches of from ten to fifteen seconds generally act better
than those of longer duration. The general condition of the patient
must always be carefully studied, and, like the Turkish bath, the
douche should always be taken under the direction of a physician,
as they are also capable of doing a great amount of harm as well as
good. The best results from the douche are obtained when it is taken
following the use of the electric-light bath.

The neutral douche is particularly applicable in cardiac affections
and in cases of high arterial tension. The sensation afforded should
not be either that of hot or cold, and the duration from one to
two minutes. The douche for this purpose should be given with only
a slight degree of pressure, and to avoid irritation it should be
directed to either side of the spinal column. This is a sedative
application.

_Contraindications for the Use of the Douche._—In all acute
inflammations and in eruptive disorders of the skin. The cold douche
is contraindicated in inflammation of the uterus, ovaries, kidneys,
stomach, liver, bowels, and bladder, in intestinal catarrh, chronic
inflammation of the stomach, and general neuritis. It must also be
avoided in rheumatism, arteriosclerosis, cardiac insufficiency,
valvular diseases of the heart with deficient compensation,
fatty degeneration of the heart, and in cases of extreme nervous
irritability.

=The Internal Use of Water.=—The internal use of water is essential
to life. Water constitutes about two-thirds of the body weight; it
is found in every tissue and organ of the body; it acts to dilute
the foods so that they can be absorbed from the digestive tract;
its presence in the blood is essential, both to carry foods to the
tissues and to convey the waste matter away from the tissues. Its
use in the form of a lavage is even more necessary, to keep clean
and free from impurities the mucous membrane lining the 30 feet
of the digestive canal and the tubules of the kidneys than is the
external use of water to keep the skin in a healthy condition. Its
use is also needed to keep the blood-pressure and the heart in a
normal condition.

About 4½ pints of water are given off daily in the excreta and
exhalations; but, since about one-half of the solid foods taken
consist of water, 3 pints of water, taken daily as such, are
sufficient to counterbalance the loss.

All water for drinking purposes should be filtered. The best method
is to have a filter attached to the pipes of the house-supply, so as
to insure filtered water running from all the spigots.

If the water is not filtered, it should be boiled for thirty minutes.
The water should be run off in the morning, then poured into a
well-kept tea-kettle and boiled. It is then allowed to stand and
become partially cooled in covered vessels, when it is poured into
large bottles—quarts are the most convenient size; these should be
stoppered with corks of absorbent cotton. When cool, the bottles are
placed in the refrigerator beside the ice. Water should be boiled
every morning for the twenty-four hours. Boiling for this length
of time secures the destruction of all the germs of disease, and
it is doubly essential on the return to town in the fall, when the
house has been closed for some time; also when typhoid fever in the
neighborhood indicates the strong possibility of the impurity of the
water-supply.

The mistake should not be made of undoing the good that has been
done by boiling the water by the addition of ice to the water when
it is placed on the table. Furthermore, ice-water is so cold that it
retards and interferes with the digestive processes.

In the internal use of water the same marked difference is caused by
the different temperatures at which the water is taken, as was seen
in the external applications of water; but, while the temperature
of the skin is about 90° F., that of the mucous membrane lining the
digestive tract is 98.6° F. and above.

_The Action of the Internal Use of Water on the Heart and
Blood._—Water improves the quality of the blood, both by its direct
action on the constituents and by the increased elimination of
waste-products. By the increase of the volume of blood, a more
energetic contraction of the heart is caused, and the activity of all
the glands of the body is increased. There is a greater amount of
oxygen absorbed by the lungs; oxidation in the tissues is carried on
more perfectly, the result of which is that there is a diminution or
absence of the products of incomplete combustion in the body, such as
uric acid, the oxalates, etc.

By the increase of the blood-pressure, caused by drinking water in
sufficient quantities, the activity of the kidneys is increased, and
this not only in the amount of urine passed, but also of the solid
constituents, which are the waste-products, removed from the body
through the agency of the kidneys.

_The Action of Water on the Digestion._—Very little water is absorbed
from the stomach; it passes from the stomach to the intestines,
where it is absorbed. In order to obtain a thorough cleansing of
the stomach, and at the same time not to cause its overdistention,
not less than ½ pint of water and not more than 1½ pints should be
taken at one time. The water must be taken one hour before meals,
in order to insure its removal from the stomach and the proper rest
of that organ before food enters it, as it has been found by actual
experiment that in a quarter of an hour after water had been taken
one-half of the quantity remained in the stomach, but that none
remained after the lapse of half an hour. Cold water is more quickly
absorbed than warm, and the absorption is hastened by the presence of
carbonic acid, while salt of any kind delays its absorption.

_The Therapeutic Indications for the Use of Water._—First, the
temperature of the water taken must be regulated by the effect
desired. Briefly stated, if the water is taken for dyspepsia in any
form, whether acute or chronic catarrhal inflammation of the stomach
or the intestinal canal, ½ pint of water, just as hot as it can be
sipped with a spoon, should be taken three times a day, one hour
before each meal.

No water should be taken during the meal, and only one glass, at a
temperature of about 60° F., on its completion.

If the water is taken as a diuretic, or, in other words, to increase
the activity of the kidneys, the most of the water should be taken
in the morning on rising and the remainder about 4 o’clock in the
afternoon. Probably the best natural waters for this purpose are the
waters of the Vosges, France. The Vittel water, “Grande Source,” acts
on the kidneys alone; where the bowels are regular or inclined to be
loose, this is the best water to use. If, on the contrary, there is
constipation or biliousness, the “Source Salée” should be taken in
connection with the first named or alone. The “Source Salée” has a
decided action on the liver and is laxative.

In order to obtain a pronounced effect, at least 3 pints of these
waters should be taken daily; in some cases more is required. Two
glasses may be taken on rising in the morning, with an interval of
twenty minutes between; the last glass must be taken one hour before
breakfast. The temperature of the water should be 50° F., which is
the temperature of the water at the springs and that of the water
when placed in bottles in the refrigerator against the ice. In the
afternoon the other two glasses may be taken, with the same interval
between.

In gastric catarrh, where there is an accumulation of mucus or
fermenting matter, with or without nausea and vomiting, hot water
alone is useful. In addition to its action in diluting the contents
of the stomach and the intestines, and its cleansing and antiseptic
effect on their mucous membranes, the reflex effect of very hot
water, slowly sipped, is a stimulation of their muscular coats,
which furthers the passage of the digested food from the stomach into
the intestines. The quantity taken must be from ½ to 1 pint, in order
to obtain a thorough cleansing and yet not to cause an overdistention
of the stomach.

In acute nephritis, inflammation of the kidneys, small quantities
of very cold water, repeated at half-hourly intervals, act as a
diuretic. Care must be had, however, not to overtax the stomach and
heart by overfilling the system with fluids.

In obesity, water-drinking is essential as a means of dissolving and
carrying out of the body the large amount of broken-down material
which results from the increased tissue destruction caused by
exercise, hot and cold baths, and other means employed to decrease
the weight.

For constipation and biliousness two glasses of cold water should be
taken before breakfast, with an interval of twenty minutes between,
the last glass being taken one hour before breakfast.

_Contraindications._—Cold water taken into the stomach produces more
marked effects than water applied to an equal area of the skin. The
quantity of water taken is a factor as well as the temperature.
Cold-water drinking lowers the temperature and slows the pulse, so
that drinking cold water must be strictly prohibited when one is in
a state of fatigue, whether perspiring or not. Feeble persons should
not drink cold water, except in very hot weather, or just before
starting out for a brisk walk in the open air, or when about to
engage in other exercise. With the air of the room at 70° F., a woman
in fair condition, moving about making her toilet, may safely drink
cold water slowly, except when there is a feeling of chilliness.
In the latter case, the powers of reaction being diminished, chill
and internal congestion, often resulting in great injury, may be
produced. Cold-water drinking is always prohibited when in a state of
fatigue. Ice-water should never be taken. When taken with meals, it
greatly retards digestion and may do much harm.


=Enemas.=—=Coloclysters.=—Another valuable internal use of water is
for emptying the lower bowel, and washing out the large bowel in
cases of catarrhal inflammation.

For constipation, in which the object is to unload the bowel as
quickly as possible, 1 or 2 pints of water, at a temperature of from
104° to 110° F., is made into a suds by means of Castile or other
good soap, and poured into a fountain-syringe. If the enema is being
given by an attendant, the patient lies on the right side in the
Sims’ position; the under leg is stretched out so that it forms a
straight line with the trunk, while the upper leg is sharply flexed
at the knee, so that the foot is opposite the knee of the under leg;
the right arm is thrown back from under the body.

If the patient is administering the enema to herself, the best
position is the knee-chest. In this the patient kneels on the floor,
the thighs are held rigid, and while the shoulders are brought to
touch the floor, the face is turned to one side. The position can
only be taken satisfactorily with the corsets and all tight bands
around the waist removed. In this position gravity causes the
intestines to fall upward toward the waist, and the water naturally
follows this course. In this position the water goes up higher, and
is retained longer, than when taken in the other positions. Two pints
of the soap-suds are prepared at the proper temperature, and the
patient uses as much of this as she feels that she can retain. The
water should be retained from five to ten minutes, to get the best
results.

For the purpose of washing out the large intestine more water is
used, but not more than 2 quarts should be used for this. The
position of the patient and the temperature of the water are the
same. But for this clyster, instead of adding soap to the water,
cooking salt is used, in the proportion of 1 teaspoonful of salt to 1
pint of water.

This lavage of the intestine removes rapidly large masses of
decomposing material, swarming with microbes and ptomains and the
toxins produced by them. It also increases the activity of the portal
circulation.

In cases of chronic constipation there are atony and dilatation of
the colon, and the patient always carries about with her an enormous
accumulation of fecal matter, and lives in a state of chronic
autointoxication. In this class of cases the coloclyster should be
administered daily for from two to three weeks; if need be, so long
as the patient complains of gaseous distention and fetid flatulence.
After the discharge of the warm water, 1 pint of cool water should
be introduced, beginning with a temperature of 85° F., and gradually
decreasing this from day to day until 70° F. is reached. This water
should be retained if possible; it acts as a tonic bath for the colon.

Care should be exercised to avoid the distention of the colon by an
excessive amount of water, and, after the colon has been thoroughly
cleansed, the amount of water used should be decreased from day
to day, until finally only 1 pint is used. Warm water is always
relaxing, whereas cold water stimulates and tones up the bowel. If
the quantity of water used is small, the cold coloclyster may be used
indefinitely without producing constipating effects.

Great care must be used to avoid the introduction of air into the
bowel with the water; to this end the water is allowed to run out of
the nozzle before its introduction into the rectum. A small-sized
nozzle should always be used, and this should be lubricated with
vaselin or some other emollient, in order to prevent irritation of
the mucous membrane.


=Vaginal Irrigations.=—To be of any service the vaginal douche should
be taken in the horizontal position. It may be taken on the bed,
couch, or lying on the floor. When taken on the floor, a heavy rug
or steamer blanket should be doubled four times, and two pillows are
used: the under one goes up and down for the support of the back,
while the second is used for the support of the head. A douche-pan
is, of course, indispensable. The agate pans holding 4 quarts of
water are the most serviceable. The douche-pan is placed against the
lower edge of the under pillow, which is protected by a bath-towel.
The woman must throw a heavy shawl or blanket over herself while
taking the douche, otherwise there is great danger of becoming
chilled, and thus doing actual harm instead of good.

The most common and best form of syringe is the fountain-syringe.
This is hung about 6 feet above the bed or floor. It should hold
4 quarts of water; this quantity of water is necessary when the
douche is given, as it most commonly is, for pelvic inflammation. On
beginning its use, the temperature of the water must be controlled by
the sensitiveness of the patient; generally one can use a temperature
of at least 112° F., but not always; sometimes one must be content
with a beginning temperature as low as 104° F., gradually increasing
the temperature by two degrees every few days, until from 114° to
120° F. is reached. The use of a bath thermometer is always essential
to test the temperature of the water. The temperature of the douche
should never go above 120° F., or actual harm will be done.

On lying down, the lower part of the body rests on the broad strip of
the douche-pan, the nates coming over the edge, and the clothing well
pushed up, otherwise the water will seep up the back.

The water acts as a hot poultice about the uterus and its adnexa;
it is also astringent, and greatly relieves ovarian irritation and
congestion. It is highly sedative, and is best used at night just
before retiring. In severe cases better results will be obtained
by its use twice daily. In that case one douche must be taken in
the morning, but in cold weather it must never be taken immediately
before going out-of-doors; there must be at least one hour between
the time of taking the douche and going out into the cold air.
Patients taking hot douches must be warned that the pelvic viscera
are much more susceptible of chilling because of these heating
procedures, and of the necessity to counteract this tendency by the
wearing of woolen abdominal bands, both night and day.

Ordinarily, plain hot water is all that is necessary to use, but if
the vaginal discharge is irritating, one teaspoonful of borax may be
added to the pint of water; or one teaspoonful of cooking salt; or
one-half teaspoonful of the sulphate of zinc.

=Douching the Ear.=—This procedure is made use of to remove impacted
ear-wax or to relieve the pain of earache. A small fountain syringe
should be used, hung not more than 3 feet above the head. The water
should have a temperature of from 105° to 110° F. The nozzle must be
small, and have a very fine opening, and great care must be used in
its introduction not to allow the nozzle to enter beyond the external
opening of the ear. A pus-basin or small dish may be used to protect
the clothing from getting wet. After the procedure is finished,
the ear is dried by means of a very fine handkerchief or a little
absorbent cotton.




CHAPTER III

THE CARE OF THE SKIN AND ITS APPENDAGES

  The Complexion; the Action of the Bath in Health; the Proper Time
  to Bathe; the Care of Wash-cloths; Cleansing the Face; Protection
  of the Face; the Use of So-called Cosmetics for the Face; Facial
  Blemishes, Freckles, Liver Spots, Sallow Complexion, Pimples, Acne,
  Eczema, Wrinkles, and Their Treatment; the Relation of Diseases of
  the Skin to Internal Disorders.

  The Hair; Dandruff; Causes and Treatment of Premature Thinness of
  the Hair and Baldness; the Care of the Hair; Gray Hair.

  The Cosmetic Care and Treatment of the Hands; Cosmetic of the
  Nails; the Care of the Feet; Painful Affections of the Feet.


The face is a complete index of the life of the individual written
large, so that he who runs may read. By looking at the condition of
the skin and the whites of the eyes we can judge very fairly of the
digestion. From the dulness or brilliancy of the eyes we can make
a very good diagnosis of the mental condition. From the general
expression of the face we can read the kind of life that has been led
by the individual, whether of pleasure, dissipation, or sorrow.

From greatest antiquity men and women have striven to beautify their
bodies. To be indifferent to the personal appearance is an indication
of some abnormal condition in the individual or her environment.

=The Complexion.=—The skin of the face is known as the complexion,
and this is the part of the skin that is most exposed to the
vicissitudes of dust and grime of the streets or of the occupation,
as well as to heat, cold, and winds.

An ideal complexion combines the qualities of clearness,
translucency, and fineness of the outer skin, with a proper
disposition of the blood-supply.

The beauty of the skin is evidence of good respiration, good
digestion, proper excretion by the bowels, skin, and kidneys, good
condition of the blood, and plenty of outdoor exercise.

It is now well known that the skin, as well as other parts of the
body, depends for its integrity upon the general nervous system.
Disturbance anywhere in the body acts upon the central nervous
system. A simple case of indigestion often manifests itself over
considerable areas of the skin.

It cannot be too earnestly impressed on the reader that beauty is
entirely dependent on the health. It will readily be seen that no
external applications can produce such qualities as fineness of
texture, translucency, and delicate play of coloring produced by the
contraction and dilatation of the blood-vessels.

The natural order in which to consider the skin will be first as
subservient to health, and then as it is conducive to beauty.

=The Action of the Bath in Health.=—Not only in the art of pleasing,
but in the maintenance of health, neatness of person must be carried
to perfection. By the use of friction, soap and water, the scarf-skin
becomes more and more constantly renewed by the layers underneath it.
It becomes softer, more pliant, and finer than satin in appearance
and texture. Besides this, as has already been shown, bathing has
upon the corium or true skin, and thence upon the general system,
a revitalizing influence. Combined with the proper kinds of soap,
avoiding the use of irritating ones, bathing removes from the skin
all effete oily matters, scales of the scarf-skin, crusts, the saline
matters excreted by the perspiration, dust of all kinds, soot,
particularly that from the clothing, and so forth.

Caustic soaps and borax in excess may remove the oil in so great
quantities as to be detrimental to the skin.

[Illustration: PLATE I

Facial expression.]

Within twenty-four hours the skin, especially those parts which
are covered, becomes vested with a pellicle of impurities, which,
when allowed to remain, become thicker every day, and may produce
injurious effects by obstructing the excretory openings and affording
lodgement for disease. The effects would be felt not only in the
skin, but in the whole organism. The skin when not cleansed will be
irritated chemically and mechanically.

=The Proper Time to Bathe.=—This depends on the nature of the bath to
be taken, the strength of the woman, the temperature of the room, and
the season of the year.

To repeat, a cold bath of any description must never be taken unless
the body has a decided sensation of warmth. In winter, if she will
drink a glass of hot water before rising and has a warm room, the
woman in average health may take a cold sponge bath. But the body
must be very gradually trained to the application of cold, just as
it is to vigorous muscular exercise. For the woman who has never in
her life taken a cold bath of any sort, except in midsummer, to begin
a heroic treatment with cold baths in winter would be utter folly,
which might easily be the cause of pneumonia and even of death. The
time to begin a systematic use of cold water is in summer, continued
through the autumn, and by the time midwinter has arrived, the system
has become so toned up that nothing but good can result.

If the woman is not very strong, she had better begin with the cold
ablutions, just to the waist, on rising in the morning. These must
always be followed by a vigorous toweling and friction. In case of
inflammation of the kidneys or pelvic viscera, cold applications to
the abdomen should be avoided, as they are badly borne.

If the woman is anemic, has a poor circulation, or is conscious of
her heart, she will feel at her best in the afternoon. In that case,
after a cup of hot bouillon, taken on rising from her siesta, she may
take a quick hot scrub, followed by a cold shower. This is much more
invigorating than the cold ablution, and the reaction at that time of
the day is more vigorous than in the early morning.

From the simple ablution, the next step in training would be the
cold wet sheet. It is impossible to take this without an attendant,
but a good maid may readily be taught to give the necessary rubbing.
Ordinarily, this will be enough to attempt in one winter.

A strong woman, who has always been accustomed to taking cold baths,
may all the year round, except just before, during, and immediately
after the menstrual period, take a cold dip on rising in the morning.
It must be literally a quick dip in a tubful of cold water, from
65° to 55° F., or, if she is sufficiently strong to stay in the tub
longer, there must be a constant brisk friction kept up while in the
water.

It is permitted only a woman in good health, with a strong heart and
normal kidneys, to get into a tub of cold water, take a cold plunge,
or attempt sea-bathing.

For the woman who is a semi-invalid, the only time allowable for a
cold tonic bath is in the afternoon.

In cold weather the shower, like all other forms of baths, must be
taken in a warm room. The shower bath can be taken every day to the
greatest possible advantage. An ideal way is to rest for half an hour
on coming home in the afternoon; to sleep, if possible, then take a
quick scrub, and follow it first by the hot shower of 100° to 104°
F., and finish with the cold shower. A brisk rubbing should be kept
up until the skin is in a good healthy glow. This bath is followed
by a feeling of great exhilaration, and it gives a beautiful glow
to the face and skin. It removes the tired feeling of the day’s
work, and leaves one feeling greatly refreshed for the evening. A
daily ablution or a daily shower, with friction, will not cause an
undue removal of the oil of the skin. All cold baths, when given in
suitable cases, tone up the system to resist disease, and are the
best preventives against ordinary colds and sore throat.

A hot tub-bath is best taken at night just before retiring. In winter
it must never be taken immediately before going out-of-doors,
because the pores of the skin are more or less open and there is
great danger of chilling. A hot tub-bath, remaining in the bath for
some minutes, should not be taken more than twice a week, as it is
too debilitating, and a prolonged stay in the hot water causes an
actual loss of flesh.

A woman may take a warm sponge bath in a warm room at any time
of the month, but during the menstrual period she must, under no
consideration, take a cold tub-bath or even a cold sponge-bath, since
this would be apt to cause a chill of the surface of the body and a
congestion, if not an actual inflammation, of the pelvic organs.

No bath should be taken within two hours after eating, as the bath
draws the blood from the stomach toward the surface of the body and
so interferes with digestion.

=The Care of Wash-cloths.=—After using each time, the wash-cloth must
be thoroughly washed, well rinsed, and hung up to dry. But this is
not sufficient: once every week all wash-cloths must be sent to the
laundry to be boiled, thus insuring the destroying of any germs that
may lurk in the cloth. If a woman has any kind of skin disease, it
is quite possible for her to reinfect herself after the disease has
apparently become cured. Further, each member of the family should
have her own individual towels, soap, and wash-cloths. Aside from
all sanitary questions, in a matter so intimate as the bath, there
is something repulsive in the thought of having your toilet articles
used by any one else.

A pure Castile soap is one of the best that can be used. All cheap
scented soaps should be avoided, as they are apt to contain impure
materials that will actually injure the skin. If the skin is rough,
rubbing it with a good sand-soap, and rubbing the same on the
flesh-brush, will remove many of the scales and leave the skin much
smoother and softer. Medicated soaps should never be used except by
the direction of a physician.

=Cleansing the Face.=—The face should be well washed twice a day
with cool or cold water, but the temperature of the water should not
be below 60° F. The degree of coolness must be determined by the
feelings and judgment of the individual. If the face were washed with
very hot or very cold water, and then exposed to the cold air, the
skin would become rough and chapped. The water should be soft. To
soften hard water, put 1 pound of bran into a muslin bag, place in
4 quarts of water, and boil for fifteen minutes. Add enough of this
bran water to the bath to make the water milky.

A soft, woven face towel, kept for the face and neck only, should be
used with a moderate degree of friction. Great care must be used to
wipe the skin thoroughly dry.

It is a question whether the daily use of soap on the face is
advisable; for the healthy skin it is not essential and may prove
very injurious. Soap should never be used on the face in winter
just before going out-of-doors, as this would cause a roughening of
the skin. When the hot tub-bath is taken, the face should be well
washed with soap and hot water, plenty of friction being applied by
means of the face towel, after which the face is thoroughly rinsed
with pure water. This will open the pores of the skin, and should be
followed by the use of cold water, which has a stimulant action on
the blood-vessels and improves the circulation in the skin. It also
improves the tone of the elastic fibers in the skin and tends to
delay the appearance of wrinkles.

If there is any tendency to dryness of the skin, a good cold cream
should be well rubbed in just after bathing the face. The cream
must be a good quality and perfectly fresh, as a rancid cream is
irritating to the skin. Only so much of the cream should be applied
as will be absorbed by the skin. When the skin is very thin, and
there has been loss of subcutaneous fat due to ill health or other
cause, the systematic application of cream in this manner aids in
the nutrition of the skin; and, when applied to the neck with good
massage, is a great protection against sore throat due to exposure to
drafts and cold.

=Protection of the Face.=—The cold winds of winter cause a dryness
of the uncovered skin of the face and lips, which often leads to a
painful chapping, and, in the case of the lips, small fissures may be
produced. In addition to the use of cold cream, a good rice powder
may be applied, which serves as a further protection to the skin.

In very cold weather a veil should be worn to protect the face from
the cold and winds. In summer a parasol should always be carried, to
protect the eyes and brain as well as the face from the hot rays of
the sun.

=The Use of So-called Cosmetics for the Face.=—All skin specialists,
and these are in the very best position to judge of the great amount
of harm that is done, say emphatically that the use of face lotions
and “paints” can only work the lasting injury of the complexion.
They may assist in hiding the defects of nature, but they frequently
contribute to increase these defects. Many of them merely fill up the
pores of the skin and give it a pasty look. Numerous cases of eczema
and other diseases have followed the use of paints. Of the advertised
cosmetics, many are not only worthless, but actually injurious.

Certain applications to the skin of the face are permissible and
beneficial. “Virgin milk,” which is a milky-looking mixture, composed
of the tincture of benzoin and rose-water, renders the skin soft, and
is said to prevent the formation of freckles. If the skin is dry,
glycerin may be added to this. The formula for this mixture is as
follows: Take of the tincture of benzoin and glycerin each 1 ounce,
mix well, and then add 2 ounces of rose-water. This should be applied
by the fingers, just after the face is washed. Pure glycerin is
irritating, and should never be applied to the face without dilution.

The various good preparations of rice and talcum powder on the market
are perfectly harmless, and, if there is a tendency to greasiness
or shininess of the skin, the use of these is essential from an
esthetic point of view. In case of greasiness a little calcined
magnesia may be used. In hot weather the use of face powder is very
refreshing, and in the hot climates it is used for this purpose to a
very striking extent. But the true cosmetics, and the only ones that
can procure and keep a beautiful complexion, are plenty of exercise
in the open air, attention to the diet, to the daily evacuation of
the bowels, to the condition of the kidneys, to baths, and to proper
dress.

FACIAL BLEMISHES.—Among the most common facial blemishes are
freckles, liver spots, a sallow complexion, pimples, acne, eczema,
superfluous hairs, and wrinkles.

_Freckles._—These are brownish or yellowish pigmentary spots, varying
from the size of a pin-head to that of a pea. They occur on the face
and the backs of the hands. They consist of a circumscribed deposit
of pigment; not much is known about their origin. The pigment is
situated in the deep layers of the epidermis, and, in order to remove
the freckles, it is necessary to use something capable of producing
desquamation. As a rule, if left alone, they will gradually disappear.

_Liver Spots._—The so-called liver spots are irregular patches of
a brownish color, which appear most frequently on the face, neck,
chest, back, arms, and hands. If not caused by disorders of the
liver and digestion, they are certainly aggravated by them. They are
not only unsightly blemishes on the skin, but sometimes cause great
nervousness by the intense itching which accompanies them.

_Sallow Complexion._—This is generally caused by disorders of the
liver, and is most frequently met with in hot countries. It is seen
in chronic dyspeptics, and, indeed, in most forms of chronic disease,
and is not only a symptom of the disordered bodily state, but a
cause of its perpetuation. This appearance of the skin is due to the
accumulation of effete matters in it and to its impaired nutrition,
and this state exists not only in the skin, but in the whole body.

_Pimples, or Blackheads, and Acne._—These are affections of youth,
and are generally seen together, the last-named being simply a
second stage of the first. Pimples, or blackheads, appear as small
elevations in the skin, with a small black point in the center. The
cause of the pimple is the alteration in the quality of the sebum,
the oily secretion, which becomes and remains a hard mass in the
excretory ducts of the sebaceous glands and plugs up its external
opening. The dust of the air becomes mixed with the fat, and thus
makes a black point. When the ducts cannot get rid of the sebum, they
become stopped up, and in consequence become swollen. This irritation
spreads to the adjacent tissues, and so inflammation arises. Finally,
the contents of the duct undergo degeneration, suppuration occurs,
and the contents become mixed with pus, small abscesses result at
various depths in the skin, and so require more or less time to break
out.

This inflammatory condition of the sebaceous glands with their ducts
is apt to become chronic and may prove an obstinate affection.
It occurs most commonly about the face, on the back between the
shoulders, or on the chest. The skin is rough to the touch, the ducts
of the sebaceous glands are enlarged, and the skin is greasy.

_Eczema._—This is the most common of all skin affections. It is a
non-contagious, inflammatory disease of the skin, sometimes acute,
but more often chronic, attended with itching and desquamation or
loss of cuticle. With the itching may be a feeling of heat and
tension in the part.

Eczema is a local disease, brought about by a local irritation in the
skin; but, in addition to this, there is generally a predisposing
cause, as some disorders of the digestive tract, a bad condition of
the blood, and so forth. The skin, like other organs of the body,
depends on the whole system for its nutrition. When this nutrition is
not sufficient, the skin appears pale, of a peculiar color, and is
easily taken up in folds, an evidence of poor nutrition of the skin.
When the skin is not properly nourished, every slight irritation is
liable to produce eczema.

=Treatment of Liver Spots, Sallow Complexion, Pimples, Acne, and
Eczema.=—First, the general treatment. While every case of skin
disease must be treated according to the peculiarities of that
patient’s case, still, there are general rules which should be
followed in the treatment of all cases, and first in importance
comes attention to the bowels. There must be procured, by some means
or other, a free daily evacuation. A hard, constipated movement is
not sufficient. Fruits and vegetables are both laxatives and the
very best. Water is also a laxative, and 3 pints a day should be
taken, not only for the laxative effects, but also because this
amount is needed to keep the kidneys properly flushed. Of the simple
medicinal laxatives, one of the best is the effervescing granules
of the phosphate of soda; the dose is from one teaspoonful to one
tablespoonful, to be taken in a glass of cold water on rising in the
morning. Sometimes patients who are troubled with gas cannot take
anything which effervesces; in that case, the plain phosphate of soda
may be substituted.

Next in importance to the attention to the bowels comes the diet. All
articles of diet must be easily digested, while at the same time they
are nourishing. Cereals, pies, pastry, fried foods, hot breads, rich
gravies, rich salads, pork, and veal must be excluded from the bill
of fare.

Fresh meat must be eaten by a woman in health at least once a day,
and young girls need it twice a day. This should be supplemented with
eggs and milk, fresh vegetables, and not an excess of stale bread
or toast. The latter is constipating. Tea and coffee should both be
avoided.

A glass of hot water, taken one hour before meals, will do much to
rid the stomach of mucus and put it in a good condition for the
digestion of the food.

For the congestion of the liver, which is so often at the bottom of
these disorders, it is generally necessary to consult a physician.

Pure air, associated with the proper kinds of exercise, promotes
the functions of the skin, assists in keeping the blood in good
condition, increases the vigor, keeps the complexion clear and
increases its beauty; while, on the other hand, a sedentary life in a
confined air produces a pallid and frequently a blotched skin, with
headache and dyspepsia.

_Steaming the Face._—It seems that the blood-vessels of the skin are
much better able to absorb vapor than water. The vapor penetrates
and softens the epidermis much better than the simple application
of water would. The increased secretion from the skin which is thus
caused is beneficial. After using the vapor bath the outer layers
of the epidermis peel off and the complexion is improved by the
substitution of new pigment. The absorption of the moisture also
causes a roundness of the skin and a filling out of the wrinkles.
Generally, vapor baths can be used in those cases of skin diseases
where the skin is rough and dry. Next in importance to the vapor bath
is steaming the face. Bathing the face with very hot water is also
recommended.

_Massage of the Skin._—Where the complexion is sallow, or there is a
tendency to pimples or blotches, massage of the skin of the face will
do much to improve the circulation.

The massage is most effective when it follows steaming or washing
the face in hot water. The tips of the fingers should be dipped in
cold cream, and then, pressure being exerted by them, the skin of
the forehead should be deeply stroked from the middle line out over
the temples. The nose should be stroked from the bridge outward and
downward. The skin of the cheeks should be pinched up and rolled
between the fingers and thumb. All these movements facilitate the
emptying of the follicles.

Never use an ointment on the face that contains vaselin or lanolin,
but particularly the former, as they are both apt to produce a growth
of hair, but these preparations are excellent to increase the growth
of the eyebrows.

_Wrinkles._—In very many cases wrinkles are the result of habit of
expression, as in scowling; or an expression of dejection, when the
angles of the mouth curve downward, and so forth.

There are twenty-eight muscles about the mouth. Since all these
muscles are developed by use, the mouth comes to assume the
expression given to it by the thoughts of the individual. The
figurative expression, “down at the mouth,” comes to be literally
true, and the angles of the mouth are seen to be habitually drooping,
until at last this is the fixed expression of the face. A healthy
frame of mind is the only means to keep the face from being converted
into a map of wrinkles and drooping angles at the mouth.

[Illustration: Fig. 3.—Muscles of the right side of the head and
neck.]

The wrinkles are not, as a rule, caused by any trouble in the skin
itself, but in the underlying muscles, the tissues of which have
become relaxed or weakened. The circulation of the parts may be
stimulated, and so increased nourishment be secured by deep massage
of the muscles, and, at the same time, the use of a good cold cream
will aid in the nourishment of the skin.

The face should first be washed and steamed according to the
directions already given. The massage of the face should always be
carried out in a systematic manner. Begin with the forehead. Stroke
with the two thumbs over the forehead, starting near the eyebrows,
and work out toward the roots of the hair. In the second movement one
hand is used to stretch the part worked upon, while deep friction is
made with the tips of the fingers of the other hand.

For wrinkles about the eyes, stroke with the tips of the fingers,
over and below the eyes, from the nose toward the temples. Great care
must be taken not to apply too much cold cream about the eyes, lest
some of it should get into them. For the removal of the “crow’s feet”
at the outer angle of the eye stretch the part with the thumb and
finger of one hand, and perform friction with the tips of the fingers
of the other hand.

To remove the lines that run from the corners of the nose to the
angles of the mouth, stroke with both hands, one on each side of
the face, beginning at the center and lower part, and stroke upward
toward the temples. This upward motion counteracts the drawn and
pulled-down condition of the face.

For the cheeks, use both friction and deep kneading; pick up the
muscles between the thumb and finger.

To remove wrinkles under the chin and a double chin, begin at the
middle line, and with both hands make deep pressure upward and
outward. To remove superfluous fat, make deep friction with the tips
of the fingers. In the latter case, only use enough cocoa-butter on
the fingers to prevent the friction against the skin. The benzoin
preparations, already given, will help to contract the tissues.

A cold cream which is a good skin food is the following: Take of
the oil of sweet almonds, 2 ounces; of spermaceti, ¼ ounce; of
white wax, ¼ ounce; and of rose-water, ½ ounce. Melt together at
a moderate heat, the oil, spermaceti, and wax, then gradually add
the rose-water; stir the mixture briskly and constantly until it is
cool, and continue the stirring until it has become uniformly soft
and creamy. The Dover egg-beater will give it the desired creamy
appearance.

=The Hair.=—From an esthetic point of view, a head of luxuriant hair
is a matter of prime importance to the woman.

The hairs are peculiar modifications of the epidermis. The hair
follicle is a cylindric-shaped depression of the skin, whose
funnel-shaped mouth opens on the free surface. Immediately below
this is a constriction, called the neck, which is the narrowest part
of the follicle; the duct of the sebaceous gland, which supplies
the hair with oil, opens at this point. The base of the follicle is
bulb-shaped, to accommodate the hair-papilla and the hair-bulb. The
hair-papilla contains the blood and nerve supply for the hair. When a
hair is plucked or falls out, a new hair grows from the hair-papilla.

According to Pincus, the life of a hair ranges from two to six years,
after which it falls out, to be replaced by a new one. In this way
about fifty or sixty hairs are normally shed every day.

In order to have thick, luxuriant, silky hair great attention must
be paid to the condition of the scalp, since it is the scalp which
contains the blood-vessels that nourish the hair. The scalp should
be thick and pliable and move freely over the bones of the skull. If
the scalp is drawn tightly over the bones of the skull, it tends to
constrict the blood-vessels, and so lessen the supply of blood to the
scalp and cause atrophy of the roots of the hair from pressure.

The hair has a great tendency to accumulate dirt. It catches the dust
flying in the air, and also retains the secretion of fat and the
desquamated epithelium of the scalp and the products of perspiration.

The two chief causes of the premature thinness of the hair are a
deficient circulation of blood in the scalp and dandruff, and it is
said that dandruff causes the loss of hair in 70 per cent. of all
cases.

=Dandruff.=—The last few years has witnessed a revolution in the
views of the skin specialists in regard to the cause of dandruff.
Previous to that time it was considered as simply a collection of
epithelial scales mixed with more or less oily matter. Now, following
the investigations that were first instituted by Unna, dandruff is
considered as a symptom of a parasitic disease of the scalp, called
seborrheic eczema. Sabouraud believes that the same parasite that
produces seborrhea causes the loss of hair. It is believed that the
parasite grows down into the hair follicle, between its walls and the
hair.

Seborrheic eczema is a chronic desquamative inflammation of the
scalp of bacterial origin. It is divided into two stages: the first
may last from one to seven years; it is attended with more or less
dandruff in the form of scales and dryness of the hair; or the
dandruff may unite with the oil, producing fatty crusts which are
removed with difficulty. This is followed by the second stage, in
which the hair falls out.

_Symptoms of Seborrheic Eczema._—In the dry form of the disease,
in which there is a scaling of the scalp, the hair is dry and
unmanageable, the head itches, especially when the patient sits under
a light or becomes overheated. There is a more or less constant
falling of the scales upon the clothes. The scalp looks pale, and
will be found covered with fine grayish or yellowish, readily
detachable scales. Sometimes there is more or less redness of the
scalp. This is the mildest grade of the disease.

That dandruff is contagious has been proved by experiment,
experience, and treatment. Lassar and Bishop made a pomade of the
scales taken from the head of a student who was suffering from this
disease, and rubbed it into the backs of guinea-pigs, which caused
the same disease in them, and falling out of the hair.

Cases have been reported in which husband and wife have contracted
dandruff after marriage, he or she having been free before.

The drugs that are most efficacious in the cure of seborrhea are
active antiparasitics.

_Causes of Seborrheic Eczema._—The general causes are debility,
constipation, and anything which undermines the general health. The
local causes are lack of cleanliness of the scalp, and using combs or
hair-brushes which have been used on the scalps of persons who were
suffering from this disease.

In most families will be found one or more members who possess enough
seborrheic infection to cause the spread of the disease throughout
the rest of the household.

=Causes and Treatment of Premature Thinness of the Hair and
Baldness.=—It has already been stated that 70 per cent. of these
cases were caused by seborrheic eczema. Among other causes may be
mentioned a progressive tightening of the scalp upon the skull, the
scalp having lost the cushion of fat that is under it in early life;
insufficient or improper care of the scalp; daily sousing of the head
in cold water, combined with improper drying of the hair afterward;
sweating of the head; constant mental strain, either on account of
intellectual work or worry; wearing stiff, unyielding hats; gout, and
all diseases which lower the general nutrition.

The chief treatment is by prophylaxis, or using preventive measures
to insure the healthy condition of the scalp. And first and most
important of these is cleanliness. Because of the great length of
time which it takes to dry long, thick hair, many women do not wash
the scalp often enough. In the healthy state of the scalp it should
be washed at least once a month.

=The Care of the Hair.=—There is never any danger of shampooing the
healthy scalp too frequently. The oil in the scalp is not removed
by washing, but is, on the contrary, always increased through the
improvement in the circulation. Where there is much dandruff, or if
the hair has begun to fall out prematurely, owing to long neglect or
following an illness, it is well to begin by washing the hair two or
three times a week, and then gradually increase the interval to every
two or three weeks.

Borax in the water cleanses the scalp well, but its continuous use is
injurious; the same may be said of ammonia water.

One of the best shampoos is the tincture of green soap. If this
cannot be obtained, take of the official green soap 2 ounces, and
of alcohol, 1 ounce; mix well, and make shampoo. One ounce of the
tincture or its substitute should be diluted with twice as much water
and applied to the scalp with the tips of the fingers. When enough
of the shampoo has been used, add sufficient water to make a good
lather. This must be thoroughly rubbed into the scalp, going over
the whole systematically. After the scalp is cleansed, the soap must
be well rinsed out of the hair. This may require many changes of the
water, but it is most important. Dry the hair with hot towels, the
process being completed by a radiator or stove oven. Fanning the
hair will hasten the process very considerably. The hair should then
be loosely braided and a hot towel wound around the head to insure
perfect dryness of the hair and as a prevention against taking cold.
One hour is sufficient for the entire procedure. In winter the hair
should be washed just before retiring.

_Brushing the Hair._—Brushing increases the growth of the hair
by stimulating the circulation in the scalp and by removing the
dandruff. To be effective, the hair should be well brushed at least
once a day, when there must be a deep brushing of the entire scalp.
The bristles of the brush must be stiff enough to warm, but not to
scratch, the scalp. Brushing and massage remove any loose hairs that
are ready to fall, but they will soon be replaced by new vigorous
ones.

Combing simply disentangles the hair. The teeth of the comb must be
far apart and have rounded ends. In no case should a fine-toothed
comb be used. It tears out the hair, and often causes an irritation
of the scalp which leads to disease.

From what has been said, it will be seen that every member of the
family should have a brush and comb for her own exclusive use, and
that no one should allow a public brush or comb to be used on her
head.

The brush and comb must be washed once a week in water containing a
little ammonia; they must be well rinsed out in pure water; the brush
should be dried quickly, with the bristles down. If the brush and
comb are not cleaned sufficiently often, the scales of dandruff would
be sufficient to reinfect the scalp.

_Massage of the Scalp._—The scalp should be thoroughly massaged
every night. Grasp the scalp with both hands laterally, as well as
anteroposteriorly, and with some pressure loosen the tissues from the
underlying parts and try to raise it in folds, or it may be pinched
with the forefingers, producing some vascular flux and a sense of
warmth.

If the scalp is too dry, nothing is better than pure vaselin, though
some persons prefer olive oil, applied by means of a dropper. The
yolks of eggs beaten up with lime-water make an elegant shampoo.

_Dressing the Hair._—Dragging or twisting the hair from its natural
direction, pulling it into constrained or artificial positions, and
even twisting the hair very tightly is injurious to it.

The curling iron acts by abstracting more moisture on one side of the
hair than on the other. The stronger the hair, the more easily it
will curl, and the longer it will stay curled. The daily use of a hot
iron, notwithstanding the greatest care, will in a short time prove
injurious; the hair is apt to become thin and fall out. Its growth is
interfered with. The use of kid curlers is much less injurious, but
even here the tight twisting of the hair around the kids is said to
be harmful.

Shell hair-pins are the best for the hair. If steel ones are used,
the points must be smooth and the pins kept in good condition.

When the hair is dressed for the night, after the scalp has been
brushed and massaged, it should be loosely braided and left hanging
down.

Cutting the hair 1 inch, every two or three months, is said to
promote the growth of the hair and prevent its splitting. It does not
increase the number of hairs.

There is no truth in the assertion that the hair is a hollow tube,
which allows the escape of oil, and that if the ends are sealed by
singeing much good will result.

=Gray Hair.=—Grayness of the hair may be either premature or
physiologic. When the grayness is due to some temporary cause, as
anxiety or some diseased state, the process may cease completely on
the removal of the cause. Usually the whitening is permanent. The
grayness of the hair is caused by obscure changes in the nutrition of
the hair-papilla, which interfere with the production of the pigment.
As a rule, the hair whitens first on the temples, then on the top of
the head.

The hair first turns gray at its root. The grayness is due to the
loss of pigment. Prolonged residence in either a very cold or a very
hot climate will cause the hair to turn gray.

A yellowish tinge of the hair is sometimes seen in patients with
jaundice, or gray hair may owe its dull yellow color to the tint of
dry albumin of which it is composed. The glitter of steel-gray or
silver-white hair is due to the high refractive power of the minute
air-bubbles that lie in the substance of the hair.

_Treatment._—The color cannot be restored to gray hair. The roots of
the hair are embedded in the hair follicles, and cannot be reached by
any fluids applied to the scalp. Not only is the use of hair-dyes to
be deprecated as an exhibition of poor taste, which happily is going
out of fashion, but the use of hair-dyes is extremely dangerous.
Cases are being constantly reported by physicians, where the use of
these supposedly simple vegetable hair-dyes has been followed by very
serious and extensive dermatitis of the face, neck, and shoulders.

Gray hair is really very beautiful when it is of silvery whiteness,
and very ugly when it is of a yellowish-white color. It must be
treated with much greater care, in order to preserve its silvery
whiteness, than was necessary to keep the hair in good condition
before it lost its coloring pigment. It should never be wet, except
when it is shampooed. For this reason, instead of using hair-curlers,
crimping pins should be used. In this way the hair is waved quite as
well and the use of water is avoided.

=The Cosmetic Care and Treatment of the Hands.=—Of all the members of
the body, next to the face, the hands have the most expression, and
serve as an index of character and refinement.

Not only should the most scrupulous attention be given to having
clean hands and nails, but every precaution should be taken to keep
the skin soft and the nails carefully manicured. This is quite
possible for the housewife, simply by wearing rubber gloves while she
does her work. It preserves the fine sense of touch in the fingers,
which aids in sewing and embroidery, at the same time that it adds
much to the beauty of the hands.

_Chapped Hands._—To prevent chapping of the hands in cold weather
heavy gloves must be worn or a muff carried. Another aid in the
prevention of the skin of the hands from becoming rough and chapped,
and the best means for curing them if this has occurred, is by
the use of a good cold cream at night, just before retiring. The
cold cream should be well rubbed in the skin, especially about the
finger-nails, and after this talcum powder be dusted over. This forms
a thick covering for the hands, the talcum powder prevents the cream
from being rubbed off on the bed-clothes, and, on getting up in the
morning, the skin will be found to be soft. Only in case the hands
are very badly chapped should old kid gloves be worn at night.

_Cosmetic of the Nails._—The physiologic function of the nails is to
protect the tips of the fingers against pressure and to give them a
firm support; this increases the delicacy of the tactile sensations.

The nails should be slightly curved from side to side, of a light
rose color, and smooth surface. The lunula should be visible at the
root of the nail. Brittleness of the nails is a defect, which causes
them to tear easily; it is generally due to the condition of the
general health.

There is a natural tendency for the dirt to accumulate on the under
surface of the nail, between it and the finger. This is not only
unsightly, but it is often the cause of actual danger, as this forms
a lodgment for the germs of disease. Not only is it necessary for
doctors and nurses to give the most scrupulous attention to the care
of the nails, but, when we learn that one cook has been the cause
of spreading typhoid fever through a number of families, in her
itinerary in going from place to place, we must be impressed with
the necessity of more careful oversight being given to the hands of
domestics and housewives who prepare the food.

For the same reason, it is self-evident that the hands should always
be washed immediately before going to the table, and cleaning the
nails is always a finishing touch in the washing of the hands.

For the purpose of cleansing the nails, an orange stick or nail-file
should be used, and never the point of the scissors or the blade of a
knife, for either of these causes a roughening of the under surface
of the nails, whereby the lodgment of dirt becomes only the more
securely fixed. After the use of the nail-file, the nail-brush should
be used, followed again by the use of the file or stick. If there
is a tendency to a roughening of the skin under the nail, it can be
obviated by the use of cold cream at night. Just before retiring, the
fingers should be dipped into cold cream, and let the tips take up
just as much as they will retain, and after this dipped into talcum
powder.

The small rim of epidermis which laps over the nail should be
gently shoved back with the orange stick every day. This skin, when
torn, forms the so-called hangnails, by which infection easily
enters the system; it may give rise to felons or even to general
blood-poisoning.

=The Care of the Feet.=—In the care of the feet it must be remembered
that the leather of the closely fitting boot allows very little
ventilation, and so more attention must be paid to the airing of the
feet as well as to their bathing. The feet should be bathed twice
daily.

On making the toilet for the evening dinner both shoes and stockings
should be changed, the stockings hung up in the room, and the shoes
left out to air and dry, instead of being stuffed into the shoe-bag,
to remain there until the next morning.

An alcohol rub will be found very refreshing to weary feet. For
profuse perspiration of the feet, boric acid or talcum powder may be
used, dusting the powder over the feet both night and morning.

_Ingrowing Toe-nails._—The common causes of ingrowing toe-nails are
improper foot-wear and an improper method of cutting the nails. If
the nail is cut too short, especially at the angles, while at the
same time the shoe is too short or too narrow, the skin of the toe
is forced over the nail, so that it necessarily happens that, by the
further growth of the nail, the flesh of the toe is pushed still
further over, until a point is reached where inflammation is set up.
There is excruciating pain, which may be accompanied by the formation
of a small tumor, which forms pus and may go on to granulation—the
so-called “proud flesh.”

The preventive measures of the trouble are, first, in cutting of
the nails. The toe-nail should be cut in a concave form, the outer
angle projecting beyond the toe. If there is a tendency for the
flesh to grow over the nail, the flesh should be pushed back from
the nail, and fastened in this position with a strip of oxid of zinc
plaster, and a gauze packing should be inserted under the nail-edge.
A saturated solution of boric acid serves as an antiseptic dressing.
It is often possible to cut off the projecting nail, and, by the use
of the boric acid dressing, the trouble disappears in a few days.
Attention should always be given to the toe-nails when bathing.

_Corns._—There are two varieties of corns; both are very painful.
Soft corns come between the toes, and unless absorbent cotton is
inserted to prevent the rubbing of the toes together, a second
corn appears on the opposing surface of the adjoining toe. A very
effective remedy for this is the application of blue-stone, or
sulphate of copper, to the corn. The stone is moistened in water
and then applied thoroughly to the corn; absorbent cotton should be
placed between the toes. In very severe cases it may be necessary to
stay off the feet for a few days and keep the foot upon a chair.

Hard corns must be cut down with the greatest care. It should be
done directly after the bath, so as to have the skin in as nearly an
aseptic condition as possible. A small scalpel, composed entirely
of steel, should be kept for this purpose. It must be thoroughly
cleaned after it is used, and just before its use be sterilized by
boiling for five minutes. The reasons for these precautions are the
possibility of cutting into the flesh and setting up blood-poisoning
by the entrance of germs into the wound.




CHAPTER IV

THE DIGESTIVE SYSTEM: GENERAL PRINCIPLES IN HUMAN NUTRITION AND
DIETETICS

  The Digestive Tract; Care of the Mouth and Teeth; Controlling
  Factors of Digestion; Psychic Aspect of Digestion; Importance
  of Mechanical Factors; Chemical Changes of Food in the Stomach;
  Intestinal Digestion; Metabolism; Constipation and its Treatment.

  The Amount of Food Required; the Classification of Foods; Standard
  Dietaries; Maintenance Diet; Relations of Diet to Various
  Conditions of Life; Practical Facts for Guidance; Dietary in the
  Tropics; Food Economics; Table of Food Values.

  The Physiologic Action of Moderate Doses of Alcohol; the Effect
  of Alcohol on the Muscular System; the Effect of Alcohol on the
  Nervous System.

  “If there is anything new of importance in the practice of medicine
  it is this modern work in nutrition.”—_Mendel_, 1914.


The activities of animals are carried on by a certain expenditure of
energy which is set free as the result of a chemical breaking down of
the living tissues of the body. In order to maintain the equilibrium
of the body this waste must be replaced by new material which is
taken in the shape of food, drink, and oxygen.

_Digestion_ is the term applied to those changes in the food-stuffs
which precede absorption; it is a refining process which separates
the useless from the useful, and further prepares the latter to be
used as building-stones for the repair of organs and tissues and to
furnish fuel to supply the motor energy of the body.

In the human body the digestive processes are brought about by
mechanical disintegration; by the action on the food-stuffs of acid
and alkaline fluids; by changes produced by active substances called
enzymes; and, lastly, decomposition is produced by the growth of
microörganisms.

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

[Illustration: Fig. 4.—General scheme of the digestive tract, with
the chief glands opening into it (Stockton).

  Nose
  Salivary (parotid) gland
  Salivary glands
  Pharynx
  Vein
  Trachea
  Thoracic or chyle duct
  Esophagus
  Liver
  Gall-bladder
  Stomach
  Spleen
  Pancreas
  Duodenum
  Lacteals
  Large intestine
  Small intestine
  Vermiform appendix
  Rectum
]

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

The digestive tract is lined throughout its entire course by mucous
membrane; that lining the mouth gives some idea of its character. It
is from the mucous membrane lining the stomach and intestines, as
well as from the liver and pancreas, that the digestive fluids are
poured forth into its cavity.

In passing downward the food meets with five different digestive
fluids: the saliva in the mouth; the gastric juice in the stomach;
and the bile, pancreatic, and intestinal juices in the small
intestine. Each digestive fluid acts only on some particular kinds
of food. This action of the digestive fluids on food is called the
chemical part of digestion.

=The Care of the Mouth and Teeth.=—It is of the first importance that
the mouth should be kept clean and as nearly aseptic as possible,
for as the food is rolled about in the mouth by the process of
mastication it is obvious that it will carry all the germs and mucus
with it into the stomach. A nasal spray containing some solution of
an alkaline or antiseptic nature should form an essential part of the
toilet of the mouth.

_The Teeth._—From simply an esthetic point of view well-kept teeth
are beautiful and greatly enhance the charm of the face. But the
proper care of the teeth is also essential to good digestion and good
health.

In perhaps the majority of people the teeth are sufficiently far
apart for small particles of food to become lodged between them. If
not promptly removed, the heat and moisture of the mouth, acting on
these small particles, cause their decomposition and set up acid
fermentation in the mouth; and it is this acid which causes the decay
of the enamel and finally of the teeth. The decayed tooth gives still
further lodgment to particles of food, and these, left to decompose,
give rise to the most offensive gases, giving fetor to the breath,
poisons the blood, and so injures the digestive and nervous systems.

Where possible a tooth-pick and dental floss should be used
immediately after each meal; the waxed dental floss between the
teeth, and the flat end of the tooth-pick to remove any particles
that may have worked in about the roots of the teeth and gums.

A tooth-brush with good tooth-powder should be used twice a day. The
brush should not be too broad, and is better if slightly curved. The
bristles should not be too hard. The use of tooth-powder, which must
be very fine, or tooth-paste is needed to produce sufficient friction
to clean the teeth well. Warm water is a better solvent than cold,
and, therefore, it is well to use it for cleansing the teeth.

While it is generally known that decay if neglected will destroy a
tooth, it is not so well known that many teeth are lost as the result
of the accumulation of tartar at the gum margin. There is a great
tendency to this, especially about the necks of the lower incisors
and upon the teeth that are not used in chewing. The deposit of
tartar encroaches upon the neck of the tooth and presses upon the
gum; the latter becomes irritated or inflamed, and recedes from the
tooth; malnutrition and loosening of the tooth follows.

With very imperfect or decayed teeth proper mastication is impossible.

The teeth should be examined by a good dentist twice a year, so that
small cavities shall be discovered at an early stage, the tartar
removed, and the teeth kept in their best condition. This will
prevent the early loss of the teeth. Lost teeth must be replaced, so
that the teeth shall be opposite each other, for a very important
factor in mastication is that the teeth shall strike properly.

=Digestion.=—The factors controlling digestion are psychic,
mechanical, and chemical.

Briefly stated, the process of digestion consists first in the
liquefaction of the solid portions of food and the conversion of
the insoluble into soluble and diffusible, for no nutriment can be
assimilated until reduced to a state in which it can pass through a
cell membrane. These chemical changes are carried on by a series of
enzymes.

[Illustration:

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

_Enzymes_ are unorganized ferments which possess the power of
producing chemical changes in certain substances with which they come
in contact under particular conditions without themselves suffering
permanent alteration. The digestion of food is largely accomplished
by the specific action of these enzyme bodies, of which every
digestive fluid contains one or more.

But neither solubility nor diffusibility is adequate. Freely soluble
substances like cane-sugar need to undergo digestive changes just
as definite as those carried out in the case of fats or coagulated
proteins. The changes which they undergo before absorption serve a
more fundamental purpose than the mere hastening of their passage
through the lining membrane of the intestine.

In the light of modern chemical knowledge we can be somewhat specific
in regard to the molecular aspects of the digestive processes. They
are probably always cleavages, large molecules giving rise to smaller
ones. When the original molecule is of extraordinary size, as with
proteins and starches, these cleavages have a serial character, and a
number of intermediary products must accordingly be formed; that is
to say, the earlier products are in turn subjected to digestion. Such
cleavages are generally, if not always, hydrolytic; that is, water
enters into the reaction and its elements are found combined in the
products.

=The Psychic Aspect or the Effect of the Emotions on Digestion.=—The
relation of the emotions to the activities of the alimentary canal
are of very practical importance, because recent investigations have
shown that not only are the first stages of the digestive processes
normally started by the pleasurable smell, sight, and taste of food,
but also the pouring out of the gastric juice.

The importance of the initial psychic secretion of the saliva for
further digestion is indicated when we realize that materials can be
tasted only when dissolved in the mouth, and thereby brought into
relation with the taste organs. The saliva which waters the mouth
assures the dissolving of the dry but soluble food even when it is
taken in large amounts.

The importance of the initial psychic secretion of gastric juice is
made clear by the fact that the continued flow of this juice during
digestion not only stimulates the glands of the stomach to pour out
the chemical gastric juice, but by its action on the mucous membrane
of the duodenum it also starts the flow of bile and pancreatic juice.

These facts are of fundamental importance in the cooking and serving
of food, especially when the appetite is fickle. A bright and cheery
dining-room, the daintiness of the table service, the center-piece
of ferns or flowers, all are factors in exciting the pleasurable
emotions, and so stimulate the appetite.

On the other hand, the digestive processes may be wholly abolished
by vexation, worry, and anxiety, or when such strong emotions as
anger or fear are allowed to prevail. This fact has long been known
in regard to the salivary secretion, and it has now been established
in regard to the secretion of the gastric juice. It is necessary to
avoid all circumstances likely to provoke emotional reactions.

The inhibitory influence of excitement on the flow of the gastric
juice has been studied by Professor Cannon, of Harvard University, in
an interesting series of experiments on dogs. And a most important
point is that the cat, which was allowed to infuriate the dog being
experimented on, was only in the room for five minutes, and in spite
of the fact that the animal was hungry and ate eagerly; there was
almost a complete suppression of the flow of gastric juice for a
period of twenty minutes.

A similar experiment was tried on a boy with a gastric fistula. Food
was shown to the boy and then withheld. He was so vexed because he
could not eat at once that he began to cry and flew into a towering
passion, with the result that no secretion appeared even after the
child was calmed. In both the case of the dog and boy there was not
only a temporary inhibition of the flow of gastric juice, but it is a
noteworthy fact that the effects of the emotional excitement remained
long after its cause had been removed.

The practical point is, that if the digestive processes have been
inhibited by emotional disturbances any food taken will lie stagnant
in the stomach; and not only will there be a suppression of the
gastric but of the pancreatic secretion as well, with the consequence
that there is likely to be an accumulation of unabsorbed organic
material in the colon and perhaps higher up as well. Bacterial
decomposition will be fostered and actual harm may be done the
organism.

And just as a single occasion may lead to a passing digestive
disturbance, so continual mental depression, worry, or grief may
permanently impair the working of the tract and so undermine the
vigor and capacity of the sufferer.

It is believed that many acute attacks of indigestion in children are
due to sharp rebukes administered at the table.

_The Psychic Tone._—Just as there is a psychic secretion, so
likewise there is a “psychic tone,” or psychic contraction of the
gastro-intestinal muscles, as a result of taking food. And just as
the secretory activities of the stomach are inhibited by strong
emotions, so also are the movements of the stomach. And, indeed, the
movements of nearly the entire alimentary canal are almost completely
stopped during moments of great excitement.

The condition of mental discord may thus give rise to a sense of
gastric inertia, so that anxiety may be accompanied by a feeling of
weight as if the food remained in the stomach, and every addition of
food causes an increase of the distress.

=The Importance of the Mechanical Factor in Digestion.=—The
mechanical reduction of food in the alimentary canal is preliminary
to its actual digestion. The first stage of digestion takes place
in the mouth, and this is the only portion of the digestive canal
which is under the control of the will. It is here that the food is
ground into fine particles by the act of mastication, and the more
thoroughly the food is pulverized in the mouth, the more rapidly and
easily can it be acted on by the gastric juice, and the very act of
chewing increases the flow of saliva as well as shortens the time
that the food will remain in the stomach.

[Illustration:

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

The _saliva_ not only protects the mucous membrane of the mouth,
but it keeps it free from small food particles, which if allowed
to remain would decompose, and thus injure the teeth by the action
upon them by the acids produced. It also moistens the dry food, aids
in the process of swallowing, and has some action on the starchy
substances of the food. By the process of mastication, then, the food
is divided into small particles and thoroughly admixed with the
saliva until the whole is converted into a fine pulp.

Besides favoring the mechanical part of digestion and its slight
chemical action on starchy foods, saliva, being an alkaline fluid,
is a distinct stimulation to the secretion of gastric juice. After
the food has been reduced into a pulp in the mouth, and the change of
starches into sugar has begun, it is swallowed and passes into the
next compartment of the digestive apparatus, namely, the stomach.

The _stomach_ may be felt at the lower extremity of the breast bone,
in the triangular space formed by the divergence of the ribs. It is
a large hollow, compound gland, the walls of which contain muscular
fibers in addition to the tubules which elaborate the special
secretions. Its cavity is lined with a thick mucous membrane, packed
with tubular glands, into which is poured out a complex secretion
called the gastric juice.

=The Chemical Changes which Food Undergoes in the Stomach.=—There are
two chief phases or periods of gastric secretion: (_a_) The psychic
or appetite juice, and (_b_) the chemical juice. Gastric juice is
not constantly poured into the stomach to accumulate there, but is
secreted only as it is needed under the influence of certain stimuli.
These stimuli may be classified as psychic and chemical.

In the second phase, or period of gastric digestion, the exciting
agent is the presence of food in the stomach. It has been shown that
a correlation of the different organs of the body is brought about by
_hormones_ or chemical messengers. The hormones of gastric digestion
are produced from proteins in the early stage of gastric digestion,
and this shows the importance of the psychic or appetite juice. A
similar effect is produced by meat extracts or infusions, which are
well-known provocatives of gastric secretion.

_Gastric Juice._—The principal active agents of the gastric juice are
hydrochloric acid and the enzymes; pepsin, the proteolytic enzyme;
rennin, the milk-curdling ferment; and lipase, the fat-splitting
ferment. The uses of the gastric juice are digestive, activating, and
disinfecting.

Gastric juice does not dissolve and chemically change all food that
enters the stomach, but acts only on that class of foods called
proteins, converting them into peptones.

The changes which food undergoes in the stomach are as follows:
food is disintegrated; meat is broken up, gelatin dissolved; the
muscle-fibers fall apart, and are split into disks and sarcous
elements; the framework of fatty tissue undergoes similar dissolution
of cellular membranes; milk is curdled; the caseinogen is transformed
into casein, and the latter broken down by pepsin. Bread and other
starchy foods are disintegrated, some of the starch being formed into
sugar by ptyalin. The other vegetable foods are but little digested
by this viscus. The whole is broken into irregular fragments by the
disintegrating power of the stomach and gradually converted into
_chyme_, the creamy emulsion which passes through the pylorus into
the intestines. The passage from the stomach into the duodenum is
aided by the motor activity of this organ.

_The Mechanics of Digestion in the Stomach._—Recent investigations,
especially those of Cannon, have thrown much light on this subject.
The food introduced into the stomach from the esophagus is lodged
first in the fundus or cardiac end of the stomach; from here it
is moved by slow degrees toward the pylorus, from which it enters
the small intestine. Formerly it was taught that this movement was
brought about by a churning motion of the stomach throughout its
entire length. Cannon has shown the error of this conclusion. From
his observations it appears that the stomach is quiet at first. The
waves of peristaltic constriction begin at the duodenal and middle
portions and move the food toward the pylorus. In this way the
constrictions that begin near the pyloric end gradually extend to the
cardiac end. The latter part of the stomach is distended after a full
meal, but gradually diminishes in size during digestion.

Moreover, there is a difference in the character of the gastric juice
coming from the different areas of the stomach; that from the middle
portion being acid, and that from the cardiac and pyloric being
neutral or nearly so. These facts show that the food remains for some
time in the fundus and meets there a neutral liquid; consequently,
the alkalinity of the mass is retained for a time, and the saliva
acts upon the starch for a much longer period than has been supposed.

It is believed that the length of time which food remains in the
stomach varies with its kind. The digesting mass is not forced into
the intestine until it becomes well saturated with the free acid of
the stomach, a result that will be reached later with a meat than
with a vegetable diet; for it is plain that much more acid will be
required to combine with the proteins of meat than with the smaller
amounts in the carbohydrate foods, and so free acid is longer in
accumulating.

Digestion is aided by the movements of the food mass through the
contractions of the walls of the stomach, so that anything which
lowers the tone of the stomach or impairs the integrity of its lining
membrane seriously interferes with the digestive processes.

The nature of the food influences the rate of its passage through
the pylorus. It has been shown by means of the _x_-rays that when
the meal consisted of lean meat, suet, and rice, properly cooked and
prepared in such a manner that the constituents were properly mixed
together, the carbohydrates (rice) began to leave the stomach in
fifteen minutes, but the protein (lean meat) and fat did not begin to
leave it under one-half hour, and were much longer in passing through.

It was further found that in a normal stomach a meal of rice and
potatoes gets out of the stomach rapidly, no trace being left in
three hours, while a meal of protein and fat meat was much slower,
some being present six hours after the meal. Indigestible substances
are rejected by the sphincter and returned to the digestive cavity
over and over again, but in the course of time the sphincter relaxes
and the peristaltic contractions increase, until the force is
sufficient to drive through the opening hard substances like peas,
plum-stones, and coins.

_The Absorption of Food from the Stomach._—A very wide-spread
misconception prevails in regard to the amount of absorption that
takes place through the gastric walls. This is very limited indeed;
some sugar, alcohol and other fluids, and a small proportion of
nitrogenous matter are taken up, but that is all. The legitimate
rôle of the stomach is a peptonizer and grinder only. Absorption of
nutrients is the special work of the intestines, and occupies but a
subordinate place in the duties of the stomach.

Proteins undergo peptonization, but that does not change them
sufficiently. The mere splitting into peptones, formerly thought
sufficient, is now known to be quite inadequate. Recent researches
have shown that the complex protein molecule has to be quite crushed
into a heterogeneous assemblage of fragments, from which those
suitable for building up into the body protein are selected for that
purpose, the remainder being used as fuel; that is, as a source of
energy. In the case of the other food principles, fats and starches,
the chemical processes are much simpler.

=Intestinal Digestion.=—The chemical changes which food undergoes in
the small and large intestines are exceedingly complex. Digestion in
the intestine is due to the combined action of the bile, pancreatic
juice, and succus entericus. The material which enters the duodenum
from the stomach is known as the chyme. The acid chyme provokes a
flow of bile and pancreatic juice. It acts upon the _prosecretin_
in the duodenal mucous membrane in such a manner that _secretin_,
a hormone, is formed and carried by the blood to the cells of the
pancreas which it stimulates.

_Bile_ is a secretion of the cells of the liver and from the inner
wall of the gall-bladder; after elaboration, bile is stored up in
part at least in the gall-bladder. The secretion of bile is irregular
in quantity, as is the case with the gastric juice, and appears
to be induced by chemical excitants, of which acids, especially
hydrochloric, seems to be especially effective. Of the nutrients,
the proteins exert the most influence. Less secretion follows the
ingestion of carbohydrates than of proteins.

Formerly it was supposed that fatty foods checked the secretion of
bile, but later experiments have proved that, to the contrary, they
increase its secretion; and olive oil is a powerful cholagogue.

Bile precipitates the proteins of the chyme, neutralizes the acidity
of the gastric juice, dissolving the fatty acids, and activates
the lipase or steapsin of the pancreatic juice and assists in the
absorption of fats. When for any reason the discharge of bile is
retarded and the organism attempts to eliminate it through the
kidneys, the tissues become charged with its compounds and take on a
yellowish coloration.

_Pancreatic Juice._—The second action upon the food in the intestine
is that of the bicarbonate of soda contained in the pancreatic and
intestinal juices, which neutralizes its acidity; and pancreatic
digestion can only take place in an alkaline medium.

The pancreatic juice has the most comprehensive action of all of
the digestive fluids; it contains a great variety of enzymes and
acts upon all classes of nutrients. Its flow is intermittent, being
induced by the action of the acids in the partially digested food
from the stomach.

The pancreatic secretion attains its maximum pressure about three
hours after a meal, but this varies according to the character of the
meal. The enzymes of the pancreatic fluid are _trypsin_, _amylopsin_,
_lipase_ or _steapsin_, and _pancreatic rennin_.

_Trypsin._—Pancreatic juice alone has but little influence on
proteins, but when mixed with succus entericus its influence is
great. Trypsin differs from pepsin by acting in an alkaline or
neutral solution, and a free mineral acid, like hydrochloric, stops
its operations; it acts much more powerfully and rapidly than pepsin.
In conjunction with other enzymes it splits protein foods into
simpler compounds, which may be regarded as the building stones of
the original proteins.

_Amylopsin._—The digestion of starch in the intestine is mainly
effected by means of a diastatic ferment or enzyme in the pancreatic
juice, called “amylopsin.” This enzyme has the power of hydrolyzing
the starch mostly into maltose.

_Steapsin or Lipase._—The pancreatic secretion acts vigorously on
fats, not only splitting them into fatty acids and glycerin, but, in
conjunction with the bile, also effects their emulsification. This
latter result is doubtless aided by the soaps which form a union of
the fatty acids and alkaline bases (mostly sodium) in the bile. The
cleavage of the fats is due to the enzyme steapsin.

The _succus entericus_ is the secretion of the glands of Lieberkühn.
It contains quite a number of enzymes, including four which act
on carbohydrates, namely, _amylase_, _maltose_, _lactase_, and
_invertase_; the proteolytic enzyme is _erepsin_, which seems to
supplement the action of trypsin. It has no action on native proteins
except casein, but it breaks down proteoses and peptones into
_amino-acids_.

In other words, the discovery of erepsin in the succus entericus and
its effects has led to the now almost generally accepted view that
the digestion of the proteins is carried further than the stage of
proteoses and peptones; in fact, that this enzyme hydrolyzes them
into amino-acids, in which form they are taken up by the cells of the
intestinal mucous membrane.

_The Absorption of Food from the Intestines._—It was formerly
believed that the main stream of the nutrient passed out of
the intestines through the lacteals and thoracic duct into the
circulation. But it is now known that only the fats take this course,
and that the dissolved proteins, carbohydrates, some fats and salts
find their way into the circulation through the portal system and the
liver.

The blood contains a constant proportion of serum-albumin and
serum-globulin, which are constructed out of the amino-acids
resulting from the digestion of protein foods. The reconstruction
of proteins takes place chiefly in the cells. Fuchs believes that
the amino-acids from the food are carried to all the tissues; and
that the cells of the muscles and glands pick out from the blood the
“building stones” necessary for the construction of their special
proteins.

Fat is absorbed for the most part in the form of an emulsion and as a
solution of soap. Only about 60 per cent. of the fat in the food is
absorbed by the lacteals; the remaining 40 per cent. gets directly
into the blood. The fat is carried directly by the blood-stream
to the tissues all over the body; it is oxidized in the tissues
to produce heat and energy; what is not immediately used for this
purpose is stored up in the cells for future use.

_Carbohydrates._—Practically all of the carbohydrates digested are
absorbed in the form of sugar. The absorption takes place more
rapidly in the upper than in the lower bowel. A portion of the
ingested carbohydrates is destroyed in the alimentary canal by
bacteria, whose enzymes transform them into various acids and gases.

_The Absorption of Sugar._—The sugars pass into the blood through
the portal circulation, and not through the lymphatic vessels. The
question is, Where does sugar go after it gets into the blood? The
proportion of sugar in the general circulation is not greater after
a meal than before it. It is necessary that there should be some
means of storing it, for it cannot all be immediately used for the
production of energy. Is it stored as glycogen? Bunge believes that
a considerable amount of carbohydrate is stored as fat, since the
total amount of glycogen in the liver never exceeds 150 grams, and
there is a similar store in the whole mass of muscles. It is evident,
therefore, that only a small proportion of carbohydrates is laid
down as glycogen, and we must assume that the greater part of it is
converted into fat. That fat accumulates in the body on a purely
carbohydrate diet is proved beyond a doubt, and the formation of fat
from sugar is considered proved by experimental evidence.

Sugar is an important source of energy for the muscles, and
provision is made for a sufficiency of it always to be in the blood
circulating through them, and the storehouse from which it is derived
is the liver. When the liver and muscles contain enough glycogen to
keep the blood supplied with it, the excess of sugar is converted
into fat, and is reconverted into sugar when there is a demand for it.

_Mechanics of Digestion in the Intestines._—The intestinal movements,
like those of the stomach, have recently been studied by means of the
_x_-rays. There are three kinds: A pendulum-like motion, consisting
of a gentle, swaying, rhythmic movement occurring in all parts of the
intestines. These movements do not affect the whole of the gut at one
time, but occur in successive segments of it, and are more obvious
in those parts which are distended with food, at a period of three
or four hours after a meal. They are most energetic in the upper
and least so in the lower part of the gut, and proceed from above
downward with the course of the food.

The movement consists in lengthening and narrowing, followed by
shortening and widening, of the canal; the contraction involves both
the longitudinal and circular muscular coats, and in the course of
its progress divides the bowel into many segments. This movement
breaks up the food, sways it backward and forward, diffuses the
digestive fluids through it, and drives chyle into the lacteals.

The second kind of movement consists of peristalsis, or wave-like
propulsive movements; also localized dilatation, followed by
contraction of the canal, progressing from above downward at the
rate of 1 or 2 inches per second, and is from three to four hours
traveling the entire length of the intestines.

Under pathologic conditions a third movement is observed, consisting
of a swift venicular movement, starting at the pylorus and traveling
the entire length of the gut in about one minute. It is produced by
toxins, gases, and other irritants.

Digestion is practically completed in the small intestine.

The _colon_ consists of a proximal portion, consisting of the cecum,
ascending colon, and one-half of the transverse colon; a mesial part,
formed by the other half of the transverse colon and part of the
descending colon and a distal portion, formed by the remainder of
the descending colon and of the rectum. The contents of the proximal
portion are fluid; food accumulates in this portion; it is gradually
concentrated by the absorption of water. It has been shown by the
_x_-rays that a meal reaches the cecum in four or five hours; the
hepatic flexure in six or seven hours; the splenic flexure in nine
hours; and the rectum in about eighteen hours.

The feces consist of the residue of the food, digestive secretions,
etc. The contents of the alimentary canal become altered in character
as they descend its course. The mass attains a greater density as it
descends, more and more nutrient being absorbed from it, and even
in the colon it becomes more solid; its color is brownish and its
odor characteristic. The amount of feces from an average mixed diet
represents from one-seventh to one-eighth of the food consumed.

_Defecation._—The waste matter which collects in the lower bowel
must be evacuated every day. Allowed to remain longer than this, the
digestive system is clogged by the non-removal of worn-out material,
and the blood is constantly absorbing matter which is poisonous
to the body. Decomposition goes on without being suspected by the
sufferer.

_Intestinal bacteria_ or _organized ferments_ are present throughout
the entire intestinal canal and play a part in the food changes.
They are most abundant in the lower part of the small intestine and
the upper part of the large. They act upon the proteins, causing
putrefaction, dissolve cellulose, and cause a decomposition of the
carbohydrates. The products of these fermentations include indol
and skatol, which have the characteristic fecal odor; volatile
fatty acids and gases, some of which are carbon dioxid, hydrogen,
marsh-gas, and hydrogen sulphid.

Fermentations of this character up to a certain extent are normal
and may be beneficial, but they may proceed so far as to be
deleterious to health. Anything which retards digestion, such as
imperfect mastication, excessive eating, abnormal amounts of meat in
the diet, and failure of the organs secreting the digestive fluids to
supply these secretions in sufficient quantity, gives these bacteria
a better opportunity to act on the food residues and so increases
their bad effects.

Some foods, especially vegetables of the leguminous class, appear
to be provocative of excessive intestinal fermentation. Flatulence
and even toxic poisoning may be the result of great bacterial
activity in the digestive tract. It is hardly possible to check this
by administering septics, but purging is of value by removing the
fermentative material. Particular foods, especially soured milk and
kephir, have been shown to have a preventive action on putrefaction.

_Influence of Food on Secretion._—The more recent investigations
reveal the fact that the kind of food has an influence not only on
the abundance, but also on the kind of digestive secretions; this
is most important because an abundant supply of digestive juices
is necessary for good digestion. Broths, meat extracts, and milk
stimulate the secretion of the gastric juice, which makes rational
the taking of soup or bouillon as the first course at dinner, or the
eating of toast or zwieback by persons with weak digestions. Fats,
on the other hand, tend to inhibit gastric secretion, so that an
excessive proportion of fat in the meat might hinder digestion in the
stomach.

Food may exert an indirect influence on the pancreatic secretion.
The acid in the chyme stimulates the flow of pancreatic juice. One
is almost inclined to speak of the physiologic education of the
digestive glands, and to conceive them as being trained for fat,
protein, or carbohydrate digestion.

=Metabolism.=—Life consists, so far as material phenomena are
concerned, in the transformation of matter into energy. To these
transformations the term _metabolism_ is applied. In the metabolism
of matter the changes are chemical; in energy the changes are
physical. It is commonly assumed that the laws of conservation of
matter and energy are conformed to or obeyed in animal bodies.

The body converts potential into kinetic energy by metabolism in
the body. The potential energy of food is transformed into the
actual energy of heat and mechanical labor. In this respect the only
difference between man and other vertebrates is the nervous and
intellectual processes, which are not yet understood.

Metabolism is anabolic and katabolic. _Anabolism_ is constructive;
it includes growth and the act of the tissues in selecting,
appropriating, and making substances absorbed from the alimentary
canal a part of themselves. The body is never stable; while growth
and nutrition progress, destruction or demolition takes place,
and this is called _katabolism_. To ascertain the exact amount of
matter and energy used daily by the body a balance sheet of the
exchange of material is necessary. The _income_ consists of (_a_)
matter—food, drink, and the oxygen of the air; (_b_) _energy_, the
potential energy of the food and drink. The _outgo_ consists of
(_a_) matter in the feces, urine, perspiration, and breath; (_b_)
energy—the potential energy of feces, urine, products of respiration,
and perspiration. A complete account would show the amount of C, N,
H, O, P, S, Cl, Na, Ca, K, Mg, and Fe in the income and outgo, it
would also show the compounds in the excreta, including proteins,
carbohydrates, water, and carbonic acid.

Experiments show that the body requires a given quantity of given
energy producing substances for sustenance, and something more to
meet the demands for muscular work.

The metabolism of nitrogen is usually measured by the amount of urea
in the urine, taking into account the small proportion of uric acid
and other nitrogenous bodies. In fasting the organism lives on its
own flesh and fat.

_The Effects of a Nitrogenous Diet on Metabolism._—The most striking
effect of a purely nitrogenous diet is a large increase in the
nitrogenous metabolism, but it also increases the metabolism of the
non-nitrogenous elements of the body. With an ordinary mixed diet the
normal excretion of urea varies from 33 to 37 grams a day, while with
a meat diet the urea may rise to 50 or even 80 grams daily.

_Carbohydrates as a Protein Protector._—It has long been observed
that when there was a deficiency of protein in the food the
metabolism of nitrogen will be spared and the tissues protected if
the food contains plenty of carbohydrates and fat. The subject was
fully investigated by Lusk. When the diet contains an abundance
of protein, carbohydrates, and fat the organism gains a little
nitrogen; when the diet contains the same amount of protein but no
carbohydrates, the body loses considerable nitrogen. Again, when
the food was the ordinary mixed kind, and contained a sufficiency
of energy, but was of a low protein character, the excretion of
nitrogen was normal. These results led to the conclusion that the
carbohydrates were a protein protector.

_Fat as a Protector of Proteins._—The metabolism of nitrogenous
tissue and elimination of nitrogen is not prevented by the
consumption of fat, but the consumption of fat reduces the metabolism
of protein so much that one-quarter or one-third as much meat will
suffice to maintain the nitrogen equilibrium as would have to be
consumed if only lean meat was used.

The nutritive value of meat extracts is comparatively small; their
chief value is in promoting digestion and metabolism of other foods.

_Water and Metabolism._—The body consists of 530 parts of water per
1000. It is of greatest importance as a component of the tissues to
assist in the exchange of nutritive substances, the discharge of the
products of metabolism, the regulation of temperature, and other
vital functions. If the supply of water is stopped the body will
die, and it may die sooner from the deprivation of water than from
starvation.

A reduction in the amount of water consumed accelerates the
decomposition of protein and fat to replace the water essential for
the bodily functions. As the result of experiments it has been found
that the average income of water is 4 pints, and the excretion is 4½
pints; so that at the lowest estimate ½ pint of water is formed in
the tissues by the oxidation of hydrogen in the food and tissues;
and during ordinary work it was found that 17 ounces of water was
excreted daily in excess of that consumed in food and drink.

The intense suffering entailed by prolonged thirst is to be accounted
for by the absolute necessity for preserving the normal aqueous
dilution throughout the body.

Water is also essential for removing the effete materials arising
from metabolism, cell growth, and other disintegration.

_Chlorids._—About 15 to 18 grams of sodium chlorid (common salt) are
excreted daily in the urine, and smaller quantities in the feces and
perspiration. It is, therefore, a most important food. The tissues
retain common salt most tenaciously, and when there is none in the
food it gradually disappears from the urine. It facilitates the
absorption of the protein foods and increases tissue metabolism. And,
further, an insufficiency of common salt is followed by a diminution
of hydrochloric acid from the gastric juice, and consequently a
failure of nutrition. There can be no doubt that the hydrochloric
acid of the gastric juice originates from the chlorids of the blood.

On the other hand, a very large number of people consume more salt
than they require. Salt is not only a food, it is a condiment, and
as such it is liable to abuse. It has been estimated that from 2 to
4 grams of salt a day is sufficient, whereas most people take from
20 to 30 grams daily in one way or another. The kidneys have to
excrete the excess of salt, which they seem to do in health without
any difficulty; but in nephritis the kidneys do not excrete it so
readily, and this may lead to a retention of salt in the body.

_Iron_ is essential to the human body. It is taken into the body
in the form of food, and is excreted from the body in the bile and
feces. It has been estimated that typical food contains 10 mgm. of
iron daily. The hemoglobin of the blood contains 0.04 per cent. of
iron.

=Constipation.=—It must be remembered that the intestine is a
permanent source of poisons, which, under certain conditions, cause
grave alterations in the principal organs, notably in the liver,
kidneys, and skin, and serious functional disturbances of the nervous
system.

Normally, the organism manages to protect itself against the
microörganisms which are found in the intestines; given, however,
certain conditions, the toxic products can be generated in excess
of the powers of the organism to dispose of them, such as errors
of diet, quantitative or qualitative, atony of the muscular walls
of the intestine, and, above all, constipation. The higher up in
the intestine the stasis occurs, the more serious is the result.
Constipation is considered by many surgeons as the most important
factor in the production of appendicitis.

There is frequently a condition present which is known as
semiconstipation, and which is most deceptive to the patient. There
may be a bowel movement every day, but the bowel is never emptied;
only the lower portion of the hardened fecal matter is broken off.
This is repeatedly found to be the case in examining women for some
form of pelvic trouble, and in a woman who says that she has a daily
evacuation of the bowels, and has had one that very morning, the
sigmoid flexure will be found to be packed with hardened feces.

Besides the clogging up of the digestive system by the non-removal
of the waste-products of digestion, the formation of hemorrhoids,
which is caused by the mechanical pressure on the veins, and so
interferes with their emptying out in the normal way, and the general
autointoxication of the entire system, there are also caused in
women serious displacements of the pelvic organs together with their
congestion and inflammation.

The general symptoms of autointoxication are: headache, vertigo,
palpitation of the heart, a feeble and irregular pulse, irritability
of temper, melancholia, numbness and tingling in the hands and feet,
and the emaciation and loss of weight are sometimes so marked as to
lead to the suspicion of malignant disease.

=Treatment of Constipation.=—This should always be preventive, and
the diet is a most important factor. The food should be of a coarse
quality, that is, such as directly stimulates the walls of the
intestine to contraction by their constitutents, or by the large
amount of the indigestible bulk. Corn and Graham bread should be
substituted for white bread. Toast is always constipating. Plenty of
fresh fruit and vegetables should be eaten. For those who can digest
them, raw apples, eaten just before retiring, are a great aid. The
drinking of a sufficient quantity of water daily is also essential,
and this quantity must be 3 pints. A glassful of cold water, taken
the first thing in the morning on rising, is often very effective. If
this is insufficient, the phosphate of soda, one teaspoonful to one
tablespoonful, may be added.

_Habit._—Nowhere is the effect of habit more conspicuous than in the
matter of a daily evacuation of the bowels. There should be a fixed
time every day for this, and the very best time is in the morning,
directly after breakfast. Such a habit, once established, will
enforce itself upon the attention and make regularity a necessity.
It not infrequently happens that constipation is the result of
irregularity in going to the toilet. The school-girl or woman gets up
a little late, and, although she may feel the inclination to empty
the bowels, she is able to defer it.

If the movement is sufficiently large, one stool daily is sufficient,
but where the stool is slight in quantity, there may be two or three
during the day, entirely consistent with health, and in a run down
state of the system there are apt to be several small movements
rather than one full stool. So long as the stools are not watery, the
individual may rest assured that there is no looseness of the bowels.

Constipation should never be allowed to become chronic. It is, as has
already been shown, the progenitor of myriads of the most serious
diseases; and, after the bad habits of years have been established,
it is one of the most obstinate of diseases to cure. In every case a
good physician should be consulted at once, and the treatment should
be persevered in until the cure is complete. It is a well-known fact
that all medicines for this trouble lose their effect, the dose has
to be increased, and a frequent change made from one laxative to
another. When everything else fails, electricity may be resorted to.
It is one of our most valuable remedies, since it brings about a cure
through the toning up of the muscular walls of the intestine.

The constant use of hot clysters to empty the rectum is one of
the most pernicious habits; in this manner the bowel becomes
overdistended and loses its tone, and the fecal mass is not
sufficiently large to cause the distention of the rectum, which is
the normal stimulus leading to the desire to defecate.

=The Amount of Food Required.=—Food is required for growth and for
repair; that is, to build up the organism and make good the loses
sustained by physiologic processes, to maintain the heat of the
organism, and to supply it with mechanical energy.

It has become an established custom to compare the human body to a
machine. Both derive their power from fuel; in both instances the
potential energy of the fuel is transformed into kinetic energy or
mechanical power which works the machine; in both cases the energy
which is not used in work escapes in the form of heat.

The human body uses the mechanical power chiefly in muscular work;
the heat is used in warming the body and causing the evaporation of
moisture from its surface. The animal organism is much superior to
the mechanical engine. It is more economic in the use of fuel; it
has a nervous organization rendering it sensible to impressions and
capable of directing its energies. The human machine is capable of
adapting itself to many circumstances and changes in the demands upon
it.

But to enable the body to continue to perform these functions
indefinitely it must be properly fed, and a proper feeding of the
body requires a knowledge of its composition and the exchanges which
are constantly going on. This knowledge is to be derived from a study
of its metabolism, the analysis of foods, and a determination of
their heat values.

=The Classification of Foods.=—Foods are divided into proteins,
carbohydrates, fats, mineral salts, and water. The body is composed
of materials belonging to the same groups. Proteins form the
principal part of muscles, bones, and many other tissues of animal
bodies; they also constitute some of the most important vegetable
structures.

_Proteins_ are probably the most complex compounds in nature; all
contain carbon, hydrogen, oxygen, and nitrogen, generally sulphur,
and sometimes phosphorus also. They are, with rare exceptions,
colloids, that is, glue-like, non-crystalline bodies, which even in
solution cannot pass through animal membranes.

The building stones of the body are the amino-acids. All proteins
contain them, but the kinds and proportions are not always the same.
It has been shown by biologic experiments that life and growth cannot
be maintained when certain amino-acids are deficient.

Proteins are of use to the human body as tissue formers, and,
secondly, as producers of energy, but they also have a food value
as flavoring agents, rendering the food appetizing, and so are to a
certain extent stimulants. The palatability of meats and soups are
due to their presence. The amino-acids have decided heat value.

The necessity for proteins in the diet has been abundantly
demonstrated. Many investigations have shown that when the food
contains no protein the waste of nitrogen continues, no matter how
abundant the supply of carbohydrates and fats. In other words, a
continuous protein cleavage is demanded by the animal organism, and
no other nutriments can serve as a substitute for protein to meet
this demand. If the food contains no protein, the body tissues will
be depleted. It cannot be said that carbohydrates or fats are an
essential part of the diet in the sense that protein is, because it
is possible to substitute one for the other to produce energy, or to
substitute proteins for both.

In spite of these facts, it is safe to assert that the welfare of
the human organism is best promoted by a mixed diet, including all
three classes of food. The larger part of man’s food is used for the
production of energy, and it is physiologically economic that this
energy be supplied by the non-nitrogenous nutrients, particularly the
carbohydrates, and to allocate to protein, so far as practicable, its
special rôle of building material.

_Nitrogenous Waste Products._—The end-product of proteins is urea,
which is formed from protein decomposition products in relatively
large amounts in the liver cells, and, being readily soluble and
diffusible, is easily eliminated by the kidneys. Besides urea there
are other smaller quantities of nitrogen compounds, the one most
deserving of notice being uric acid.

When the proteins are broken down to supply energy, there is always
a definite proportion of urea and uric acid residue that must be
eliminated through the kidneys. An excessive protein diet would
burden these organs beyond their accustomed habit, and flooding
the system with these nitrogenous wastes increases the tendency to
rheumatism and gout.

Uric acid is of general interest, and when present in the system
in abnormally large amounts, as in gouty persons, has a pathologic
significance. It is more complex in its composition, and, what is of
particular importance, is that it does not readily dissolve. It forms
very insoluble salts which have unpleasant tendencies to settle in
the joints, causing great pain. Did its metabolism proceed properly,
it should be resolved into urea and carbon dioxid. The quantity of
uric acid that appears in the urine is the residue that has escaped
this oxidation.

Uric acid is built up from purin bodies in the food, so that it would
be well for those with a gouty diathesis to abstain, at least when
an attack of gout threatens, from all aliment in which purin is at
all abundant. The most valuable of the purin-free foods are eggs and
milk, and to these the uric-acid sufferer has to turn in times of
trouble.

_Carbohydrates Physiologically Economic._—This group of compounds
comprises starches, sugars, and gums; the elements of which they are
composed—namely, carbon, hydrogen, and oxygen—are so balanced that if
all of the carbon were removed the residual hydrogen and oxygen would
be in the proportions to form water.

Carbohydrates are usually characterized as the fuel portions of the
food, or, in other words, that part which is burned to produce the
various forms of energy. They are also essential for the well-being
of the organism; reduction of the intake below the essential point
frequently leads to acetonuria.

When the metabolism is perfect, any carbohydrates consumed in excess
of the ordinary requirements are converted into glycogen and fat and
stored for providing fuel at a future date. When stored as fats they
are completely oxidized in the simplest compounds, carbon dioxid and
water, and are eliminated through the lungs and skin, possibly part
of the water so formed acting as a solvent for the urinary compounds.
Investigations seem to prove that the body has a preference for the
carbohydrates over fats or other nutrients as a source of energy.
There is every justification for the abundance of starches in man’s
diet.

_Fat_ is essential in the food of mankind; it is absorbed ready
formed from the food, or manufactured in the body from the proteins
and carbohydrates. Neutral fats and fatty acids are valuable foods;
their primary function is to supply the body with fuel for heat and
energy.

The _mineral substances_ form 5 or 6 per cent. by weight of the
human body, and are constantly leaving it by different channels;
they are indispensable elements of food. They give solidity and
stability to the organism, constituting a considerable proportion
of the bones. They keep various proteins in solution and confer
upon them the property of electric conductivity. They are necessary
for all of the secretions and assist in the general metabolism. The
carbonates of soda, potash, iron, and other minerals render the blood
and secretions alkaline. The removal of carbon dioxid is performed
mainly by the alkaline carbonates, which take it from the blood and
surrender it to the lungs. We have already considered the need of
sodium chlorid. The total daily requirements of salts is estimated at
about 360 grains.

_Vitamins a New Factor in Nutrition._—But recent investigation has
proved that something more is essential for the maintenance of growth
and well-being than protein, carbohydrates, fats, and salts; that
food contains a minute portion of accessory bodies, and that when
they are deficient or absent from the diet the immature body does
not grow, the mature body does not maintain its condition, and there
are manifestations of more or less serious disease. These accessory
bodies have been called “vitamins,” and they are essential to
maintain the normal metabolism of the body.

It is recognized that although vitamins are undoubtedly widely
distributed in food products, they occur for the most part in very
minute amounts, and the various foods differ in the proportion which
they contain. If the diet is made up of substances which are poor
in vitamins, or rendered so by their mode of preparation, abnormal
metabolic processes have been found to follow.

The study by many scientists during the past few years of the enzymes
and their striking specificity; of the salts; of the insufficiency
of many proteins, and of the vitamins is epoch making, and has
caused a corresponding advance in dietetics. These discoveries are
so important as to raise the question whether nutritive failure or
success does not depend as much on the accessory bodies—the vitamins,
the enzymes, and lipoids—as on the primary element of the diet.

In addition to these food principles, there exists in our food a
number of compounds which, while not indispensable, act beneficially
as flavorings, stimulants to digestion, etc.; these are termed food
adjuncts, and comprise such bases as caffein, essential oils, organic
acids, etc.

=Standard Dietaries: The Maintenance Diet.=—There is great need of
_standardization_ and of knowledge regarding the maintenance diet,
first among physicians and then among the people in general, or
scientific dietaries based on the nutritive value of foods. These
are given in terms of proteins, carbohydrates, and fats, together
with the aggregate energy of the nutritive value in each. This is the
corner-stone of dietetics.

_Dietetics_ is the science of feeding. It has to do with the
necessities of the body and the ability of the food to meet these
necessities in the various circumstances and conditions of life. The
ultimate scientific knowledge concerning human nutrition should be to
promote the healthful and economic use of food.

The problems to be dealt with are quite complex. These are: (1)
changes in the economic conditions of the population; (2) changes
in food production and food supply; (3) changes in the methods of
preparing food.

In regard to the influence of the economic conditions of the people
on the composition of their diet, it might be expected that a
considerable decrease in the earning capacity of the poorer people,
or an increase in the cost of foods, would be followed by a change in
their diet. Everyday experience teaches that under such conditions
the more expensive foods—meat, eggs, and milk—are reduced in the
diet. These same foods are also rich in vitamins, so that a reduction
here would, therefore, reduce the vitamin content of the dietary
unless other dietary complements rich in vitamins, such as legumes,
were introduced.

The value of any food as a source of heat and energy is measured by
a bomb-calorimeter. The heat given off during the combustion is a
measure of the latent or potential energy of the food. The kinetic
energy of the food is the amount of heat developed by the proportion
which is digested. The unit commonly used is the calorie, or the
amount of heat which would be required to raise the temperature of
1 kilogram of water 1° C., which is about equal to that required to
raise the temperature of 1 pound of water 4° F.

_Heat Value and Digestibility of Foods._—One of the chief functions
of food is to supply the body with heat and energy; the food must
be capable of digestion and absorption. Herein lies the exact value
of any food to the consumer. In science the figures that are given
for the digestibility of the various foods refer to the completeness
or extent to which the food is dissolved and transferred to the
circulation, and an indigestible one is that of which a considerable
portion passes out of the system into the feces without being
disintegrated and absorbed.

_Animal food_ is more completely digested than vegetable food, as
shown by the difference of nitrogen in the feces. In meats 97 per
cent. of the protein and 98 per cent. of the fat are absorbed. Lean
meat is more rapidly digested than fat, and the flesh of young
animals than that of older ones.

The breast of chicken, fresh beef, and mutton are among the most
digestible of the solid foods. Raw and rare meats are more easily
digested than well-done meats; in other words, cooking lessens the
digestibility of meats. Steak should be broiled and never fried; all
fried foods are difficult to digest. Veal and pork are both difficult
to digest.

_Eggs_ are almost as nutritious as meat; their digestibility is
unsurpassed and only equalled by a few foods, such as milk and
oysters. They are most easily digested when soft boiled or poached.
Dry toast finely broken up and mixed with a soft-boiled egg aids in
its digestion. Soft-boiled eggs are more easily digested than raw
eggs, but the latter are less irritating to the stomach, probably
because they are digested in the intestines. It has been found that
two poached or soft-boiled eggs leave the stomach in from two to
three hours; that is, in the same time as milk, oysters, white bread,
and light fish.

_Milk._—Although one of the most completely digested of foods in a
mixed diet, milk is not quite so completely digested as meat and
eggs. When milk is the sole food (milk diet) the proportion digested
depends partly on the amount consumed. With the consumption of 3½
pints of milk daily the loss of milk solids varies from 10 to 11.16
per cent. Young children digest milk more completely than adults.

The addition of aërated waters or crackers broken up in the milk
prevent the formation of tough clots, and hence render it more
digestible. Hot (not boiled) milk is more digestible than cold.
Boiling increases the toughness of the curd, but it destroys the
bacteria. Buttermilk and koumiss are more easily digested than cows’
milk.

_Wheat flour_ enters largely into the diet of every family. In
producing it the outer coating of the wheat kernel is removed, thus
throwing into the milling offals that part of the kernel which is
most heavily charged with mineral ingredients and vitamins. The
proportion of digestible proteins in white flour is not less than in
whole wheat flour, as is so often claimed, but because the latter is
richer in mineral ingredients its use is recommended.

Bread is readily digestible; white bread digests more rapidly than
brown or black; and crackers more rapidly than either.

_Rice_ is another cereal of great economic importance. As a food for
invalids it possesses a high value on account of its digestibility,
especially in intestinal diseases. Ordinarily polished rice contains
only 0.5 per cent. of cellulose, and almost all of the substance of
the grain is absorbed.

There is a perfect analogy between the well-known relation of the
polishing of rice to its nutritive value, and the milling of wheat
and corn to the nutritive value of wheat, flour, and cornmeal; that
is, it loses the mineral ingredients and vitamins.

_Potatoes._—In European countries potatoes rank next to bread; this
arises from the ease of their digestion. From 92 to 95 per cent. of
the starch is absorbed, but there is a loss of 23 per cent. of the
protein.

The manner of preparation of vegetable foods determines the
proportion of loss. When potatoes are baked or boiled in the skins
the loss is negligible. The greatest amount of loss occurs when the
skins are removed, the potatoes then allowed to soak in cold water,
and placed in cold water to boil. The potatoes should be pared just
before cooking, and the water should be boiling hard before they are
put in. Mealy potatoes digest more rapidly than waxy ones, and mashed
quicker than unmashed.

Oatmeal, barley meal, and other cereals which are not ground very
fine do not digest so easily as wheat flour, but much depends on the
mode of cooking. When oatmeal-gruel is consumed with a sufficient
amount of milk it forms a complete diet.

Nuts are valuable as a source of protein and fat, but they are rather
difficult of digestion.

_Fats._—As a rule, children do not thrive whose diet is deficient in
fats, and even adults are prone to tuberculosis and nervous diseases
when fat in the body is deficient.

Cheese is one of the most indigestible of foods. All fried foods are
highly indigestible because the fat envelope of the foods has to be
melted off before the gastric juice can act on the food substance
itself. Pastry is also very indigestible. Of the vegetables, beans,
while highly nutritious, are exceedingly difficult of digestion; also
boiled cabbage, cauliflower, hot breads, iced drinks, ice-cream, and
water-ices.

=The Relation of Diet to Various Conditions of Life.=—The chief
factors influencing bodily needs are age, height, weight, occupation,
idiosyncrasies, and atmospheric conditions.

All activity of the human body, whether in the maintenance of its
functions or in the performance of labor, is work. These two forms
of work may be classified as physiologic and mechanical. Nothing in
nutrition is more important than the relation of food to work.

_Children_ are practically in constant motion during their waking
hours, and their demand for food energy is from two to three times as
much per unit of weight as that for adults.

_Sex._—Men and women of the same age and weight, doing the same kind
and amount of work, require the same amount of food. The fact that
men usually require more food than women is because, as a rule, they
weigh more, are more active physically, and perform more external
work.

_Temperament._—Persons of a nervous type, being more active, use more
energy than the phlegmatic, and, therefore, require more food.

_Brain Workers._—A man whose work is sedentary and chiefly mental
does not need so much food as a man doing muscular work. The amount
of carbohydrates required is less, and the amount of fat rather more
than for the man doing light muscular work.

Ranke’s diet for the brain worker is: Protein, 100 grams; fats, 100
grams; carbohydrates, 240 grams; giving an energy value of 2310
calories.

The diet should not be bulky, but light and easily digestible. Excess
of food and heavy foods are especially bad for brain workers because
they produce heaviness, dulness, and drowsiness. Spiced and rich
foods upset the alimentary functions, whereby the circulation is
flooded with the products of imperfect metabolism to the detriment of
the brain.

Trained workmen will do a given amount of labor on less food than
untrained, because when persons take up mechanical operations with
which they are unfamiliar, or undertake work which exercises a new
set of muscles, a unit of work accomplished costs more in food energy
than when the muscles have been trained to do a particular thing.

Very strenuous exercise, like athletic contests and unnaturally slow
movements, are both wasteful of food energy.

Again, a continuance of the same labor for hours, and a state of
fatigue, whether it comes after a longer or shorter time, causes an
increase in the energy expenditure per unit of work performed.

Economy in the use of energy that food supplies to the body is most
fully secured when the movements of the body are at the natural rate;
when periods of intense effort do not occur, and when the labor is
not too long continued and is not carried to the point of fatigue.

_Standard for Daily Dietaries (American)—Atwater._

                                                Fuel
                                     Protein.  value.   Nutritive
                                       Grams. Calories.   ratio.

  Woman with light muscular exercise    90     2400       5.5
  Woman with moderate muscular work  } 100     2700       5.6
  Man without muscular work          }
  Man with light muscular work         112     3000       5.5
  Man with moderate muscular work      125     3500       5.8
  Man with hard muscular work.         150     4500       6.3

=The Relation of Food Economics to Social Welfare.=—A virile nation
is one whose citizens are of a good physical type, which means that
they are well nourished. A well-fed people, other conditions being
favorable, is a strong people. Food is the physical basis not only
of the individual activity, but also of social energy. Any causes,
therefore, which limit the food supply or increase the burden of
securing adequate nourishment strike a blow at the nation’s vital
power.

We must constantly keep in mind that the energy output is practically
the energy requirement, under given conditions, of course; and
the expenditure caused by the muscular activity of a particular
individual cannot be reduced without affecting the work done or
causing the loss of body substance.

Investigation has shown that there is a necessary daily protein
minimum use. When insufficient protein is taken in the food, the
necessary balance will be supplied by drawing on the tissues of
the body. The food standards which are based on the observation
of practice call for not less than 100 grams of protein daily for
professional men and 175 grams for men at severe labor.

It is held to be significant that communities holding leading
positions in the world consume a liberal amount of protein, or,
conversely, that communities with an inferior physical and mental
status use a low proportion of proteins in the diet. Again, if we
argue from the analogies in feeding farm animals, generous protein
feeding is desirable for the growth and maintenance of vigorous
organisms and a satisfactory rate of production.

On the other hand, the well-known experience of the ages has shown
that the poor who live on a low protein diet are the most liable
to disease. It cannot be gainsaid that the meat eater has greater
stamina and energy than the one whose diet is poor in protein.

The conclusion is, that while a minimum of protein is essential to
the organism, a greater proportion is advantageous by acting as a
stimulant to the metabolism and as a ready source of energy; that
people are better for the consumption of proteins in quantities
greater than in Chittenden’s standard, and possess greater resistance
to disease, probably because the body is stimulated to manufacture
antibodies.

=Practical Facts for Guidance.=—The housewife who keeps the following
facts in mind may combine foods in an approximate way that will fully
meet the demands of the human organism.

The proper ratio is 1 part of protein to 5 parts of non-protein; and
the fat should equal one-half of the weight of the protein. This
gives the following normal dietary:

                                    Energy
                     Weight.        supplied.
                  Grams. Ounces.    Calories.

  Protein          100     3½          410
  Carbohydrates    400    14½         1640
  Fats              50     1¾          465
                                      ————
                                      2515

=Proportion of Proteins in Foods.=—_Foods Rich in Proteins._—Lean
meat, dried peas, beans, and lentils, 18 to 25 per cent.; fat meat,
12 to 18 per cent.; eggs, 12 per cent.; oatmeal, 10 to 15 per cent.;
cheese, 25 to 35 per cent.

_Foods with Moderate Amounts of Proteins._—Milk averages 3½ per
cent.; fresh peas, beans, and lentils, 3 to 8 per cent.; white bread,
6 to 7 per cent.; fine wheat flour and barley, 8 to 10 or 12 per cent.

_Food with Usually Less than 3 Per Cent. of Proteins._—Green
vegetables, potatoes, and roots, such as carrots, turnips, and
onions, etc.

Legumes and certain nuts supply relatively more protein than other
vegetable foods, so that when the cost of meat, fowl, fish, eggs, or
milk is prohibitive, the freer use of beans, peas, lentils, and nuts
is strongly recommended.

The unmodified foods, such as grain, vegetables, fruit, meat, eggs,
and milk, may be depended upon to amply supply all the necessary
elements to sustain growth, functions, and waste of the human
body. On the other hand, foods which it is proper to designate as
“artificial” are not only not essential to an adequate diet, but when
they are used freely may render a diet very one-sided or deficient.

Foods may be so selected as to furnish an abundant supply of mineral
ingredients. For instance, the dry substance of certain vegetables
like asparagus, lettuce, spinach, and such animal foods as eggs, and
beef extracts are relatively rich in iron compounds, and the dried
substance of leguminous seeds, carrots and other vegetables, milk,
and cheese are relatively rich in calcium compounds.

_Variety of foods_ is necessary, for monotony of even the best kinds
leads to satiety, loss of appetite, loathing of food, and subsequent
ill-health. Vegetables and fruits are absolutely essential, but
raw fruits are not so easily digested as cooked. Salads, lettuce,
water-cress, green onions, celery, tomatoes, etc., are so valuable
for the juices contained in them that they cannot be too strongly
recommended to those who can digest them. Similar juices are
contained in cabbage, cauliflower, spinach, etc., but these are lost
to a very great measure in the cooking.

Oranges, lemons, grapes, strawberries, and bananas contain equally
valuable juices, and may be eaten raw with advantage to the consumer;
but apples, pears, plums, gooseberries, and many other fruits are
better cooked before being eaten.

The simpler the meals, the less work will be expended in their
preparation, and there is no advantage in an elaborate meal. The main
thing is that the table should furnish a sufficient variety from day
to day.

The following specimen dietary has been found to be most satisfactory
for women with sedentary occupations. On it women have maintained
good health and other women have regained their health:

_Breakfast._—Fruit, bacon and eggs, breakfast hominy, rolls or toast
and butter, a glass of milk, and one cup of coffee.

The fruit may be any raw fruit in season except apples or bananas;
apples should always be cooked for breakfast because they are more
easily digested; bananas are too heavy and indigestible to be served
for breakfast. Stewed prunes are good and especially laxative.

Bacon is not a necessity, though it is an appetizer. Eggs may be
served in any way, though they are most digestible when soft boiled
or poached.

The hominy is boiled in water and served as a vegetable, with a
little salt and butter, but _no_ sugar.

For women with good digestion and taking more active exercise,
oatmeal and cream may be substituted for the eggs, hominy, and glass
of milk.

_Luncheon_ may be served in a very appetizing way from the cold meat
and vegetables which have been left from the previous day’s dinner
in the form of stews, baked hash, etc. Stewed fruit should always be
served, and oysters always make a nice dish for lunch.

The criticism of the ordinary lunch for women is that it is too
light. The food served for lunch should furnish about 1000 calories;
90 per cent. of these should be in the form of starches and fats.

_Dinner._—The following is a balanced ration given in the Educational
Lunch Room of the New York Department of Health:

                                                              Proteins.
                              Price.    Quantity.   Calories.  Grams.
  Vegetable soup             5 cents.   ½ pint.        150      5
  Roast beef                20 cents.   4 oz. lean.    140     30 or
  Roast beef with                       4 oz. fat.     460     27
  Mashed potatoes, creamed              Av. helping.   110      4.0
  String beans               5 cents.   2 h. tbsp.      10       .5
  Salad a la Sauté           8 cents.   Av. helping.   370      2.0
  Whole wheat bread                     2 slices.      140      5.5
  Butter                                ½ ounce.       120
  Apple pie                  5 cents.   ⅙ pie.         300      4.0
  Black coffee               3 cents.   1 cup.
  Sugar                                 2 squares.      60
                           ——————————                 ————     —————
                            46 cents.                 1760 or   50 or
                                                      1440      53

One glass of water is served with each meal; it should be taken when
the meal is finished.

The mineral waters promote digestion by promoting an earlier and more
abundant secretion of the gastric juice.

Lemon juice should be substituted for vinegar in all salad dressings.
For a French dressing the correct proportions are 1 tablespoonful of
lemon juice and water each to 2 of olive oil. Mix well, and pour over
the salad just before serving.

Three meals a day has been found to be the best arrangement, and
there should be an interval of five hours between the meals. If
possible dinner, which is the principal meal, should be taken at the
end of the day, after its work is over, so that comparative repose
may be enjoyed after it. It is of extreme importance that the meals
be served at the same hour every day. The perfectly healthy woman
should never take anything to eat between meals.

A hearty meal should never be eaten when one is exhausted or
greatly fatigued. Half an hour’s rest before dinner is a great
aid to digestion. Sleep directly after a hearty meal is injurious
and sometimes proves fatal because there is a depression of the
circulation, and the digestive processes may stop absolutely during
sleep.

_Preparation of Food._—Fresh meats are highly nutritious, but in
order that the nutritive properties may not be lost in the cooking,
they must be eaten “rare,” that is, beef and mutton should be at
least pink.

A roast should be done in a quick oven, so that the albumin shall
rapidly coagulate on the surface and prevent the escape of the
nutritive juices. Or if the meat is boiled, it should for the same
reason be plunged into boiling water.

On the other hand, in treating meats in order to obtain “stock” for
soup, the meat after having been cut up into small pieces should be
allowed to stand in cold water for twenty minutes and then be put on
to simmer for six hours or more.

Plenty of bones with gristle should be gotten with the soup meat;
these do not add to the cost, and add materially to the value of the
stock; for, while the gelatinoids are not flesh formers, they are
admirable protein sparers. The same thing holds true of gelatin and
its preparations.

_Indigestible Combination of Foods._—The acid of vinegar being a
fermentation acid renders the digestion of many foods with which
it is taken more difficult, while vegetable acids, such as citric
and tartaric, do not cause that objectionable effect. Vinegar also
retards salivary and gastric digestion.

_Strong tea_ taken with any meat meal converts the albumin of the
meat into a dense precipitate that is absolutely indigestible. The
tannin of tea inhibits the salivary and gastric secretions and so
retards digestion. Indigestion, atony, or catarrh of the stomach
is frequently due to excessive tea drinking, and the artificial
stimulation of the nervous system may be carried so far as to produce
insomnia, palpitation, muscular tremors, and other signs of nervous
irritability.

Claret and coffee both delay digestion.

Water is the best beverage to be taken with meals; but the
moderate use of tea and coffee is commendable because they have an
invigorating effect arising from the caffein and the essential oils,
but their use should not be abused.

_The Proper Way of Making Tea._—The water should be freshly boiled;
the tea-pot heated so that the water will be maintained at the
boiling-point; one teaspoonful of tea is allowed to the cup. The
tea is measured out, put into the tea-pot, and the requisite amount
of boiling water poured over it. It is then allowed to stand on the
kitchen table, _not_ the range, for from two to three minutes; it
should then be strained into the tea-pot for the table.

Unless the tea is strained off the leaves the infusion continues
for some time; this extracts the tannic acid and bitter principles.
In addition, the prolonged infusion dissipates the volatile oil, to
which much of the fragrance of a good cup of tea is due.

As it is almost impossible to have the requisite amount of care
exercised in the making of tea in the kitchen, it is much better that
it should be made on the table. Sugar detracts from the healthfulness
of the beverage.

_Coffee._—Most that has been said about tea is true of coffee. It is
aromatic and refreshing, stimulates the mental activity, invigorates
the muscular system, and removes the sense of fatigue. The excessive
use of coffee often leads to insomnia. Its use retards gastric
digestion, but less so than tea; but strong coffee or café noir has
a still greater inhibitory effect. It has a slightly aperient effect
on the intestines by increasing the peristaltic action. It is also
slightly diuretic.

The aromatic oils are dissipated by boiling, and the best temperature
of the water is 210° F., or just below the boiling-point.

_Defective Methods in the Preparation of Breads which Reduces
the Vitamin Contents, Especially of Corn Bread._—By resorting to
artificial methods for procuring the lightness of breads, baking
soda (sodium bicarbonate) is used. In order to prepare bread in this
way the cornmeal is mixed with milk or water to which baking soda
has been added, and put in the oven to bake. The high temperature of
the oven liberates the carbon dioxid (CO_{2}) from the baking soda,
causing the bread to rise, and the sodium bicarbonate is transformed
into sodium carbonate, a strong alkali. Recent experiments have
clearly demonstrated the destructive action of the alkalies on the
vitamins, this being especially true at high temperatures.

It should be strongly emphasized that the old-fashioned way of
combining baking soda with sour milk in the preparation of bread is
an entirely harmless procedure, provided that sufficient sour milk
is added to perfectly neutralize the alkalinity of the soda. The
label on some brands of baking soda clearly states that sour milk, or
tartaric acid, should be added in order to obtain the best results.

=Dietary in the Tropics.=—Sir R. Havelock Charles says, “It is
impossible to form exact rules for dietary in the tropics because
there are differences in climate which require modifications.” He
says nothing about limiting the amount of meat, but he does say, “no
_cold_ meat whatever should come on the table.” It is important that
everything should come straight from the fire to the table. It cannot
then cause bacillary mischief, and there should be no fear of cholera
or dysentery.

Boiled water only should be drunk. No salads of any kind should be
used except in the greatest moderation.

_Fruit._—Every fruit which possesses a rind that can be removed
may be eaten raw with impunity by a healthy man at any time of the
year. Fruits which do not possess a rind are incapable of being
thoroughly cleansed; such fruit may be contaminated and dangerous
to the consumer, and, at any rate, ought only to be eaten after it
is cooked. Therefore oranges, grape-fruit, pears, apples, bananas,
mangoes, pineapples, custard-apples, mangosteen, tomatoes, etc.,
may be eaten raw after peeling them. But it would be unsafe to eat
grapes, currants, strawberries, and other fruits which cannot be
peeled until they are cooked.

As regards proteins, some fish, fowl, or meat may be taken for
breakfast; animal food ought not to be taken in the middle of the
day. It is better to take dinner in the evening. Beef, mutton, pork,
kid (goat-flesh), venison (deer and antelope), poultry, many kinds
of birds, eggs, and fish are obtainable in one place or another.
Tinned meats and fish should be avoided; indeed, the importance of
fresh meat is so great that hunting, shooting, and fishing should be
strongly recommended as exercise.

Fat is obtained in the form of meat, dripping, butter, ghee, nuts,
and various oils used in cooking. The pure oil from peanuts,
palm-nuts, and cocoanuts is salutary; but many samples are
adulterated with sesamé oil, poppy-seed oil, and colza oil, which are
deleterious by causing dyspepsia or other gastro-intestinal troubles.
These in turn render the subject susceptible to dysentery, sprue, and
other tropical disorders.

=Food Economics: Regulation of Diet with Reference to Minimum
Expenditure.=—The cost of a meal for an individual or a family is
made up of two factors—the money cost of the raw materials, and the
time, cost of labor, and other expenses required for the preparation
and serving of the food.

_The Cost of Raw Food Materials._—Meats of all kinds, poultry, and
fish are the most expensive articles of diet. Then, too, the waste
has to be considered—the bones and legs of a dressed fowl and the
bones and skin of fish.

At the present time the dairy products supply the cheapest nutriment
among animal foods, but the price of butter and eggs are apt to soar
enormously during the winter months.

_Leguminous Food._—The dried pea, bean, or lentil are especially rich
in protein, and are thus fit to take the place of a part of meat
in the dietary. Their price is low in comparison to their value,
and must be considered next to bread in importance. They are less
completely digested than cereals if eaten in any quantity; and,
highly nutritious as these are, it cannot be denied that in large
quantities they are very indigestible for any but persons with strong
constitutions and leading an active outdoor life.

Great care is needed in their preparation. Dried legumes should be
soaked in cold water for eight hours, and then boiled for one hour
and a half. They are then sufficiently soft to be pressed through
a sieve. The skin of peas and beans that have been dried should be
removed, for they pass through the intestines unchanged. Soft water
should be used in preference to hard, as insoluble lime compounds are
formed by the latter with the protein “legumin.”

_Outside Preparation Expensive._—From the standpoint of food value,
white bread is more than twice as costly as the wheat flour from
which it is made. A barrel of flour of 196 pounds will make on the
average 315 5-cent loaves of bread. The bread costs the consumer
$15.75, whereas the flour can be bought at the time of writing for
$6.50.

Breakfast foods ready for the table, instead of the cheaper cornmeal,
oatmeal, and hominy cooked at home, and bread, cake, and other pastry
cost double the amount of the raw materials.

There are, however, other factors which complicate and increase the
cost of living. At present the exorbitant cost of labor, cost of
fuel, etc., and the amount of the housewife’s time consumed are all
important factors to be taken into consideration.

The size of the family, the number of small children demanding the
mother’s attention, the kind of labor in which they are engaged,
whether hired help has to be depended on for all the work, etc., are
all factors which must be taken into consideration as to whether
the outside preparation is more expensive than when the labor is
performed in the home. This is a matter for every housewife to work
out in making her monthly and yearly budgets.

                                        TABLE OF FOOD VALUES[4]
  ——————————————————————————————+————————————————————————————
                                |   Percentage composition.
                                |
      Kind of food, edible      +————————+———————————+———————
         portion only.          | Water. |  Protein. |  Fat.
                                |        |           |
  ——————————————————————————————+————————+———————————+———————
          _Meats._              |        |           |
  Beef:                         |        |           |
    Roast, average              |  48.25 |   22.25   | 28.55
    Roast ribs, fat             |  45.20 |   19.14   | 39.04
    Boiled, average             |  39.10 |   26.30   | 35.00
    Broiled steak               |  44.25 |   23.45   | 26.50
    Corned                      |  51.19 |   26.32   | 18.65
  Veal: Cooked, average         |  51.88 |   32.20   | 11.40
  Mutton:                       |        |           |
    Roast, average              |  51.00 |   26.00   | 22.60
    Boiled leg                  |  57.67 |   27.60   | 14.38
  Lamb:                         |        |           |
    Roast leg                   |  67.10 |   19.70   | 12.70
    Various parts               |  47.25 |   23.80   | 28.50
  Pork: Roast, various parts    |  45.00 |   32.00   | 20.00
  Organs:                       |        |           |
    Heart, cooked, average      |  62.60 |   16.60   | 20.00
    Kidney, ox, cooked, average |  76.15 |   16.50   |  4.90
    Liver, ox, cooked, average  |  71.00 |   20.60   |  4.60
    Sweetbread, ox, cooked,     |        |           |
      average                   |  71.00 |   16.80   | 12.00
    Tongue, ox, cooked, average |  71.00 |   19.00   |  9.00
                                |        |           |
        _Soup, etc._            |        |           |
  Beef-tea                      |  93.00 |    4.30   |   .50
  Bouillon                      |  96.50 |    2.30   |   .10
  Chicken broth                 |  94.00 |    3.80   |   .10
  Consomme                      |  95.50 |    2.40   |   .10
  Meat hash                     |  80.00 |    6.50   |  2.00
  Meat stew                     |  84.50 |    4.60   |  4.30
  Oxtail soup                   |  89.00 |    4.00   |  1.50
  Pea soup                      |  87.00 |    4.00   |   .80
  Soup stock, beef              |  89.10 |    5.80   |  1.50
  Tomato soup                   |  89.00 |    2.00   |  1.50
  Meat juice (natural), average |  90.00 |    5.37   |   .19
                                |        |           |
           _Fowl._              |        |           |
  Domestic, average             |  64.00 |   19.00   | 16.00
  Chicken                       |  67.00 |   22.70   | 10.00
  Capon                         |  56.00 |   21.80   | 21.00
  Duck                          |  55.75 |   17.50   | 25.00
  Goose                         |  52.00 |   16.50   | 35.10
  Turkey                        |  55.50 |   21.10   | 23.00
    Roast                       |  52.00 |   27.80   | 18.50
  Roast capon                   |  59.00 |   27.00   | 11.50
    Chicken                     |  66.90 |   22.00   |  8.10
  Boiled fowl                   |  57.60 |   27.00   | 12.80
                                |        |           |
           _Eggs._              |        |           |
  Chicken eggs:                 |        |           |
    Raw                         |  73.70 |   13.40   | 11.50
    Boiled, white.              |  86.30 |   12.80   |   .20
      Yolk                      |  50.00 |   14.80   | 33.70
                                |        |           |
   _Fish and Shell-fish._       |        |           |
  Bluefish                      |  78.50 |   19.10   |  1.20
  Haddock, fresh                |  81.40 |   17.20   |   .30
                                |        |           |
  Halibut steak                 |  74.80 |   18.50   |  5.30
  Mackerel                      |  74.80 |   18.50   |  6.50
  Oysters                       |  80.00 |   10.60   |  2.60
  Perch                         |  75.70 |   19.00   |  4.00
  Salmon, Atlantic              |  63.60 |   21.60   | 13.90
  Sardines                      |  56.30 |   24.80   | 12.70
  Shad                          |  70.60 |   18.50   |  9.50
    Roe                         |  71.20 |   21.00   |  3.80
  Trout:                        |        |           |
    Brook                       |  77.70 |   19.30   |  2.10
    Lake                        |  69.30 |   18.30   | 10.60
  Salmon                        |  70.80 |   17.80   | 10.20
  Calf’s foot jelly             |  77.50 |    4.50   |  ....
                                |        |           |
        _Milk Products._        |        |           |
  Cows’ milk, average           |  87.30 |    3.50   |  3.70
    Skimmed                     |  90.30 |    4.00   |   .20
  Condensed milk, full cream,   |        |           |
      unsweetened               |  62.40 |   10.60   | 10.80
    Full cream, sweetened       |  20.00 |   10.50   |  9.90
    Skimmed and sweetened       |  26.40 |   10.40   |   .90
  Cream, hand skimmed           |  74.00 |    2.50   | 18.50
  Buttermilk                    |  90.00 |    3.20   |  1.20
  Cheese from skimmed milk.     |  45.30 |   32.00   | 16.50
  Butter:                       |        |           |
    Best quality                |  13.00 |    1.00   | 82.50
    Second quality              |  16.00 |    2.00   | 73.00
  Margarine                     |  16.00 |    1.10   | 76.70
                                |        |           |
        _Cereal Foods._         |        |           |
  Wheat flour, superfine, white.|  10.50 |   11.90   |  1.60
  Entire wheat                  |  10.80 |   12.20   |  2.20
  Graham                        |   8.60 |   12.60   |  2.40
  Maize                         |  10.90 |   10.20   |  4.80
    Meal                        |  12.50 |    7.10   |  1.30
  Rice                          |  12.40 |    6.90   |   .40
    Boiled                      |  72.50 |    2.80   |   .10
  Oatmeal, boiled               |  84.50 |    2.80   |   .50
  Macaroni, cooked              |  78.40 |    3.00   |  1.50
                                |        |           |
        _Bread._                |        |           |
  White, best                   |  44.10 |    7.70   |   .90
  Entire wheat                  |  49.10 |    7.40   |  1.10
  Brown (Graham)                |  47.20 |    7.70   |  1.20
  Gluten bread                  |  38.20 |    9.30   |  1.40
  Toasted bread                 |  24.00 |   11.50   |  1.60
  Zwiebach                      |   5.80 |    9.80   |  9.90
                                |        |           |
       _Pies and Puddings._     |        |           |
  Apple pie                     |  42.50 |    3.10   |  9.80
  Cornflour blanc mange         |  66.00 |    2.60   |  3.10
  Custard with crust            |  62.40 |    4.20   |  6.30
  Maize pudding (Indian meal)   |  60.00 |    5.50   |  5.00
  Rice pudding                  |  60.00 |    4.00   |  4.70
  Tapioca pudding               |  64.50 |    3.30   |  3.20
    With apples                 |  70.10 |     .30   |   .10
                                |        |           |
        _Roots and Tubers._     |        |           |
  Carrots, boiled               |  92.50 |     .50   |   .20
                                |        |           |
  Beets, boiled                 |  91.70 |   1.40    |   .10
  Parsnips, boiled              |  92.10 |   1.30    |   .30
  Potatoes, boiled              |  75.50 |   2.50    |   .10
    Mashed, with cream          |  75.10 |   2.60    |  3.00
    Fried in fat                |   2.20 |   6.80    | 39.80
                                |        |           |
        _Vegetables._           |        |           |
  Asparagus, cooked and buttered|  91.60 |   2.10    |  3.30
  Brussels sprouts, boiled      |  93.70 |   1.50    |   .10
  Cabbage                       |  85.50 |   2.30    |   .70
    Boiled                      |  97.00 |    .60    |   .10
  Cauliflower, boiled           |  97.30 |    .60    |   .10
  Celery, boiled                |  97.00 |    .40    |   .07
  Green peas, boiled            |  73.80 |   6.70    |  2.50
  Beans, string, boiled         |  89.20 |   2.30    |   .30
                                |        |           |
        _Salads._               |        |           |
  Celery                        |  94.50 |   1.10    |   .10
  Cucumber                      |  94.90 |    .70    |   .20
  Endive                        |  93.00 |   1.00    |   .10
  Lettuce                       |  93.80 |   1.80    |   .60
  Onions                        |  87.60 |   1.60    |   .30
  Radishes                      |  91.80 |   1.20    |   .10
  Tomatoes                      |  91.80 |   1.20    |   .10
  Watercress                    |  92.80 |    .70    |   .40
                                |        |           |
        _Dried Legumes._        |        |           |
  Peas                          |   9.50 |  23.80    |  1.80
  Haricot beans                 |  12.60 |  22.50    |  1.90
  Butter beans                  |  10.50 |  20.60    |  2.00
                                |        |           |
        _Nuts._                 |        |           |
  Almonds, dried                |   4.80 |  21.00    | 54.90
  Brasil nuts                   |   5.40 |  18.00    | 66.00
  Butter nuts                   |   4.50 |  28.00    | 61.00
  Chestnuts                     |   4.80 |  11.60    | 15.30
  Cocoanut, fresh               |  19.20 |   5.40    | 51.00
  Hazel and filbert nuts        |  48.00 |   8.00    | 28.50
  Peanuts                       |   9.20 |  26.00    | 38.60
  Walnuts, dried                |   4.90 |  15.50    | 62.70
                                |        |           |
        _Fruits._               |        |           |
  Apples:                       |        |           |
    Raw                         |  85.20 |    .40    |   .50
    Cooked and sweetened        |  66.10 |    .20    |   .80
    Dried                       |  28.10 |   1.60    |  2.20
  Apricots                      |  85.00 |   1.10    |  ....
    Canned                      |  81.40 |    .90    |  ....
  Bananas                       |  75.70 |   1.30    |   .50
  Blackberries                  |  86.30 |   1.30    |  1.00
  Cherries                      |  82.00 |    .90    |   .80
  Cranberries                   |  88.90 |    .50    |   .60
  Dates, dried                  |  20.00 |   3.50    |  2.30
  Figs, dried                   |  22.70 |   4.30    |   .70
  Grapes, fresh                 |  80.50 |    .90    |   .80
    Dried, raisins              |  18.60 |   3.00    |  2.80
  Jam, or preserve, average     |  30.50 |   1.50    |  ....
                                |        |           |
  Melon                         |  89.50 |    .60    |   .30
  Oranges                       |  82.80 |    .90    |   .20
  Peaches                       |  88.80 |    .50    |   .20
    Canned                      |  88.10 |    .70    |   .10
  Pears                         |  80.90 |    .90    |   .50
    Canned                      |  81.10 |    .30    |   .30
  Pineapples                    |  89.30 |    .40    |   .30
  Plums                         |  74.50 |    .90    |   .20
  Prunes:                       |        |           |
    Dried                       |  22.30 |   2.10    |   .20
    Stewed                      |  76.60 |    .50    |   .10
  Raspberries                   |  86.20 |    .50    |  ....
  Strawberries                  |  94.00 |   1.00    |   .60
  ——————————————————————————————+————————+———————————+———————

  ——————————————————————————————+—————————————————+——————————+——————————
                                | Percentage      | Heat     |  Food
                                | composition.    |  value   | values
      Kind of food, edible      +——————————+——————+ calories |comparison
         portion only.          | Carbo-   | Ash. |   per    | of 1000
                                | hydrate. |      |  ounce.  | grams.
  ——————————————————————————————+——————————+——————+——————————+——————————
          _Meats._              |          |      |          |
  Beef:                         |          |      |          |
    Roast, average              |    ...   | 1.25 |  160     |  1868
    Roast ribs, fat             |    ...   |  .82 |  122     |  2057
    Boiled, average             |    ...   | 1.00 |  175     |  2268
    Broiled steak               |    ...   | 1.43 |  100     |  1942
    Corned                      |    ...   | 4.10 |   80     |  1810
  Veal: Cooked, average         |    ...   | 1.50 |   68     |  1896
  Mutton:                       |          |      |          |
    Roast, average              |    ...   | 1.19 |   90     |  1805
    Boiled leg                  |    ...   | 1.05 |   67     |  1738
  Lamb:                         |          |      |          |
    Roast leg                   |    ...   |  .80 |   66     |  1318
    Various parts               |    ...   | 1.25 |  100     |  1966
  Pork: Roast, various parts    |    ...   | 1.76 |   90     |  2122
  Organs:                       |          |      |          |
    Heart, cooked, average      |    ...   | 1.00 |   70     |  1370
    Kidney, ox, cooked, average |     .40  | 1.20 |   32     |   940
    Liver, ox, cooked, average  |    1.80  | 1.50 |   38     |  1150
    Sweetbread, ox, cooked,     |          |      |          |
      average                   |    ...   | 1.60 |   51     |  1157
    Tongue, ox, cooked, average |    ...   | 1.00 |   46     |  1188
                                |          |      |          |
        _Soup, etc._            |          |      |          |
  Beef-tea                      |    1.10  | 1.10 |    8     |   234
  Bouillon                      |     .20  |  .90 |    3     |   116
  Chicken broth                 |    1.80  | 1.00 |    6     |   200
  Consomme                      |     .30  | 1.10 |    3     |   120
  Meat hash                     |    9.00  | 2.40 |   24     |   560
  Meat stew                     |    5.50  | 1.10 |   23     |   420
  Oxtail soup                   |    4.30  | 1.50 |   13     |   278
  Pea soup                      |    8.50  | 1.30 |   15     |   291
  Soup stock, beef              |    ...   | 3.60 |   11     |   324
  Tomato soup                   |    5.50  | 1.30 |   12     |   158
  Meat juice (natural), average |     ...  | 1.36 |    7     |   269
                                |          |      |          |
           _Fowl._              |          |      |          |
  Domestic, average             |     ...  | 1.00 |   65     |  1130
  Chicken                       |     ...  | 1.00 |   62     |  1395
  Capon                         |     ...  | 1.30 |   91     |  1656
  Duck                          |     ...  | 1.00 |   95     |  1554
  Goose                         |     ...  | 1.20 |  110     |  1800
  Turkey                        |     ...  | 1.00 |   85     |  1679
    Roast                       |     ...  | 1.30 |   82     |  1872
  Roast capon                   |     ...  | 1.30 |   60     |  1677
    Chicken                     |     ...  | 1.70 |   58     |  1298
  Boiled fowl                   |     ...  | 1.90 |   80     |  1708
                                |          |      |          |
           _Eggs._              |          |      |          |
  Chicken eggs:                 |          |      |          |
    Raw                         |     ...  | 1.00 |   45     |   983
    Boiled, white.              |     ...  |  .70 |   16     |   633
      Yolk                      |      ... | 1.20 |  106     |  1883
                                |          |      |          |
   _Fish and Shell-fish._       |          |      |          |
  Bluefish                      |      ... | 1.20 |   27     |   935
  Haddock, fresh                |      ... | 1.10 |   21     |   922
                                |          |      |          |
  Halibut steak                 |    ....  | 1.40 |   35     |   850
  Mackerel                      |    ....  | 1.10 |   40     |  1086
  Oysters                       |    6.50  | 1.30 |   25     |   655
  Perch                         |    ....  | 1.20 |   33     |  1049
  Salmon, Atlantic              |    ....  | 1.40 |   64     |  1445
  Sardines                      |    ....  | 5.00 |   79     |  1560
  Shad                          |    ....  | 1.30 |   47     |  1170
    Roe                         |    2.50  | 1.50 |   38     |  1252
  Trout:                        |          |      |          |
    Brook                       |    ....  | 1.20 |   28     |   995
    Lake                        |    ....  | 1.20 |   48     |  1190
  Salmon                        |    ....  | 1.20 |   48     |  1156
  Calf’s foot jelly             |   17.40  |  .70 |   26     |   210
                                |          |      |          |
        _Milk Products._        |          |      |          |
  Cows’ milk, average           |    4.60  |  .73 |   20     |   320
    Skimmed                     |    4.60  |  .83 |   11     |   245
  Condensed milk, full cream,   |          |      |          |
      unsweetened               |   14.10  | 2.00 |   52     |   973
    Full cream, sweetened       |   57.50  | 2.10 |  100     |  1368
    Skimmed and sweetened       |   60.20  | 2.10 |   40     |  1232
  Cream, hand skimmed           |    4.50  |  .50 |   56     |   210
  Buttermilk                    |    5.00  |  .60 |   10     |   238
  Cheese from skimmed milk.     |    2.00  | 4.20 |   85     |  2140
  Butter:                       |          |      |          |
    Best quality                |    1.50  | 2.00 |  225     |  2371
    Second quality              |    4.00  | 5.00 |  203     |  2235
  Margarine                     |    ....  | 6.30 |  220     |  2210
                                |          |      |          |
        _Cereal Foods._         |          |      |          |
  Wheat flour, superfine, white.|   75.40  |  .50 |  114     |  1283
  Entire wheat                  |   73.60  | 1.00 |  114     |  1300
  Graham                        |   74.50  | 1.70 |  116     |  1330
  Maize                         |   71.00  | 1.30 | ....     |  1242
    Meal                        |   78.30  |  .60 |  108     |  1106
  Rice                          |   79.40  |  .50 |  102     |  1084
    Boiled                      |   24.50  |  .20 |   45     |   258
  Oatmeal, boiled               |   11.50  |  .70 |   18     |   244
  Macaroni, cooked              |   15.80  | 1.30 |   26     |   558
                                |          |      |          |
        _Bread._                |          |      |          |
  White, best                   |   46.90  |  .30 |   71     |   793
  Entire wheat                  |   41.70  |  .50 |   65     |   770
  Brown (Graham)                |   42.80  |  .90 |   67     |   780
  Gluten bread                  |   49.80  | 1.30 |   72     |   910
  Toasted bread                 |   61.20  | 1.70 |   90     |  1126
  Zwiebach                      |   73.50  | 1.00 |  125     |  1399
                                |          |      |          |
       _Pies and Puddings._     |          |      |          |
  Apple pie                     |   43.00  | 1.80 |   80     |   866
  Cornflour blanc mange         |   27.00  | 1.00 |   36     |   456
  Custard with crust            |   26.10  | 1.00 |   52     |   604
  Maize pudding (Indian meal)   |   28.00  | 1.40 |   51     |   628
  Rice pudding                  |   32.00  |  .60 |   52     |   608
  Tapioca pudding               |   28.50  |  .80 |   45     |   505
    With apples                 |   30.00  |  .20 |   36     |   289
                                |          |      |          |
        _Roots and Tubers._|          |      |          |
  Carrots, boiled               |    4.50  |  .80 |    8     |    70
                                |          |      |          |
  Beets, boiled                 |    5.13  | 1.00 |   11     |   102
  Parsnips, boiled              |    6.50  |  .70 |   11     |   126
  Potatoes, boiled              |   21.00  | 1.00 |   26     |   312
    Mashed, with cream          |   17.80  | 1.50 |   31     |   364
    Fried in fat                |   46.70  | 4.50 |  166     |  1807
                                |          |      |          |
        _Vegetables._           |          |      |          |
  Asparagus, cooked and buttered|    2.20  |  .80 |   30     |   200
  Brussels sprouts, boiled      |    3.40  |  .20 |    6     |    98
  Cabbage                       |    5.10  | 1.70 |    9     |    89
    Boiled                      |    1.40  |  .20 |    3     |    41
  Cauliflower, boiled           |    1.40  |  .50 |  ....    |   41
  Celery, boiled                |    1.00  |  .50 |          |    26
  Green peas, boiled            |   14.60  | 1.50 |   34     |   588
  Beans, string, boiled         |    7.40  |  .80 |   12     |   176
                                |          |      |          |
        _Salads._               |          |      |          |
  Celery                        |    9.70  | 1.00 |   13     |   144
  Cucumber                      |    3.10  |  .50 |    4     |    64
  Endive                        |    3.00  |  .60 |    8     |    73
  Lettuce                       |    4.80  | 1.20 |    9     |   138
  Onions                        |    9.50  | 1.10 |   13     |   167
  Radishes                      |    5.60  |  .70 |    5     |   107
  Tomatoes                      |    5.60  |  .70 |    5     |   107
  Watercress                    |    4.00  | 1.20 |    6     |    79
                                |          |      |          |
        _Dried Legumes._        |          |      |          |
  Peas                          |   60.30  | 2.60 |  104     |  1544
  Haricot beans                 |   59.60  | 3.50 |  100     |  1654
  Butter beans                  |   62.60  | 4.20 |  102     |  1519
                                |          |      |          |
        _Nuts._                 |          |      |          |
  Almonds, dried                |   17.30  | 2.50 |  189     |  2645
  Brasil nuts                   |    8.00  | 2.70 |  204     |  2606
  Butter nuts                   |    3.50  | 2.90 |  192     |  2956
  Chestnuts                     |   65.70  | 2.60 |  117     |  1537
  Cocoanut, fresh               |   10.00  | 1.20 |  108     |  ....
  Hazel and filbert nuts        |   11.50  | 1.50 |  160     |  ....
  Peanuts                       |   24.20  | 2.00 |  160     |  2071
  Walnuts, dried                |    7.50  | 1.90 |  190     |  2364
                                |          |      |          |
        _Fruits._               |          |      |          |
  Apples:                       |          |      |          |
    Raw                         |   12.60  |  .30 |   18     |   149
    Cooked and sweetened        |   37.20  |  .70 |   46     |   395
    Dried                       |   66.10  | 2.00 |   84     |   753
  Apricots                      |   13.40  |  .50 |   18     |   176
    Canned                      |   17.30  |  .40 |   21     |   208
  Bananas                       |   21.70  |  .70 |   29     |   276
  Blackberries                  |    8.40  |  .50 |   17     |   120
  Cherries                      |   14.30  |  .60 |   23     |   197
  Cranberries                   |    4.00  |  .20 |   14     |    76
  Dates, dried                  |   69.00  | 1.30 |  101     |   885
  Figs, dried                   |   62.50  | 1.30 |   80     |   805
  Grapes, fresh                 |   14.70  |  .50 |   28     |   201
    Dried, raisins              |   70.50  | 2.70 |  100     |   870
  Jam, or preserve, average     |   60.00  |  .50 |   70     |   744
                                |          |      |          |
  Melon                         |    7.20  |  .60 |   11     |   103
  Oranges                       |   10.60  |  .70 |   15     |   146
  Peaches                       |    9.20  |  .60 |   12     |   117
    Canned                      |   10.80  |  .30 |   14     |   128
  Pears                         |   15.70  |  .40 |   18     |   203
    Canned                      |   18.00  |  .30 |   22     |   195
  Pineapples                    |   10.00  |  .90 |   13     |   112
  Plums                         |   19.10  |  .50 |   24     |   200
  Prunes:                       |          |      |          |
    Dried                       |   73.30  | 2.30 |   86     |   724
    Stewed                      |   22.30  |  .50 |   27     |   243
  Raspberries                   |    5.60  |  .50 |   16     |    76
  Strawberries                  |    8.80  |  .60 |   12     |   144
  ——————————————————————————————+——————————+——————+——————————+——————————


=The Physiologic Action of Moderate Doses of Alcohol.=—The result of
a series of experiments by Dr. Parke were as follows: “By quickening
the action of the heart, it shortens the interval of rest, and,
therefore, interferes with the nutrition of the heart. It also
produces palpitation and breathlessness. Even small doses of alcohol,
by increasing unnecessarily the action of the heart, are injurious.
It acts on the nervous system by lessening the rapidity and the
delicacy of the impressions, as well as by lessening the power of
control of a train of thought. Further, by this same blunting of the
nervous system, voluntary muscular power is impaired, and the finer
combined movements are less perfectly made. It causes a lowering of
the temperature of the body, and, although it is taken to overcome
the effects of exposure to cold, it has been learned that persons who
take it are less able to resist the exposure to cold.”

As the result of modern scientific investigation and experimentation,
alcohol with its compounds has been taken out of the list of
beverages, where it has heretofore been classified with tea and
coffee, and out of the list of foods, to which class it had been
admitted because of the known oxidation of alcohol in the body, and
has been placed in that list of drugs known as narcotics, alongside
of ether, chloroform, opium, and cocain—all of them, the most deadly
drugs in the Pharmacopeia, yet, when used by skilled hands, the most
beneficent.

The first effect of this class of drugs is a short temporary stage of
exhilaration, more or less rapidly followed, according to the amount
taken, by a stage of sleepiness or actual insensibility, which lasts
longer than the stage of excitement, and this in turn is followed by
a long period of depression.

Like other members of its class, alcohol has a cumulative action, the
residual quantities habitually taken accumulate and gradually affect
the efficiency and well-being of the individual.

A point that must always be borne in mind in giving any medicine is
that not a few drugs have a curious tendency to induce a craving for
their repetition.

The amount of alcohol contained in some of the most commonly used of
the alcoholic beverages is as follows: beer, 4 to 5 per cent.; hard
cider, from 5 to 10 per cent.; claret, 8 to 11 per cent.; port, 9 to
22 per cent.; champagne, 10 to 15 per cent.; rum, gin, and strong
liquors, 40 to 50 per cent.; whisky, 44 to 50 per cent.; brandy, 48
to 56 per cent.

These alcoholic beverages are often made still more harmful by
adulterations by ingredients in themselves harmful.

A large percentage of alcohol is also found in bitters and patent
medicines.

We will consider the subject of alcohol under the following aspects:
First, the question of alcohol as a food; second, the effects of
alcohol on the digestive system and the metabolism; third, the
effects of alcohol on the heart and the muscular system; and fourth,
the effects of alcohol on the nervous system.

_First, Is Alcohol a Food?_—The substances used as foods act in
providing energy for muscular work, in maintaining the heat of the
body, in building up of the tissues, and in saving the waste of
the tissues. Moreover, a food which does harm to any organ, or to
the system as a whole, when taken in moderate repeated quantities,
becomes a poison for that individual.

A food may be defined as any substance which, when absorbed into
the blood, will nourish, repair waste, and furnish force and heat
to the body, without causing injury to any of its parts or loss of
functional activity. From any one of these four standpoints alcohol
cannot be regarded as a food.

The physiologic effects of alcohol and real food-stuffs are totally
different. Fats, carbohydrates, and nitrogenous foods after
mastication at once begin to be digested and assimilated, and
to fulfil the true functions of a food by maintaining a natural
temperature, pulse-rate, and tissue repair of the body, without any
disturbance of its mental and physical functions and activities.

Alcohol, on the contrary, is absorbed from the stomach unaltered by
the digestive processes; circulated in the blood in its original
form, it at once interferes with the ordinary activity of the
brain and other organs, and, by its anesthetic action, hampers the
mental and physical activities and interferes with the processes of
metabolism.

_The Effects of Alcohol on the Digestive System and Metabolism._—The
local action of alcoholic liquids is particularly destructive on an
empty stomach; and when taken in strong solution, but it is also
known that smaller doses, taken continuously, are liable to effect
the digestive organs in a slower though similar way.

The injurious effects of alcohol are that it acts as a local
irritant, producing dilatation of the blood-vessels of the stomach
and subsequent gastritis; it leads to hyperacidity, by stimulating
the secretion of hydrochloric acid; the tartrates and malates
contained in wine are decomposed in the stomach, setting free organic
acids, and thus producing acidity; the acetic acid and yeast in beer
set up an acetic acid fermentation in the stomach-contents.

Whether taken alone or with food, the tendency of alcohol throughout
is to lessen the churning movements of the stomach, and leads to
atony of that organ, which in turn leads to dilatation of the stomach.

Alcohol appears to have a particularly deleterious effect on the
digestion of women. This is explained by the fact that men lead a
more active outdoor life, and consequently retain their appetite
for food longer than women. For the same reason, they are able to
work off the effects of drinking more easily and start afresh the
assimilation of food. The indoor life led by women, their clothing,
worn tight around the stomach, are added causes for lack of appetite.
Catarrh of the stomach results; this is followed by insufficient food
and an increased amount of stimulants. There follow nausea, irregular
and insufficient nutrition, indigestion, and a faulty elaboration of
the food.

By its action on the liver alcohol interferes with the amount
and quantity of bile, and so inevitably leads to indigestion and
constipation, and a similar interference with the action of the
liver-cells and their chemical changes set up in many cases gouty
conditions, accompanied by mental depression and irritability.

Diseases of the liver occur more frequently as the result of taking
frequent small doses of alcohol, though never reaching the stage of
intoxication, than as the result of indulging more freely, but at
longer intervals.

_The Effect of Alcohol on the Blood._—The blood is a mixture of
corpuscles and a fluid known as the blood plasma. The corpuscles are
of two kinds—red and white. The red blood-corpuscles are the oxygen
carriers; they carry the oxygen to the tissues, where they readily
give it up. They are constantly being destroyed by the liver and
spleen, and are replaced by new ones, which come from the red marrow
of bones. The white corpuscles are much fewer in number, but they
play a most important part in protecting the body against disease. It
is now about twenty years since Professor Metchnikoff, of the Pasteur
Institute of Paris, announced to the world his discovery that the
white corpuscles have the power of destroying the microbes to which
so many diseases are due. These white blood-cells form the standing
army or policemen of the body, and their duty is to attack, and, if
possible, to destroy, any foreign matter, such as dust or disease
germs.

The plasma of the blood contains various kinds of salts, and include
sodium chlorid or common salt, the phosphates, and chlorids of
calcium and potassium.

The way which the body fights disease is partly by means of the
white blood-corpuscles, which totally destroy the germs, and partly
by the increase in the blood of those chemical substances which are
antidotes for the poisons given out by the germs.

Alcohol taken into the stomach is quickly absorbed and reaches the
blood in two minutes. The maximum of alcohol is found in the blood in
fifteen minutes after it is swallowed.

The blood is the medium by which food and oxygen are conveyed to the
tissues, and by which the refuse material from the tissues is carried
away; alcohol interferes with both these processes.

The red cells are liable to become damaged and anemia results. It has
now been proved that even tiny doses of alcohol paralyze more or less
the white cells, and thus interfere with their power of destroying
microbes. Chemical substances tend to exert a delaying or inhibitory
influence over the chemical processes of the body. These chemical
processes are oxidation, the storing up of nutriment, the manufacture
of secretion, the production of energy and muscular movement, and the
excretion of waste materials.

The greatest possible difference exists as to the rate at which
oxidation goes on. When there is nothing to hinder its occurrence,
the poisonous toxins and waste matters are rapidly burned up and
eliminated and health prevails. Alcohol, by its affinity for
oxygen, robs the tissues of oxygen which they would otherwise use
for combustion. Hence the tissues are kept starving for oxygen,
metabolism is interfered with, and they cannot get rid of their waste
material.

This delayed oxidation tends to increase the body weight. The cells
in an intermediate stage of fatty degeneration clog the body, and, of
course, add to its weight. The natural effect of taking alcohol is
to make the body obese. On abstaining from alcohol, the superfluous
tissue is often burned away, and the weight of the body reduced, and
a look and feeling of youth is recovered.

_The Effect of Alcohol on the Heart and Circulation._—By the
circulation we understand the driving of the fluid blood around the
body, through the blood-vessels, such driving being maintained by the
pumping power of the heart, which is practically a hollow muscle.

In consequence of this pumping power of the heart, the blood in the
vessels is under considerable pressure, which is naturally increased
if the blood-vessels are narrowed or contracted, and diminished if
the blood-vessels are expanded or dilated.

Gradual deterioration in the heart power is a cause of premature
death. One of the early indications that the foregoing changes may
be occurring in a heart is a sense of fatigue and breathlessness on
slight exertion, or a feeling of disinclination for normal effort.
The result of such depression of the efficiency of the heart is often
seen when the individual is attacked by some disease; she succumbs
to heart failure, instead of being able to resist the disease. This
probably accounts for a great many deaths between forty and sixty
years of age.

Further, it must be remembered that all the nutritive action of the
blood depends on its power of rapidly filtering through the walls
of the blood-vessels to the tissues, and, conversely, its power of
drawing off the waste-products of the tissues depends on the facility
with which such products can penetrate its walls.

As soon as degeneracy sets in, the walls of all vessels tend to
become thickened, and the active transference through them, more and
more prevented; the nutrition of the body is thus gravely hampered,
and, with the advance of this thickening of the walls, the vessels
are less able to adjust themselves to the variations in pressure from
within; and, finally, when unable to withstand the pressure, they
rupture, causing hemorrhage and apoplexy, which, when occurring in
the brain, cause paralysis and mental decay.

A similar degeneration takes place in old age, but the point is,
that many persons, instead of waiting until old age comes to them,
deliberately precipitate these senile changes.

_The Effect of Alcohol on the Kidneys._—The elaborate mechanism of
the kidneys consist of a filtering system of thousands of tubules,
arranged closely side by side, whose function it is to carry away
from the body the waste material, which otherwise would interfere
with the vitality of the different organs.

The part played by the kidneys in rapidly eliminating effete material
cannot be too carefully safeguarded. Anything which interferes with
its work will sooner or later cause a retention of waste-products
in the system, and will also permit of the escape of valuable
albuminous materials of the substance of the blood through the
filtering apparatus. The effect of alcohol upon the kidneys can only
be described as disastrous. In proportion as the kidney shrinks,
there is a diminution of the excretion of urine, and, finally, the
condition known as Bright’s disease is established.

_The Effect of Alcohol on the Muscular System._—The muscular tissue
forms 43 per cent. of the body weight. It has been proved that under
the moderate use of alcohol the muscles become flabby and less
vigorous and effective; that troops cannot work or march on alcohol;
that in training for athletics, for races, or for other sports, total
abstinence is always practised; the true sportsman depends quite as
much on his brain as on his muscles for success. In England it is
recognized that total abstinence is a necessity where great exertions
are concerned, and it is now beyond all question that alcohol, in
even so-called dietetic quantities, diminishes the output of muscular
work, both in quantity and quality, and that the best physical
results are obtained under total abstinence from its use.

Alcohol actually lowers the temperature of the body from
three-fourths of one degree to three degrees. This depression of
temperature is not transient, but lasts for several days, so that
its use, when the person is exposed to intense cold, is extremely
hazardous to life.

_The Effects of Alcohol on the Nervous System._—Kraepelin has
carried out a series of experiments to prove the effects of small
doses of alcohol on the output of work. In all mental work there are
two elements to be considered, namely, quality and speed. Now, all
observers are agreed that the quality of mental work is affected even
before speed, more mistakes being made. Tests were made in reading
aloud; in adding figures in various combinations; in type-setting;
and in memorizing; in all these instances it was found that, after
taking moderate doses of alcohol for a number of consecutive days,
the work done was less, was less accurate, and that there was a
decrease in the power of memorizing.

Another series of investigations, made by Rudin to determine how long
the intellectual abilities continue to be depressed after the effects
of alcohol pass off, showed that the effects of a single dose of
alcohol persisted until noon or evening of the next day.

Von Helmholtz, one of the greatest observers and thinkers of the
nineteenth century, noted on himself the effect of alcohol in
interfering with the highest powers of thought and conception.
Describing the conditions under which his highest scientific
thoughts had matured and come to fruition, he said: “As far as my
experience is concerned, they never come to a wearied brain or at the
writing-desk; they were especially inclined to appear to me while
indulging in a quiet walk in the sunshine or over the forest-clad
mountains, _but the smallest quantity of alcohol seemed to drive them
away_.”

Professor Sikovsky’s testimony is that “alcohol diminishes the
rapidity of thought, makes the imagination and the power of
reflection commonplace and deprived of originality, acts upon
fine and complex sensations by transforming them into coarse
and elementary ones, provokes outbursts of evil passions and
dispositions, and in this predisposes men to strife and crime, and
upsets habits of work and perseverance.”

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


FOOTNOTES:

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




CHAPTER V

THE RESPIRATORY AND CIRCULATORY SYSTEMS: THE KIDNEYS

  The Mechanics of Circulation and Respiration; the Circulatory
  Apparatus; the Lungs; Hygiene of the Lungs and Its Relation to
  the General Health; Relation of Respiration to Body Heat; the
  Respiratory Functions of the Abdominal Muscles; the Importance
  of Good Chest Development; Proper Relation Between the Height,
  Weight, and Chest Measurements; Chemical Properties of Air; Town
  and Country Air; Dust and Its Relations to Disease; Rôle Played by
  Bacteria; Ventilation; the Injurious Effects of Overheated Air; the
  Proper Degree of Moisture for the Air of the House; Ventilation of
  Bed-rooms.

  Care of the Nose, Throat, and Ears; Impediments to Respiration;
  Ventilation of the Lungs and Breathing Exercises; Cure of Chronic
  Bronchitis by Deep Breathing Exercises; Relation of Colds to
  Pneumonia and Tuberculosis, and Their Prevention.

  The Kidneys and Their Function; the Physiology of the Female Pelvic
  Organs.


It is said that diseases of the lungs are the cause of four-fifths of
all indispositions, ill health, and actual disease among civilized
people, and that, between the age of fifteen and twenty-five, almost
one-half of the mortality is due to pulmonary tuberculosis.

This almost universal weakness of the lungs, as it may be styled, is
a product of modern civilization, and is caused by our unhygienic
mode of life. Too little importance is attached to physical
development, and well-developed lungs can only be found in a
well-developed chest; too little time is spent in outdoor exercise;
and private houses, public conveyances, and public assembly rooms are
not properly ventilated.

Good development of the chest and lungs, and thorough and systematic
ventilation of the lungs, are essential to a strong heart, a vigorous
circulation, and power of the tissues to resist disease.

=The Mechanics of Circulation and Respiration.=—In order to
understand the mechanics of circulation and respiration, it is
necessary to appreciate four fundamental facts—that the thorax is a
distensible, air-tight cage; that it contains and is filled by the
heart, lungs, and great blood-vessels; that the exchange of gases
in the blood takes place in the lungs; and that, on the development
of the chest and respiratory muscles, depend the development of the
lungs and the force of the circulation.

[Illustration: Fig. 7.—The bony thorax, anterior view (Ingals).]

_The Thorax._—The chest or thorax is a cone-shaped, distensible
cage, formed of bones, elastic cartilage, and muscles. The spinal
column forms the fixed part of this living cage, and the ribs are
attached to this in such a way as to allow of their being raised in
inspiration, thus increasing the anteroposterior and the lateral
diameters of the chest.

The thorax is converted into an air-tight cavity by means of
muscles. The base is made up of one huge muscle, the diaphragm.
This is attached at its border to the ribs and posteriorly to the
backbone. It is the diaphragm which separates the cavity of the
thorax from that of the abdomen. When the diaphragm is relaxed, it
has a concavoconvex form, the convexity being directed toward the
chest, and the heart and lungs rest directly on it, while the concave
surface covers or rests on the liver.

_The Circulatory Apparatus._—This consists of a central force and
suction-pump, the heart, and a series of elastic tubes that grow
smaller the further from the heart they are situated; they divide and
subdivide, like the branches of a tree. The smallest arteries, called
capillaries, from their hair-like size, are so minute that they only
allow the passage of a single corpuscle at a time and their walls are
transparent.

The heart is a somewhat cone-shaped organ, placed between the
two lungs; it is situated more or less obliquely in the chest,
immediately back of the breast-bone. Roughly speaking, the base of
the heart corresponds to the right edge of the sternum, while the
apex lies a little below and to the right of the left nipple.

The heart is divided into a right and left side. The left side forms
the force pump, whose motive power is supplied by the contraction of
its own muscle-fibers. The bright red blood, with its fresh supply
of oxygen—hence its color—flows from the lungs into the left heart,
which then contracts automatically and forces the blood into the
arteries of the body.

The arteries consist of a series of elastic tubings; hence, the
smaller the tubing, the greater the resistance which has to be
overcome by the force of the heart’s beat, so that during violent
exercise, when the contraction of the muscles causes a pressure
on the minute arteries and capillaries situated in them, the more
forcible must be the beat of the heart to overcome this additional
resistance. Likewise, when the surface of the body is suddenly
chilled, as by a plunge into cold water, all the vessels situated
here contract, and, again, more work is thrown on the heart.

The three chief factors in the mechanics of the circulation are the
force and frequency of the heart’s beat, the peripheral resistance,
and the elasticity of the arterial walls. Any disturbance between
these relations brings about abnormal conditions.

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

The average frequency of the heart’s beat, or the pulse, is 72 times
a minute. It is increased by exercise; it is quicker in the standing
than in the sitting posture. It is quickened by meals, and, on the
whole, it is quicker in the evening than in the early morning hours.
Independent of muscular exertion, it is quickened by great altitudes.
It is said to be quicker in summer than in winter. Its rate is
profoundly influenced by mental conditions.

The whole of the blood of the body passes through the heart in 32
beats—that is, in less than half a minute. The greatest part of this
time is spent in the capillaries. There the tissues are obtaining
their fresh supplies of food and discharging their waste matter into
it.

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

The heart, great blood-vessels, and the lungs are placed in the
air-tight cavity of the thorax, and are subjected to the pumping
action of the respiratory movements. The inspiratory muscles elevate
the ribs, at the same time that the diaphragm, by its contraction,
pushes the contents of the abdomen downward. The cavity of the
chest, so enlarged, causes the pressure around the heart and the
great blood-vessels within the chest to be less than that on the
blood-vessels outside the chest; hence, during each inspiration the
venous blood is sucked back into the right side of the heart.

The tissues deprive the blood of its oxygen, so that which flows back
to the heart in the veins is blue. The right heart then sends this
blue blood to the lungs, that it may get rid of its carbonic acid,
which is not only not needed, but is actually injurious to the body,
and to receive a fresh supply of oxygen, which has been carried into
the lungs in breathing.

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

[Illustration: Fig. 10.—The diaphragm (after Kitchen).]

The blood holds in suspension a vast number of minute cells or
corpuscles; the red corpuscles give its color to the blood, and
are the oxygen carriers, while the white are the phagocytes or the
protective agents of the body against disease.

The blood constitutes about one-thirteenth of the body weight. Of
this, one-fourth is distributed to the heart, lungs, and great
blood-vessels, one-fourth to the liver, one-fourth to the skeletal
muscles, and the remainder to other organs.

In order that the blood may be a satisfactory medium of exchange
between all the tissues of the body two things are necessary—first,
there must be through all parts of the body a flow of blood of a
certain rapidity and general constancy; and, second, this flow must
be susceptible of general and local modifications.

The =lungs= are the essential organs of respiration or ventilators
of the body. They are two in number, separated from each other by
the heart, are placed in a semi-distended state in the air-tight
thorax, which we have seen they, together with the heart and great
blood-vessels, completely fill. The lungs ultimately consist of
air-cells, surrounded by dense plexuses of capillaries and nerves.
The air-cells communicate with the exterior through the bronchial
tubes, trachea, larynx, throat, and nose.

The larynx is the organ of voice. It is situated between the trachea
and the base of the tongue, at the upper and back part of the neck,
where it forms a considerable projection in the middle line, called
Adam’s apple.

The trachea is a cylindric tube, which extends from the larynx
downward about 4½ inches, when it divides into the right and left
bronchial tubes. The bronchial tubes, on entering the lungs, divide
and subdivide, until finally they terminate in a lobule which is
composed of air-cells and intercellular passages.

In inspiration the cavity of the thorax is enlarged by an active
contraction of the muscles, in consequence of which the pressure of
air within the lungs becomes less than that of the air outside of the
body, and this difference of pressure causes a rush of air through
the trachea into the lungs, until an equilibrium of pressure is
established between the outside air and that within the lungs. This
constitutes _inspiration_. Upon the relaxation of the respiratory
muscles, the elasticity of the chest-walls and lungs, aided perhaps,
to some extent, by the contraction of certain muscles, causes the
chest to return to its original size. In consequence of this, the
pressure within the lungs now becomes greater than that outside, and
the air rushes out of the trachea, until the equilibrium is once more
established—_expiration_.

During quiet respiration all parts of the lungs are not equally
expanded; it is chiefly the apices of the lungs, reaching up into the
region of the neck, and the central parts of the lungs, which undergo
the least change of volume. This lack of a thorough distention and
aëration of every part of the lungs is a cause of weakness of the
lungs as well as of the entire body, for it is precisely those parts
of the lungs which are the least active that are most prone to become
the seat of tuberculosis.

In forced inspiration the cavity of the thorax is increased from 2
to 3 inches, partly by the elevation of the ribs and partly by the
descent of the diaphragm, due to the contraction of its muscular
fibers. In contracting, the diaphragm presses upon the abdominal
viscera, pushing them downward about 3 inches, so that a projection
of the flaccid abdominal walls occurs. The movements of the diaphragm
are less extensive in women than in men, which is believed to be due
to the corsets and general manner of dress. A perfectly free mobility
is necessary for change in the size of the chest and lungs, in which
the respiratory movements take place from sixteen to twenty times a
minute.

The amount of air entering and leaving the lungs varies greatly in
ordinary and forced respiration, being often three times as much
in the latter. The volume of air is determined by the spirometer.
Mr. Hutchinson, who invented the spirometer, has defined the vital
capacity of the lungs as that amount of air which can be expelled by
the most forcible expiration, and so the measure of the individual’s
respiratory power. The vital capacity varies according to a number of
conditions, as age, sex, weight, but, most important of all, is the
height. It has been found that between five and six feet the vital
capacity increases eight cubic inches for each inch in height.

The vital importance of the rôle which oxygen plays in the health and
life of the individual may be better understood from the facts that
about 10,000 liters of air are breathed daily, which makes the amount
of food and drink consumed daily seem almost infinitesimal, and,
important as the quality of the food is, the quality of the air is
much more so, and, finally, that one can live for some days without
either food or drink, but dies in a few minutes if the supply of air
is cut off.

_Secretion of the Lungs._—Like the lips and mouth, the lungs are
invested on their free inner surface by a delicate mucous membrane,
which constantly secretes a clear viscous fluid, the mucus. The
lungs, therefore, like the nose, are always moist, and just as the
nose is cleared by blowing it, so the lungs are cleared by hawking
or coughing. A sense of discomfort or a feeling of irritation of
the windpipe induces a deep inspiration, followed by an explosive
expiration, which quickly brings up the mucus, so that it can be
expectorated. The only difference between the mucus of the lungs and
that of other organs is that the former is mixed with air and has,
therefore, a frothy appearance.

The secretion of the lungs naturally flows down and accumulates,
until it is voluntarily brought up and expelled. Any one with a
cold on the chest, or who is subject to catarrh, will notice that,
on moving about in the morning in making the toilet, especially
on raising the arms to dress the hair, expectoration is greatly
facilitated, and that this is followed by a feeling of clearing out
of the throat and lungs.

Because of the great aid given to the lungs in clearing them of
mucus, moderate exercise in the open air is a much better treatment
of an ordinary cold than a prolonged stay in bed. And for the same
reason, in the treatment of lung troubles, so soon as the temperature
of the patient is down to normal, and her strength makes it safe to
allow her to move about, the recovery of the patient is hastened by
getting up and moving about the house.

=Hygiene of the Lungs and Its Relation to the General Health.=—Two
conditions are essential for the preservation of the health and
prevention of diseases of the lungs—good chest and lung development,
and a continuous supply of fresh air for the proper ventilation of
the lungs.

Fully one-third of the whole volume of blood is always circulating
in the lungs, and each corpuscle passes through them 8000 times in
the twenty-four hours. In other words, the lungs are the vitualizing
stations of the corpuscles which unceasingly go hurrying by. If these
carbonic-acid-laden corpuscles arrive in the lungs, and do not find
the requisite amount of oxygen awaiting them, they return to the
tissues, carrying part of their carbonic acid back to them instead
of a fresh supply of oxygen, and so the tissues are weakened instead
of being nourished, while the corpuscles themselves suffer from lack
of proper nourishment and deteriorate in form and color. Imperfect
ventilation of the lungs is the most frequent cause of anemia or
thinness of the blood.

It must not be overlooked that the air may be fresh and pure, and yet
not able to penetrate all parts of the lungs because of superficial
and improper breathing.

=Relation of Respiration to Body Heat.=—The heat of the body is
generated by the oxidation of the tissues. The chilliness experienced
by persons engaged in sedentary occupations is by no means always
caused by the low temperature of the room, as will be proved by
the thermometer, but by the close air of the room and superficial
respiration, which causes internal overheating with imperfect
combustion. The correctness of this statement may be proved if the
woman will throw the windows wide open and take deep breathing
exercises for five minutes. She will then go back to her work
thoroughly comfortable. In other words, she has breathed herself warm.

=The Respiratory Function of the Abdominal Muscles.=—Well-developed
abdominal muscles play an important part in expiration, hence, in
emptying the lungs of their impurities. Under normal conditions
the pressure in the abdominal cavity is greater than that of the
atmosphere; hence in the elastic recoil following inspiration, the
abdominal viscera constitute a buffer, so to speak, and drive the
diaphragm upward.

The chief causes of flabby abdominal muscles, with its consequent
low intra-abdominal pressure, are a sedentary life, the wearing of
corsets which prevent the free play of the abdominal muscles, and the
overdistention of the abdominal walls by repeated pregnancies and by
the accumulations of fat.

As a result of lax abdominal walls, there is very frequently an
enteroptosis or a falling of the abdominal contents far below their
normal position; this includes the liver, spleen, pancreas, the
intestines and stomach, and is the most frequent cause of floating
kidney.

Further, the accelerating influence of the diaphragmatic movements on
the circulation is seriously interfered with.

=The Importance of Good Chest Development.=—The least chest
development of the adult woman—that is, the underarm girth around the
chest—consistent with good health is 28 inches, and this girth must
be enlarged 3 inches on forced inspiration. In ordinary respiration
the waist expansion should be from ½ to 1 inch, while during muscular
activity it should be from 1½ to 3 or 4 inches.

In women the movements of the upper part of the chest are very
conspicuous, the breast rising and falling with every respiration;
whereas, in children and in men the movements are almost
wholly confined to the lower part of the chest, and are called
diaphragmatic, in contradistinction to those seen in women, which
are called thoracic. It is now the opinion of many observers in this
country and in Europe that the habit of thoracic breathing in women
has been brought about by constricting the waist and the lower ribs.
Observations made among the Indians and Chinese women show that the
abdominal is there the type of breathing, _and_ civilized women who
wore no corset had relatively good abdominal breathing. Further, that
a thoracic type of breathing can be produced in man by putting him in
a corset.

Vital capacity is, as we have seen, the term employed to denote
the amount of air that can be expired after the fullest possible
inspiration. The amount for persons 5 feet in height has been
estimated as 174 cubic inches, with an increase of 8 cubic inches
for every inch in height above this. The relation between height
and vital capacity is rather remarkable, since height is chiefly
determined by the length of the legs, and not by the size of the
trunk and thorax. This is due to the fact that mobility of the chest
increases with stature.

The capacity of the chest is determined by the spirometer. A person
who can only blow, say from 180 to 250 cubic inches, has a good pair
of lungs, while, on the other hand, an ability to blow only 100, even
where percussion and auscultation had revealed nothing, is suspicious.

One test by the spirometer is not sufficient to judge of the
condition of the lungs, since the woman may be nervous or may not
understand how to breathe into it, so that a number of tests should
be made on different days, which may give a much better result,
though no change has occurred in the lungs.

=Proper relation between the height, weight, and chest measurement=:

     Height.     Average weight.  Average chest measurement.
  Feet. Inches.      Pounds.              Inches.
    5                  120                 29.80
    5      1           122                 30.60
    5      2           125                 35.00
    5      3           128                 35.75
    5      4           131                 36.25
    5      5           135                 37.00
    5      6           139                 37.50
    5      7           143                 38.00
    5      8           147                 38.50
    5      9           151                 39.00

_The Chemical Properties of Air._—It is of more vital importance
that the air which we breathe should be pure than the food which we
eat should be, although the latter is universally conceded to be a
matter of prime importance. The reason is that the poisons in the
air, inspired by the lungs, pass directly into the blood, whereas,
taken into the stomach, the action is much slower, and there is at
least the possibility of their passing through the digestive tract
unassimilated.

The olfactory nerves are the normal guides as to the purity of the
air, and, if they have not been dulled by long usage in breathing
impure air, they are extremely sensitive to impurities in the
atmosphere.

_Country Air._—In the open air there is a constant, even though
insensible, movement of the currents of air; the result is a constant
renewal or ventilation of the air. There is, in addition, the
evaporation from brooks, rivers, lakes, the dew and rain, which aid
in cleansing the air from dust; the peculiar freshness of the air in
the country after a heavy fall of rain is familiar to all.

The “bouquet” of the air, most noticeable and delightful in the
early morning, especially in the spring of the year, is due to the
fragrance given off from the flowers, plants, and trees, and imparts
a feeling of exhilaration and a sense of the joy of living.

Sunshine increases the respiratory movements.

Wind clears the air of impurities, and is only harmful when it
carries dust with it, or when it is so strong that it impedes the
respiration or bodily movements. Very weak persons get out of breath
easily when battling against the wind.

_Town Air._—Even the outdoor air of towns has its full quota of
oxygen,—21 per cent.,—and so is healthier than indoor air. The
carbonic acid in the air varies from 0.2 to 0.6 per cent. Among the
impurities of the air are smoke, fog, and dust.

=Dust and Its Relation to Disease.=—Dust, consisting of particles of
all kinds of organic and inorganic matter, is a nuisance of indoor
as well as outdoor life. That the dust in cities is the intolerable
nuisance and menace to public health that it is, is due to the filthy
condition of the streets.

The specific cause of tuberculosis is the tubercle bacillus.
Considering the prevalence of the custom of spitting on the
pavements, streets, floors of public conveyances, and public halls,
that the dust from the streets is carried into the houses on the
shoes and the trailing skirts of women, it is self-evident that
anything which stirs up the dust, as sweeping, stamping on the floor
with the feet, dancing, and on the streets strong currents of air and
high winds are a most serious menace to the health and lives of the
community.

In addition to the fact that dust is the great carrier of the
tubercle bacillus, the particles of dust cause a direct irritation of
the mucous membranes lining the nose, throat, larynx, and bronchial
tubes.

That dust is an important factor in the causation of colds may be
inferred from the facts that they are more common in the city than
in the country, and that in the city they are more frequent in the
spring and fall, when the streets are not watered.

=The Rôle Played by Bacteria.=—Bacteria are distributed nearly
everywhere and in larger quantities than is generally believed. The
air in open spaces in cities contains from 100 to 1000 bacteria per
cubic meter, while the air of an inhabited room contains from 6000 to
10,000.

It can now be definitely stated that microörganisms are the immediate
or exciting cause of bronchitis observed in diphtheria, in influenza,
measles, whooping-cough, pneumonia, etc. These microörganisms are
conveyed both directly from the sick to the well, and from the
inhalations of the germs floating in the atmosphere. Whenever dust is
raised, we breathe in a great number of microörganisms.

In influenza the bacilli are found in the secretions of the nose,
throat, and in the expectorations from the lungs.

The bacilli are not only the cause of the acute infections, but also
of chronic bronchitis.

The bacterial flora usually present in the throat and the respiratory
passages is rich and varied. So long as the mucous membrane lining
these passages remains in a healthy condition, an unfavorable
condition is offered for their growth and development and these
microörganisms are harmless. But just so soon as the general vitality
is lowered, or there is an impairment of the normal condition of
the epithelium lining the respiratory tract, a culture-medium is
provided in which these germs flourish and grow. Anything which will
cause an irritation or congestion of the mucous membrane of the
throat and bronchial tubes furnishes the necessary conditions for
the infection to take place. The germs themselves excite an acute
inflammation, and the inflammation extends from the head or throat to
the bronchial tubes, through the spread of the infective agent along
the respiratory tract.

=Ventilation.=—Very few people in cities spend more than one hour
a day in the open air, which means that they are housed up for the
other twenty-three hours, so that no pains should be spared to bring
up the quality of the indoor air to approximate as nearly as possible
that of the outdoor air. The air of houses contains many more
microbes than that of the street.

For dwelling-houses 3000 cubic feet of fresh air is needed every
hour. It is said that in the country the only bad air is in farmers’
houses, whence it has no chance to escape.

Direct sunlight kills the tubercle bacillus in thin layers of sputum
in five or six hours, and diffused sunlight in several days, and
proper ventilation greatly facilitates this bactericidal action.
A large cubic space is of little avail if the ventilation is
inadequate. The windows should be at least one-seventh of the floor
space.

The air of the house must be fresh, pure, and cool, to allow proper
ventilation of the lungs and skin. Colds are prevalent in winter,
because that is the season when people are housed up and breathe
impure air.

The commonest causes of impurities of the air in houses are the
expired air and the transudation of the skin; the production of the
combustion of lights or unconsumed gas may come from the burner when
lit, if the pressure is very strong, or the rubber fittings may
retain the gas; tobacco smoke; the effluvia of simple uncleanliness
of rooms and persons; and the products of the fluid or solid excreta
retained in the room. In addition, there may be special conditions
which allow the impure air to flow into the room, as from the
basement or cellar of a house, from imperfectly trapped soil and
waste-pipes, or from other impurities outside of the house.

In respiration the air is vitiated by a decrease in the amount of
oxygen and an increase in the amount of carbonic acid; the expired
air contains about 4 or 5 per cent. less oxygen and about that amount
more of carbonic acid than the inspired air. It has been estimated
that an individual takes into her lungs about 500 cubic inches of air
per minute and exhales the same amount of vitiated air. The expired
air is of a higher temperature, and is loaded with aqueous vapor.
The organic substances present in expired air are in part the causes
of the odor of the breath; it is probable that many of them are of a
poisonous nature. The air is still further vitiated by the products
of decomposition of persons having decayed teeth, nasal catarrh, and
disorders of the digestive systems, as well as by personal emanations.

When the sensibilities of the sense of smell become dulled, they give
no warning of the sense of danger, and the individual may not feel
conscious of the harm, although the nervous centers may be greatly
depressed, and, because discomfort has not been experienced in a
vitiated atmosphere, it does not follow that harm has not been done.
The effects are slowly and imperceptibly cumulative, but are on this
account none the less injurious, and are now recognized as being
among the most potent and wide-spread of all the predisposing causes
of disease.

The physiologic effects of breathing vitiated air are that, owing
to the impurities of the air, the respirations become quicker and
shallower, the heart’s action more rapid and feeble; there is a more
or less irritation of the mucous membranes lining the nose, throat,
and larynx. In extreme cases, where many people are crowded together
and the ventilation is totally inadequate, the air often becomes so
impure as to cause headache, lassitude, nausea, and fainting.

The long-continued action of such impurities on the olfactory
nerves may ultimately induce, through the central nervous system,
alterations in the respiration, circulation, and nutrition. When
moderately vitiated air is breathed more or less continuously, the
individual becomes pale and loses her appetite; after a time there is
a decline in the muscular strength and animal spirits. The aëration
and nutrition of the blood is interfered with, and the general tone
of the system falls below par.

It has further been maintained that metabolism is hindered by
much-breathed atmosphere. In addition to the ordinary symptoms of
discomfort, the long occupancy of so-called stuffy rooms so lowers
the resistance as to be conducive to the contraction of colds and
even to more serious infections.

People in this lowered condition of health, which is very common
among those who spend the greater part of the day indoors, in
offices, houses, schools, factories, and workrooms, offer much less
resistance to attacks of acute diseases than do people who lead an
outdoor life.

In considering the ventilation of a house, the purity of the air, the
temperature, and the dryness of the air must all be considered.

The test now generally accepted as the standard of purity of the air
is not the chemical one of the estimation of the amount of carbonic
acid contained in the air of a closed space, but that, on entering a
room or closed space from the outside fresh air, no sense of impurity
or closeness should be noticeable.

The so-called natural ventilation of houses, which takes place
through the porosity of the walls, the cracks around the doors and
windows, is generally too inconsiderable to be taken into account.

Where houses are heated by furnaces, a certain amount of ventilation
is furnished by this means, but the air is by no means so pure as the
air of a house heated by hot air or steam pipes. In the latter case,
the greatest drawback is the dryness of the air.

As the air contained in an inhabited room cannot be kept as pure as
the outside air, the object of ventilation is, by the admission of
the pure external air, so to minimize the impurities that the air
respired may not be detrimental to health.

The most effective means for the ventilation of houses and apartments
is the throwing wide open all doors and windows; the windows must
be opened at both top and bottom, as the hot impure air rises and
the cold air falls to the floor. The length of time which the house
should be left open will depend on the outside temperature and the
velocity of the winds. This ventilation of the entire house should
be carried out three times a day—in the early morning, at noon, and
again in the evening.

In addition to this, provision should be made for a constant access
of fresh air to the room. A simple and rather primitive method is by
raising the lower sash by a strip of wood several inches in height
and the exact width of the window. The air will then enter the space
between the upper and lower sashes. Some such or any better method of
ventilation should be in continuous use, day and night, when the room
is occupied. So soon as the weather is sufficiently mild, some of the
windows should be left open all the time.

When the air of a room is fresh and pure, the human system is
furnished with all the oxygen it can consume, and heat is thus
introduced into the body, so that a lower external temperature is
necessary for comfort. Hence, supplying a sufficient quantity of
fresh air minimizes the amount of coal consumed, besides increasing
the vigor of the body.

The temperature of the house will depend on the occupation, age, and
health of the inhabitants. With a sedentary occupation, a temperature
of from 64° to 70° F. is the most suitable. The temperature of the
bedroom at night should not be allowed to fall below 50° F. Every
room in the house should be furnished with a thermometer.

=The Injurious Effects of Overheated Air.=—A rise of temperature in
the surrounding air diminishes the amount of oxygen consumed and the
amount of carbon dioxid discharged; a fall of temperature has the
opposite effect. In addition, this overheated air forms a hot jacket
about the body, which prevents the radiation of heat necessary to
keep the body in a healthy condition.

For the same reason, when out-of-doors, furs should not be worn
close up around the neck, and fur coats should only be worn in
the extremely cold weather. Paper and rubber worn about the body
act in the same way, by preventing the radiation of heat and
moisture—practically steam jackets are formed; the skin is rendered
very sensitive and susceptible of chilling on the slightest fall of
temperature.

=The Proper Degree of Moisture of the Air of the House.=—The air
below the freezing-point is deprived of much of its moisture; brought
into the house, and raised from 70° to 80° F., or drawn into the
nostrils and raised to 98° F., it must take up its quota of moisture.
This moisture must, therefore, be provided in the air of the house.
In the case of houses heated by furnaces, some moisture is furnished
by the water-pans of the furnace; but in the case of heating by hot
air and steam pipes, there is less circulation of air, the air is
very much drier, and generally of a very much higher temperature. A
satisfactory method of furnishing these houses with the proper degree
of moisture has not yet been invented.

One is only comfortable in a dry air when it is of a low temperature.
When the dry air becomes heated, there is more moisture given off
by the mucous membranes, which causes a feeling of dryness and
irritation in the nose, throat, and larynx; there may also be a
sensation of uneasiness of the chest, and, at the same time, the
individual feels chilly.

Persons constantly breathing abnormally dry air lower the resisting
power of the respiratory mucous membranes and become very susceptible
of taking cold.

Since the degree of moisture of the air of a house is equally
important as its temperature, every room should be furnished with a
hygrometer, which should register from 65 to 70 per cent. of moisture.

=The Ventilation of Bed-rooms.=—The importance of the proper
ventilation of the sleeping-room will be seen from the fact that
two-thirds of the oxygen absorbed in the twenty-four hours is
absorbed between 6 o’clock in the evening and 6 o’clock in the
morning; and on the state of the air of the bed-room will depend
greatly the vitality of the individual. During sleep inspiration
occupies ten-twelfths of the respiratory period, while at other times
it occupies only five-twelfths of that period. In a closed room the
oxygen would eventually be consumed, the air become filled with
impurities, and the body languish for want of oxygen and incapacity
to throw off its impurities.

The air of the room should be perfectly fresh on retiring; where it
has been used as a sitting-room, it should be thrown wide open and
thoroughly ventilated just before going to bed. The temperature of
the room should not be above 65° F. In the bed-room at night all the
air coming into the room should come from the same side of the room,
and the doors opposite should be closed. If the room is small, and
the window is at the head or foot of the bed, some provision must
be made to screen the bed, and to allow the air to enter the room
without falling directly on the sleeper.

In the intense heat of summer, especially if the air is saturated
with moisture, one sleeps much more comfortably on the side, with
the face almost at the edge of the bed; in this way the formation of
a stagnant pool of exhaled air about the face is prevented, which
would otherwise be rebreathed, and greatly increase the feeling of
discomfort and malaise.

On retiring at night the clothes worn during the day should be spread
out over chairs to become thoroughly ventilated, instead of being
hung up in a closed press or closet. From a sanitary point of view,
it is essential that every article of clothing worn during the day
should be removed at night. Both clothes and body need ventilation.

In the morning the clothes should all be taken off the bed, and they,
as well as the night-clothes, should be spread out to be aired during
the ventilation of the room. The windows are thrown wide open when
one goes to breakfast.

=The Care of the Nose, Throat, and Ears.=—It will be most profitable
to consider the care of the nose, throat, and ears together, since
the mucous membrane lining these cavities is continuous, and so there
is always great danger of an inflammation of one extending to the
others.

It has been calculated that about one-third of our adult population
are notably deaf in one or both ears. In the majority of cases
deafness is the result of colds and throat troubles, and much can be
done to prevent its occurrence.

The nose communicates through the nasal fossæ with the nasopharynx,
and the mucous membrane lining the nose is continuous with that
lining the throat.

The nose performs four important functions—it serves as a passageway
for the air in breathing, and it warms, moistens, and filters the
inspired air; it is the organ of smell; it aids in phonation; and
it affords ventilation to the ears and accessory sinuses. But by
far its most important function is the rôle which the nose plays in
respiration. To supply the large amount of water necessary to moisten
the inspired air, it has been calculated that about one pint of
water must be secreted by the nose daily; part of this amount of
moisture is furnished by the tears. Mouth-breathing always causes
dryness of the throat.

The filtration of the air is accomplished first through the action
of the hairs at the external margin of the nose, which hinder the
entrance of large particles, and, second, by the adherence of small
particles to the moist surface of the intricate passages of the nose
and nasopharynx. The microbes are expelled with the dust; in addition
to this, the nose probably has the power of destroying any bacteria
through the action of its germicidal mucus.

_Obstruction of the Nasal Passages._—In adults the commonest modes
of obstruction are the bending of the nasal septum to one side, or
by a thickening of the septum by which one nostril may be completely
closed up. The occlusion may also be due to the swelling of the
mucous membrane or the presence of polypi.

In children the most common form of obstruction of the nose is by the
adenoids and the enlargement of the tonsils; this enlargement may be
so great as to prevent nasal breathing and interfere with the normal
ventilation of the ears.

_The Throat or Pharynx._—The throat or pharynx is the upper and
funnel-like portion of the alimentary canal, which is seen at the
back part of the mouth. It extends up back of the nose. The cavity
of the throat is somewhat separated from that of the mouth by the
soft palate. This is a membranous curtain, which is attached to the
posterior part of the hard palate. The pendulous part of the soft
palate is known as the uvula. The uvula sometimes becomes so greatly
relaxed that it rests on the base of the tongue, which causes a
constant irritation and slight cough, a condition which is easily
relieved by a few astringent applications.

On looking into a mirror there will be seen, on either side of the
throat, two arches, formed by folds of mucous membrane; these are
known as the pillars of the throat. Between these pillars, on either
side, is an almond-shaped body called the tonsil. In health the
tonsil should not protrude beyond the anterior pillar.

_Causes of Diseases of the Nose and Throat._—Exposure to wet and
cold, when insufficiently clad, or, even worse, sitting still with
damp skirts or shoes on. A still more potent factor than exposure
to cold is the relative degree of humidity of the atmosphere; great
humidity is frequently accompanied by epidemics of influenza.
Exposure to very high winds; sudden changes of temperature; the
very dry air and the overheating of houses; insufficient covering
at night; the inhalation of irritating vapors and finely divided
mechanical irritants. Also, gastro-intestinal affections and uric
acid.

Chronic enlargement of the tonsils predisposes to tonsillitis and
to all the infective and contagious throat diseases. In addition,
the breath is apt to be fetid, and swallowing the mucus, germs, and
toxins has a deleterious effect on the stomach and general health.
Mouth-breathing and anemia often follow, and there is an increased
liability to inflammation of the eyes.

_The Importance of a Healthy Condition of the Throat and Nose._—The
nose and throat are the portals of entrance to the bronchial tubes
and lungs, and it depends on the condition of their mucous membranes
whether the germs of disease will find lodgment here and be carried
down into the bronchial tubes and lungs, or whether they will be
expelled with the mucus.

Any irritant which destroys the vitality of the epithelium covering
the mucosa, or a local congestion which interferes with the
nutrition, circulation, and secretions of the part, offers favorable
conditions for the culture of bacteria normally present. Also,
anything which will cause a lowering of the general health, and
thereby lessen tissue resistance, acts as a predisposing cause to
local inflammation, while the germs themselves excite inflammation by
their active growth _in loco_.

From these facts will also be seen the importance of having cut
short, as rapidly as possible, any congestion or inflammatory
troubles of the nose and throat.

_Prevention of Nasal Catarrh and Sore Throat._—First in importance
comes attention to the general health. Under this must be considered
the clothing, food, ventilation, and exercise.

The clothing should be light, yet sufficiently warm to be a
protection against the cold and winds. Heavy shoes with thick soles
are necessary to protect the feet, and it is not so much the matter
of getting wet as it is of sitting down with damp clothing on.

An atmosphere filled with dust in sweeping should not be tolerated in
any well-kept house.

_Local Treatment for the Prevention and Cure of Mild Cases of Nasal
Catarrh and Sore Throat._—The treatment is practically the same.
The toilet of the nose and throat should be made at least as often,
and at the same time, as that of the teeth; certainly, the first
thing on getting up in the morning and again before dressing for
dinner. In our seaboard cities and towns, at least, there is a very
general predisposition to some degree of congestion of the mucous
membrane of the nose and throat. This means an abnormal amount of
mucus which collects in the parts during sleep. Again, on coming in
from out-of-doors on a windy day a large amount of dust, which means
microbes as well, has become lodged in the mucous membranes of the
nose and throat.

This toilet of the nose and throat is best carried out by means of
a nasal spray. The spray apparatus consists of a bottle holding
some two ounces, a hard-rubber spray piece, and a bulb with tubing
to force the liquid through the spray piece. The tip of the spray
should have the form of a cone; this should be introduced into each
nostril, the bulb squeezed several times, until the amount of fluid
is sufficient to be hawked out, and this process is facilitated by
holding the mouth open during the spraying of the nostrils. After the
nostrils have been thoroughly cleansed, the throat should be sprayed
directly.

The liquids used must be bland and unirritating, and only enough
should be used at one time to cleanse the parts. There are on the
market excellent alkaline and antiseptic tablets; one tablet should
be dissolved in a spray-bottle not quite full of water. This solution
keeps in perfect condition, and is always ready for use.

A solution of boric acid, in the proportion of two teaspoonfuls of
boric acid to one pint of water, may also be used.

If the nose and throat are inflamed, this so-called water spray
should be followed by an oil spray, which will be found to be
most soothing and healing. A separate apparatus for this will be
necessary, as an oily solution would clog an ordinary water-spray,
but the principle of the spray is the same, and it is used in the
same way. The following is an excellent formula: Take of menthol
and carbolic acid each two grains; of eucalyptol, six drops; and of
albolene, two ounces. Mix well, and fill the spray-bottle one-third
full; it is to be used in the full strength. Use only enough of this
spray to moisten the nose and throat; by inhaling simultaneously with
squeezing the bulb, the very fine spray is carried into the larynx,
and so is very useful when there is an irritation of that organ, as
shown by hoarseness. If there is only a slight irritation of the
parts, the use of the spray twice daily will be sufficient; the last
time should be just before retiring. On windy days it will be a
great protection to the mucous membrane of the throat to use it just
before going out-of-doors, on the throat only. If the inflammation
is severe, the spray may be used as often as every two hours. This
prescription should be put up by a good druggist.

Ear specialists condemn all nasal _douches_ as dangerous, on account
of the possibility of the water being forced into the Eustachian
tubes.

_General Treatment._—First of all, the system must be toned up by
the systematic use of cold baths, adapted to each particular case,
tonics, iron, and cod-liver oil. It is a grave mistake to allow these
cases to become chronic, as they may be the forerunners of influenza
and even general tuberculosis. They need prompt and scientific
treatment, which the physician alone is capable of giving.

=The Ear.=—The ear is divided into three parts—the external ear,
the middle ear or tympanum, and the internal ear or labyrinth.
The internal ear is the essential part of the organ of hearing in
which the auditory nerve ends. Its structure is very complicated.
The external ear is separated from the middle ear by the tympanic
membrane or drumhead. This is a thin, small, membranous sheet, which
is stretched tautly across the junction of these two cavities, and
vibrates inward and outward between them. The external ear collects
and conducts the waves of sound to the tympanum.

The middle ear, or tympanum, is an irregular cavity, situated within
the bone. It is traversed by a chain of movable bones, which connect
the drumhead with the internal ear, and serves to convey vibrations
of sound to it. The middle ear, or drum cavity, is filled with air,
and communicates with the pharynx by means of the Eustachian tube.
The middle ear is lined throughout with mucous membrane, which is
continuous with that of the throat and nose.

The Eustachian tube is continuous with the middle ear, and extends
downward and forward about an inch to connect it with the pharynx,
where it opens by a trumpet-like expansion, just above the soft
palate, at the junction of the throat and nose. It serves to carry
off the excess of fluid from the middle ear and to preserve the
equilibrium of the pressure between the gaseous contents of this
cavity and the atmosphere. The walls of the Eustachian tube are in
close contact, but they are normally opened during every act of
swallowing, yawning, etc., when the air finds its way into the middle
ear. A stoppage of the nose reverses the process, and when the tubes
are not likewise stopped up, every swallowing motion draws air out
of the tubes. If the openings of the tubes become closed, deafness,
dizziness, and subjective noises will result.

The middle ear is the seat of about two-thirds of all aural troubles,
and, since much of this could be prevented, this becomes a matter of
great practical importance.

_Causes of Impairment of Hearing._—The majority of the affections of
the middle ear originate from extensions of catarrhal inflammations,
from the nose and throat, through the Eustachian tubes. In children
adenoids are the most frequent cause of deafness. The so-called
hereditary deafness is probably due to an inherited configuration of
the septum of the nose, a bending of the septum to one side, or a
tendency to catarrhal affections of its mucous membranes.

Every cold in the head tends to mechanically involve the ears,
and, while recovery may seem complete, there is likely to be some
unrelieved trouble which insidiously but steadily increases—first one
ear, and then the other, shows signs of defective hearing. If only
one ear is involved, the condition may progress seriously before the
patient is aware of the trouble.

_Preventive Measures Against Deafness._—From what has been said,
it naturally follows that the preventive measures must be chiefly
those already given against taking cold. If one does take cold,
instead of leaving it to run its course, as is too often done, proper
therapeutic measures should be at once adopted to bring as speedy a
cure as possible.

_Impacted Ear-wax and its Removal._—A healthy ear should never
show more than enough wax to render the hairs within soft, and the
individual should be unconscious of the wax coming away. Wax does not
collect in a healthy ear. When it does occur, there is a stopped-up
feeling in the ears, due to the occlusion of the meatus by wax.

The only procedure that is safe to follow in order to remove the
wax from the ear is to gently douche the ear with warm water, at
a temperature from 105° to 110° F. If this does not suffice, a
physician must be consulted, as all efforts to remove the wax after
it has become impacted are dangerous and futile except in skilled
hands.

_Earache._—The best thing for the relief of earache is the external
application of heat by means of a hot-water bag. If this does not
give relief, the ear may be douched with warm water. Earache can
often be prevented, by those subject to it, by placing a very small
piece of absorbent cotton in the ear before going out in very high
winds or in automobiling.

=Impediments to Normal Respiration.=—These are, for the most part,
acquired through improper habits of posture, dress, lack of muscular
and chest development. Other impediments to respiration are a
deviation of the septum of the nose to one side, marked curvature of
the spine, and deformities of the chest which may be the results of
rickets.

Curvature of the spine is frequently the result of muscular weakness,
combined with faulty position at the desk.

The clothing must be sufficiently loose to admit of the fullest
possible chest expansion; the measurements for the clothing, and most
especially for corsets, must be taken during full chest expansion.

Heavy clothing suspended from the shoulders is also hurtful, because
it renders impossible the expansion of the apices of the lungs.
Obviously, all tight bands around the neck interfere with the
respiratory movements.

_Bodily position_ plays a very important part in maintaining the
symmetric development of the chest and in the proper ventilation
of the lungs; and this is a matter of the greatest importance to
students, clerks, and writers who spend a great part of every day at
the desk.

The faulty attitude, together with the weak muscles and the poor
muscular development, are fruitful sources of spinal curvatures and
flat chests; and free respiration is interfered with. Writing with a
pen is most apt to be accompanied by a peculiarly cramped position of
the body, rendering normal respiration impossible.

_The Correct Attitude at the Desk._—The chair should be of such a
height that the woman may rest her feet firmly and easily on the
floor or upon a foot-rest, the seat being deep enough from before
backward to accommodate about three-fourths of the length of the
thighs, while the back of the chair should be so curved as to support
the spine easily in its natural curves, both at the waist and at the
level of the shoulder-blades.

The chair and desk should be sufficiently close together so that the
student may sit erect to read from books, since leaning forward at
the desk causes round shoulders, flat chest, and short-sightedness.
When the desk and chair are properly arranged, two-thirds of the
forearm can be rested upon the desk without raising the shoulders.

In reading, the distance of the book from the eyes should be twelve
inches, and the book-rest should be inclined, sloping downward toward
the reader, at about an angle of 85 degrees.

If the woman has any great amount of writing to do, she should learn
to use a typewriter. In using this machine she not only writes very
much more rapidly and easily, but the position of the body is much
more erect than that assumed when using the pen, and it is not nearly
so fatiguing to the muscles of the hands and arms.

All closely confining sedentary occupations, as writing, sewing,
etc., should be frequently interrupted to move about for a few
minutes, rest the eyes, and take a few deep breathing exercises
before an open window; this is necessary for the eyes as well as for
the ventilation of the lungs.

=Ventilation of the Lungs and Breathing Exercises.=—Forced
respiration is essential to completely change the air in the lungs,
to maintain the elasticity of the lung tissue, and to expand the
chest in every direction. Only in this way can a thorough ventilation
of the lungs take place; a full supply of oxygen is taken in, which
stirs up, disinfects, and cools the stagnant residual air, and
forced expiration expels the respiratory excretions. One of the
frequent causes of foul breath is lack of ventilation of the lungs,
so that the expired air becomes laden with impurities.

In normal breathing the current of air which passes in and out of the
lungs travels through the nose, not the mouth. The ingoing air, by
exposure to the vascular mucous membrane of the narrow and winding
nasal passages, is warmed and moistened, and at the same time the
mouth is protected from the desiccating effects of the continual
inroad of comparatively dry air.

By means of respiratory exercises the mobility of the chest may be
greatly augmented; there is an increased flexibility of the ribs and
sternum, as well as loosening of the thoracic joints, which may have
become stiff, and these exercises also lead to a development of the
respiratory muscles.

In this manner only can the frame work of the chest become thoroughly
inflated from within, and thus all parts of the lungs, which run the
risk of becoming incapacitated from lack of use, be brought into play.

It is highly important that this thorough ventilation of the lungs
should take place at least three times a day—the first thing in the
morning, while making the toilet, again about the middle of the day,
and at night just before retiring.

To obtain the greatest benefit from these exercises they must be
taken without corsets, the clothing must be light and loose, and
the body lightly clad. The air in the room must be fresh, and after
they have been learned, they can, as a rule, be taken before an open
window. In the morning they are best taken just after the cold bath,
when, by removing the impurities and filling the lungs with fresh
air, and at the same time starting up a good vigorous circulation,
they cause one to begin the day with energy and zest.

The respiratory movements are diminished during sleep, and at the
same time there is a large accumulation of blood in the splanchnic
veins, so that, particularly when there is any tendency to difficulty
with the breathing at night, the trouble is greatly lessened by
filling the lungs with pure air just before retiring.

It is necessary, first of all, to learn the art of breathing, to be
able to dissociate the clavicular, the costal, and the diaphragmatic.
By clavicular breathing is meant the raising of the collar-bone
and shoulders as high as possible by means of a slow but deep
inspiration—this expands the apices of the lungs; costal breathing
is the throwing out and expanding the chest to its utmost capacity,
and so enlarging the chest in its transverse and anteroposterior
diameters; diaphragmatic breathing is the depression of the diaphragm
and the protrusion of the abdomen without raising the lower ribs.
The last is the most readily learned in the supine position; the
bed supports the weight of the body, so that the individual is able
to concentrate her entire attention on fixing the bony thorax,
depressing the diaphragm, and protruding the abdomen at every
inspiration and retracting it to the utmost with every expiration.
This, of course, develops and gives tone to the abdominal muscles.

When the woman has conquered these first principles of respiration,
she is ready to put them into practice in the standing posture. They
should be learned before a mirror, and after that taken before an
open window. The hands should be placed on the hips; first elevating
the collar-bones and the shoulders to the utmost, while still holding
the breath, she expands the chest, always breathing in from above
downward, and, lastly, the diaphragm is depressed. With the lungs
thus expanded to their utmost capacity, the breath is held as long
as possible, then the lungs are emptied by an abrupt and forced
expiration.

These exercises should be repeated at first ten times, gradually
increasing to thirty times. It is well to take one or two ordinary
respirations between the forced ones.

It will be found that, as these exercises proceed and the lungs are
filled with purer air, the breath can be held for a longer period of
time, and that with practice the length of time that the breath can
be held is greatly increased; it should be held for half a minute.
Public speakers, singers, and divers are all skilful in this respect.

When these simple breathing exercises have been mastered, breathing
exercises can be combined with other exercises, which have as their
aim the development of the muscles of the chest.

Reading aloud, singing, talking, laughing, are all good exercises for
developing the capacity of the lungs.

=The Cure of Chronic Bronchitis by Deep-breathing Exercises.=—The
upper part of the body must be nude and the exercises taken before
a mirror, so that the woman can watch the movements of the chest
and abdomen, see that all the hollows of the chest are filled out
during forced inspiration, and that the muscles of the abdomen are
properly retracted. For the average woman this last will be the
most difficult; in beginning these exercises she will find that it
will require all her concentrated energy and will power to cause a
retraction of these disused muscles.

Patients with chronic bronchitis do not have the ability to perform
forced respiration properly. The respirations are too superficial,
and the respiratory movements are not properly performed.

As respiration is ordinarily performed, the partial expansion of
the upper part of the chest is accompanied by a contraction of the
abdominal muscles, whereby the diaphragm is forced upward, with
the result that the lower part of the lungs remains very slightly
expanded, whereby the circulation as well as the removal of mucus is
imperfectly performed. This lack of forced respiration is a frequent
cause of acute bronchitis running into a chronic form.

In chronic bronchitis it is especially in the lower part of the lungs
that stagnation of the secretions takes place, and they can only be
dislodged from the mucous membrane by forced abdominal expiration
and the ascent of the diaphragm. This causes a cough which expels
the mucus, and forcible abdominal expiration and cough are the only
means of drainage of the lower and deep-seated parts of the lungs.
Further, in forced respiration the muscle tissue of the bronchial
tubes contracts, which certainly does not take place in ordinary
respiration, but, on the contrary, this tissue atrophies.

Other beneficial results from forced respiration are increased
oxygenation, improved nutrition, changes of a mechanical nature,
ventilation, and disinfection of the lungs, massage of the lungs and
pleura, and drainage.

No other method of treatment is so successful in the cure of chronic
bronchitis not dependent on disease of the nose and throat. In from
two to six weeks of treatment, in which there is a profuse discharge
of mucus, it will be found that the bronchial tubes have cleared up,
provided that the patient is supplied with an abundant supply of
fresh air day and night. Methodically practised, deep breathing is
not only the surest cure, but also the safest stimulating expectorant.

=Relation of Colds and Influenza to Pneumonia and Tuberculosis and
their Prevention.=—We have already seen that bacilli are not only
the cause of acute infections, but also of chronic bronchitis, and
that this was especially true of the bacillus of influenza and the
pneumococcus of pneumonia.

It is well known that influenza is an infectious disease, which
rapidly spreads through the family and the community, but it is
not so well known that the so-called “common colds,” ordinary sore
throat, and tonsillitis are also highly contagious. The infection
is carried from one person to another by direct contagion; the air
is being constantly sprayed with the germs of disease in talking,
laughing, sneezing, and coughing. In coughing and sneezing it is not
sufficient to hold the hand before the mouth—a handkerchief must be
used for this purpose.

_Colds_ are among the most frequent of the so-called minor ailments
in this country. The causes are the overheating of the houses, the
great dryness of the air, badly ventilated houses and public assembly
rooms, which render people very susceptible to the great variations
in temperature.

_Prophylaxis_, or _the prevention of colds_, combine all those
measures which promote the general tone of the system, and may be
said to embrace all the elements of personal hygiene. Good digestion
and proper nourishment of the body with suitable food; the proper
ventilation of houses, all public buildings and conveyances, for in
these latter the public are brought into very close contact with
their fellow-men.

Local prophylaxis would consist in the toilet of the nose and
throat—the removing of adenoids and enlarged tonsils.

The individual must remember that she can reinfect herself; for this
reason, an abundant supply of handkerchiefs must be used; they should
be placed in a handkerchief bag and washed separately. Packs of cards
should be thrown away before they become soiled. Sprays and atomizers
must be individual property, and be kept thoroughly cleansed.

With the exception of deep-seated chest colds, in the early stages a
cold may often be nipped in the bud by a few hours of hard sudorific
work in the open air. In half a day the nasal ducts and respiratory
system will throw off irritating matter that would take much longer
time if the patient remained indoors and relied on the action of
drugs alone.

_Treatment._—Other methods of treatment are a hot tub-bath on
retiring, an active but not too severe cathartic, as two grains of
calomel, taken just before going to bed, and, if the individual
is chilly, a hot lemonade should be taken at the same time. Both
the cathartic and the free perspiration will aid in relieving the
internal congestion and thus aid in its abortion. A cold sponge
should be taken the following morning to tone up the system. Turkish
baths are also useful in breaking up colds; again, the precaution
must be taken to avoid chilling on leaving the bath.

The following tablet is a very simple and very efficacious remedy
for breaking up a cold in the early stages: Take of powdered camphor
¼ gr.; of the sulphate of quinin ¼ gr.; and of the fluidextract of
belladonna root ⅛ minim. This should be well mixed, and made up into
one tablet or a capsule. One tablet is taken every half-hour, until
four doses have been taken; after that one tablet every three hours,
until the running of the nose has ceased, which generally occurs
within twenty-four hours. If there is not marked improvement at the
end of this time, or if there is any fever, a physician should be
consulted at once.

Quinin, when given alone to abort colds, must be given in
sufficiently large doses to produce cinchonism, the subjective
symptom of which is a slight deafness or ringing of the ears. The
natural tendency of cold is to cause inflammation of the middle ear,
and since the use of quinin in large doses causes a congestion, and
so predisposes to inflammation of the middle ear, its use should be
avoided.

The great amount of illness and mortality from pneumonia during and
following epidemics of influenza is too familiar to the public to
need more than mentioning. The patient is so rapidly and extremely
prostrated by the attack of influenza as to be susceptible to
the ready action of the pneumococcus, which, as we have seen, is
ever present, and the extension of the inflammation from the fine
bronchial tubes to the air-cells of the lungs rapidly takes place. In
the exhausted condition of the patient she is not able to resist this
invasion, the heart is already weakened, and death frequently rapidly
ensues as the immediate result of heart failure.

=The Prevention of Tuberculosis.=—The tubercle bacillus is
practically ubiquitous, and the prevalence of tuberculosis is
universal. Hence it is imperative to raise the resistance of the
individual in every way possible, as well as to limit the spread of
the infection. This means the employment of all the resources of
public and personal hygiene, public and private sanitation, and the
education of the public in how the disease is disseminated, and how
its spread may be prevented; also the teaching of the individual, her
duty to the family and society, as well as to herself, in order not
to spread the contagion.

Tuberculosis attacks the crippled and poorly developed lung just as
surely as it shuns the one which is fully expanded and in constant
and active service. Numerous observations have established the
existence of a constant ratio between tuberculosis of the lungs and
deficient chest expansion.

_Diet._—The doctrine has been growing among the laity that the
child’s likes and dislikes should determine what food it should eat.
Thus a finical taste is cultivated and a lack of proper nourishment
follows, and it is this finical diet class of people which forms a
large percentage of tuberculous invalids. It has long been recognized
that a proper diet and the tolerance of it is of the utmost
importance in the treatment of tuberculous patients, but from the
foregoing it would appear that a proper diet throughout life is also
of the utmost importance in the prevention of disease; a sufficiency,
not only as to quantity, but also as regards variety.

It is the patient who can eat everything who stands a good chance of
getting well. So, too, it is the individual whose diet for years has
been perverse, who could not eat meat, to whom eggs were distasteful,
who could not stand milk, who was infected with the vegetarian fad,
or the two-meal-a-day fad, who stands a fair chance of falling
a victim to tuberculosis, through a lowered tone of the system,
because it offers but a feeble resistance to a powerful and insidious
enemy. And the mode of the preparation of the food is an equally
important factor. It has been shown that the poor cooking among the
lower classes is a powerful predisposing cause to intemperance and
tuberculosis.

Influenza is a frequent and important agent in bringing to light
latent tuberculosis, and must be classed as an important exciting
if not predisposing cause. Low, damp climates predispose to the
infection by lowering the vitality. Tuberculosis is more prevalent in
cities than in rural communities, due to the manner of housing and
the character of the occupation.

_Summary of the Present Views of Infection._—The doctrine of
inherited and acquired susceptibility still holds sway; next, that
all infants are susceptible, and that susceptibility lessens with
increase in age; that adults are comparatively insusceptible when
free from general and local lowered resistance and repeated and
prolonged exposure.

As to the source of infection, the consensus of opinion and
ascertained facts point to the sputum as of overwhelming importance;
cow’s milk is an important factor; the food may be infected directly
by coughing, or the dirt and dust from the floor and hands; the
fingers and many other objects that find their way into the child’s
mouth are sources of danger. To adults, both dust and moist droplets
are more often the source of infection than infected food.

_Expectoration._—Careless expectoration is the chief source of
infection. Laws should be passed and enforced prohibiting the
expectoration on pavements, stairways, in all public conveyances, and
all public places.

The danger of infection from tuberculous house servants has not been
sufficiently appreciated. A chronic cough in the case of a servant
should be at once investigated by the family physician. Servants
should be taught the necessity for washing the hands before touching
the food or cooking utensils. The condition of their rooms, clothing,
bathing, and other personal habits should be closely investigated,
and personal cleanliness should be demanded as a _sine qua non_ for
obtaining or keeping a situation.

Since it is a well-known fact that tuberculosis can be acquired from
the occupation of houses and rooms formerly occupied by tuberculosis
patients, it has been suggested that a clean bill of health should
be demanded of the owner of the house before renting it; that is, a
certificate from the Board of Health, that no case of infection has
existed in the house, or that it has been properly disinfected since
that time. If such a movement became popular, landlords would be
obliged to furnish these bills of health in self-defense. Since the
Boards of Health demand the reporting of all cases of tuberculosis,
this scheme is by no means impracticable or Utopian.

The tubercle bacillus is not destroyed by any degree of cold, but
both light and sunlight are distinctly injurious to these bacteria.
The lowest fatal temperature to the tubercle bacillus is 131° F. of
moist heat, acting for a period of six hours. The thermal death-point
of tubercle bacilli in milk is of great practical importance,
and many experiments have been made which have determined that a
temperature of from 140° to 167° F., was sufficient if continued
for one hour. If it is desired to pasteurize the milk, it should be
placed in a closed bottle or stirred and heated for at least twenty
minutes at a temperature of 149° F.

_Disinfection._—The use of formaldehyd gas has practically displaced
the use of sulphur for the fumigation of rooms, as well as for the
disinfection of furniture and clothing. For this purpose a moist
vapor used in a sealed room is essential.

At least 8 ounces of the commercial 40 per cent. formalin should be
used for each 1000 cubic feet of air content. The most efficient
method is that used by Biggs, of New York, which is as follows: For
an ordinary room, 1000 cubic feet, 1 pound of lime, 8 fluidounces of
formalin, and from 2½ to 3 fluidounces of commercial sulphuric acid
are required. All openings but the door are sealed. The formalin is
poured into an empty water-pitcher, 4 ounces of water are added, and
then the sulphuric acid is poured slowly in. The lime is placed in
a china or earthenware wash-basin on the floor upon newspapers; all
water is removed from the room. All drawers and cupboards opened;
the mattresses stood on end; and the mixture poured quickly upon the
lime, when the door is sealed. The sulphuric acid may be packed in a
tin bucket containing the lime, and, with the formalin in a separate
bottle, may be used by any person of ordinary intelligence. The room
should remain closed from twelve to eighteen hours. It must not be
lost sight of that after disinfection by means of formalin a thorough
cleansing is imperative. A room which has been thoroughly cleaned
and carbolized is safer than a room which has been disinfected with
formalin and not properly cleaned.

After death or removal the entire place should be renovated. Besides
disinfection and scrubbing the painted woodwork with a solution of
hot soda water, the walls should be repainted or repapered, and the
woodwork repainted.

Rugs, bedding, pillows, and clothing should be disinfected by hanging
up in the room while it is undergoing disinfection. Books and all
articles of small value should be burned. All soiled linen should be
boiled.

=The Kidneys and their Function.=—The kidneys are the secretory
organs of the urine; they are two in number, and are the largest
tubular glands in the body. They are deeply seated in the lumbar
region, lying one on each side of the vertebral column; the kidneys
extend from the eleventh rib nearly to the crest of the pelvis. They
are usually embedded in a considerable quantity of fat, which is the
chief factor in holding them in position, aided to some extent by
the large blood-vessels with which they are connected. The kidneys
are oblong bodies and measure about 4 inches in length, 2½ inches
in breadth, and over 1 inch in thickness. Their weight is about 4½
ounces.

As an excretory organ the kidney probably stands second to the
alimentary canal; it surpasses in importance the skin, whose total
excretion of water it equals. The abnormal substances appearing in
the urine are often not the products of disease of the kidneys, but
of some other organ or system.

The kidneys excrete and put the finishing touches upon the urinary
fluid; they act at the end of the metabolic course, both as active
and as passive agents. While to some extent the kidneys are
mechanical contrivances, mere filters, so to speak, they are to a
far greater degree active, specific glands. The renal epithelium has
the power of synthesis, and builds up complex substances that are
not apparent as such in the blood or lymph, as well as the power
of analysis or breaking down of substances. These changes are due
to the formation in the tubular cell of an enzyme, which we call
histozyme. The kidney is the end link in the vascular chain, and the
daily performance of healthy kidneys is no doubt a combination of the
mechanical and the vital processes.

_The Secretion of the Urine._—In a perfectly normal being the
problems of waste and repair are balanced to a nicety. As we know,
the tissues of the body are bathed in lymph containing in solution
the compounds that are necessary for their nourishment—proteids,
carbohydrates, fats, salts, and gases. Waste follows in direct
proportion to the activity of the tissues. The worn-out, effete
material first finds its way into the lymph, and from it into
the blood-stream, to be later eliminated from the economy, else
deleterious results will follow their retention in the body. It is
by the selective action of the cells of the various glands of the
body that these useless substances are removed from the blood, and
converted into such forms as can be readily excreted. In the main,
the products to be removed are urea and the allied nitrogenous
bodies—carbon dioxid, salts, and water. These organs are of vital
importance, since nearly all of the waste-products containing
nitrogen are eliminated in the urine.

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

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

The separation of the solid substances of the urine form the
next function of the kidneys, and these substances fall into two
groups—inherently useful materials, which are in excess or which have
served their purpose, and substances which are inherently harmful.
The latter class embrace many end-products of metabolism, which we
are accustomed to consider as normal constituents of the urine.

The analytic study of the urine is of great value to the physician
and surgeon, because of the knowledge which it gives concerning the
processes of metabolism occurring within the body. The nature and
amounts of the various end-products of metabolism are carefully
investigated as they occur in the urine, whether they be normal or
pathologic.

_The Urine._—The normal human urine recently passed is a clear
liquid, of a straw color, with an average specific gravity of 1020,
the specific gravity indicating the amount of solids contained in the
urine. It is acid in reaction. The quantity for twenty-four hours
is 50 ounces, or about 3 pints, depending on the amount of water
ingested. During sleep the amount secreted is less than at other
times. The amount of urine is decreased after profuse sweating,
diarrhea, thirst, diminution in the blood-pressure, and after severe
hemorrhage. When the body temperature is considerably higher than
normal, the amount of urine is again diminished in quantity.

Urea forms nearly one-half of the solids in normal urine and nearly
one-half of the urea is nitrogen. It is the principal representative
of the waste of the nitrogenous tissues. The chief source of urea is
from the metabolism of the muscles; the ingestion of a large amount
of proteid food stimulates metabolism. The quantity of urea passed in
the twenty-four hours is about 500 grains.

The uric-acid constituent is very small, and in the human urine
scarcely reaches 0.03 per cent. of the solids. Lack of exercise
leads to an increased formation of uric acid by a lessening of the
oxidation of the tissues. In gout the amount of uric acid excreted is
abnormally small, because it accumulates in the blood and tissues.
The brick-dust deposit sometimes seen in the urine is composed
chiefly of the urate of sodium. The average daily amount of uric acid
passed in the human urine is about 7 grains. The excretion of uric
acid may be increased by drinking copious drafts of water.

_Toxicity of the Urine._—After the removal of both kidneys the
animal dies of uremia; that is, there is an accumulation of urinary
products in the blood. The removal of one kidney is not necessarily
fatal, and women have so lived very comfortably for many years. A
human being excretes enough poisonous material by the kidneys in two
days to cause death.

_The Urinary Excretory Apparatus._—After the urine has been secreted
by the kidneys it must be carried away from the body, so that the
economy may not suffer from the resorption of the contained toxic
principles. The excretory apparatus comprises the ureters, the
bladder, and the urethra.

The ureters are two cylindric tubes of the diameter of a goose-quill
and about 15 inches long. They make their exit from the inner border
of the kidney, and pass downward and inward toward the median line,
to empty into the base of the bladder by a slit-like orifice.

The bladder is the reservoir for the urine. It is a musculomembranous
sac, situated in the pelvis, and in the female it is in front of the
uterus and above the vagina. It normally contains one pint. It should
be emptied four times a day. If it is allowed to go longer than this,
it becomes overdistended, and is apt to displace the uterus backward,
and the bladder-walls themselves become weakened.

=The Physiology of the Female Generative Organs.=—The internal
and essential organs of generation are the uterus, ovaries, and
the Fallopian tubes. These organs have to do with the process of
ovulation, menstruation, and reproduction.

_The Ovaries._—These are two small bodies of an almond shape, and lie
one on either side of the uterus. The bulk of the organ consists of
connective tissue, in which lie embedded the Graafian follicles, or
ovisacs, in which the ova are contained.

During the child-bearing period, or from about the age of fifteen to
forty-five years, the development of the Graafian follicles and the
discharge of the ova are continually taking place. The liberation
of the ova usually takes place at definite times, which, in general,
coincide with the menstrual epochs, one or more ova being set free at
each period, but this is by no means invariable.

_The Uterus._—The virgin uterus is a small, hollow, muscular organ,
somewhat pear shaped, whose cavity is about 1½ inches deep. The
uterus is situated in the middle of the pelvic cavity, between the
bladder and the lower bowel. It is held in position by broad elastic
bands, which go to different sides of the pelvis; it is also in part
supported by the structures below and above it; but so loosely is the
uterus held that it is easily pushed about, as, for instance, by a
full bladder or a packed bowel, and persistently allowing the bladder
to become overful, and failure to have a daily evacuation of the
bowels, are prolific sources of displacements of the womb.

_Respiratory Movements of the Uterus._—When no constrictions are
placed about the waist, the uterus moves freely up and down with
every respiration. So distinctly, and with such regularity, do these
movements occur that an operator, by watching the movements of the
uterus, can tell the effect that the anesthetic is having on the
patient’s breathing. These so-called respiratory movements play a
very important rôle in the circulation of the uterus, and in the
return of the venous blood to the heart.

Anything which interferes with these movements, as the wearing of
corsets or of tight bands about the waist, prevents the free return
of the venous blood. The uterus becomes congested, and through the
constant abnormal weight of the organ itself, as well as by the
pressing down upon it from above of the superincumbent organs, the
uterus is pushed down below its normal position, the ligaments whose
duty it is to hold it up become relaxed, and the unhappy woman
suffers all the agonies that are attendant on the “falling of the
womb.” For this reason the disorder is frequently met with in women
who have never borne children as well as in those who have.

_The Functions of the Uterus._—The function of the uterus is to
provide a favorable place for the reception of the product of
conception, where it may be protected and nourished during the period
of its development. The purpose of menstruation is to keep the uterus
in suitable condition for the reception of this product of conception
at any time. It is now known that the menstrual flow is not the whole
of menstruation, and that the changes going on in the uterus are
almost as continuous as the process of digestion.

_Average Duration of the Menstrual Flow._—The average duration of the
menstrual flow is five days, although the variations are considerable
in healthy women. A flow lasting any place from two to six days is
perfectly consistent with health, but a flow continuing less than two
days or more than six days generally indicates a local or general
disease.

_Character of the Menstrual Flow._—For the first few hours, or
perhaps for the first day, the flow is usually slight in quantity
and light in color; on the second and third day the flow reaches
its height, and is profuse and dark in color, but it should never
be clotted; after this it generally ceases. The amount of the flow
varies from 5 to 10 ounces. If less than 5 or 6, or more than 18
napkins, are pretty well saturated through, the amount may be
considered abnormal.

_Premonitory Symptoms of the Flow._—The premonitory symptoms of the
monthly flow should not be so marked as to cause the individual any
discomfort. The first indication of the return of the period should
be the flow. There is generally a feeling of abdominal fulness, with
some lassitude and sometimes slight headache. The temperature is
lower and the pulse is slower than at other times. This lowered tone
of the system is an additional reason for increased care against
exposure in wet or cold weather.

=Hygiene of Menstruation.=—During the menstrual period all _cold_
baths must be strictly prohibited, whether tub-baths or cold sponges.
The reason for this is that the application of cold to the surface
causes a driving in of the blood from the exterior of the body to the
internal organs, and, at the time of the menstrual periods, there is
already a congested condition of the pelvic organs, and it must be
remembered that congestion is the first stage of inflammation.

Hot or warm sponge baths may be taken throughout the period, and the
vulva should be bathed with warm water twice a day throughout the
entire period of the flow, as this not only removes the clotted blood
before it decomposes and becomes the source of irritation, but also
removes other irritating matters, and prevents the nervousness that
is caused by local irritation.

Another question which is still _sub judice_ is the necessity for
and the frequency with which vaginal douches should be taken; all
physicians are agreed that a vaginal douche, taken immediately after
the menstrual period, is beneficial, as it removes all of the débris
of the flow, which is sometimes very irritating.

_Exercise._—A moderate amount of exercise should be taken every day;
this is needed now quite as much as at any other time, and only good
can result from it, and no harm comes of a woman going out in the
rain or the cold weather. As has been shown, the menstrual process
is going on for a large part of the time, and the flow is only the
external appearance, but during the time of the flow the woman must
be unusually careful not to get her feet wet or sit down with damp
clothing on. Violent exercise of all kinds is to be prohibited at
this time, as dancing, bicycling, gymnastics, and walks of over
three miles. The reason for this is very obvious: the uterus has now
reached the height of its turgescence, and is heavier than at any
other time, hence the danger that displacements or a very profuse
flow would be caused by any kind of violent exercise.

_Treatment._—If the woman has been so unfortunate as to have been
caught out in a heavy rain, so that her clothes have been wet
through, or if in the cold weather she should come into the house
thoroughly chilled, the best thing to do is to take off her wet
things as quickly as possible; be well rubbed down with hot rough
towels; drink a cup of hot tea, and go to bed at once, with a
hot-water bag placed over the abdomen or under the small of the back.
She should remain in bed until the next morning, to the end that the
circulation may regain its equilibrium as quickly as possible by the
immediate relief of the pelvic congestion.

If this exposure should have caused the sudden cessation of the flow,
a hot mustard foot-bath should be taken. One tablespoonful of ground
mustard is used to the gallon of water, as hot as it can be borne;
the pail should be made as nearly full as possible, without running
over, and a blanket wrapped about the pail and woman, so as to cause
a profuse perspiration; this should be kept up for ten minutes; as
the water cools off, hot water may be added.

Profuse menstruation, painful menstruation, and scanty, very slight,
or irregular flow are all abnormal conditions that are due to some
abnormal or pathologic causes, and a good gynecologist should be at
once consulted, so that not only suffering may be prevented, but that
serious consequences to the general health may be averted.




CHAPTER VI

THE NERVOUS SYSTEM AS THE BALANCE OF POWER IN THE BODY

  The Brain the Master Organ of the Body; the Functions of the Brain;
  Habit and Automatism; the Physiology of the Brain and Nervous
  System; the Hygiene of Work; the Toxins of Fatigue; Overwork; Signs
  of Overwork; Nature’s Restoratives; Avocation; the Physiologic
  Necessity for Laughter; Vacations and Health; Sleep; Insomnia.

  The Eyes; Eye-strain; Description of the Visual Apparatus; Optical
  Defects and Their Correction; the Mechanism of Eye-strain; Local
  Symptoms of Eye-strain; Artificial Lighting; Hygienic Precautions
  in Reading and Sewing; Injuries to the Eyes; Symptoms and Treatment
  of Conjunctivitis; Trachoma; Styes.

  Functional Nervous Disorders, Headache; Neurasthenia.


=The Brain the Master Organ of the Body.=—The brain is not only
the most important organ in the body, but its essential organ, for
the sake of which all the other organs and tissues exist, and it
is the master of the whole. It not only receives help from every
other organ, but it also largely controls the working of each. By
its mental action alone it can hurry the heart’s beat or slow its
pace; it can make the skin shrivel or flush; it can quicken or stop
digestion; it can stop or change the character of all secretions;
it can arrest or improve the general nutrition. Every organ and
every vital process is represented in the structure of the brain, by
special centers and groups of cells that have a direct relation with
such organs and processes, and through which they are controlled.

=The Functions of the Brain.=—The brain may be said to have four
chief functions; the first is that of motion; it presides over
and stimulates all the voluntary muscular movements of the body,
regulating their force, and coördinating in their working the
different groups of muscles needed to perform them. Mind and
muscular movement have the closest possible connection with each
other. The second function of the brain is that of feeling and
sensation; the third is that of nutrition; through this its own
nourishment and that of the rest of the body is regulated. While mind
is the fourth and highest form of nerve force, it is not created in
the brain, but is absolutely conditioned by that organ.

Different groups of brain-cells have different work assigned them;
some have motion, some have sensation, some have nutrition, and some
have mind. For example, special tracts of brain govern inhibition.
While every group does its own work, it is related to and combined
with others, influencing them, and being influenced by them.

Every kind of mental activity uses up the brain energy of the cells.
To think clearly, plenty of healthy blood must be supplied to the
cells. In order to make healthy blood, there must be an abundance
of fresh air supplied to the lungs, and a vigorous heart to pump it
up to the brain. It has been demonstrated that, during intellectual
work or emotional feeling, there is an increased supply of blood to
the brain, which may become more or less congested, and that there is
an actual rise of temperature; whereas during periods of relaxation,
rest, or fatigue, the brain is pale and anemic.

The brain-cells generally, but particularly those cells involved in
mental activity, are of such a nature and constitution that they
cannot rest absolutely during the waking hours. They may act slowly
or with great rapidity; different brains have different capacities
for energizing, both in regard to speed and force; and, further, the
brain may be pushed to work greatly in excess of its normal activity,
just as an engine may be allowed to go at the rate of 50 or 60 miles
an hour, or may be pushed to go at the rate of 100 miles an hour. In
both cases the danger resulting from speeding are greatly in excess
of going at the normal rate of speed.

In any case, the continuous brain action implies the necessity for
continuous repair. The only complete physiologic rest which the brain
enjoys is during sleep, when the process of repair goes on most
rapidly; during this period the brain-cells absorb their nourishment
from the blood in excess of their needs, and so lay up a store of
energy for the waking hours.

=Habit and Automatism.=—It is one of the innate qualities of every
tissue and of every organ in the body, that when any vital action is
performed, any vital process gone through with, it is easier to do it
the second time, and the continuous exercise of the action makes the
performances more and more easy, until they become automatic.

The physiologic basis of habits consists of the plasticity of the
nerve substance, and in the capacity of nerve substance to receive
and retain impressions. There results the certainty that the nervous
system will act again more easily in those ways in which it has
already acted.

On the one hand, the automatic performance of work saves an enormous
amount of brain energy; on the other hand, bad habits may be formed
whose effects may be most pernicious, and which are gotten rid of
only with the greatest difficulty. An example of the first is the
young child learning to walk; at first he accomplishes the feat
only by the fixed concentration of every power of the brain on the
act; whereas the healthy adult walks automatically, without paying
the least regard to the movements or the manner in which they are
accomplished. Hysteria and ungovernable outbursts of passion furnish
good examples of the bad habits that may be formed, owing to the lack
of discipline and the powers of inhibition; every time that a woman
gives way to one of these outbursts, so much the harder will it be
for her to prevent or control another outbreak. Inhibition is the
highest and most important function of the brain.

Habits woman must have, but it is for her to choose what they shall
be, provided she chooses quickly; the _time limit_ in habits is one
of the strong evidences of the close connection of body and mind. It
is a startling fact to face, that a woman’s habits are largely fixed
before she is twenty; that the chief lines of her future growth and
acquaintance before she is twenty-five; and her professional habits
before she is thirty; yet to something like this James believes that
physiologic psychology points. The woman becomes a bundle of habits,
and her habits settle about her like a plaster cast.

=The Physiology of the Brain and Nervous System.=—The brain, spinal
cord, and spinal nerves constitute the so-called cerebrospinal
nervous system. The brain is that portion of the nervous system
which is contained within the cranial cavity and which it completely
fills. The spinal cord is the continuation downward, from the brain
through the spinal canal, of nerve substances, and from which the
spinal nerves are given off. The nerves may be described as cords and
threads of varying degrees of fineness, distributed to every tissue
and organ in the body.

The nervous system has been likened to the electric telegraph, the
brain being the central station, while, in addition to the special
senses, the body is provided with numerous terminal substations
in the skin and internal organs of the body, which keep the brain
informed of what is going on in the world around it, as well as in
the various parts of the body. The nerves simply act as conductors to
transmit the messages. The body is supplied with two distinct sets of
nerves or wires, one of which carries messages from the outside world
and various organs to the brain, while the other set transmits orders
from the brain.

The spinal cord is the center of reflex acts; that is, if the leg of
a brainless frog is touched with acid, he will take the other leg
to wipe it off with. There are, as we have seen, substations in the
skin, hence the acid causes the sensation of a foreign body, word is
telegraphed the spinal cord, where there is a large central station;
from here word is sent out by another set of nerves, to move the leg
away from the acid, but this being insufficient, word is telegraphed
to the other leg to wipe off the offending substance. Did the same
thing happen in the body, at the same time that the cord telegraphed
word to the affected member to withdraw it, it would telegraph the
brain, and the sensation of pain would be felt.

A message travels along a nerve at the rate of about thirty-six
yards a second, or a mile a minute. This is about the time made
by a lightning express train. The distance in the body being so
short, the time taken is imperceptible, and we say that movement is
instantaneous.

The paths traveled by nerve impulses are made passable by use; the
oftener an impulse traverses a given route, the more adapted such a
route becomes for future traffic.

But all of this has to do with the nerves which are under the control
of the will. There is another set of telegraph wires in the body,
called the sympathetic or vegetative system, so-called because it
presides over the processes of nutrition and is beyond the control of
the will.

=The Hygiene of Work.=—Since the motor centers are located in the
brain, it is natural to expect that all definitely directed movements
will directly affect the brain and the mental development, and so it
is. Du Bois Réymond says that it is easy to demonstrate that such
bodily exercises as gymnastics, fencing, swimming, riding, dancing,
and skating are much more exercises of the central nervous system, of
the brain, and spinal cord than of the muscles.

It is further urged that healthful energy of will is impossible
without strong muscles, which are its organs, and that endurance,
self-control, and great achievement all depend on muscle habits.

The philosophy of work consists in its necessity. The brain-cell in
health cannot cease to be active, except to a partial extent during
sleep. There must be some output of mind from the mind cell and of
motor stimulus from the motor cell. The proper selection of work
for that particular brain to do, and the physiologic regulations of
the work done, is the basis of the hygiene of work. For health, for
happiness, and for efficiency, right work rightly done is the most
important matter in any man’s or any woman’s life.

The physiologic, as well as the moral necessity, has always been
conceded for every man to have a life-work—a vocation; a work for
which he should be fitted, and for which he was capable, sufficiently
congenial not to sink into mere drudgery, and which would, at the
same time, afford ample financial compensation to be remunerative and
a stimulus to his power of endurance.

Important, from a physiologic point of view, as a vocation is for
men, it is equally or even more important for women. It is highly
probable that the unstable nervous system of women and their
emotional extravagance and dissipations, whether of frivolity,
wickedness, or grief, is largely due to lack of mental discipline and
muscular development. It is a psychologic proposition that any woman
who has a toothache suffers less if she keeps busy, and any one will
testify that she suffers much less from the intense heat of summer if
she is busily employed.

One of the great objects of a definite and fixed occupation is
to turn the thoughts out from the ego. Work of some kind is
indispensable to the health and happiness of every one, since it
necessitates an objective instead of a subjective attitude of mind.

Experience teaches that the brain, like the muscles, is subject
to training; occasional excessive efforts, with long intervals of
repose, are rather injurious, while a many-sided activity, constantly
repeated, interrupted by sufficient shorter rests and supported by
sufficient nutrition, is strengthening. A healthy training of the
brain should be as many sided as possible.

Symmetric development and training of every function of the brain
is as essential for mental efficiency and sanity as the development
of all the muscles of the body is for bodily vigor, and a one-sided
training of the mental powers is as certain to produce eccentricities
of habits of thought and actions as those occupations which call into
play only the action of certain groups of muscles is to cause bodily
deformities. Anything which will prove injurious to the delicate
nerve substance must be avoided, as laziness, idleness, and, worst of
all, any form of narcotics.

Many-sided life work, consistently carried through, not only
strengthens the brain, but also its continued power of adaptation,
and one’s whole life is a continuous struggle for adaptation. The
more the brain works, the more capable it is of receiving new
impressions and elaborating old ones, and it retains its elasticity
longer.

Hurry generally implies lack of system in carrying out the routine
of work, or the undertaking of more work than the individual can
accomplish without injury to herself. Few things can more certainly
muddle the brain and produce a sense of physical exhaustion than a
sense of hurry. Without the sense of this insane driver with a lash
in his hands standing over one, she can work more rapidly, with
complete self-possession, and do more accurate and better work. The
peculiar sense of being hurried has a direct benumbing physical
effect, that can often be felt in the brain as distinctly confusing.

=The Toxins of Fatigue.=—By speeding the machinery to the utmost,
a strain is placed on nerves and muscles, and they are kept keyed
up to the greatest possible tension. There is a natural pace that
one can keep up; force the pace, and weariness results. A man can
go for hours at the rate of five miles an hour; he can run at the
rate of six miles an hour for quite a long while; but if he tries to
run eight miles an hour, he will drop out very soon. The powers of
endurance must be gradually developed, but no machine should ever be
run at its utmost speed.

By undue pressure, at any period of life, it is possible to use up
energy that ought to have been spread out over long periods; and
this is emphatically the case during adolescence; too heavy a drain
is made on futurity, which means a serious breakdown, or, at least,
premature old age.

It has long been assumed that during the activity of muscles
substances were produced which exerted a poisonous influence upon the
muscle tissues. Exactly what these substances were was not known,
but it was supposed that they were definite products of metabolism
or tissue waste. It is a well-known phenomenon, observed during the
training of athletes and soldiers, that prolonged and disciplined
exercise makes it possible for individuals to support easily an
amount of work which would prove exhausting or even fatal to the
untrained. Increased work, under any circumstances, means increased
metabolism, and consequently a more rapid accumulation of its
products.

A German investigator, Dr. Weichardt, has shown that if guinea-pigs
were put upon a miniature treadmill and forced to run it until they
dropped dead from exhaustion, a highly poisonous liquid could be
pressed from their muscles, and that the injection of this liquid
or extract into the veins of healthy guinea-pigs produced, when
administered in small doses, rapid fatigue; whereas, larger doses
caused death, accompanied by all the symptoms observed in the
original animal during the process of mechanical tiring.

On the other hand, liquid taken from unworked guinea-pigs had no
such effect. Further, that if these little animals were put upon
a treadmill and worked to just short of exhaustion, and then were
given time to recuperate, as we say, the liquid or extract from their
muscles had no such effect: it was quite harmless.

From the results of these carefully carried out scientific
investigations, Weichardt has come to the conclusion that fatigue
is due to a definite toxin, analogous to that of diphtheria and
tetanus, and he believes that the explanation of the phenomena of
training lies in the fact that in the body of the athlete there must
be a specific “antibody,” which neutralizes the “fatigue toxin” as
soon as it is formed.

In the animals undergoing these experiments of extreme fatigue there
was a fall of temperature. A practical use of this fact could be made
for the individual, by noting the fact that a subnormal temperature
was a grave danger-signal.

Other observers concede that fatigue is due to chemical substances,
produced in the body as the result of brain and muscle activity, and
find that these toxins produce a depressing effect, especially on
the muscular system, and that the sensation of fatigue is in large
part the manifestation of this depression. The action of toxins is
not confined to the tissues in which they arise; excessive activity
of one tissue can cause fatigue of others. The facts of acid
intoxication are noticed as analogous to fatigue phenomena, so far as
the latter are due to toxic substances. As antidotes, only rest and
sleep can be relied upon.

Observations in the electric experiments on nerve-cells have shown
a remarkable shrinking of the nerve-cells, and especially of their
nuclei. After five hours’ continuous work, the cell nucleus was only
half its normal size, and twenty-four hours of rest was necessary in
order to restore it to its normal size, but half that amount of work
does not require half that amount of time for its recovery.

The mental symptoms of normal fatigue are loss of memory; the sense
of perception is less acute; the association centers act less
spontaneously and therefore slower; the vocabulary diminishes; the
emotional tone is lowered; the attention is unstable and flickering.
All these are marked symptoms that the individual is far below her
best. All kinds of perceptions are more acute in the morning.

Fatigue is not, therefore, merely physically uncomfortable; it is
intellectually, physically, and morally dangerous.

=Overwork.=—A surplus nervous energy must be persistently aimed
at—what Emerson calls “plus health.” It must be indelibly impressed
on the intelligence of every one that no fatigued individual can
be at her best; she is doomed to do inferior work, to be mentally
depressed, and to be morally weakened. Hope and courage ooze away,
and all sense of proportions and perspective are lost.

The amount of work that can be performed without fatigue is a
matter of individuality, and the only safe gauge of overwork are
the danger-signals sent out by nature—loss of appetite, insomnia,
increasing exhaustion from day to day without increase in the amount
of work done, mental depression, lack of interest and initiative. No
one can afford to disregard these danger-signals.

Habitual overwork produces fag and a desire for stimulants to act
as a spur to the overworked muscles during the day, and recourse
to increased stimulants or sedatives to act as hypnotics at night.
The inert nerve-centers have no reserve energy to give out, so it
is worse than useless to stimulate them. On the other hand, the
nerve-centers are at too low an ebb to react from the depressing
effects of sedatives, which, to the individual, must be positively
injurious. The aim must be to promote nutrition, and to give complete
rest to the exhausted nerve-centers.

Brain work, to be beneficial, must be regulated with the greatest
care. During the exercise of the brain there is always an increased
blood-supply to it. If the exercise is continued too long, there is
a tendency for the blood to remain in too great quantity, due to the
exhaustion of the nerve-cells, which are no longer able to control
the vessels.

During sleep the blood-supply to the brain is diminished and the
cells recover themselves, but if this hyperemia be persistently
kept up, sleep soon becomes impossible, the brain-cells have no
opportunity to become repaired, and their activity is diminished.

Richardson says: “Making all allowances for differences, even in the
prime of their mental and physical vigor, few individuals can exceed
six, and for most persons prudence would direct not more than four or
five hours of close mental application, without seriously endangering
their health.”

No real advantage is gained by eight or ten hours of daily study,
since the memory and reasoning powers become so exhausted that the
assimilation of ideas becomes slower and more difficult. When in
his prime, Walter Scott declared that six hours a day was all that
he could profitably spend upon his literary compositions. In later
years, because of his pecuniary embarrassment, he worked beyond this
limit, and, as the result of excessive labor, his last years were
spent in hopeless imbecility.

=Signs of Overwork.=—These show themselves in irritability, with a
sense of exhaustion, the irritability being due to an exhaustion
of the nerve-centers. Work becomes irksome. There are periods of
depression and melancholia, which recur at shorter and shorter
intervals and continue for a longer period of time. There is a
slight loss of memory, together with inability to concentrate the
mind upon any given subject for any considerable length of time, and
the power of thought and judgment are impaired. There are sleepless
nights, ringing in the ears, fatigue from the slightest exertion, an
irregular action of the heart, with palpitation and a frequent desire
to urinate. Various forms of pain and neuralgia occur.

There may be as yet no loss of flesh or impairment of the appetite,
but this condition of cerebral anemia furnishes the possessor with
a pair of blue spectacles through which the intelligence must look,
and which throw their own color over everything. Distressing dreams
and unrefreshing sleep allow the brain little opportunity for either
rest or repair. The mind becomes as sensitive as the skin after
a blister, and the calm, vigorous mental labor is superseded by
feverish anxiety, wearing responsibility, and vexing chagrin.

When the brain is well supplied with a powerful circulation, and
a rich blood-supply from a good digestion furnishes it with an
abundance of pabulum, the cares of life are borne with equanimity and
cheerfulness. One of the most unerring signs of failing health is the
inability to withstand the pressure of these same daily cares. When
the cares that formerly sat lightly on the shoulders become well-nigh
an insupportable burden, a state has been reached where the mind
reacts on the body.

_Worry._—It is readily evident that worry is bred of exhaustion,
and is one of the signs of overwork; but, if too often indulged in,
it becomes a fixed habit, and the mind rapidly becomes settled in a
state of gloom.

It is most important for overwrought business and professional women,
but most especially for those women whose vocations in life combine
three distinct occupations or callings—namely, wives who act in the
capacity of housekeepers, ministers of finance to the household,
and the bringing up of children—to realize the importance of not
undertaking more than they can accomplish without fret and worry. The
overconscientious woman may object that it is selfish to consider her
own comfort when she has work to do for others, but to expend too
freely of the nervous energy, even in a good cause, is like giving
so much of our substance to charity that we ourselves are in turn
obliged to lean on others for support. In properly conserving our own
energies, we may ultimately be lightening the burden of others. There
is a proper balance between the duty one owes to one’s self and to
others.

Once bred, worry is an endless chain. Tell such a woman not to worry,
and she worries for fear she may worry. She is afraid that she has
decided wrongly, and regards decisions in regard to the most trivial
affairs of life as though they were matters of vital importance.

The obsession “to arrive” is a fertile source of fret and worry. This
habit of mind leads to frantic and incessant labor and blocks all
pleasure at every point. The person who plays a game only to see who
wins, loses half of the benefit of the recreation.

“The legs of the stork are long, the legs of the duck are short; you
cannot make the legs of the stork short, neither can you make the
legs of the duck long. Why worry?” (Chinese proverb.)

_Insomnia._—This is another symptom of overwork. The mind, worried
and harassed all day, retires at night to struggle in the darkness
and solitude with worries, forebodings, doubts, and regrets, which
now assume gigantic and fantastic shapes. In this case the insomnia
is due to faulty habits of mind.

Another form of insomnia is caused by intellectual work being carried
on at night until time for retiring; the mind is then so fully
saturated with the subject that it is unable to throw it off on going
to bed.

Whatever be the cause of the insomnia, it soon becomes a fixed habit,
and, whether it is a case of laying awake a long time before sleep
comes, or waking up at a regular hour toward morning,—and it is a
curious fact that the habit of waking up recurs at almost precisely
the same hour in the morning,—the longer this habit of insomnia is
indulged in, the more difficult it is to break it up.

_Nervousness._—This is a well-known sign of overwork, which shows
itself in intense nervousness and irritability. Everything jars on
the nerves. The woman gives way to her emotions, over which she loses
control.

To keep placid when overworked to the limit of physical endurance
requires a stolidity of soul and lack of nerves only known to the
North American Indians, and perhaps the Japanese, and it matters not
what the kind of overwork is, whether business, pleasure, or charity.

=Nature’s Restoratives.=—The proper division of the day is eight
hours to be allotted to work, eight to sleep, and the remaining
period of eight hours is to be divided among the various methods of
refreshing body and mind—the toilet, eating, rest, and recreations.

Not only are rest, recreation, and sleep in proper proportions
essential to the health of the body, but they are equally essential
to the quantity and the quality of the output of work. From them
result a feeling of physical well-being, an exuberance of animal
spirits which go into the work. The perspective is more accurate, the
judgment is clearer, and the creative power is greater. Work goes of
itself with a swing. Happiness is an expansive quality, that makes
itself felt throughout the entire body, but its effects are most
manifest in the mental power.

The mother who so honestly works and plans for the good of her family
as to give herself no time to rest after her physical efforts is in
such an exhausted condition as only to be able to give them the tired
and critical side of herself for daily association. There are few
human achievements much finer than to make human beings happy, and
this power woman is endowed with to a very large extent.

_Rest_, to be of value, must be systematically taken. Bearing in mind
the shrinking in size of the nerve-cells after stimulation caused by
work, and that they recovered their normal size in relatively less
time if the shrinkage were less, it becomes obvious that, in order
to accomplish the best work, whether purely mental, or of the more
complex mental and physical work demanded of the mother who is at the
same time the housewife, that a break in the day’s work will aid in
securing the best results.

The exact time of the daily _siesta_ must be adapted to the family
régime, but a fixed hour should be set aside for this purpose, and
this should be known as the mother’s hour, and nothing short of a
catastrophe should be allowed to infringe on it.

The woman should retire to her bed-room, undress, and go to bed.
The room should be darkened, and at the same time there must be an
abundant supply of fresh air. One soon forms the habit of taking a
short nap, of perhaps half an hour; one hour should be spent in bed.
After this, she gets up, takes a shower or other bath, dresses, and
is then ready to enjoy life and be a comfort to her family. In this
way alone can absolute relaxation, rest of mind, and body be secured.

=Avocation.=—Second only to the physiologic necessity for a vocation
in life, is the necessity for an avocation, and this must be in the
nature of a recreation.

It is a well-known fact in farming that any one kind of crop will
exhaust the very best soil, but few people recognize the necessity
for a change of occupation and recreation in order to produce the
best mental and physical results.

Joyless drudgery drains the springs of health. There is a mental
starvation, due to the lack of recreation, as well as the physical,
due to the lack of bread. The French aristocrats, noted for the
gaiety of their pastimes, in spite of their dietetic and other
sins, furnish a remarkable list of longevity. Persons of a cheerful
disposition are generally long-lived, and anything tending to
counteract the influence of worry and discontent directly contributes
to the preservation of the health. Despair, which frequently results
from years of overwork, can paralyze the energies of vital functions
like a sudden poison, while hope fulfilled has cured many a disease.

The nature of the avocation chosen will necessarily depend upon the
character of the vocation. For women whose vocations are intellectual
and sedentary, as writers, teachers, stenographers, etc., some
outdoor employment, which calls into activity the muscles of the
body, rests the eyes and brain, and, at the same time, pleasantly
occupies the mind, is the best, as walking, gardening, lawn-tennis,
golf, rowing, etc.

For all women engaged in sedentary occupations, daily exercise in the
open air is the first essential, and let them be assured that their
feelings of fatigue and disinclination to exercise are no safe guide
as to their ability to take exercise.

The first cause of the feeling of fatigue is due to the lack of
oxygen in the lungs and the impure air of the room. On going
out-of-doors, the woman will be surprised at how much stronger and
better she feels after an hour’s brisk walk than she did on starting
out.

“Fancy work” and lace-making, instead of being classed with
recreations, must be classed with fine hand-sewing of the most
taxing kind. It calls the same groups of muscles into play, and is
productive of the same evils, with a greater tendency to produce
eye-strain and a paralysis similar to writer’s cramp.

The proper avocation of the tired housewife, who has been on her
feet all the time and whose vocation is manual labor, will be the
diversion of the mind by reading a good book, while comfortably
pillowed on a veranda chair, a drive, a visit to some congenial
friend, a game of cards, or music.

Literary clubs for women should be more largely organized through the
country and in country towns. In the cities women have found these
clubs a great boon, not only to the health and happiness, but they
are in the highest degree educational.

Further, women have found that these literary clubs were profitable,
as a means of bringing their minds in contact with other educated
minds, and thus they had not only the additional stimulus to study,
but a broadening of their horizon, which the woman’s heretofore
shut-in household life had precluded. Courses in domestic science
would be a boon to the home.

The greater the number of interests which education and culture have
created, the greater will be the diversity of the recreations open
for the woman’s enjoyment.

Care must be taken that the avocation, which is at first an enjoyment
and relaxation, is not turned into hard labor. The moment that any
one strains every nerve, even to excel in a game, that moment it
ceases to be a relaxation.

History shows that the laws of all nations have always provided a
certain number of days of rest, or at least a change of occupation,
and that these days were fixed at more or less regular intervals.
This was partly from a religious and partly from a hygienic
standpoint. The necessity for the interruption of the regular routine
work has always been recognized, and one day out of every seven has
been set aside for this purpose.

The custom that is so frequently adopted by city folk of going out of
town over Sunday might very well be imitated by country folk by going
into the town or city over Sunday. For not only is the too continuous
application to one’s employment fraught with danger, but it has been
conclusively shown that a monotonous routine of occupation, such as
lived by the average farmer’s wife, is a severe tax on the sanity of
the mind. Statistics show that the heaviest percentage of insanity
falls on farmer’s wives, and the supposed cause of this is the
monotony of their lives.

A horse cannot gallop as many hours as it can walk, and the daily
task should be the sum-total of what man or beast can do compatibly
with health. To combine a day of toil with a second of amusement in
one twenty-four hours does not give the proper allowance for sleep,
and cannot be done without injury to the individual.

Fun and laughter are the most efficacious remedies in the
pharmacopeia, and tired humanity owes a debt of gratitude to the
guild of humorists, be they writers, comedians, or musical composers.

=The Physiologic Necessity for Laughter.=—The attitude of the
individual varies with age, temperament, and the perspective of life.
Grave adults are apt to think of laughter and smiling as something
occasional, a momentary lapse once in a while from the persistent
attitude of seriousness. Healthy children, on the contrary, consider
that a state of laughter is the normal condition of humanity, and
that seriousness is a tiresome necessity, which must be tolerated
from time to time. But very few people have any idea that there
exists a well-defined physiologic necessity for laughter, and the
greater the intellectual labor and the mental strain, the greater is
this necessity.

The deep forcible chest movements increase the rapidity of the
circulation, the force of the heart’s beat, and secures a more
complete oxygenation of the blood.

It is not improbable that this accelerated circulation produces
remote effects on the organism. One of the immediate effects of a
good laugh is that it relieves the brain by the rapidity of the
movements of the blood through the capillary circulation.

In addition to the immediate physiologic effects which result from
laughter it is highly beneficial, by relieving the brain and nervous
system from the intense strain and tension of the daily affairs and
occupations of life, and gives relief to the severely congested
capillaries, which otherwise involve considerable risk to the
individual.

Physiologists hold that pleasurable feelings tend to further the
whole group of organic functions, and that laughter produces a
considerable increase of vital activity by the heightened nervous
stimulation. There is a sense of increased energy, of a high tide of
the fulness of the life current.

=Vacations and Health.=—The secret of success of the old Romans in
conquering the world lay as much in their ability to maintain the
health of their troops in their various campaigns as by the courage
and organization of those troops; or, rather it may be said that
courage is but the coefficient of a good physique and a general
mental vigor.

A rest one day out of seven, with an occasional outing for the
week-end, is good but not sufficient. If one would keep up to her
highest standard of physical and mental efficiency, she must have at
least one month of absolute change of environment and outdoor life in
the year.

The kind of place one chooses for her vacation will depend on where
her home is. To dwellers in cities, the mountains and seaside resorts
are the most beneficial. August is our most trying month, and every
one who can would do well to take her vacation at that time, always
selecting some resort north of her own home, so that she may have the
additional advantage of a more bracing climate.

Maine furnishes many of the most beneficial of our health resorts,
combining as it does so many attractions—its bracing atmosphere of
pine forests, its beautiful scenery with vast expanses of water, and
the great variety of diversions which it affords.

It is always wise to send an advance scout to investigate the place
in which you contemplate spending your vacation. Avoid low and swampy
land; investigate the character of the water-supply and the nature of
the plumbing, together with the sewerage system, for it is all too
frequent that an attack of typhoid fever follows an outing in the
country. Every good summer resort should furnish facilities for a
variety of outdoor sports—golf, tennis, boating, swimming, etc.

During the vacation needless exposure to the direct rays of the sun
must be avoided. There is probably nothing which lowers the vital
resistance, and so prepares the way for disease as much as exhausting
exposure to the hot rays of the sun.

Long hours of sleep should be indulged in. The morning air is the
most beneficial; it is, therefore, a good habit to retire early and
to rise early.

If the vacation is not properly spent, it may be the means of doing
more harm than good. On the other hand, if properly spent, vacations
prepare one as nothing else can to meet and resist the vicissitudes
of the following winter. It is the people who go off on long
vacations who have the least need of the doctor’s care.

=Sleep.=—During sleep all the bodily functions are in abeyance and
the secretions are diminished; respiration is slow and confined to
the chest, so that the amount of inspired air is only one-seventh of
that during the waking hours; the temperature of the body falls; less
blood circulates through the brain; and the sensibility of the nerves
to external stimuli is diminished. Sleep is not only _par excellence_
the time of repose and recuperation of the brain and nerve substance,
but it is the only time when, by the diminution of waste caused by
the incessant activity of the brain, that the organ can be properly
nourished, the deficit in nerve force canceled, and the surplus of
energy stored up.

Without this absolute remission of brain activity every twenty-four
hours an actual destruction of substance would occur, which, if
persisted in, would be so depressing to the nervous functions as to
be inconsistent with life, and this is the case in the concluding
stages of fatal diseases.

The sleepy feeling caused by fatigue is due to the circulation in
the blood of toxins resulting from tissue waste, which benumb the
brain-cells; while the feeling of freshness and _bien-être_ with
which one awakens in the morning is due to the elimination of the
fatigue products from the blood during sleep. If the blood of a tired
dog be transfused into the veins of a perfectly fresh animal, the
latter will immediately show symptoms of somnolence and seek a dark
corner for sleep.

The medical authorities of to-day are pretty well agreed that eight
hours of sleep is the minimum required for the maintenance of health,
and all concede that the brain-worker requires more sleep than the
manual laborer. Every moment after the feeling of languor presents
itself is a strain upon the nerves and muscles which will sooner
or later invalidate for life, and finally bring the victim to a
premature grave. Habitual deficiency of sleep will undermine the
strongest constitution.

It is a matter of great importance to train one’s self in the habits
of sleep, regularity in the hour of retiring, abstinence from active
brain work for the hour immediately preceding going to bed, since, if
active brain work is continued until one goes to her room for the
night, the chances are that the brain will continue its activities
after getting into bed, and sleep may be banished from the pillow for
several hours.

A few minutes spent in breathing exercises, the vigorous use of the
flesh brush or hair glove, a hot plunge or foot-bath are no mean
hypnotics.

A sound sleep is dreamless. Dreams require a certain expenditure
of nerve force and mental energy, so that dreamless sleep is the
most restful. Disagreeable dreams and “night-mares” are generally
associated with indigestion and biliousness, which also occasion
a general restlessness. All this can be overcome by taking some
medicine for the liver. Two grains of calomel taken just before
retiring often works like a charm. The dose must not be repeated
under a month. In case of tendency to insomnia, no coffee should be
taken after breakfast.

=Treatment of Insomnia.=—The mechanical measures for the relief of
insomnia have for their purpose the withdrawing of the blood from
the brain to the surface of the skin. Hot foot-baths; general warm
baths; cold douches to the spine, brisk exercise; light massage, and
cold rooms. Mental work should be laid aside several hours before
retiring; late suppers avoided; coffee, if taken at all, should only
be taken for breakfast, and then only one cup. Reading or amusement
should be selected that does not excite the nerves.

To woo sleep the woman should put herself in a position of rest,
which of itself physiologically induces sleep. Avoid irritations,
noises, bad air, cold feet, overloaded bowels, all of which tend
to wakefulness and to prevent the proper physical rest. Then sleep
usually comes of itself.

=The Eyes: Eye-strain.=—Of all the misfortunes that could befall a
human being, the loss of sight is probably the greatest, and yet no
organ of the body is so constantly abused as the eye.

The trouble is that the possessor of the normal eye does not take
into consideration that in all near work, as in reading, writing,
sewing, etc., the eye is actively engaged as well as the hands and
brain, and that the eye only is at rest when looking into space or
when closed.

=Description of the Visual Apparatus.=—The eyeball is contained and
protected in a bony cavity, formed by the bones of the face and
skull, and is supported by a cushion of fat and other tissues. It
is held in place by its membranes and muscles, by which it is also
moved. It is further protected by the eyelids, the eyebrows, and the
eyelashes. The eyebrows protect the eyes from dust and perspiration
and shade the eyes.

The eyelids are lined by a very delicate mucous membrane, called the
conjunctiva. They are maintained in close apposition to the eyeball
by atmospheric pressure. The tears are secreted by the lacrimal
gland, which is at the upper and outer angle of the orbit. The
lubrication by the tears and the mucus secreted by the conjunctiva
cause them to move smoothly and without friction. An important
function of the lids is to distribute the tears over the front of the
eyeball, and by incessant winking to free the front of the eye from
dust and to keep it moist.

The conjunctiva is continuous with the mucous membrane of the nose
and mouth. Hence, in inflammation of the nasal mucous membrane, as in
an ordinary cold in the head or influenza, the conjunctiva is liable
to become very much congested or inflamed.

The _eyeball_ is spherical in form, having the segment of a smaller
and much more prominent sphere ingrafted on its anterior part. The
segment of the larger sphere, which forms about five-sixths of the
globe, is opaque, and forms the sclerotic coat, the so-called “white”
of the eye. The smaller sphere, which forms the remaining sixth, is
transparent, and is formed by the cornea.

The _iris_ is a circular contracting membrane, suspended from the
edges of the cornea, in front of the eye like a curtain. The iris
gives color to the eye, and when we say that an eye is blue or
brown, we mean that is the color of the iris. The iris is freely
movable, and, according as to whether it dilates or contracts, there
is an alteration in the size of the central aperture, called the
pupil.

The chief function of the iris is to regulate the quantity of light
admitted to the interior of the eye. In a very strong light the pupil
quickly contracts, shutting out the excessive light, while in a
subdued light the pupil dilates, thus allowing more light to enter.
When looking at a distance or when looking languidly into space, the
pupil dilates.

_The Formation of the Image._—The eye is a camera, consisting of
a series of lenses and media arranged in a dark chamber, the iris
serving as a curtain. The object of the apparatus is to form on the
retina a distinct image of external objects.

_The Mechanism of Accommodation._—In the passive condition of the
eye, when it is adjusted for far objects, the anterior surface of the
lens is somewhat flattened. Accommodation for near objects consists
in a contraction of the circular ciliary muscle and an increase in
the convexity of the anterior surface of the crystalline lens.

The light enters the eyeball through the pupil, falls upon the
retina, which has often been compared to the sensitive plate of
a camera, is received and transmitted by the optic nerve to the
visual centers of the brain. The eyeball does not see. It is only a
sensitive end-organ, which receives and transmits the impressions to
the higher centers of sight. The act of vision is performed in the
brain.

The focusing power of the eye is the property of bending nearly
parallel rays of light from distant and divergent rays or from close
range so that they meet exactly on the sensitive retina; this is
called refraction. In the normal eye these rays are focused exactly
on the retina.

=Optical Defects and their Correction.=—In the normal eye the near
limit of accommodation is from 4 to 5 inches, and the far limit may
be put at an infinite distance.

_Myopia or Near-sightedness._—This is one of the most common
refractive defects of the eye. In this condition, because of the
greater length of the eyeball or increased refractive changes of the
media, rays of light from a distance are focused in front of the
retina, producing an indistinct image.

The near-point is brought much nearer—from 2 to 2½ inches—and the far
limit is at a very short distance.

In reading, the myope is obliged to hold her book very close to
the eyes in order to see. In doing so, she strains her muscles of
convergence, producing ocular congestion and compression of the
eyeball.

The predisposing causes of myopia are heredity; it is said that half
of myopics are descended from near-sighted parents; uncorrected
astigmatism, and the effort to read very fine print or figures,
entails severe strain on the eyes, which may result in myopia.

Myopia is corrected by a concave lens, which diverges the rays of
light, prolonging the focal distance, so that the rays of light are
focused exactly on the retina.

Not only are myopic eyes not injured by wearing suitable glasses,
but, on the contrary, are often preserved from injurious pressure on
the globe, due to the indulgence of the habit to nearly close the
lids in order to see better, as is commonly done when glasses are not
worn.

_Hyperopia or Far-sightedness._—In this condition the eyeball
is too short, and the rays of light from a distance are focused
behind the retina. Instead of being distinct, the image is blurred.
Hyperopia is corrected by a convex lens, which converges the rays
of light, bringing them sooner to a focus. In the hyperopic eye the
near-point of accommodation is at some distance, and a far limit of
accommodation practically does not exist.

_Presbyopia._—This is a loss of the power of accommodation, by which
reading, writing, sewing, and other near work is accomplished. This
power of accommodation is greatest in early life, and gradually
diminishes until about the age of forty years, when reading at the
ordinary distance becomes uncomfortable. At about seventy-five years
of age the power of accommodation is practically lost.

Every person over forty-five years, with normal or far-sighted eyes,
should wear glasses to perform near work.

_Astigmatism._—Astigmatism does not depend on the length of the
eyeball, but on the curvature of the cornea, and rarely on that
of the lens. Uncorrected astigmatism necessitates the expenditure
of more muscular effort in the attempt to see distinctly than is
necessary when refraction is normal. This is accompanied by early
fatigue and more or less congestion of the vascular tunics of the
eye. Astigmatism is corrected by a cylindric lens, which has a plane
surface in one axis and a concave surface in the axis at right angles
to it.

[Illustration: Fig. 12.—Astigmatic chart.]

In simple astigmatism, on looking at the accompanying astigmatic
chart with each eye separately, certain lines in the defective
meridian seem very much blurred, while those at exact right angles
appear clear and black. This furnishes a test for astigmatism,
since to the normal eye the lines appear of equal distinctness and
clearness. Astigmatism is a very common ocular defect.

=The Mechanism of Eye-strain.=—Comparatively few eyes are perfect.
Far-sighted or astigmatic eyes can secure perfect vision by means
of accommodation. By constant strain on the ciliary muscle, the
crystalline lens is so increased in curvature as to exactly
counterbalance the optical defect of the eyes.

Healthy eyes should do their work without the consciousness of the
owner, and this is a safe test as to the kind and amount of work
demanded of them.

Perfect rest for the eyes is impossible in the waking state—distant
vision represents rest for the eyes and near vision exertion.

Near work is the chief cause of near-sightedness. Distant vision
should alternate with near work, and in near work the object should
not be brought nearer to the eyes than 12 inches.

=The Local Symptoms of Eye-strain.=—There may be a sense of fatigue
in the eyes after reading for a short time, and this may be followed
by a constant sense of discomfort in the eyes, which is increased on
using them, and which may be accompanied by severe pain in the back
of the head. There is a sensitiveness to light, and inflammation of
the eyelids and conjunctiva. There may be twitching of the eyelids,
and in extreme cases difficulty in keeping the eyes open on account
of drowsiness. The eyes may smart, itch, or burn, and continually
“water.”

As the trouble becomes more pronounced, reading for a short time may
be followed by a blurring of the type, and finally the lines may
run together. There is a constant sense of the eyes feeling for the
lines, and, perhaps one of the first things to call attention to the
condition of the eyes may be the losing of the lines in reading.

The general or reflex symptom of eye-strain is headache, which
frequently takes the form of migraine. This is increased on reading,
sewing, riding in the cars, etc. The headache is usually over the
region of the temples or just above the eyes, but it may be on the
top of the head or at the base of the skull.

Vision is so fundamentally related to all the brain functions that
eye-strain, or anything which interferes with normal sight, may cause
the most varied disturbances of bodily functions.

_The Prevention of Eye-strain._—Persons whose work necessitates much
ocular labor should vary their duties with intervals of rest. In
continued reading or sewing it is well to desist at short intervals
and fix the gaze on some distant object, and to frequently close the
lids.

Lace work, very fine needle work, working on black goods, reading
very fine print, or print on an inferior quality of paper, or
attempting to read in a dim light, are all a severe tax on the eyes,
and should be avoided, as they are certain to cause them permanent
injury.

Defective vision is so common in school-children, it is so often
present without being suspected, and so much harm is done to the eyes
and the general health of the individual before it is discovered,
that there should be a compulsory law requiring the examination of
all school-children; and, again, before boys and girls enter the
normal schools and colleges.

Clear vision gives clear judgment; defective vision in its various
manifestations gives different warps and bents to the mind of their
unfortunate possessors.

_Veils._—The wearing of veils is responsible for not a little
deterioration of vision, particularly when they are thick or dotted.
Unless the meshes of the veil are very large, it holds a layer
of impure air close to the face, so that the wearer is breathing
vitiated air. It hinders clearness of vision, because the external
world is viewed through a narrow lattice.

The best veil for the eyes is one with a single mesh, either without
dots, or the dots so far apart that none shall come over the eyes.

_Protection of the Eyes from the Glare of the Sun._—In very hot
weather the eyes should always be so protected that the rays of the
sun do not shine directly into them. This protection may be afforded
by the brim of the hat or by a parasol. At the sea-shore, or on an
ocean voyage, where the glare of the sun is constant and particularly
trying, the eyes should be protected by wearing slightly tinted
smoked glasses.

=Artificial Lighting.=—The main sources of artificial lighting are
kerosene, gas, and electricity. The principal questions of importance
are the quantity and quality of the light, its steadiness, the
vitiation of the atmosphere by the products of combustion, and the
expense; also the proper arrangement of the light.

Kerosene is the most extensively used means for artificial lighting.
The principal objections are—the heat, the trouble of filling and
keeping the lamps in order, and the danger of explosion and fire if
upset; the odor and the great vitiation of the atmosphere.

The modern lamp gives a brilliant light, and if properly shaded by a
slightly bluish chimney, so as to absorb the excess of yellow rays,
it is very satisfactory.

Illuminating gas, as furnished in cities, has a great excess of
yellow rays, which are very injurious to the eyes, and the vitiation
of the atmosphere is very considerable. Gas-light is modified by the
Argand and Bunsen burners. Of these, the Bunsen burner, a patented
composition burner, heated to incandescence, is the best. It gives
a white light, resembling daylight, and, under proper adjustment,
a far greater volume than any other burner. It is not so hot, does
not consume as much gas, and so there is less vitiation of the
atmosphere. It is intensely brilliant, and must be shaded by ground
glass or a proper shade.

Electricity gives the very best light, with a minimum amount of heat
and vitiation of the atmosphere. For individual use 16-candle power
is sufficient.

The lamp-shade should be opaque, of a dark-green color, and lined
with a white, reflecting surface. Transparent lamp-shades,
especially when patterned, are always bad, whatever their color;
because of the different degree of illumination thrown upon the work,
the light is irritating to the eyes.

=Hygienic Precautions in Reading and Sewing.=—There should be free
access of open daylight. Near the window is obviously the best place
for working, and the seat should be so selected that the window is
to the left of the worker. This prevents the work from being shaded
by the hand, and protects the eyes from being fatigued by the light
falling directly into them.

Any room will have too much light into which the sun shines directly.
Even if the worker’s face is not turned directly toward the sun, yet
the light reflected from the book or other work will be so intense
as to be dazzling. The softest and most pleasant light to work by is
the diffused light from the northern sky. An excess of light may be
easily regulated by a shade.

_Reading._—Very fine type should always be avoided, it is a very
unnecessary strain on the eyes, as are also books printed on a poor
quality of paper with improper spacing. The paper should be unglazed.

_Length of Line._—The length of the printed line should not be more
than 4 inches, nor less than 2¾ inches; that is, not more than 10 or
less than 7 centimeters. If the line is too long, the effort to find
the succeeding line is too great. If, on the other hand, the line is
too short, the lateral movements of the eye are so frequent that the
muscles concerned in these movements soon become fatigued.

The position of the reader should be sitting upright, with the back
toward the light, which should fall over the left shoulder, and the
book held nearly on a level with the eyes. The book should be held
at a distance of about 12 inches from the eyes. The light should be
on a level with the head or slightly above it. In desk work, a shade
should always be worn to protect the eyes.

Reading in the recumbent position is a pernicious habit, and is
particularly bad when convalescing from an illness or when very tired.

Reading in carriages or cars is injurious to all eyes, but especially
so to myopic eyes; because of the constant jolting, the distance
between the type and the eyes is continually changing, necessitating
the frequent and abrupt adjustments of accommodation; besides, the
illumination is apt to be very poor. Reading in a dim light or the
twilight is also very bad for the eyes.

Sewing and embroidery require the most trying ocular labor and
the best conditions for illumination. Working on black goods by
artificial light should be absolutely forbidden.

=Injuries to the Eyes.=—The most common injuries to the eyes are the
entrance of small particles of dust, cinders, steel filings, etc.,
into the conjunctival sac, or into the substance of the cornea.
Frequently, with the aid of a little winking, the tears wash away
these foreign substances, but if the substance lodges in the lining
membrane of the upper or lower lid, or is imbedded in the cornea, it
may be necessary to resort to other means in order to remove them.

The lining membrane of the lower lid is brought into view by simple
tension of the lower lid downward by one finger. If the offending
particle is not seen, the upper lid should be averted. This may be
easily effected by the fingers alone. The patient is told to look
down, the edge of the upper lid and the lashes are seized by the
thumb and forefinger of the right hand, and the lid is drawn at first
forward and then downward away from the eye, then upward over the
point of the thumb or forefinger of the left hand, which is held
stationary on the lid and acts as a fulcrum. The foreign body should
be removed with the handkerchief, but, if it is imbedded, it may be
necessary for a competent physician to remove it.

The habit of opening the eyes when dipping the face into a basin of
water, or when diving, produces congestion and inflammation of the
conjunctiva.

=Symptoms and Treatment of Conjunctivitis.=—The eyes may be
blood-shot and the lining membranes of the lids intensely red. There
is a sense of irritation about the eyes and an intolerance of light,
with a constant sense of discomfort. The sensation produced is that
of having sand in the eyes. The eyes are heavy, and tire after using
them for a short time.

The best treatment for acute conjunctivitis, which is so often
caused by the penetration of dust or other foreign bodies into
the conjunctival sac, is the application of cold water. A folded
handkerchief is wrung out of ice-water and laid on the closed lids.
It must be changed every few minutes, so that it shall not become
warm; two cloths are necessary. When the acute symptoms have begun to
abate, the patient will no longer find these applications grateful,
and they must be discontinued.

For chronic conjunctivitis hot applications are the best. For these,
one teaspoonful of fine table salt may be dissolved in a pint of
hot water, or two teaspoonfuls of boric acid may be used instead;
the last named is a mild antiseptic. The boric acid dissolves very
slowly, so that it is well to prepare enough in the morning for the
entire day. One tablespoonful of boric acid may be put into a quart
bottle of hot water, and be well shaken from time to time, until
there is a perfect solution.

When ready for use, half a pint may be heated, poured into a tumbler,
which is then placed in a basin of hot water; this latter serves as
a water-bath to keep the solution in the glass hot. The application
should be made with a rather thick wad of absorbent cotton or a piece
of fine cheese-cloth. The absorbent cotton should be picked up with
all the water it will hold, and be placed over the closed eyes just
as hot as can comfortably be borne, and held there until it begins
to cool, when the procedure should be repeated. The two eyes can be
treated simultaneously. These hot fomentations should be kept up for
ten minutes, and be repeated four times a day.

=Trachoma.=—This malady, of which so much is heard now, is another
name for granular conjunctivitis or granular lids. The affection is
very contagious. It comes on slowly, and is frequently accompanied by
redness and an appreciable degree of secretion in the early stages.
Presence of secretion or of interference of the vision should always
attract attention.

Strict precautions must be taken that the patient’s handkerchief,
towel, and wash-basin are not used by other members of the family.
Further, the other members of the family should bathe their eyes
several times a day with a solution of boric acid.

=Styes.=—Styes are a very painful species of small boils that
generally form on the edges of the eyelids. They are apt to appear in
succession. Certain persons are liable to them if the system is run
down from general causes. Like boils in other parts of the body, they
give evidence of impaired nutrition.

Hot fomentations of boric acid solution will sometimes abort them if
used early. If pus has formed, the stye must be opened by an incision
parallel to the edge of the lid. This should not be attempted by any
one except a physician.

=Color-blindness.=—As a rule, about 4 per cent. of males and about
one-half of 1 per cent. of females are color-blind. The part of the
color sense that is most often deficient is that for green and red.

=Cataract.=—This is a disease in which the crystalline lens or
its capsule, or both, lose their transparency and become opaque.
Eventually total blindness is the result. Senile cataracts appear
after the forty-eighth year. The only remedy for the disease is the
surgeon’s knife.

=Functional Nervous Disorders.=—Evidences of sound health are: first,
individual adaptability or capacity of the individual to easily
adapt herself to extremely opposite conditions of existence; second,
endurance, or the capacity to do a considerable amount of mental
work for a short time without suffering fatigue, or to be able to
quickly recover from the fatigue; third, to be able to control the
emotions; fourth, to be able to resist morbific influence; that is,
the capacity on the part of sound organs of excretion to quickly
eliminate all poisons from the system.

The signs of debility are just the reverse: first, deformity,
obesity, or leanness; second, personal inadaptability, that is, when
physical or mental discomfort is caused by such slight provocations
as change of food, clothing, or climate; third, lack of endurance,
so that a long rest is required to repair the fatigue incident to
slight exertion; fourth, lack of control of the emotions; fifth, a
proclivity to morbific influences, so that the individual succumbs to
every contagion or miasm that she encounters.

Nervousness is a disease of civilization, coupled with overwork and
indoor life. The more complex the environment in which the individual
finds herself, and to which she must adjust herself, the greater the
demands made on the nervous system.

The extreme dryness of our climate, together with the great
variations of temperature between winter and summer and the rapid
fluctuations of temperature, predisposes to nervous disorders.

=Headache.=—Headache is a symptom rather than a disease, but there
is no symptom which requires more careful investigation of its cause
than that of headache. It occurs at all ages, but is most common from
ten to twenty-five years and from thirty-five to forty-five years.
Women suffer from headache more than men, in the proportion of about
three to one. Headaches are most common in the spring and fall of the
year and in the temperate climates.

_Causes of Headache._—These may be classified into those in which
the blood is at fault; reflex causes; various nervous disorders; and
organic diseases.

The blood may be impoverished, as in the case of anemia, where there
is a deficiency in hemoglobin; but by far the most frequent cause of
headache is where the blood is disordered, as in gout, rheumatism,
kidney diseases, diabetes, and the infectious fevers and malaria.

Among the more common reflex causes are eye-strain, especially errors
of refraction; disorders of digestion, particularly constipation; and
pelvic disorders, as in inflammation of the pelvic viscera.

Functional diseases of the nervous system causing headache are
overwork, neurasthenia, hysteria, epilepsy, and neuritis.

Among the most common of the organic diseases is arteriosclerosis;
other diseases are meningitis and brain tumors.

_Symptoms._—The pain is often dull in character and rendered worse
by stooping; the location of the pain depends on the cause of the
headache. The most common variety is over the forehead or eyes. In
eye-strain the pain may either be in the front or back of the head.
In indigestion, the pain is most frequently over the eyes, but it
may also be on the top of the head. In anemia the pain may be either
frontal or diffuse. In pelvic disorders the pain is generally at the
base of the brain, though it is sometimes in the top of the head.

Neuralgic headaches are generally characterized by sharp paroxysmal
attacks, located in the temporal regions, and associated with pain
in other parts of the body. It is perhaps most frequently caused by
anemia.

In hysteria the headaches are characterized by a circumscribed
pain—it has been likened to the driving of a nail into the head.

In migraine the pain is paroxysmal and intensely severe;
it is frequently caused by some poison in the blood, as in
autointoxication, due to failure of proper regulation of the bowels,
also by pelvic disorders.

_Treatment._—The treatment is constitutional, and is based on the
removal of the cause. First, there should be a regulation of the
diet, a free evacuation of the bowels, and their proper regulation.
In every case of headache there should be an examination of the
urine. Often there is some congestion of the kidneys where it is
least suspected. If the headache is persistently made worse by
reading or sewing, the patient should be referred to a competent
oculist. An inquiry should always be made into the condition of the
menstrual function, backache, and leukorrhea. Any marked disorders
here will necessitate a gynecologic examination.

For the immediate relief of migraine, the patient should go at once
to bed and drink a glass of hot water; sometimes a cup of hot tea
gives great relief. No food should be taken for from six to twelve
hours, according to the severity of the case. The room must be kept
dark and quiet and the head high.

A strip of prepared mustard leaf, 5 inches wide by 8 inches long,
should be cut, and a piece of cheese-cloth, 6 or 8 layers thick,
should be folded the same size. The cheese-cloth is then wrung out of
hot water, and the mustard leaf is quickly dipped into the same. The
cheese-cloth is placed on the back of the neck, between it and the
mustard leaf. The clothes should be kept dry by a folded napkin. In
this way the mustard may be kept on from six to eight minutes, until
it begins to burn and the skin get red. If left on too long, the
mustard may produce the most painful kind of a blister. When taken
off the neck, the mustard may be put on over the stomach.

The medicinal treatment must be directed by the physician, but a
perfectly safe prescription, and one which may be kept on hand,
is the following: Take of sodium bromid, 15 grains; of essence
of peppermint, 10 drops; and of water a sufficient quantity to
make 1 dram. Mix well. The dose may be repeated in three hours if
necessary. This prescription should be put up by a good druggist, in
a three-ounce quantity. Sometimes relief is afforded by 1 teaspoonful
of the aromatic spirits of ammonia, taken in four tablespoonfuls of
water, and this is about the right quantity of water to take any
liquid medicine in. At night 2 grains of calomel should be taken, so
that the patient shall not be disturbed through the night, and it is
not so apt to cause nausea as when taken through the day.

=Neurasthenia or Nervous Prostration.=—This disease first saw light
in the United States, and was christened by Beard as an American
disease that was absent from no household in which the inhabitants
used their brains. It is certainly much more prevalent in this than
in any other country. Americans scarcely treat their bodies with more
consideration than their automobiles; they put on high pressure and
speed them to the utmost. Add to the high pressure under which we
live that other fact of heredity, that many persons are born with
unstable nerve-cells, and may be nervously bankrupt, and it is not
difficult to understand that 50 per cent. of Americans are suffering
in some degree from lowered nerve tone.

_Causes of Neurasthenia._—All classes of men and women who use
their brains severely, and who have seasons of excessive anxiety
and responsibility, are subject to neurasthenia. We have seen that
fatigue was caused by the accumulations of toxins in the body,
due to muscular activity, but these toxins may also be caused by
intellectual overwork or anxiety over domestic or business affairs.

Other causes are the intemperate amount of intellectual work which
is forced on the brain, and the excessive indulgence of the emotions
and the passions. Combined with the strenuousness of life is the
large element of uncertainty, the intense anxiety, and the restless
energy which is the price of success. Added to these may be lack of
suitable and sufficient recreation and short hours of restless sleep;
the restrictions of a narrow lot, loneliness, and isolation, the
frequent repetitions of uninteresting tasks, added to the burdens of
maternity, domestic cares, and worries.

In cities the ear-strain caused by the incessant noises of the
street, the amount of work done by insufficient and improper
lighting, the unsanitary mode of life, the improper diet, the
monotonous and infertile work, the unhappiness and discontent bred
of a life of idleness, or one given to society and gambling, whether
bridge, whist or poker, the senseless bolstering of shattered nerves
with alcoholic stimulants and beverages, patent medicines, and
hypnotics, all add their quota to the breaking down of the nervous
system.

A man can do a prodigious amount of work if he only varies it with
play which really amuses him, or if he substitutes for mental
occupation those which involve bodily exercises.

In so-called latent gout insomnia is a frequent symptom, or insomnia
may develop as the result of bad nervous habits. Insomnia from
whatever cause is followed by the impairment of nerve substance
and an overloading of the body with toxins. This continued nerve
exhaustion leads to oxaluria, uric acid, gout, anemia, gastric and
intestinal dyspepsia, muscular insufficiency, and precordial distress.

Whatever enfeebles the body by overtaxing the nervous system the
waste is in excess of the repair, in all overwork the destructive
metamorphosis is greater than the reparative processes, and so there
is an accumulation of toxic products and a more or less severe and
permanent injury is done the nervous system.

Other causes of neurasthenia, not so generally recognized as
overwork, are to be found in the pathologic conditions of the
intestinal canal, which becomes a veritable culture tube, and
absorption from this into the blood constantly takes place. And this
condition of putrefaction has to be overcome before relief can be
afforded, and in many cases this condition is associated with an
insufficiency of the elimination of urine.

The large intestine is the seat of an enormous bacteriologic flora;
they are not there by millions, but by billions. Some of them are
harmless, but not all of them, and if these pathogenic bacteria are
present in sufficient quantity, they, too, may produce symptoms of
mild poisoning. So, too, may mere indigestion, or the malfunction
of any other organ, torpidity of the liver, a deficiency of the
excretion of bile, which is generally accompanied by constipation.

_The Symptoms of Neurasthenia._—The symptoms are essentially those
of chronic fatigue, which has become exaggerated and pathologic.
They may be classified as sensory, motor, psychic, and somatic. The
sensory symptoms first noticed are those of generalized fatigue, with
such localized sensations as headache, backache, and limbache. The
motor symptoms are muscular fatigue, muscular weakness, and muscular
exhaustion on slight exertion. The psychic symptoms are manifested
by a diminution in the capacity for sustained mental effort and the
spontaneity of thought and exhaustion after slight mental effort. The
somatic symptoms show themselves in atony of the digestive tract and
the circulatory apparatus, with disturbances of the secretions.

Headache is one of the most common symptoms of localized fatigue,
and, associated with this, may be a sense of constriction about the
head, and there may be either a sense of lightness or fulness of the
head.

A woman who is chronically tired loses all her personal vigor, force,
aggressiveness, and, above all, will power. Associated with this lack
of will power are hesitation, indecision, a marked irritability, and
timidity. Neurasthenic patients are subject to spontaneous attacks
of fear, causeless in origin, and generalized in character. These
attacks may be accompanied by pallor of the face and palpitation of
the heart, just as in normal fear. The tired woman is a cross woman.
The irritability shows marked impairment of the power of inhibition.

_The Rational Treatment of Neurasthenia._—First of all, there must
be a removal of the cause which has produced it. There are two
distinct classes of cases—the overworked and the idle. The first
class, and the most important to the world, are the overworked. We
may have to deal with the intellectually overworked, in which the
mental overwork was combined with financial anxieties, domestic
difficulties, or lack of success in their work, or the cause may
have been the tremendous responsibilities of their positions, which
involved the lives or fortunes of many people. Added to this great
strain and overwork, has been a lack of proper intervals for rest,
recreation, and sleep, and the body has become a storehouse for
various toxins, and so is suffering from both acute and chronic
poisoning.

This class of patients must have the most rigid rest treatment, such
as was prescribed by Weir Mitchell years ago. It is most important
that the patient should be removed from her old surroundings; if this
is not possible, she should be isolated on the top floor of the house
with a good nurse. The room selected must be bright and cheerful,
with plenty of sunshine and fresh air; a window should be open
practically all the time, for oxygen and sunshine are two of the best
restoratives. The diet must be easily digested and very nutritious.
The patient should be urged not to use her mind at all. Carefully
selected short stories may be read aloud by the nurse; the reading
should not be continued for more than half an hour at a time.

A great deal may be done to eliminate these toxins from the system
by the proper use of electric-light baths, followed by the shampoo
and the percussion douche; massage with salt water, salt rubs, and
electricity.

In most cases a month of this absolute rest is as long as is
beneficial to the patient. And for most of them the sea-shore is the
best. There should be enough going on to be diverting without being
overtaxing, and a climate should be selected which is warm enough
for the patient to live out-of-doors. There should be short walks,
drives, sails, etc., and this outdoor life, with a contemplation of
nature, is the most powerful restorative. The grandeur of nature,
whether it is the mighty forests, with their refreshing shade and
quiet, or even stretched in a hammock watching the sky and trees, or
the constant surging of the vast sea, bringing rest in its unceasing
restlessness, with the ships sailing lazily along, until the whole
fades away in the distant horizon. In the vastness of the universe,
the _ego_ becomes contemptibly unimportant and insignificant.

After several months spent in this way the body has gotten rid of
its toxins, nerves and muscles are rested, and through the soothing
influence of nature the neurasthenic is gradually trained back to a
healthier habit of thought and a more rational frame of mind. There
is substituted for the morbid emotional complex a feeling of pleasure
and energy. Reason and judgment reassert their sway; outdoor life
quickens the perceptions, and forms tranquilizing memory pictures on
the brain that return later to solace and refresh the individual.

There is another, and a very large class, of cases among women of
leisure who have suffered all their lives from a lack of a vocation;
they have nothing to think of except themselves. They do not know
what it is to be quite well; they travel from one part of the country
to another, and from one country to another, but they never rise
above a certain level of invalidism. They are self centered, and
what they need is the work cure. In the majority of cases, before
these patients can be restored to health, powerful habits must be
eradicated, new interests in others must be supplied to supplant the
most intense egotism, new paths must be hewn out in the brain, the
will must be recreated, and character can only be imparted by those
who possess it.




CHAPTER VII

THE HYGIENE OF THE MIND AND ITS RELATION TO THE PHYSICAL HEALTH

  Heredity; Temperament; Social Instincts; Fear.

  Mental Development; Self-control, the Moral Sense, the Religions
  Instincts; the Advantages of College Life; Balance of the Mental
  Faculties; the Effects of the Higher Education of Women.

  The Environment; the Choice of Friends; Literature.

  The Power of the Will or Inhibition; the Effect of the Mental
  Attitude on the Physical Health; A Definite Occupation a Physical
  Necessity; the Psychology of Success.


The solidarity of brain and mind is an axiom of modern medicine,
and it is a fundamental principle that must be kept constantly in
view in all physical and mental training. Hitherto unsoundness,
inefficiency, and weakness of mind have only been lightly touched
upon in preventive medicine, but the importance of the mind as the
chief factor in health and disease is so paramount that it can no
longer be ignored.

The problems that present themselves to the mother and the educator
to-day are practically the same, and the mother is one of the most
potent educators that we have—how the mind can best be strengthened,
broadened, and be made the most efficient working instrument possible
through the application of modern scientific and physiologic
knowledge. These are questions of vital importance to the human race.

=Heredity.=—Holmes says: “Each one of us is only the footing up of
a double column of figures that goes back to the first pair. Every
unit tells, and some of them are plus and some of them are minus.
We are mainly nothing but the answer to a long sum in addition and
subtraction. Slight obliquities are what we most have to do with in
education.”

There are certain hereditary predispositions that will develop under
certain conditions; some of them are good, some are evil; that is,
with the natural development of the mind, certain peculiarities of
the ancestors will be reproduced. The problems suggested are how the
mind can best be developed, educated, and trained, so that hereditary
weaknesses may be counteracted or held in abeyance, and that latent
hereditary talents may be discovered and developed.

The first proposition that we have to face is that like produces
like. There are modes of education, of conduct in life, and of
occupation that should be avoided where a boy or girl is handicapped
by a bad heredity. There are special precautions and attention to
physiologic laws which would save the minds of many young men and
women with a bad heredity from passing into a state of inefficiency
and actual disease. Heredity implies only potentiality toward good
or evil, and the latter may be averted by knowledge and the proper
practice.

_Temperament._—This comprises the general make up of the individual,
the shape of the head, the appearance of the eyes, the mobility of
the features, the texture of the hair and skin, and the kind of
movement. The recognition of the kind of temperament, and a suitable
training for its best development, is of the greatest importance in
attaining good health and success in life.

There are four general types of temperaments—the nervous, the
phlegmatic, the arthritic, and the scrofulous or lymphatic.

The nervous temperament has certain marked characteristics, as the
small, wiry figure, the well-shaped head, the bright, restless eye,
nervous bearing, highly strung and sensitive nerves, feeling pain
keenly and bearing it badly. This woman is imaginative, sensitive,
fond of intellectual work, often artistic and ambitious. In her the
brain and mind are dominant above all else. When run down, this
woman will be difficult to bring up again to the normal level. She
will grow thin, dyspeptic, irritable, and often neuralgic. She will
be peculiarly liable to nervous disorders.

This temperament has its special temptations—alcohol and sedative
drugs are two of them. Alcohol is not taken steadily or for social
reasons, but for the effect of alcohol on the brain, and there is the
greatest danger of becoming addicted to alcoholic habits, and finally
of becoming an uncontrollable dipsomaniac.

The phlegmatic or bilious temperament relates more to the training of
the body, since in this class of cases the mind is not exposed to the
same dangers, but the oversanguine temperament has its own dangers,
which may lead to lack of effort, speculation, and financial ruin.

The arthritic have a predisposition to both rheumatism and gouty
disorders, to which they are distinctly more liable than others, and
the fact that there is this latent tendency should be taken into
consideration during childhood and youth.

_Social Instincts._—Social instincts lie at the foundation on which
the family and community is based. It may be said that any individual
who is destitute of them is in an abnormal condition, hence a right
training of the social instincts is, beyond doubt, one of the most
important means of securing happiness to the individual and order to
society. The child’s or youth’s relation to others, her affection
for others, and her altruistic practices, all go for the making of
society, good citizenship, and patriotism in the race.

At the school age the social instincts are one of the strongest
elements in life, and one of the most powerful adjuncts in developing
mind and body. The cravings of young women for social amenities are
stronger, and her deprivation of them more hurtful, than in the case
of young men. There are few girls in whom it does not require some
regulation. The strain of too much social life is injurious; social
dissipation cannot be combined with school life without wrecking
the health of the young woman; nervousness, anemia, and mental
depression follow.

That individual cannot be said to be healthy mentally whose social
instincts are poor and perverted. Commonly one of the first symptoms
of a disordered mind is the diminution of the social instinct. The
insane are notoriously asocial.

_Fear._—This is one of the most elemental and primitive of the
emotions. Biologists assure us that fear and surprise were the
first of the emotions to be developed, and that the feeling of the
ludicrous was the last. Darwin says that the earthworm knows fear,
and darts into its burrow like a rabbit when alarmed. So we see that
fear is common to all forms of animal existence, even to the lowest.
This universality of fear has come about through the working of the
laws of natural selection, which prescribe that only those creatures
shall survive that can best adjust themselves to their environment.
Within limits, fear as a primary instinct has been and is eminently
useful. It is the cry of alarm raised by the senses which act as
guardians of the body, and, at a signal, in virtue of the nervous
automatism, the organism is put in a position of defense. On the
other hand, fear may serve to paralyze, as has been observed in the
case of birds, many of which, though scarcely wounded by the small
shot, fall to the ground as if struck by lightning, panting with
wide-open eyes. In human life, while fear incites to activity, it may
also paralyze that activity.

Mosso says that the fear that young children have of cats and dogs,
before they have learned why they are to be feared, is a consequence
of heredity. We are born to a heritage of fear. If we fear ghosts and
demons less, we fear microbes and bacteria more. The professional
or business man fears failure, but fear should be a guardian, not a
jailer. A healthy fear of indigence will lead to thrift, industry,
and such measures as will secure one’s personal independence. Up to a
certain point, fear is a protection, but beyond that it paralyzes.

=Mental Development.=—We note that at birth the brain is mindless,
and that the brain-cells, which are the vehicle of the mind, undergo
their greatest development during childhood from stimuli coming from
without the body. The brain-cells possess infinite possibilities and
potentialities. They are developed from the stimuli from without
through the eyes, ears, touch, taste, and smell. There is another
series of constant impressions which are received from within the
body, and these come from the muscles.

These impressions, conveyed to the brain-cells from the body, and
from the outer world beyond the body, leave a fixed registration, the
writing on the brain-cells has begun, and this constitutes memory;
and the imprint on these cells is similar to that which type leaves
of letters and words on the page of the printed book. These printed
impressions on the cells can be revived and seen and heard by the
mental consciousness, just as a printed book can be opened and seen
and read by its owner.

The natural qualities of the mind are imitation, acquisitiveness,
emotionalism, and imagination.

The force of example in the home, at school, and in the book world
is among the most potent influences in molding character. The young
girl instinctively imitates her mother, her friends in real life, and
in her book world, and the woman will be the composite production,
combining traits of all of these, which will be ingrafted on the
ancestral traits which have been inherited.

In young children it is difficult to decide where the imagination
leaves off and the spirit of untruthfulness begins. In any case,
the tendency to exaggeration and untruthfulness are so prevalent
in childhood that it must be checked at the earliest signs of its
appearance. The vice becomes so deep rooted that it affects the mind
in all its workings and the entire life as well. It follows men and
women into their business careers, their scientific life, and their
professions.

Professor Swift, in a very interesting study of the development of
the mind, invokes the aid of biology to show that all children are
but little animals, having no inborn notions of right and wrong,
inheriting no sense of justice; savage, by nature, and predatory by
instinct.

He finds a psychic justification for fighting among boys. “Fighting
in some form,” he says, “is one of the first means by which the mind
becomes accustomed to intense action. To fight well, a boy must be
capable of severe concentration of attention.”

And he has found the age at which boys come to think that laws and
the recognized rules of right conduct should be voluntarily respected
varies from fifteen to seventeen years and older. These figures are
approximately correct for girls.

Absolute truthfulness, square dealing, honesty, honor, and an _esprit
de corps_ should be demanded. Hitherto these principles have not been
sufficiently inculcated in girls as the fundamental principles on
which life must be met. The discipline has been too lax in the home
and in the school; it is that of implicit and prompt obedience on
the word of command; the proper subjection to and respect for those
placed in authority; the kind of discipline given in business life,
the hospital, and the army, and the lack of which has cost so much
happiness and so many thousands of lives.

_Self-control._—The perfect capacity for self-control in all
directions and at all times is the ideal state at which we aim. It
is the standard aimed at by developing the power of the will and the
strength of inhibition. The great difficulties, the magnitude of
the task, may be conceived of from the saying of the wisest of all
men: “He who conquers his own spirit is greater than he who taketh a
city.” The reason is plainly evident—all the hardest battles of life
must be fought out alone, there is a feeling of isolation, as if one
were struggling alone against the combined forces of the universe,
and, at the same time, there is going on the struggle for the mastery
between the two conflicting natures, “When I would do good, evil is
present with me.” Whereas, in concerted action there is a feeling
of sympathy, of reinforcement from outside help, and the pleasant
stimulation of competition.

If youth were taught that certain enemies were going to present
themselves on the field, that they come for the most part in the
first instance single handed, and if grappled with one at a time, and
the contest between right, and perhaps inclination, be then and there
fought to a finish, each successive time the conflict would be easier
and the victory more certain; that in losing such a battle there
must always be a certain loss of self-respect, a feeling of moral
weakness, it may be even so slight a fault as the exaggeration of
facts; while, on the other hand, a victory always gives something of
the same feeling of exultation that one has in any fairly won contest
or game. A feeling of pleasurable superiority, of having one’s self
well in hand. In the moral habits every gain on the wrong side undoes
the effects of many conquests on the right. The training of the will
becomes the most vital of all problems. Nothing that is learned in
youth is really so valuable as the power and habit of self-restraint,
of self-sacrifice, of energetic, continuous, and concentrated effort.

_The Moral Sense._—From fifteen to twenty-five years of age is the
most crucial period of life in regard to the hygiene of the mind.
It is during this period that the brain first exhibits some of its
strongest hereditary tendencies. While such mental factors in human
life as conduct and character are being consolidated, as they now
are, hereditary predispositions manifest themselves, telling for good
or evil, for success or failure.

The acquisitions then made are critical in the extreme and often
final. The real love of right, hatred of wrong, duty, conscience,
religion, become solid and effective in forming character.

The emotional nature instinctively shows a leaning toward the
opposite sex; love between the sexes toward the close of adolescence
is the most intense and most unreasoning of human passions. The sense
of right, wrong, and duty become active principles, dominating the
character. There are yearnings after the ideal, an intense scorn
of and hatred of evil. The purposes in life are then shaped. The
impressions and resolutions then formed affect the whole tenor of the
woman’s life, as a rule, more than at any other time.

The capacity to feel pleasure reaches its greatest intensity. The
sex relations are built up on safe and natural lines, regulated by
family life, social feelings, and the carrying of the thoughts and
the emotions into other channels, controlled by certain instinctive
natural tendencies, by morality and religion. To think and feel
properly should mean to act rightly as a physiologic corollary.

Music, literature, and art, imaginative works of all sorts, mix
themselves up with the sex feeling, so that the two help to form the
emotional nature. Far-away glimpses of poetic feeling, pleasurable
altruism, citizenship, and patriotism show themselves in the earlier
stages and give direction to life in the later. The whole period
is one of immense importance for the health and happiness of the
remainder of life, and the risks to the body and mind are then very
great. A fact which is of great importance, and which is especially
true of adolescence, is that it is possible by undue pressure to use
up stores of energy that should have been spread out over very long
periods. Through such overexertion in study or in games too heavy a
drain is made on futurity, and mental disorders at this time are by
no means infrequent, mental depression being generally the first to
appear. This is more especially true in the descendants of neurotic
families. The subjects are troubled with neuralgias, insomnias, and
there is a pessimistic view taken of life.

_The Religious Instincts._—Möbius says, “We reckon the downfall
of religion as one of the causes of mental and nervous diseases.
Religion is essentially a comforter. It builds for the man, who
stands amid the evil and misery of the world, another and fairer
world. Besides his daily careful life, it lets him lead a second
and purer life. The consciousness of being within the hand of
Providence, and the confident hope of a future redemption, is a
support to the believer in his work and care, for which unbelief has
no compensation. Meditation calms and refreshes him like a healing
bath. Worship breaks in upon the daily drudgery of his days with rest
and meeting.” The morality of a nation suffers most severely through
the downfall of its religion, as experience has always and everywhere
proved.

The religious instinct has a very close relation to the emotions,
morals, esthetic feelings, to social instinct, and to sex. The
feelings of reverence and awe, and the consciousness of the infinite
in man are vague, but are the most powerful parts of his nature.

Religion furnishes the only pure ideals that half of the world has
access to. It has proved an intellectual stimulus, and roused a
metaphysical frame of mind in some of the most vigorous nations, such
as the German and Scotch. It leads more toward refinement of life
than any other agency. It stimulates the benevolent and altruistic
feelings, and leads to their practical demonstrations; it fights vice
and immorality; it seizes on the best that is in man and transforms
the character.

=The Advantages of College Life.=—College life is of the greatest
possible advantage to girls in many ways: it is broadening to the
mind; discipline is maintained, and, at the same time, the girl
is thrown on her own resources; adequate means are provided for
developing both mind and body to their greatest capacity.

Whether the girl comes from the country, a country town or city,
her social group is comparatively limited; her world is very
little and the _ego_ is very large. The discipline that any large
body of students bring to bear on the conduct and behavior of the
individual is one of the important advantages of a college training.
The insignificance of the ego, who is only a unit in this large
community, is quickly impressed on the gray matter of the brain, and
the rough and unpleasant angles are soon smoothed off. This, in
addition to the discipline afforded by the college officers, and the
total lack of discipline is the weakest point in the average girl’s
education. To be brought into intimate relation with the members of
a large and educated community is in itself a liberal education. To
learn to respect the rights and the opinions of others, to perceive
that any given subject has a great number of points of view, is
attaining toward a healthy mental balance that will make the woman
broader minded, more sympathetic, more companionable, and more
charitable in her views of life.

In addition to the regular college curriculum are the opportunities
afforded, not only to special students, but to the entire body of
students, for a liberal education in music and art, and so a broad
foundation for general culture is laid that will greatly increase the
opportunities for pleasure all through life.

So that, in addition to the actual knowledge acquired by a college
education, there are also the advantages of the discipline of and
development of mind and body; the knowledge of how and what is worth
while to study; the power to study and solve life’s greatest problems
for herself and those dependent on her; the firm muscles, the clear
brain, the steady nerves, the power of judgment, the control of the
will, and the formation of character—on all of which the ultimate
happiness and success in life depend.

Dr. Beard gives to brain workers a value of life of fourteen years
above the average. The brain-working classes are less apt to worry,
less apprehensive of indefinite evils, and less disposed to magnify
minute trials than those who live by the labor of their hands.

Spinoza says that every advance toward perfection gives us happiness,
and it is safe to say that the buoyancy which characterizes
contemporary thought, the hopeful outlook amidst the dangers which
threaten us, the sense of the added cubit to the man’s stature, are
due largely to the recognition of the power for good within his soul
of which he was not formerly aware.

_Balance of the Mental Faculties._—There must exist a certain balance
between the various faculties of the brain in order to insure sanity.
A high order of intelligence without much will, or keen emotions
without a corresponding power of inhibition, and overmastering will
and slight moral sense, vivid imagination without common sense,
intense social instinct without much conscience, fervid religious
instinct without much sense of duty or altruism, must invariably
produce one-sided and unbalanced individuals, and the results would
be bad for society; and too many of these one-sided or unbalanced
people would impair if not endanger the safety of the State.

Excessive ambition, misdirected energy, longing for the unattainable,
regret for the unalterable, anticipation of future unhappiness, lack
of a sense of perspective, fretting over non-essentials, indecision,
reopening of troublesome questions already settled, avarice,
selfishness, excessive emotions, uncontrolled passions, and the
actual cultivation of the melancholic state are some of the causes of
mental anguish and subsequent physical suffering.

Well-balanced mental faculties give a philosophic view of life;
guard the mental and hold the emotional in check; grasp the true
relationships in life, and view it in the proper perspective.

_The Effect of the Higher Education of Women._—Nothing is so
convincing as actual experience and statistics;[5] and nothing is so
broadening to the mind as the study of history.

Never before in the history of the human race has any such large
body of young women been given the educational advantages for
the development of body and mind which they enjoy to-day. From
antiquity there have been exceptional women, who were highly educated
and cultured, as in Alexandria, Athens, and in the old European
universities, but up to the present day any tendency toward the
education of the masses of women has been looked at askance, and in
this respect the position of the people of the United States was long
peculiarly provincial.

To two men belong the great credit and honor of conceiving the idea
of a liberal college education, and a medical college training, for
women in this country.

In 1865 Mathew Vassar, “having recognized in woman the same
intellectual constitution as in man,” founded a college for women
only, and thus gave women the opportunity for the same education that
young men enjoyed at their colleges.

In 1850 the Woman’s Medical College of Pennsylvania was incorporated.
The idea of establishing a college for the medical education of women
originated with Dr. Bartholomew Fussel, of Chester County. The query
arose in his mind, “Why should women not have the same opportunities
in life as men?”

Just how strong the public sentiment was against these movements, and
the leaders of the opposition comprised the most prominent educators
and physicians of the day, and what impediments they placed in the
way, it is now difficult to realize.

The opponents of the higher education of women urged three final
objections: First, women were mentally incapable of receiving the
same kind of intellectual education as was given to young men at
college. Second, they lacked the physical endurance to bear the
strain of mental work. And, third, such an education would render the
young woman masculine—she would no longer be willing to look after
the ways of her house, her natural affections and power to love would
vanish, she would become unwilling to marry and bear children.

Ex-President Eliot, of Harvard University, who has so long been the
great educational leader in this country, in his paper on “The Higher
Education of Women,” says: “During the past thirty-five years three
distinct apprehensions concerning the effect of the higher education
of women seem to me to have been removed. In the first place, there
was a perfectly sincere doubt (because there was little experience
to go upon) whether young women were so capable as young men of
receiving what was then called the higher education; or, in other
words, whether the young woman had the capacity to master by study
the traditional subjects of the higher education. That doubt has been
completely removed.

“Secondly, it was feared that if the young women studied in the
colleges three or four years, beginning at about eighteen years of
age, that such study would have serious effect on their health and
on their fitness for their natural functions in after-life. This
apprehension was felt by many physicians and was warmly expressed.
For a whole generation we have been trying the experiment, and
the result is perfectly clear. These apprehensions have not been
justified. It is apparent that young women can do much mental work
for three or four years between the age of eighteen and twenty-two,
not only without impairing their physical vigor, but all the time
improving it, if they live wisely and under right conditions.

“And thirdly, there was the strong apprehension felt by many
excellent people, lest in the process of the higher education young
women would be denatured. They admitted that young men were not
denatured in any way by the higher education at college, but they
thought that there was a serious chance that young women would be
altered in their feminine nature by the process of education. It has
turned out that a young woman who studies in college, from the age of
eighteen to twenty-two, is no more altered in her nature than a young
man is who goes through a similar process. It takes a great deal more
than that to alter the nature of a woman.

“I suppose that this apprehension was based on the fact that women
seem, to men at least, more tender, fragile, and delicate than men,
and, therefore, more liable to be bruised or coarsened than men; it
was feared that the kind of public life, so to speak, in large groups
would have some tendency to deprive them of their natural delicacy,
refinement, and tenderness. It has not turned out so, and everybody
recognizes that it has not turned out so.”

When higher education, the professions, and industrial pursuits
are all unquestioningly thrown open to women, then it can be
reasonably supposed that they will come to possess those traits of
mind—judicial, logical, creative, etc., now generally considered
as masculine traits, and they will not only be more attractive and
companionable for their husbands, but will be far more competent
teachers for their children, their enlarged range of thought and
vision inspiring greater confidence in their sons, and stimulating
higher ideals in both sons and daughters.

=The Environment.=—As we have seen, the brain registers every
impression from within and from without; if the impressions are
those of discomfort, gloom, darkness, ugliness, those things, being
inharmonious to the constitutional working of the brain, do harm and
tend to set up bad habits. First, the body must be healthy, and the
environment good in order to insure a healthy, vigorous mentality.
Too much thought and care cannot be given to the environment of the
child, youth, and adult.

Careful attention must be given to the toilet. The quality and
condition of the underlinen, the cut and fit of the clothes, all
tell on the mind. It has been said that a man tries to live up to
his clothes; hence, the uniform of the soldier and the cassock of
the priest. Clothes are not only an index of the character, but they
help to make it. The clothing that comes into intimate contact with
our bodies has a soothing or irritating effect upon the mind. It has
also been said that for a woman to know that she was properly dressed
had a soothing influence on the mind, second only to that of religion
itself.

In the evening, laying aside the business suit of the day with all
the anxieties and dust of toil, and replacing it by a tasteful
house-gown, brings a sense of freshness that brightens the mind and
stimulates the appetite. The clothing should always be suitable to
the employment, to the purse, and to the surroundings, or good taste
is violated, and, again there is an unhealthy reaction on the mind.

To live in a gloomy house, with a dull ugly wall-papers, and no
sunshine entering the room, may produce in their inhabitants want of
appetite, interfere with nutrition, make them gloomy, unhappy, and
hard to live with. While esthetic surroundings render life happier,
brighter, and higher.

If one cannot afford expensive paintings to hang on her walls, she
can select photographs of the old masters, neatly framed, which,
placed in harmonious surroundings, elevate the mind, cause a love of
the beautiful, develop the taste, and lay the foundation for a broad
culture that will increase the enjoyment of nature as well as of art.

_The Choice of Friends._—We have seen that the impressions conveyed
to the brain-cells leave a fixed registration and are indelibly
stamped there. These may be called the sensitive plates of the mind,
and it is because of this writing on the brain that the selection of
our friends and associates is a matter of such vital importance.

The subconscious mind, of which we hear so much to-day, does not
originate thought; it can only elaborate and develop it, and the most
important fact which has as yet been discovered in regard to the
subconscious mind is that it is suggestible; that is, it is subject
to moral influence and direction. A few words of commendation and
praise brighten the whole day; if we can forget our pain for a little
while, it is apt to cease.

All our greatest intellectual leaders, from time immemorial, have
been unanimous in their teachings that one of the most important
elements in the molding of the mind and character was the nature
of our friendships. Tennyson says, “I am a part of all that I have
met.” “A man’s friendships shape his life more than aught else, or
more than all else.” The immortal bard puts it, “It is certain
that either wise bearing or ignorant carriage is caught, as men
take disease of one another; therefore, let men take heed of their
company.” And again, “’Tis meet that noble minds keep ever with their
like, for who so firm that cannot be seduced?”

Certain requirements and standards should be met, and the girl or
woman should be sure that the individual, whether man or woman, comes
up to the standards of her own clan.

A friend should be congenial, with similar tastes, opportunities, and
training; frank in criticism, yet sympathetic in spirit; loyal and
staunch in adversity, and one who disseminates an atmosphere which is
broadening, elevating, and uplifting. Such a friend is to be desired
and to be sought after.

_Literature._—Not one of the least of the great molding influences
on the mind and the social life of to-day is its literature, and the
form of this which reaches the greatest masses of the people are
the daily press, the literary magazines, and the modern novel. It
is scarcely possible for the young to conceive the great impression
which is made on the mind and character by the kind of books which
they read. Carlyle said, “We cannot look however imperfectly upon a
great man without gaining something from him.” And to this statement
might well be added, it is impossible for the mind to be brought
into intimate contact with the lives of dissolute men and women, so
vividly portrayed in many of the novels of the day, without being
smirched by it. It is no more safe to read such a class of books,
hoping to escape contamination, than it would be to live in the
malarial districts of Africa, and hope to escape contracting that
insidious disease.

However limited the geniuses may be in our immediate circle of
friends, each of us may have for her most intimate friends the
greatest geniuses the world has ever known, and have them at their
best.

Two axioms should always be kept in mind—a real love for books is
formed in early life or not at all, and to have books for friends one
must own them, have them on her own shelves, to take down and put up
at will, to mark, to compare, and study. So whatever else one lacks,
she should always have her own library, even if it is a limited one.

Next in importance to the recognition of good reading must
necessarily be a recognition of the limitations of one’s reading.
Whether in the capacity of student, housewife, mother, or business
woman, the time that can be devoted to general literature is very
limited.

A careful study of history and biography should always precede
fiction. It is a fundamental part of a liberal education to know
something of the world’s history, and the history of the English
nation, as well as the biographies of the men and women who were such
important factors in making its various epochs.

This should be followed by a study of the classics, and that
education has not been liberal which has not included a study of the
modern classics. German literature opens up a new and delightful
world. A study of the classics forms the taste, elevates the mind,
broadens the vision and the power of judgment, and it is a profound
help in the formation of character. After such reading as this, who
would be willing to spend her time on the cheap and trashy novels of
the day.

Good modern fiction should be taken up as a recreation by the
woman whose life is laborious, its questions perplexing, and its
complications tiresome; in other words, after the woman has left the
high-school or college and has entered on her life’s vocation. For
young girls, not only is too much time apt to be given to fiction
which should be devoted to other and more important matters, but it
is apt to do much harm by giving them a wrong impression of life.

=The Power of the Will or Inhibition.=—The conduct of mankind is
chiefly governed by the emotions, instincts, and impulses. Spencer
traces all human action to the desire for pleasure in the large and
philosophic sense of the term. If this be so, then the education and
hygiene of the emotions and impulses must be of the very highest
importance in the life of each individual and in the social world.
The question arises, and it is all important, can those inhibitory
centers be so developed in youth, and so cultivated in life, that
they can act as antagonists to what is morbid? Can they be used
as direct preventive and curative agencies against tendencies and
impulses which are foolish and hurtful? And the answer of educators,
as the result of large experience and observation, is emphatically,
yes.

But the training, to be efficient, has to be systematic, persistent,
and along well-defined lines. The first step in this training must
be the strict avoidance of all that has a tendency to lower the
standards of morality, whether this is in the line of companions,
literature, the stage, music, or art. To do otherwise is not brave,
but as foolhardy as it would be for a weak army to advance against a
powerful foe; it means annihilation or to be taken prisoners of war.

To overcome obsessions and delusional beliefs by volitional effort,
the effort should be made to direct the mind to other subjects which
have nothing whatever to do with the obsession, rather than to make
a direct stand of the will against it, since the will may put forth
its utmost strength in the way of direct repression of the temptation
to any immoral action, and may entirely fail, while, by directing the
same amount of force in changing the direction of thought, complete
success may be attained.

The influence of the will upon the emotions is a matter of the
highest importance in regard to the direction of the current of
thought and the determination of actions. Control your passions;
govern your temper. We can no more avoid feeling mentally hurt than
we can feeling physical hurt, but we have exactly the same power of
the withdrawal of the attention from the mental hurt as from the
bodily pain, by determinately fixing it upon some other object.

“I am, I ought, I can, I will,” are, as has been well said, the only
firm foundation-stones upon which we can base our attempts to climb
into a higher sphere of existence. The first implies a faculty of
introspection, the second a moral judgment, the third a consciousness
of freedom to act, the fourth a determination to exercise that power.

The influence of the will on the conduct is first automatic, through
previously acquired habits; second, through the emotional state,
and third, by our notions of right and wrong. In the fundamental
principles of living must be included a genuine consideration of the
right of others. The memory is an automatic reproduction of ideas,
the mechanism of recording processes.

The education of the will, the power of breasting the current of the
desires, and doing for long periods of time what is distasteful and
painful, all tend to increase the power of inhibition and strength
of the will. Nothing that is learned in youth is really so valuable
as the power and habit of self-restraint, of self-sacrifice, of
energetic, continuous, and concentrated effort.

Seneca claims that difficulties strengthen the mind as labor does
the body. Plato said, that “self-conquest is the greatest of all the
victories.”

Character lies preëminently in the sphere of the will, and anything
which weakens the will saps the worth of life at all points. The
strength of will bears not only on character, but on happiness and
influence as well. The leader must show reserved power, and make it
plain that she has herself well in hand, to secure confidence. “Will
makes men giants.”

=The Effect of Mental Attitude on the Physical Health.=—The ordinary
operations of the mind have little effect on the physical condition,
but such emotions as fear, worry, anxiety, grief, despair, anger,
hatred, and the like depressing emotions act directly upon the
muscular and nervous mechanisms, profoundly affecting the secretions
and the excretions, and stamp themselves upon the very tissues of the
organism.

Of all the mental attributes the emotions are the most exhausting.
A woman can spend more of her strength in five minutes of unnatural
excitement than in a day of calm, steady brain work.

A perfect temper is not only a prime requisite for a club president,
but for every man and woman in this hard workaday world, with its
fierce competitions, its petty jealousies, and the stiletto practices
of the cowardly, and it is one of the greatest preventives of
indigestion, insomnia, and nervous prostration.

Forget your grievances. Every time that one repeats them to herself
or to a friend she lives them over again, and the original trouble
was but the merest moiety of suffering compared to a wound torn open
afresh every day. To cherish a vindictive spirit does a vast amount
of injury to the possessor of that spirit. In view of the facts of
the beneficial effects of fighting upon small boys, and that the
combative propensities of the Irish peasant commonly evaporates with
his shillelagh, it would seem commendable to introduce boxing matches
among women as a way to settle their differences.

From the standpoint of health, the intense excitement attendant on
playing for high stakes, the loss of sleep, the unnatural life, the
loss of money that one can ill afford to lose, must eventually lead
to a serious if not to a fatal breakdown.

It is not the natural and reasonable intellectual work that
injures the brain, but the various emotions—ambition, anxiety,
disappointment, the hopes and fears, the loves and hatreds of our
lives—that wear out the nervous system and endanger the balance of
the brain.

Powerful emotion is like concentration attended with dissociation, it
occupies the mind to the exclusion of all else, even to the dictates
of self-preservation and reason. The will is more or less suspended
and held in abeyance during the emotional states.

The too great concentration of the attention on one’s business or
occupation is a self-indulgence that often ignores the importance
of the lighter side of life and the legitimate claims of family and
friends.

Less ambition and more philosophy would greatly lessen the number
of cases of nervous prostration and allied neuroses. All of one’s
fortune is not staked on one throw of the dice; if the woman fails in
one direction, there are other resources left.

Concentration of the mind on the physical suffering leads to the
so-called habits in disease; there may have, in the first place,
been a real physical cause. For example, in case of injury to a limb
followed by severe pain in that member it has happened that after
amputation of the limb the consciousness of pain persisted in the
brain. In the functional neuroses, the first cause may have been a
real physical one, but the individual becomes so self-centered, it is
with difficulty that the mind can be withdrawn from the ego, and a
cure can only be effected by supplanting the intense egotism by new
interests.

Medical literature contains numerous observations of ailment caused
by fright, and even of death itself so caused. It is not uncommon
for medical students to contract the disease about which they are
studying. In the old small-pox epidemics it was a very generally
observed fact that those who feared contracting the disease were
the most apt to get it. The reason is very easily explained—fear so
suppressed the functional activities of circulation and nutrition,
as to predispose the individual to take any disease to which she was
exposed.

Autosuggestion is the predominant element in the concentration of
the thought on one particular subject, and of the narrowing of the
perspective to a single point of view.

Prolonged anxiety or grief will cause an emaciation, second only to
that of tuberculosis itself, by the depression of the heart’s action
and the circulation, the loss of appetite, the interference with
nutrition, and the loss of sleep.

Worry is, as we have seen, in the first instance most frequently bred
of exhaustion, but, if indulged in, it readily becomes a fixed habit,
and the mind rapidly settles into a state of fixed gloom.

Worry is a type of fear. It is a futile regret over past mistakes and
the miserable forecasting of the future. It has been called the great
shortener of life under civilization—of all forms the financial one
is the most frequent and, for ordinary minds, the most distressing.

Anxiety and the anxious frame of mind is in readiness to take fright
in connection with our most vulnerable points on all occasions
of apprehension or uncertainty. As no one’s future can be clear
throughout, there is never wanting the matter of anxiety to a mind
susceptible of this state.

It is a significant fact that our asylums are recruited from the
classes who spend their lives amid narrow monotonous surroundings;
hence the large proportion of women, especially of farmers’ wives,
whose lives are probably the most narrow and the most monotonous.
From this result the fixed ideas, the obsessions, and all the
absorbing egotism of insanity.

With a variety of valuable and permanent interests, the mind is well
safeguarded against attacks of worry. The overworked woman should
increase her recreations, leave home for short intervals, travel, and
have entire rest and change of scene. With increased vigor of body
will come increased power of the will and the capacity to abolish
worry.

Anger floods the brain with blood, and if the arteries are brittle,
as they are in old age, and the individual is just as old as her
arteries, the rise in arterial tension may result in the rupture of a
blood-vessel, and the subsequent hemorrhage into the brain may cause
an attack of apoplexy, paralysis, or even death. Attacks of anger
hasten the deterioration of the arteries; in this way anger has been
known to cause death.

Every violent physical sensation will react on the lungs; every
powerful normal emotion, whatever its cause, will also make its
influence felt on the respiratory functions. An exercise which is
performed with tranquil breathing if the mind is free from care,
quickly produces respiratory disturbances if the mind is brooding
and preoccupied. Those who have acted as seconds in a duel to men
accustomed to the use of the sword know that they become breathless
in the duel much more quickly than they do in the fencing school.

Depressing emotions make themselves felt in the respirations of
animals as well as of man. A sensitive horse, which is badly used at
its work, or even roughly spoken to, rapidly becomes breathless.

The dog is incomparably less swift than the hare, but is able to
catch it; the fright of the hunted animal disturbs its breathing and
robs it of much of its strength.

In fright the disorder of the respiratory movements destroys the
regularity of the interchange of gases which takes place in the
lungs, between the venous blood and the atmospheric air, and thus
profoundly hinders the function of the aëration of the blood.

The more impressionable the subject, the more easily do the emotions
influence his respiratory actions. Hence, the superiority in
certain bodily exercises of men whose minds are calm and masters of
themselves.

Emotional causes, such as worry, anxiety, and grief, as well as the
more tangible physical factors, cause softening and disease of the
tissues, which frequently accounts for the arteriosclerosis and
premature senility. Alienists have long found abundant evidence
that abnormal physical conditions are capable of producing mental
diseases, but the reverse is quite as true.

And not only the imagination, but the intellect, the emotions, and
the will have or may have a powerful influence over the sensations
and organic functions.

It is not only profoundly true that mental attitude has much to do
with bodily function, capable of producing changes in its nutrition
and secretion, but we may go further and say that healthful and
hopeful habits of thought do much to put the body on the defensive
against the assaults of disease.

Mental attitude refers not to the will or the emotions, but to the
mind in its entirety. The trend of a woman’s thoughts, the use she
makes of her intellect, the strength of the volition, the sense of
responsibility, and the objects of her life are all questions that
have a distinct bearing upon the bodily functions and the health of
the individual.

=A Definite Occupation a Physical Necessity.=—It is now generally
conceded by the leading sociologists of the day that women who are
not engaged in the duties of maternity need the same intellectual
and industrial activities as men. Many go further, and it is their
opinion that there is no reason for excluding women, who are
fulfilling the duties of maternity, from exercising full intellectual
and physical activities in other directions. And the proof that this
is not a mere theoretic assumption is to be found in the fact that
many women have not only given birth to a family of children, but
have successfully reared them, and, in addition, have been eminent in
other pursuits and callings. Well-known illustrations of this fact
are to be found among the most noted sovereigns that Europe has ever
had—Catherine de Medici, Maria Theresa, Catherine II of Russia, and
Queen Victoria.

Pleasure seeking, as the end and object of life, leads to ennui,
disgust, and physical and mental deterioration, while the slavery
of housework, the childish vanities, and petty cares and vexations
are most injurious to the nervous system, so that for the life of
the housewife the education preceding it should be broad; and the
more highly educated the woman is, so much the more effectually
can she free herself from attaching too much importance to every
little detail, and so neglecting what is higher and more important,
and it will be a great preventive of irritability of temper,
quarrelsomeness, and even melancholia and mental derangement, from
which so many of these women suffer in consequence of the monotony of
their lives.

Every girl when she leaves school, which she should consider the very
alphabet of her education, should prepare herself for some definite
occupation, just as her brother does.

Clouston, in answer to the question as to how the powers of the mind
can best be developed, conserved, and made the best use of for life’s
work, says: “It is a most fortunate thing, if, during the later
period of adolescence, an occupation in life has been selected which
really suits the capacity of the individual and goes with his innate
tendencies. The seriousness and the settledness of the life of the
period, with the bracing of every nerve and sinew to do the work, to
gain a reasonable position in society, and to enjoy a fair amount of
happiness, is in itself a tonic of no mean value, while overtaxing
of body and mind is always a risk, as well as an ambition which
overreaches itself. The repressions of woman’s life in civilized
society constitute one of her serious strains and dangers. The life
and conditions of a working woman who has six or seven children in
a few years, who has small means, and but little help, is in my
judgment the very hardest of any human being in our modern social
system.”

Thomas[6] thus sums up his views as to the evils resulting from the
non-occupation of women of the better classes. “Human nature was
made for action; and perhaps the most distressing and disconcerting
situation which confronts it is to be played on by the stimulations
without the ability to functionate. The mere superinducing of
passivity, as in the extreme case of solitary confinement, is
sufficient to produce insanity, and the emotion of dread or of
passive fear is said to be the most painful of the emotions, because
there is no possibility of relief by action.

“The American woman of the better class has superior rights and no
duties, yet she is worrying herself to death; not over specific
troubles, but because she has lost her connection with realities.
Many women, more energetic and more intelligent than their husbands
or brothers, have no more serious occupation than to play the house
cat, with or without ornament. It is a wonder that more of them do
not lose their minds; that more of them do not break with the system
entirely, is due solely to the inhibitive effect of early habits and
suggestions.

“The remedy for the irregularity, pettiness, ill health, and
unserviceableness of modern women seems, therefore, to lie along
educational lines. Not in general and cultural lines alone, but in
a special and occupational interest and practice for women, married
or unmarried. This should preferably be gainful, though not onerous
or incessant. Normal life without normal stimulation is impossible,
and the stimulation best suited to the nervous system is some form of
interesting work.”

=The Psychology of Success.=—Success has been defined as the
accomplishment, the realization of what has been willed or wanted,
the ripe fruition of the well-tended tree. The achievement of fame or
fortune is what the world generally regards as success.

Before entering on an enterprise, all the premises in the case must
be had in order to form correct judgments, otherwise incomplete and
imperfect knowledge of the case will lead to error in judgment, in
which there could be said to be “no _chance_ of failure, it was a
certainty.”

An element that always makes for success is to be able to supply a
want of the public; it is partly a question of demand and supply. It
is sometimes possible to create a demand. But, as a rule, success is
the fruition of patience and well-directed energy.

There is nothing which tends so much to the success of volitional
effort as the _confident_ expectation of its success, while nothing
is so likely to induce failure as the apprehension of it. Since
the tendency of the cheerful and joyful emotions is to suggest and
keep alive the favorable anticipations, while that of the depressing
emotions is to bring before the view all the chances of failure, the
former will increase the power of volitional effort and the latter
will diminish it.

The mental condition also exerts a direct influence upon the physical
powers, through the organs of the circulation and of the respiration,
the heart’s impulse being more vigorous and regular, the aëration of
the blood being more efficiently performed, in the former of these
conditions than in the latter.

Success too easily won, or won early in life, may really be a cause
of failure, because, having been once achieved, the individual may
be content with what she has and not proceed to higher development.
And so a very inferior success may be the tomb of energy and the
satisfied goal of ambition, instead of a stimulus to higher things.

Lack of success may also be caused by indulgence or lack of courage,
the individual preferring to sail along the chartered course of
mediocrity rather than to strike out a new path for herself,
involving risk, anxiety, and endless work.

And perhaps jealousy in the rank and file of the lazy, indifferent,
and mediocre far more often impedes effectually the road to success
than is dreamed of, so that a greater degree of secretiveness,
warding off the scent, of the intentions, the aspirations, and the
methods of work, until the object shall have finally been achieved.

Another and most important secret of success is to recognize
failure as only a stepping-stone to higher things. Eggleston says,
“Persistent people begin their success where others end—in failure.”

The people who succeed in this world are the people who get up
and look around for the circumstances they want; if they cannot
find them, make them. “Circumstances,” said Napoleon, “I make
circumstances.”

There are four mental requisites necessary to the achievement of
success, namely: a clear view of the end; a judicious indifference
to the sentiment around by the sweeping away of obstacles; an
indomitable energy; and the power to resist the temptation to rest on
the soporific plane of mediocrity.


FOOTNOTES:

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

[6] “Sex and Society.”




CHAPTER VIII

DRESS THE FUNDAMENTAL CAUSE OF WOMAN’S PHYSICAL DETERIORATION

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


A careful study of the history of woman’s dress affords a forcible
demonstration of the fact that the fundamental cause of the inferior
physique and lowered vitality of the modern woman of civilization is
to be found in not only her own, but also in her female ancestors’
unhygienic mode of dress for many centuries.

Study the physique and dress of the ancient Greeks, then follow the
history of dress down through the Middle Ages and the Renaissance
to the present time, and, if further proof be needed, visit, as has
been done, the savage races of the earth to-day, and behold women of
powerful and classic physique still exist in lands where the body
is not molded according to the barbarous decrees of the “modiste of
fashion.”

=The History of Woman’s Dress.=—The history of Greek costume is for
the most part free from what is known as change of fashion, for the
reason that the Greeks did not attempt to reconcile the two opposite
principles of covering, and at the same time displaying the figure;
that is to say, of cutting the dress to fit the body.

[Illustration: PLATE II

Greek costumes. “Queen and two attendants.”]

The dress of the Greeks, when at the height of their civilization—and
that of the Assyrians, Egyptians, and ancient Romans was not
essentially different—was very simple. It often consisted of a simple
garment, the tunic, which pleased the eye by the gracefulness of
its drapery, and at the same time was comfortable by reason of its
looseness.

The chief and indispensable article of female dress was the _chiton_,
or tunic, consisting of one piece of material, sewed together in the
form of a sack, open at top and bottom, in height reaching from the
neck to the feet of the wearer, and in width equal to that of the
extended arms. Within this stands the figure, and first it is girt
around under the breasts by a girdle, to keep it from falling; next
the upper edges are fastened together on the top of the shoulders by
a brooch, and the arms are either left bare, pressing down into folds
at each side the masses of material, or these masses may be gathered
around each arm, and fastened down the outside with buttons and
loops, so as to form sleeves.

To secure greater warmth on the breast and shoulders the chiton was
made long enough to be doubled back at the top, and this part reached
to the waist. Underneath the chiton was worn a band of cloth, to
support the breasts, and, in addition to this, a cord was sometimes
crossed round the breasts outside the chiton, to assist either in
supporting them or in bringing out their form. Round the loins was
sometimes worn either a short petticoat of thick woolen stuff or a
sort of bathing drawers, such as acrobats wore. This was all of the
essential dress for indoor wear. The chiton was made of a variety of
fabrics, though generally of linen.

For outdoor wear was the _himation_, a garment also worn by men; it
was made of woolen stuff and was worn like a plaid.

The chiton and himation, as above described, continued to be the
standard dress from 450 B. C. onward.

The hair was most usually worn gathered back from the temples, and
fastened in a knot behind by hair-pins of ivory or bone, either plain
or mounted with gold.

For the feet, sandals were usually worn, in exceptional cases shoes,
and for hunting, high boots. Gloves were never worn by the Greeks,
except to protect the hands in working.

From the time of Pericles, the great European distinction between
male and female dress consisted in the length of the skirt, old men,
priests, and officials being allowed the privilege of wearing long
or women’s skirts, and young girls being permitted to wear the short
or man’s skirt. Among the Romans, this single garment, worn by both
sexes, was called the toga.

As time rolled on, this loose cord, which had formed the girdle, was
reinforced by a broad belt or band to support the breasts. Among the
Assyrians this belt was made of stiffened linen or thin metal; the
Egyptians wore a folded belt; a broad belt for supporting the breasts
was also worn by the Roman ladies. But whatever the material used,
this stay-belt does not show any signs of tight laces or of vertical
ribs of iron or bone. It was, however, the forerunner of “stays,”
and when the moral fiber of the Greeks grew lax, the courtesans set
the fashions, and dress was used to display rather than to conceal
the figure, and, in order to make the hips more prominent, the waist
was constricted by a many-layered belt. At the same time, the use of
cosmetics was introduced.

=The Mediæval or Middle Ages.=—From the end of the fifth century to
the beginning of the seventeenth there was a singular resemblance in
many marked particulars between the dress of the two sexes. It now
became the object of dress in both sexes not merely to clothe the
person, but also to display the figure and adorn it. In the temperate
climates there are always greater changes in fashion than in the very
hot or very cold.

Subjugation by the Romans in the first centuries of the Christian era
was followed by a general conformity to their mode of dress, so that
the Roman dress may be considered to have become European.

In marked contrast to the loose, flowing robes worn by the southern
nations of Europe in their decadence were the short skirts and
jackets clinging to the limbs, which were worn by the hardy nations
of the North, who were given to constant fighting and the pursuit
of the chase. The Norman lords, following the fashion of the south,
swept about in long tunics and flowing robes.

In the twelfth century the Anglo-Saxon women, dressed in their loose
garments, were indebted to the Norman ladies for the introduction
of “stays,” and the fashion of tightly lacing the body with a robe,
laced down in front in order to show its undulations, as well as the
use of cosmetics.

In the household register of Eleanor, Countess of Leicester, which
bears the date of May 24, 1265, is one of the earliest places in
which the word _corset_ occurs. The word is again found in reference
to the wardrobe of Richard King of the Normans, and Edward his son.
Corsets were at this time worn by men as well as women.

The author of the life of St. Thaïs, who lived in the twelfth
century, tells us that the French were so tightly laced that they
could bend neither their bodies nor their arms.

Peter the Great wrote that the robes are so tightly stretched over
the body, that the ladies can scarcely breathe in them, and often
suffer very great pain in order to make their bodies slender.

It was in the thirteenth to the fourteenth century that the last
trace of the Roman drapery gradually disappeared: the women adopted
for the most part the robes with the tightly fitting corsage, leaving
ordinarily uncovered the neck and the skin of the breast; this
closely fitting corsage was closed in the back by lacing.

Boots and shoes of this period had their pointed toes made two or
three times the length of the wearer’s foot. The fashions of England
were the same as those of France, though apparently they were not
carried to quite the same excess as on the continent. The singular
aim of each sex was not only to emulate the other in the sumptuous
style of dress and its profuse adornment, but also to imitate
the form and fashion of the other’s attire; this obtained in both
countries.

=The Renaissance.=—In the sixteenth century a distinct separation
between ancient and modern dress took place, and our present fashions
took their origin from about that time. It was during this century
that men adopted clothes closely fitting about the body, overcoats
with tight sleeves, felt hats with more or less rigid brims, and
closed boots or shoes. The women also wore their dresses tightly
fitting to the figure, with tight sleeves, low-crowned hats, and
richly trimmed petticoats. These garments, which differ wholly from
antiquity, constitute, as it were, the common type, from which has
risen the endless variety of modern male and female dress.

At this time the general resemblance between the clothing of the two
sexes, which may be traced to the earliest times, became decided.
After the accession of Queen Elizabeth in 1558, the well-known
costume, associated with herself from about the middle to the close
of her reign, gradually became established. The long-peaked and tight
stomachers of the ladies, and the padded quilted doublets of the
men—it might truthfully be said that each garment was a parody of the
other.

Ruffs of an exaggerated amplitude and of a painfully severe stiffness
were worn by both sexes.

At the beginning of the seventeenth century the dresses were tight at
the waist, but begun to be made very full around the hips, by means
of large padded rolls, which were still more enlarged by a monstrous
arrangement of padded whalebone and steel. To both boots and shoes
high heels were added, in place of the flat heels previously worn.

About 1710 the hooped petticoat was introduced, and about 1740 they
obtained enormous dimensions.

When traced to their original sources, we find that all of the
extremes of fashion were made to conceal some deformity of the
figure, or to give to a part of it undue prominence, as in the case
of the corset, which was first introduced when clothes were not
wanted for the concealment of the person, but to make more prominent
the curves and undulations of the figure. The ruff grew out of a
scrofulous complaint on a royal neck; the hoop-skirt, to conceal the
_enceinte_ condition of a French queen.

=The Corset in History.=—Dr. Bouvier divided into five epochs the
transformations undergone by the corset, or by that part of the
clothing which took its place from earliest antiquity to 1853.

The first epoch is that of antiquity; in this, as we have seen, the
band or girdle, which was worn by the Greek and Roman ladies, was the
forerunner of the corset.

The second epoch comprises a great part of the Middle Ages. This was
a period of transition which partook of the styles which preceded and
followed it. At first there was an abandonment of the narrow Roman
band, and later the introduction of the corsage fitting tightly about
the body.

The third epoch embraces the end of the Middle Ages and the first
part of the Renaissance, which was marked by the general adoption of
robes with a very tightly laced corsage.

The fourth epoch is that of the whaleboned corset, which extended
from the middle of the sixteenth century to the end of the eighteenth.

The fifth epoch is that of the modern corset.

The busk, known since the fourth century, was introduced into France
in the sixteenth century; men also wore busks or stomachers. The
busk relates closely to the history of corsets. The middle of the
sixteenth century is the epoch of transition from the corsage to the
whaleboned waist, which constituted a sensible approach to the modern
corset.

We find that the reign of Queen Elizabeth was marked by the first use
of the whalebone stays. These were much affected by her successor
James, who insisted that all his courtiers, male as well as female,
should cultivate the appearance of the wasp.

The corset of George II, represented in Hogarth’s pictures, is said
to have been one of the most harrowing forms of screw torture. We are
told that the doughty warriors of Gustavus Adolphus wore stays almost
to a man.

To Catherine de Medici is generally attributed the introduction of
the closely whaleboned waist into France, and the corset which she
invented resembled in more than looks that instrument of torture—“The
Machine Virgin of the Inquisition.” This corset was made of steel,
and was as inflexible as a suit of armor, and, like a warrior’s
breast-plate, consisted of two pieces. It opened longitudinally
by hinges, secured by a hasp and pin, made like an ordinary box
fastening. In the front and back a rod or bar of steel projected
in a curved direction downward, and on their bars depended the
adjustment of the long-peaked body of the dresses and the set of the
skirt behind. During the forty years in which she ruled at court a
thirteen-inch waist measure became the accepted standard.

Madame de Sévigné, born thirty years after the death of Catherine de
Medici, formulated the axiom which has since been a law to the French
modiste, “Les hommes ont la permission d’être laid; les femmes ne
l’ont’ pas; aussi n’en est-il aucune qui consente à l’être.”

The idea of the waist was unfortunately that which concerned the
execution. Instead of being adapted to the body or figure, in
accordance with its form, to bend with its movements, as the supple
corsage which preceded it had done, this new garment became an
inflexible mold, which distorted the natural contours and imposed
upon them a conventional mold, and prevented the least variation of
size or situation of the contained organs, as well as their continued
integrity and the proper performance of their functions.

The use of the whaleboned corset prevailed even among infants
scarcely out of their swaddling clothes. This was the natural
consequence of the pretended necessity to mold the human form in
order to obtain beautiful proportions, to reform nature, and
prevent her mistakes, and one could never take too much care to
obtain such laudable ends. Mothers would have been considered
culpably indifferent of their children who had neglected these first
indispensable cares for the regulation of the formation of their
bodies.

=The Crusade Against the Corset.=—From the time of Galen, 130 A.D.,
to the present day, in spite of the anathemas hurled against it by
the state and medical profession, denouncing this great injury which
woman does herself, has the corset still prevailed.

In the thirteenth century, Henry III, having permitted its use for
some time, proclaimed a very severe edict against the wearing of
corsets, which was considered so pernicious to the health of women,
but of no avail.

In the fourteenth century an edict was issued by the Emperor Joseph
of Austria, forbidding the use of corsets in all nunneries and places
where girls were educated, and calling upon the Church to aid him,
threatening excommunication to those evil-disposed damsels who should
persist in operating upon their waists. The College of Physicians
of that day took up the subject with activity and zeal, and
dissertations upon the evils of tight lacing were scattered broadcast.

Professor Virchow, that eminent pathologist, wrote, “What is the use
of introducing the principles and appliances of hygiene into the huts
of the poor and ignorant, when the scions of wealth and pretended
intelligence, especially of the gentler sex, show their contempt of
hygiene by their dress and general wearing apparel. In days gone by I
have battled against that diabolical invention called the corset, but
this crusade has been given up by me as absolutely futile.”

The modern hygienist has taken the stand that, since the corset
cannot be suppressed, it _must_ be reformed. About 1880, for the
first time, some attention began to be given to the hygienic
consideration of the style of the corset.

=The Influence of the Corset on the Female Body.=—As a result of the
four hundred years in which the corset has molded the plastic form of
woman, she has become physically so degenerated that it is necessary
to have recourse to the artifices of the modiste in order to have
even the appearance of a good figure, and the support afforded by the
corset to maintain the erect position.

[Illustration: Fig. 13.—Normal chest.]

[Illustration: Fig. 14.—Effects of tight lacing on bony thorax.]

The modern corsets, made of one piece, can be classified in three
categories, according to the region of the body on which they exert
the greatest pressure. First, the “curved front” corset, enveloping
the thorax and abdomen, but making the strongest compression at the
base of the thorax; second, the “straight front” corset, enveloping
the thorax and abdomen, but making the strongest pressure upon the
abdomen; and third, the “abdominal corset,” only embracing the
abdomen, and supporting neither the breasts nor the base of the
thorax. In studying the effects of the corset on the body they will
be considered in this order.

_The Curved Front Corset._—The corset is applied to the trunk of
the body, consisting of the thoracic cavity, a distensible cage
containing and filled by the heart and lungs; second, the abdominal
cavity, whose walls are almost wholly composed of muscles, and
containing the liver and the entire digestive apparatus; and third,
the pelvic cavity, whose walls are partly bony and partly muscular.

When the anterior wall of the body is forced to take the shape of
this curved corset, it is pressed back toward the vertebral column,
and even when the corset is not laced tightly, there is always more
or less constriction of the base of the thorax, so that a serious
deformity of the lower part of the thorax and abdomen is produced;
instead of the normal outward curve of the anterior surface of the
body, with its most prominent part in the region of the umbilicus,
there results a broken line at the waist, and an obtuse angle is
formed here, pointing outward. This causes a marked incurvation
of the lower part of the chest and its approach toward the spinal
column, with a corresponding flatness of the chest and lessening of
the respiratory capacity of the lungs, and the action of the heart is
seriously interfered with.

The chest or thorax is forced into the shape of a cone, the lower
opening is narrowed, and its walls are brought too near together.
The lower ribs become too short, and, if the corset is worn early in
life, the upper ribs become too long; and the thorax as a whole is
too long.

The greatest constriction produced by the corset occurs in the plane
extending from the ninth to the twelfth ribs, which corresponds to
the position of the diaphragm, stomach, and liver.

Just how seriously the curved corsets interfered with the expansion
of the lungs was shown in a paper published by Dr. Sargent in 1889.
He found that the average lung capacity when corsets were worn was
one hundred and thirty-four cubic inches; when corsets were removed,
the lungs showed a capacity of one hundred and sixty-seven cubic
inches—a gain of thirty-three cubic inches; that is, corsets crippled
the lungs to the extent of one-fifth of their entire capacity.

Nature endeavors to make up this loss by the increased rapidity of
the heart’s action and more frequent respirations, but this is at the
expense of greater wear and friction of the machinery. Palpitation
and shortness of breath follow, and the woman is obliged to give up
all active exercise.

Through this failure of the suction power of the heart there result
disproportionately larger lower limbs and an accumulation of adipose
tissue below the waist. This condition is much more common in women
than in men, and is due to the lack of power of the heart to draw the
blood back from the lower limbs against the force of gravity. Hence,
the blood tends to linger in the lower extremities and the oxidation
of the tissues is interfered with.

[Illustration:

  Fig. 15.—Diagram showing the action of the curved front corset
  (O’Followell).
]

_The Relation of Corsets to Abdominal and Pelvic Disorders._—By
the constriction of the lower part of the thorax, as we have seen,
the action of the diaphragm is very greatly impaired; this not
only seriously interferes with its respiratory function, but with
digestion as well, since, by the active contraction of the diaphragm
in inspiration, it presses down the liver and other abdominal
contents, and produces a powerful massage of those organs, which
aids in the digestion of food and in the unloading of the bowels,
and, at the same time, the pelvic circulation is interfered with and
pelvic congestion is favored.

The direct pressure of the corset upon the side walls of the chest
forces the ribs in upon the abdominal contents; the liver suffers
most from this, and not only does the liver sometimes actually show
furrows upon its surface from the pressure of the ribs, but, in the
postmortem room of the great Vienna Hospital deep grooves upon the
liver were repeatedly found with great distorsions of the body caused
by the corsets, and, in a few instances, the left lobe of the liver
was found to be nearly separated from the right.

[Illustration: Fig. 16.—Relation of bony thorax to lungs, heart,
liver, and stomach, with artificial outline produced by corsets
(after Gray).]

By the constriction of the waist, the liver and all the abdominal
contents are pushed downward below their normal position, and their
functions are greatly interfered with. The effects of this pressure
upon the stomach are most disastrous, and cause a host of digestive
and nervous troubles. There is very frequently a prolapsus of the
kidneys; the right one is more frequently prolapsed than the left,
owing to the relation of the right kidney to the liver.

In a study of 50 cases Dr. Gallant found that in 90 per cent. the
stomach was pushed down below its normal level, and in 80 per cent.
there was prolapsus of the right kidney.

The constriction of the waist crowds the small intestines, with the
accompanying mesentery and colon, into the pelvis; if the rectum is
loaded with feces and the bladder empty, there follows an anterior
displacement of the uterus; if, on the other hand, the rectum is
empty and the bladder distended, there is a backward displacement
of the uterus. In very many of these cases the compression and
constriction are great enough to interfere with and retard the
peristaltic action of the intestines, and constipation is produced.

Gynecologists are unanimous in the opinion that tight lacing is a
most serious impediment to the development of the pelvic organs,
and is a prominent factor in causing disease of these organs. Tight
lacing displaces the uterus downward from two to three inches, and,
at the same time, the pelvic floor is bulged downward from two and
one-half to three inches and the circulation rendered sluggish.

When there is no interference with the respiratory movements the
uterus rises and falls with every breath, and the movements of the
uterus promote the circulation of the blood in the pelvis.

A high corset compresses the breasts, and so interferes with their
development. The low corsets of the present day support rather than
compress the breasts.

_The Effects of Corsets on the Muscles._—In the back the corset
forms an extended plane from top to bottom, destined to support the
posterior part of the thorax and to diminish as much as possible
the size and projection of the shoulder-blades. This compression of
the muscles of the back leads to their atrophy, and, as it is their
function to hold the spinal column erect and to approximate the
shoulder-blades to the thorax, when they become atrophied the bony
parts become much more salient. Further, the corset, in weakening
the muscles of the dorsal region, interferes with the normal forward
projection of the chest, and so leads to its flatness.

The corset atrophies the articulations of the vertebral column,
produces a round back, an inequality in the height of the hips and
shoulders, with the resulting familiar awkward, waddling gait.

When the healthy skeleton offers to the muscles of the body a solid
base of support, the action of the muscles of the back are not
interfered with, there is nothing to prevent their contraction,
and the body is held erect. With a perfect muscular development,
the shoulders are effaced, the back is admirably straight, and the
carriage is erect and graceful.

The strong compression of the muscles of the abdomen not only
destroys the normal contour of the body, but, by the atrophy of the
abdominal muscles, a partial paralysis is caused, and so the support
which should be afforded the viscera by these muscles is weakened,
and a prolapsus of the abdominal contents follows.

It will be seen that the two bony cavities of the body are connected
in the back by means of the vertebral column and are not immovably
fixed in relation to each other, but by reason of the flexibility
of the spinal column, they can be approximated or the distance
extended. The suppleness which results from this mobility corresponds
to the physiologic needs, and constitutes one of the most essential
conditions for gracefulness of carriage.

The movements of extension of the chest are rendered possible by the
action of the muscles of the back, which hold the trunk erect and
extend the vertebral column.

When the corset is applied, the compression and constriction fix all
those portions of the muscles at and below the waist; the action of
the muscles between the chest and pelvis is diminished at least
one-half, so that these muscles become atrophied from disuse, and
when the corseted woman wishes to straighten up the movement must be
executed by the entire trunk.

[Illustration: Fig. 17.—Skeleton of head and trunk (O’Followell).]

Without the corset, the pelvis remains fixed and furnishes the normal
base of support for the thorax, which gains the erect position
through the action of the muscles of the back acting on the vertebral
column. Whereas, with the corset on, the pelvis is immobilized, and
it follows the movements of the thorax. The movement of extension of
the thorax, instead of taking place in the region between the false
ribs and pelvis, takes place at the hip-joints—the vertebral column
remains rigid, it takes no part in these movements.

[Illustration: Fig. 18.—Muscles of the anterior surface of the trunk
(O’Followell).]

Then, as a result of the incurvation of the anterior surface of the
trunk, there is an interference with the movements of extension of
the spine and its immobilization, which causes the propulsion forward
en masse of the abdominal contents. The anterior portion of the
chest is shortened, and an exaggeration of the sacrolumbar angle is
produced.

On the sides of the body lateral flexion of the trunk is possible,
through the contraction of the muscles between the chest and pelvis,
but with corsets on this is impossible. The two cavities are fixed by
the rigid armature which composes the corset. This not only prevents
the lateral flexions of the body, but also causes an unnatural
depression above the crests of the ilium. The waist is constricted to
such an extent that the woman can only fasten her corsets in front by
having them widely separated in the back.

All these conditions cause a complete immobilization of the thorax on
the pelvis, so that the movements of the upper part of the body are
characteristic in corseted women, and she moves all in one piece.

[Illustration:

  Fig. 19.—Diagram showing the action of the straight front corset
  (O’Followell).
]

_The Straight Front Corset._—This corset, when worn loose, is a great
improvement on the curved-front corset. When properly fitted, all
the compression comes at the hips and across the lower part of the
abdomen, which is lifted up, and the waist-line is increased in size.
This corset has for its base of support the bony pelvis, and there
should be sufficient space to easily introduce the hand between the
lower part of the thorax and the corset. In this case there is great
freedom of movement of the entire chest cavity, so that respiration
is not nearly so much interfered with as in the curved-front corset,
and if the corset is properly fitted, the lower part of the abdomen
is raised together with the contained viscera, and, indeed, this
style corset is prescribed in cases of prolapsus of the kidneys.

By having the base of support from the bony pelvis, the chest is left
free, and a good chest expansion and its throwing forward is favored,
and at the same time an erect carriage is secured.

The waist-line runs below the short ribs, which lengthens the waist,
producing graceful lines without compression.

But not all straight front corsets fill these conditions. Unless
sufficiently long and well fitted about the hips, they may fail to
raise and support the abdomen, and when too tightly worn may press
too strongly upon the abdomen in the pretext of obliterating it, with
the result that it is placed in a vice from before back. Pressed
down, the intestines find a means of escape at the lower border of
the corset.

The front of the corset is frequently carried too high up, and does
not leave the epigastric region sufficiently free. The corset must
absolutely not be thoracic, and must definitely renounce the support
of the breasts, which should be accomplished when necessary by an
extra bust supporter. The long straight corset immobilizes the trunk
in the same manner as the curved front corset.

_The Abdominal Corset._—In 1902 Madame Gaches-Sarraute proposed to
abandon the thoracic corset and to introduce instead the abdominal
corset. This corset embraces the pelvis without compressing it, and
takes as the foundation of its support the bony girdle; the plan of
the line of support is oblique, and inclined forward in such a way
that there can be no compression.

In this way the pressure, instead of coming from above and annuling
the contractions of the abdominal muscles, comes below and reinforces
their action; the stomach resumes its normal position, and is
supported in the plane of its greater curvature, facilitating its
functions, so that digestion will be performed under the most
favorable conditions.

The abdominal corset should not exceed the height of the false
pelvis, should have as the base of support the bony girdle of the
pelvis, and should be rectilinear in front and very slightly curved
in the back and below. The hips should be simply surrounded and their
projection preserved. A curve which follows the normal sinuosity of
this plane joins the piece from the hips with that of the abdomen.

The part corresponding to the back must be sufficiently wide and
free, so that the posterior borders of the corset will be parallel
when it is put on, and the plane preserved for the back in the pieces
which form the corset. This garment will be adjusted without strain
in the back, and it will embrace the form of the body so exactly that
it can be put on without being unlaced.

The frame of the corset must be reduced to a minimum—a rigid busk in
front and some whalebones in the back; the hips remain free, and a
slight, separate brace supports the breasts.

[Illustration: Fig. 20.—The abdominal corset (O’Followell).]

=The Wearing of Corsets by Young Girls.=—The greatest dangers come
from putting corsets on young girls who are still growing and are
very imperfectly developed, and later by an undue constriction of the
lower part of the thorax and the waist, so that the development of
the entire body and its organs is seriously interfered with and all
beauty of form is prevented.

The muscles of the back, like those of the abdomen, are prevented
from their full development, and, later, in their action, by the use
of the corset. The earlier the corset is put on, the more pernicious
will be the effects, because during the period of growth the bony
framework is more pliable and delicate, so that a relative slight
compression is sufficient to make an indelible impression upon the
form. Before the complete development of the hips and the entire
bony framework an enormous amount of harm is done by the wearing of
corsets.

In early youth the heart lies higher than in the adult. By narrowing
the intercostal spaces, the heart is retained, as it were, in its
youthful position; in the adult female the heart is found to lie
higher than in the male, and the contraction of the space in which
the heart has to play is one of the causes of woman’s fainting, and
it is also a cause of organic disease of the heart.

At puberty, when the girl is rapidly increasing in stature, and her
menses begin to be a drain on the system, relentless custom adds the
compression of the corset and long skirts, suspended from tightly
drawn bands around the waist.

The spinal column at this age lengthens rapidly, and it should carry
upward all the viscera attached to it; but, owing to the weight of
the clothing and the compression at the waist, this normal process
cannot take place; instead, there is stretching of the ligaments, and
the viscera are prevented from rising and hang at a level much below
the normal.

A girl of this class is apt to be slender, with undersized hips, and
has a characteristic configuration of the anterior surface of the
body, a hollowing out of the region over the stomach, and a very
great protrusion of the abdomen.

The uterus remains undeveloped and in an infantile state until near
the approach of puberty, when it develops rapidly, and continues to
increase in size until the normal size is attained—about twenty years
of age. By the putting on of corsets the free mobility of the uterus
and its appendages and their normal development are interfered with.

This period of growth and development is one of the greatest
importance for the future health of the woman, both physically and
mentally, and the most intelligent care should be given the girl at
this impressionable age. By putting corsets on their daughters at
this time, mothers are doing them a very great wrong, which can never
be entirely atoned for. The corset prevents growth, development, and
the participation in those exercises which make for physical vigor
and good health. To the well-developed girl corsets are as much of
a superfluity as crutches would be, and nothing but the prevailing
style of dress causes girls to put them on.

It has been suggested that the wearing of any kind of corsets before
thirty years of age should be a penal offense; and in case of a
minor, the parents should be fined from one hundred to one thousand
dollars.

As regards the wearing of corsets after the age of thirty, opinion
is divided into three classes—first, those who utterly condemn their
use; second, those who approve of it; and third, those who tolerate
the wearing of corsets, but only under the condition that they shall
cause absolutely no constriction.

=What Style of Corset is the Least Injurious?=—From the nature of the
structure of the chest and abdomen and the functions of respiration,
circulation, digestion, and the pelvic organs, the wearing of any
style of corset must be more or less detrimental to the health and
vigor of woman, and a perfectly developed woman, in perfect health,
does not need a corset if she lives under normal conditions of dress
and life; but in our present state of civilization, with the present
style of dress, and with the very imperfect muscular development,
women in and past the prime of life may wear hygienic corsets without
any very great amount of injury.

The type of feminine beauty which approaches most nearly the ideal is
that of harmony of proportions and modulations of lines. The waist
proportions of the Venus de Milo is 47.7 per cent., while that of
the Grecian man is 46.4 per cent. In proportion to her height the
hips of the modern woman exceed the girth of those of a man by about
four inches, and a woman of the same height as a man exceeds in hip
girth by six inches. If the muscles which pass from the thorax to the
pelvis were properly developed, the artistic proportions would be
preserved, and the waist of the woman would be proportionately larger
than those of a man.

The ideal figures of the Greek women show a torso bounded by outward
curves, softly melting into one another, until the broadest part is
reached at the hips, thence again declining to the feet. The line
from the armpit to the ankle is one of the chief lines of beauty in
sculpture, while the anterior surface of the body should present, in
the median line, a gentle curve from the upper end of the breast-bone
to the brim of the pelvis, the convexity of the curve coming
about the umbilicus. An inward curve of this line is a deformity
artificially produced.

In order that the corset should become an inoffensive garment it must
be well adapted to the figure, so that it shall not embarrass the
action of the diaphragm or the vital organs or the movements of the
body.

The injurious effects of wearing the curved front corset have been
given, and this style of corset should be condemned without appeal,
since its use is dangerous from every point of view.

The straight front corset is much less injurious than the curved
front, but its use is detrimental to health, and prevents the free
movements of the body, so that the abdominal corset remains the only
one which is perfectly safe and at the same time esthetic.

The chief rôle of the corset must be to sustain the clothing and to
prevent the constriction of the lines about the waist and to prevent
the falling of the viscera.

This can only be accomplished by selecting the proper points of
support for the corset; this is in the lumbar region of the spine
and the crest of the bony pelvis, a region of several centimeters in
height. Except for the vertebral column, the viscera of the region
immediately above this have no bony protection, and are subject to
the greatest amount of constriction; the organs being piled up on top
of each other, as it were, and thereby suffer very great displacement
and impairment of function, while, on the other hand, the solidity of
the bones of the pelvis permits of their use as a base of support for
the corset, as well as for the clothing.

It is based on this idea that the hygienic abdominal corsets are
built, and, further, this style of corset does not sacrifice the
normal curve of the anterior surface of the body. That the abdominal
corsets do not support the bust is no detriment, as the woman with
very fully developed breasts can wear a bust supporter, entirely
separate from the corset, and in those pathologic conditions of
ptoses of the abdominal contents—and from an orthopedic point of
view, the abdominal corset affords an excellent solution.

In order to prevent misfits, all corsets should be made to order;
the measurements must be taken with the corsets removed. The corset
must be shaped so as to fit exactly over the hips, with the lower
parts of the busks very slightly curved, following the normal curve
of the body. The upper part of the corset must be a little loose, in
order to permit of the easy movements of the body. Behind, the line
of the corset must correspond to the line of the body, in order not
to interfere with the erection of the body. In front, the corset
overlaps the pubic bones, and must be tight enough to give the
abdominal contents some support.

Instead of the lacings forming two “V’s,” the lower V, with its apex
at the waist-line, and the longer V superimposed on top of this, the
ensemble of the lacings to be normal must form only one V, with the
inferior point very elongated. The corset is too tightly laced if,
when, with the strings untied at the waist, the upper parts of the
corset separates.

The corset should be put on with the lacings wide open, be carefully
adjusted in the proper position, and fastened from below up. After
the stocking supporters have been attached, the lower part of the
corset is held down with one hand, while the other hand gently draws
up the abdomen by means of drawing on the undervest, or slipping the
hand within the corset; in this way the abdominal organs are lifted
up. The corset is then laced from its lowest point to the waist-line,
and from the top to the waist-line, in such a way that only one long
“V” is formed. The laces are then firmly tied and slipped in under
the corset.

Corsets that slip up are probably either too long waisted, too tight
over the fulness of the hips, or there is not sufficient curve in the
back and sides at the waist-line. High-backed corsets are apt to make
the woman look round shouldered, while a low back gives smoother and
more desirable lines.

=The Shoe.=—The style of the shoe is very closely related to the
corset in the amount of harm it is capable of doing. Considering
the fact that the feet form the base of support for the entire
body, and that on their condition depends the woman’s ability to
take a sufficient amount of exercise and maintain her good health,
surprisingly little attention is given to their care.[7]

The compression of the foot into a rigid body, not unlike the
shoemaker’s last, destroys the natural relation of the parts,
prevents the growth, interferes with the circulation, compresses the
nerves, weakens muscles and ligaments which should support the arch,
and is the prolific source of corns, bunions, weak ankles, and “flat”
foot.

But, in addition to the direct injuries to the feet, the excessive
elevation of the heel displaces the center of gravity, and transfers
the weight of the body for the most part from the heel to the line of
union of the instep with the toes, a series of joints with shallow
sockets not formed to bear the brunt of the body weight. In addition
to which the equilibrium of the body can only be maintained by an
increase of the natural curves of the bony framework, with the
resulting increased curvature forward at the small of the back, is an
increase in the prominence of the buttocks and abdomen. This tilting
forward of the pelvis interferes with the circulation of the pelvic
organs, and their congestion and inflammation follow.

By walking around in her bedroom slippers any one can easily convince
herself of the greater grip that the foot has on the floor when
so clad, and of the greater ease and sureness in walking; this is
chiefly due to the greater breadth of the sole, and the fact that the
slipper has no heel. The greater firmness of men on their feet on
slippery pavements is doubtless due to the difference in the cut of
the shoe and the lower and broader heel.

The front part of the sole of the shoe must be so designed that the
great toe will retain its normal position and rest on the inner
border of the sole. In many shoes the great toe is forced out of its
natural position toward the middle of the sole, and the tip, instead
of pointing straight forward, is thrust toward the line of the sole.
This not only lessens the thrust of the great toe as it leaves the
ground in walking, but also leads to a malformation of the foot and
ingrowing toe-nails.

The soles of the shoe should project a reasonable distance beyond the
uppers, to give firmer support to the foot and to protect the soft
parts in walking.

The front part of the upper leather must be broad enough for the free
movement of all the toes in walking and in springing; when it does
not give room enough for the toes to spread outward and forward in
walking, they are bent on themselves. This makes the descent of hills
and all active exercise and games very painful. Tight upper leather
is also productive of chilblains and corns.

The shoe should be slightly longer than the foot when the entire
weight of the body is placed upon it, and sufficiently broad for the
foot to spread in walking; but, at the same time, the shoe must fit
snugly about the heel and instep, or else the foot will slip forward
in walking, and all the evil effects of too short a shoe will result.

The heel of the shoe must be broad and low. High heels force the
foot to keep perpetually and unnaturally on the stretch; if they are
worn in early youth, they may bring about permanent deformity of the
skeleton and of the foot. Moreover, the high heel interferes with the
natural walk, in which the pressure of the foot on the ground passes
from the heel to the toes. The high heel requires that the front of
the foot should be set down first instead of the heel. The result is
an awkward tripping gait and a short step, which is very fatiguing.
This is one of the causes for woman’s frequent dislike for exercise
in the open air, such as walking, mountaineering, games, etc., and so
the general health is affected.

Again, from the esthetic point of view, the size of the foot must be
in proportion to that of the body. Artists declare that every foot
that has worn a shoe is deformed, and so, when they wish to make a
study of the foot, they go to the shores of Italy, where the peasant
women have never worn shoes.

Paget’s description of a perfect female foot is great breadth and
fulness of instep, a well-marked great toe, a long second toe,
projecting a little beyond the great toe, and a very small little toe.

Since the feet are the part of the body to come in direct contact
with the greatest amount of cold, whether on the floor of the house
or the pavement of the street, it is a matter of prime importance to
the entire body that they should be warmly clad. While for house wear
and in the summer time a French kid is a most comfortable shoe, for
street wear and outdoor exercise in cold weather a heavier leather
with thick soles is requisite as a protection against the cold and
damp.

Rubbers should always be worn when the pavements are damp, even if it
is not raining, and in snow-storms and very heavy rains cloth gaiters
should be worn over the shoes, to keep the ankles dry, and later to
protect them from the wet skirts.

=The Stockings.=—Great care must be taken to have the foot of the
stockings sufficiently long and loose; this is doubly the case with
woolen stockings, which are apt to shrink so much in the wash. A
too tight or too short a foot of the stocking interferes with the
circulation and causes a cold foot, and when the stocking foot is too
short, it produces the same deformities that too short a shoe does.

The trouble generally begins in childhood; mothers forget in buying
stockings for their children that stockings shrink in the laundry and
that children’s feet grow. The result is that the stocking-foot is
apt to be too short before it is worn out, and so the toes are bent
or cramped together, and there is the starting-point for deformities
of the feet as well as corns and bunions. As much harm may come from
wearing too short a stocking-foot as too short a shoe.

Again, with the present mode of wearing the stocking supporters
attached to the corset, or, indeed, one of the functions of the
stocking-supporters may be said to be the holding down of the
corsets, the supporters are shortened for this purpose, and as
a result the entire foot of the stocking is pulled on, and an
artificial shortening of the stocking-foot is produced; and this
point must be borne in mind in purchasing stockings.

Woolen stockings should always be worn during the cold weather.
Garters should never be worn around the leg, whether above or below
the knees, since, in order to be sufficiently tight to hold the
stockings up, they interfere with the circulation by the constriction
of the leg, and so cause cold feet and greatly increase the trouble
in case of varicose veins.

=The Essential Qualities for Winter Underclothing.=—These are that
the clothing must be light, loose, warm, and equally distributed over
the body. From the hygienic standpoint, the underclothing is the most
important part of the dress.

We have seen that much of the energy of the body is spent in
maintaining its normal temperature, and that the two main functions
of the skin are the preservation of the normal body temperature and
the excretion of certain effete matters in the form of watery vapors.

In the temperate zones two qualities are required of
underclothing—that it shall prevent the too rapid radiation of heat
from the body and that it shall be absorbent. No material is warm
_per se_. The warmth is necessarily derived from the body, so that
what is required of the underclothing is that it shall confine the
warmth in its meshes; atmospheric air being one of the poorest
conductors of heat, the material should be so constructed as to
imprison a considerable quantity of air in its meshes.

The second necessity is that the excrementitious matters should be
rapidly absorbed, as they are being constantly poured out from the
skin, so that the material must be absorbent in the highest degree,
otherwise the fluids remain in contact with the skin to irritate it,
and the atmospheric air confined between the undergarment and the
skin rapidly becomes surcharged with gases and moisture, and so acts
like a warm jacket around the skin. Heat radiation is interfered with
and the skin becomes extremely sensitive to changes of temperature
and to drafts.

Wool is a poor conductor of heat and a great absorber of water. Its
powers of hygroscopic absorption is at least double in proportion to
its weight, either cotton or linen, and this property is an important
one. During perspiration the evaporation from the surface of the body
is necessary to reduce the heat which is generated by exercise. When
exercise is finished, evaporation still goes on, and, if unchecked,
to such an extent as to chill the body. If dry woolen clothing is
put on after exertion, the vapor from the surface of the body is
condensed in the wool, and gives out again the large amount of heat
which had become latent when the water was vaporized, and from this
cause alone a woolen covering feels warm during sweating. In the
case of tightly woven cotton and linen fabrics, the perspiration
passes through them, and evaporates from the external surface without
condensation; the loss of heat then continues.

In addition to this, the texture of wool is warmest from its poor
conducting powers, and it is less easily penetrated by cold winds.
The more readily material conducts heat, the cooler it feels. The
property of the conduction of heat is in proportion to the closeness
of the weave and the amount of air which it contains. For this reason
all loosely woven fabrics feel warmer than closely woven ones, on the
same principle that the more layers of clothing there are, the more
layers of air will be retained between them.

The recent methods of weaving cotton and linen fabrics more loosely
have materially reduced their general defects as underclothing in
cold weather, and if cotton or linen is worn next the skin it must be
so woven as to give both thickness and porosity to the fabric.

For the majority of people, during the wet and cold seasons woolen
undergarments are the best. If cotton is worn, it must be loosely
woven, so that it may entangle a large quantity of air within its
meshes.

The underclothing should fit tolerably closely the outlines of the
figure, without impeding the movements. Combination undersuits, which
reach from the neck to the ankles, are the best; the weight should
be adapted to the season of the year, and should be changed with the
weather, regardless of the date of the calendar.

The great disadvantage of woolen undergarments is the way in which
its soft fibers shrink in washing, and after a time become smaller,
harder, and less absorbent. To avoid this, the greatest care must be
exercised in the wash. Woolen fabrics are sometimes very irritating
to the skin, in which case some of the loosely woven cotton or linen
fabrics must be substituted. In the choice of woolen undergarments
the touch is the best guide; there should be smoothness and great
softness of texture.

In very cold weather the combination undersuit worn in the house
should be reinforced by “equestrian tights” for outdoor wear. These
come in black and can be drawn on over the shoes. They are a much
greater protection against the cold and wind than a flannel skirt,
and do not possess the grave objection of winding about the legs in
walking in the wind.

Lack of proper clothing of the lower part of the body is beyond
question one of the chief causes of the great prevalence of pelvic
inflammation and of Bright’s disease in women.

But not only is there to be considered the danger of laying the
seeds of disease from going out into the cold air while the body is
too lightly clad, but also that, in order to maintain the normal
temperature of the body in winter without the aid of warm clothing,
requires a greater expenditure of nervous energy, which in turn
is the equivalent of a large amount of life force. It is not only
imprudent, but most injurious, to exhaust unnecessarily the powers,
of the body, when mere mechanical appliances, like clothing, will
obviate this continuous expenditure of vital energy.

Another way in which clothes save the wear and tear of the body is
by diminishing the amount of heat the system must produce by the
oxidation of the elements of food. When properly clad, there is less
loss to the body of its heat, and consequently there is less food
needed to supply this loss.

=The Length of the Walking Skirt.=—The present vogue of having the
walking skirt five inches from the ground is an excellent one, as
it not only considerably diminishes the weight of the skirt, but it
interferes much less with the forward swing of the leg in walking,
which otherwise has to be overcome by the muscular force of the leg.
In walking, the length of the step should be proportionate to the
length of the limb; the leg is carried forward by the unconscious
swing at the hip.

The chief exertion in walking is caused by the raising of the foot
and leg to the point at which it goes forward and downward. By any
artificial shortening of the step, such as is caused, for instance,
by long skirts, it requires much more muscular effort to walk the
same distance. Besides which, there is the additional friction of
the skirts, which is increased by the slightest wind; this has been
likened to the process of eternally walking through a field of long
grass.

Another most important reason for not wearing long dresses on the
street is that they stir up the dust and collect microbes, and thus
contribute materially to the dissemination of the germs of disease
and subject the wearer and her family to the risk of infection.

The question of clothing takes an important place in the hygiene of
the lungs. All clothing may be approved which is sufficiently warm,
and which allows of modifications according to the variations in
the temperature, and does not hinder the movements of the body, and
particularly those which are carried out by the respiratory muscles.
In the first place, it is very important that the muscles about the
shoulders should have perfect freedom of motion, in order that the
expansion of the apices of the lungs should not be interfered with.
Clothes which hang heavily on the shoulders, and especially those
which grasp the neck tightly, are unsuitable. Special attention must
be given to this point in the selection of winter clothing.

In going up long flights of stairs furs and heavy top coats should be
taken off and carried over the arm; this will prevent much shortness
of breath and gasping when one reaches the top of many flights.

=The Winter Street Dress.=—The street dress for winter should be warm
enough to prevent a feeling of chilliness, and yet be light enough to
prevent the wearer from becoming overheated while walking, or from
feeling a sense of weight of the clothing, which is always a sign of
being too warmly clad.

For outside coats impregnated woolen materials, waterproof, but at
the same time porous, are the best, except in very heavy rains. A
storm coat of some kind should complete the costume for rain or
snow. The woman should never stay indoors on account of very cold
or inclement weather, as being housed up and the lack of sufficient
exercise make one very susceptible to the very sudden changes for
which our climate is so notable.


FOOTNOTES:

[7] See pages 337 and 339.




CHAPTER IX

PHYSICAL TRAINING THE KEY TO HEALTH AND BEAUTY

  The Ancient Greeks the Most Perfect Type of Beauty; the Cause of
  the Inferior Physique of American Women; the Physical Training of
  the Japanese Women; Improved Physique as the Result of Physical
  Training; Increasing Stature and Improved Physique of American
  Men; Report of the Royal Commission of Great Britain on Physical
  Training; Physical Training Among the Ancients; the Influence
  of Physical Training on the Health and Life of the Individual;
  the Effect of Exercise on Brain Development and Character; the
  Physiology and Pathology of Exercise; the Relative Proportions
  of a Perfect Female Form; Table of Standard Weights for Women;
  the Muscular System; the Benefits of Exercise; Passive Exercise;
  Massage; the Balance and Carriage of the Body; Common Defects
  in the Carriage of the Body; the Heart’s Need of Exercise; the
  Gymnasium in the Campaign against Disease; Gymnastic versus
  Athletic Training; Exercise after Eating; Effect of Brain Fatigue
  on Body Fatigue, and vice versa; Marks for Physical Efficiency;
  Advantages Derived from Athletic Sports; Ethical Value of Sports
  for Women; Forms of Athletic Games Best Suited to Women.


Physical training is the key to all beauty of form and face as well
as grace of motion. Beauty without health is inconceivable.

The Greeks were the devotees of the beautiful, and they were the
most perfect embodiments of health and beauty the world has ever
seen. Their splendid physique was due to their outdoor life, physical
training, which began in childhood and youth, and was systematically
carried on throughout life, their public baths, and their athletics,
sports and national games. Beauty is the inevitable corollary of
health.

And the Greek artists bequeathed to all future generations a legacy
of untold value, using the men and women of the golden age of Greece
as the prototypes for the most beautiful statues which the world
has ever seen, proving that through the perfect development of the
muscular system alone can an ideal type of beauty be attained, and
these statues also show that the women of that day were the physical
compeers of the men.

The greatest attention to the physical development of her citizens
was given in Sparta. Girls and young women were subjected to a
similar, though less severe, training than men and boys. It included
running, leaping, wrestling, and throwing the lance; these formed the
favorite contests in the national games. Xenophon says: “The Spartans
are the healthiest of all the Greeks, and among them are found the
finest men and the handsomest women in Greece.” The women of the
Teutonic tribes frequently accompanied their husbands to war, and
exhibited instances of the most daring bravery.

History, as well as these magnificent legacies in marble and on
canvas, teaches us that no greater fallacy could be imagined
than that “we are women, and therefore weak.” On the contrary,
“We are weak, because it never entered into our thoughts that we
might be strong,” and it has been repeatedly proved that physical
deterioration can be overcome by exercise, and that the same means
greatly increases the mental capacity.

In savage races women are the equal, if not the superior, of the men,
and woman’s smallness of stature, physical inferiority, and lessened
powers of endurance must be attributed to the customs of civilized
society carried on for hundreds of years.

=The Cause of the Inferior Physique of American Women.=—The majority
of American girls and women of the present day have undeveloped
muscles, a bad carriage, an impaired digestion, and are without skill
in outdoor games, and unable to ride, row, or swim.

From the measurements of twelve hundred boys and girls, Professor
Sargent ascertained that at the age of fifteen years boys are
three-quarters of an inch taller than girls, but that the mean
height in the two sexes is the same, and that, taking the sum of
the measurements of the head, chest, waist, legs, and arms, the mean
total was equal in boys and girls. The sum of these measurements is
regarded as indicative of the strength of the individual, but that,
as a matter of fact, it was found that the girls did not compare
favorably with the boys in point of strength. In capacity of lungs
the girls were seventy cubic inches behind the boys, and that, in
strength of the expiratory muscles, the weakest boy was stronger than
the average girl. In strength of back, leg, chest, and arms, the
showing of the girls was a little better, though considerably below
what it should have been.

At twenty years of age the man was found to be five inches taller
and twenty pounds heavier. The superiority of the male in strength
was now much more apparent than at an earlier age. He now presented
ninety cubic inches greater lung capacity and one hundred and
forty-three pounds, greater strength of legs, while the muscular
power of the arms and chest was more than double that of woman. The
charts showed that women were physically inferior to men in almost
every particular.

Dr. Sargent then goes on to say, “The principal characteristics
of general form that distinguish civilized women from men are
smaller muscles, sloping shoulders, broader hips, and shorter
legs. The smaller muscles and the shorter legs may be said to be
embryonic, while the superior breadth of the hips indicates a greater
evolutionary advancement in this part of the body than has taken
place in man. The constricted waist must be regarded as a deformity
artificially produced. When the hips are large in the male or female,
the waist will naturally be larger if the muscles which connect the
trunk with the pelvis have nothing to constrict them. Since the hips
of women are much wider than those of men, we should expect to find
the waist proportionately larger in women than in men.

In close antithesis to these observations of Dr. Sargent’s on the
physical inferiority of American women to men, it is both interesting
and instructive to note those of Dr. Hancock in his work on
“Physical Training for Women by Japanese Methods.”

=The Physical Training of the Japanese Women.=—A Japanese woman is
usually the peer of a man of her own race who is of the same age
and height, especially when weights are about equal. This is due to
the fact that the Japanese women exercise in much the same way that
the men do, and devote fully as much time in the endeavor to gain
strength.

In the Japanese system of bodily training, known as jiu-jitsu, it
is considered advisable in the initial stages to have boy and girl
contestants as nearly equal in age and height as possible. The girls
enter the arena upon equal terms with the boys, and have proved
their fitness to do so. Grown men and women practise together; other
conditions being equal, the women show an equal amount of strength
with the men.

The back of the average Anglo-Saxon woman is generally the weakest
part of her body, while the normal Japanese woman satisfies the
artist’s ideals as well as the surgeon’s. The average Japanese
woman of to-day shows a figure as perfectly molded, and of as true
proportions, as the women of ancient Greece were able to display.

First of all, the Japanese women are taught that life is impossible
without a sufficient supply of fresh air. This internal cleansing
with air is deemed of more importance than the bath which follows
soon after. That the Japanese woman is a deep breather is shown by
the firm muscles that stand out on the abdomen.

Consumption is a rare disease in Japan; even winter coughs are of
rare occurrence. The Japanese look upon full, deep breathing as being
the most vital function in life; food is not so important, although
it is necessary. The best exercises are of little importance when the
breathing which accompanies them is not properly done.

=Improved Physique as the Result of Physical Training.=—Dr. Mary
Taylor Bissell, formerly the medical director of the New York
Berkeley Ladies Athletic Club, and one of the pioneers in the
systematic physical training for women, gave as the result of her
experience there, “The gain of twelve months’ exercise in the
gymnasium is, for the chest two inches, stature two inches, and an
increase of 30 per cent. in the lung capacity; many of the strength
tests were doubled, the spine became erect and the arm vigorous, and
the girl gained for herself the consciousness of controlling her own
body instead of having it control her.”

=Increasing Stature and Improved Physique of American Men.=—Dr.
Born’s measurements of Yale athletes and students suggest the
inference that American men are becoming physically greater than any
other known race. Comparing averages in 1903 and 1908, it appears
that Yale men are one inch and a half taller than their predecessors
of five years ago; they are twenty-seven pounds heavier, broader
chested, and have an increased lung capacity of seventy-two cubic
inches.

The measurements of Harvard students, published last fall by Dr.
Sargent, corroborate Dr. Born’s deductions, that American college men
have larger and more vigorous bodies than their fathers.

Dr. Sargent’s association of vigorous brains with strong bodies
is borne out by Professor W. T. Porter’s examination of 30,000
school-children in St. Louis in 1893, and by subsequent observations
made by other men.

It is the opinion of Dr. Crampton, director of physical training in
the New York city schools, that this improved physique in American
men, observed in the universities, is not in a small measure due
to the fact that within the last five years athletics have been
introduced into the public schools, so that there are now hundreds of
teams of baseball, football, basket-ball, and track athletics, where
there was only one before, so that already the colleges are reporting
that the young men entering them are bigger than they were ten years
ago.

Professor Phillips of Amherst thinks that the young women are
certainly one inch taller and five pounds heavier than they were
ten years ago. This improved physique of Americans he attributes,
like Dr. Crampton, to the fact that the American boy has now come
in for his heritage of athletic sports, and he makes a strong plea
for “adult play”—that every man and woman should have as good an
opportunity as boys and girls to get out on an open space and play
baseball, football, hockey, run, jump, and have a good time.

To show the importance which Great Britain places on physical
training for boys and girls the following report of the Royal
Commission of that country for 1903 is given under the caption “A
National System of Physical Training.”

=Report of Royal Commission of Great Britain on Physical
Training.=—“(1) Physical training should be regarded as of equal
importance with mental training.

“(2) During school life physical training is quite as important for
girls as for boys.

“(3) Systematic physical training is necessary both for country and
town children.

“The daily walk to school is exercise, but not exercise which
develops the body as a whole, or counteracts the liability to stoop,
to be round-shouldered, or to be slovenly in gait. Moreover, all
children during school life must spend many hours with but little
change of position, the effects of which can only be corrected by
systematic physical exercise.

“It should aim at the healthy development of the body, as well as
of the mind, by the regular development of all the muscles, the
quickening of the intelligence and activity, and the formation of the
habits of prompt obedience, precision, smartness, and discipline. The
exercises should not be for mere display or entertainment, but each
should have its particular purpose and value to develop all parts of
the body.

“A certain amount of physical exercise once a day or oftener
is preferable to even a greater amount, at longer or irregular
intervals.

“Games are very useful and ought to be encouraged, but they cannot be
played by all children, and usually the weaker ones go to the wall;
that is, those most needing systematic development are excluded.
Games affording opportunities for violent exercise are useful for
the development of reserve strength, and form an admirable field for
the cultivation of social and public spirit. We strongly favor their
organization and development at all schools.

“For boys, in addition to the regular games, country runs, leaping
and dancing the Highland Fling; for girls, skipping and hockey. For
both, swimming is strongly advised.”

=Physical Training Among the Ancients.=—Greek culture regarded the
individual as valuable in and for himself, and sought to promote
first of all his full and free development. The idea was symmetry and
balance of parts, and, to attain complete and harmonious manhood,
mind and body were trained together.

Games played an important part in the life of the Athenians, and
their importance in the education of children was early recognized.

From the age of seven to sixteen it is probable that one-half of
the day of the Athenian boy was spent in intellectual and the other
half in physical education. The aim of the Athenian education was
to produce men, independent but respectful, freedom loving but law
abiding, healthy in mind and body, clear in thought, ready in action,
and devoted to their families, their fatherland, and their gods.

Gymnastics included everything relating to the culture of the body.

The culmination of the Athenian education was dancing. As a
supplement to gymnastic culture, it toned down the ardent exercise of
the gymnasium and the over-energy of muscular development to the ease
and grace which was the Athenian ideal.

_The Romans._—The early Romans possessed some traits in common with
the Spartans. They were intensely practical and interested in those
things whose usefulness was apparent. Education should fit a man for
his work in the world.

A Roman structure, quite as characteristic as the Greek gymnasium,
was the public bath or therma, found not only in Rome, but in every
important provincial town in the days of the empire. Both made
provision for exercise and contained a system of baths, but in the
thermæ the baths occupied the greater part of the space, and the
rooms and courts for exercise were smaller and fewer.

=The Influence of Physical Training on the Health and Life of
the Individual.=—If we believe, with Spencer, that “Education is
preparation for complete living,” we must appreciate that good
carriage, bodily control, physical judgment, will power, and courage
are an important part of the equipment of every man and woman. These
qualities are intimately associated with motor coördination, and they
are best developed through physical training.

The power of self-preservation, by which the individual is enabled
to handle his body easily under all conditions, and so escape
physical injury and death, depends upon physical judgment of time and
distance, and the ability to run, jump, vault, climb, and swim. These
are all fundamental exercises.

The love of play and the ability to play a number of games contribute
very largely to health and happiness. The play habit must be acquired
in youth or it will never be developed.

The best qualities of mind and character can only be obtained through
physical experience and physical struggle. With stalwart physique
comes a vigorous type of womanhood, physical courage; with flabby
muscles there is apt to result flabby thinking and flabby acting,
superficiality, and inefficiency. Next to hunger the most dominant
instinct is the play instinct.

=The Effect of Exercise on Brain Development and Character.=—The
growing interest in preventive medicine, and the very great
popularity of the opportunities afforded for athletic training,
attest to the value which people are beginning to place upon health
as an asset in their social, domestic, business, and professional
lives.

But it is not generally or sufficiently understood just how great is
the effect of physical training on the development of the brain or
upon the mental activities. With a strong, vigorous action of the
heart there is a feeling of courage and general exaltation, whereas
with a weak heart and enfeebled circulation, fear and impaired mental
activity predominate.

The manner in which the organic functions are performed not only
determine the health of the body, but the temperament and character
as well. There is a conservation of energy in the fashioning of the
will—only part of the energy is expended in the outward effort,
while the rest goes to lay the foundation of a future will, so that
exercise builds up faculty and conduct character.

We cannot perform an act voluntarily unless we know what we are going
to do, and we cannot know exactly what we are going to do until we
have learned to do it. The very simplest movement brings about a
change in the organic structure of the brain, and this change leads
to more complex movements and further improvement in brain structure.
Most skilled movements give more exercise to the central nervous
system than to the muscles. Movements calling for a high degree of
skill, correlation of the different senses, sense discrimination,
fine coördinations, and a rapid and responsible exercise of judgment,
all tend, through the action of the association fibers, to a high
degree of brain development.

An essential feature of exercise is that a part of it at least shall
afford amusement, diversion, and recreation to the overwearied
and harassed brain. Hence, the necessity to introduce dancing,
field sports, etc. By these means industrial efficiency, communal
morality, and social consciousness are promoted. Public amusements
of a proper sort are a public necessity.

The great menace to the city is the limited opportunities for
healthful play, and over one-third of the population of the
United States live in towns. The physical side of the question is
the largest, for it involves health, and consequently poise and
self-control. It involves a legitimate occupation of surplus energy
and its wise direction, and it also involves companionship.

The great object of physical training is then to secure the most
perfect development of the body, with the corresponding development
of the brain, so that the highest physical and mental efficiency of
the individual may be attained.

The possession of a large reserve of muscle and nerve force, ready
to be used in any emergency, gives confidence to the individual,
increases the spirit of taking the initiative and undertaking grave
responsibilities that come into the life of every woman, especially
those who are engaged in the business or professional world, and the
building up of this necessary reserve force is one of the inestimable
advantages of a gymnastic and athletic training.

=The Physiology and Pathology of Exercise.=—Exercise is divided into
active or voluntary and passive.

Passive exercise does not require any exertion of the will power.
Massage increases the local nutrition of the parts, stimulates the
nerves, and is restful, rather than exhausting, to the overwrought
brain and wearied nerves.

Active exercise is further divided into exercise of effort and
exercise of endurance. Under exercise of effort are classed all
gymnastic feats. The primary object of a gymnastic training or
education is to produce a symmetric development of the entire body,
while, on the other hand, the training necessary to execute gymnastic
feats produces an overdevelopment of one part of the body at the
expense of the rest, as is seen in the arm of the blacksmith and the
leg of the danseuse. All exercises of effort, whether of strength,
skill, or speed, demand and cultivate mental concentration, a rapid
response of the muscle to the orders of the will, develop the power
to accomplish complicated coördinations, and the knowledge of how
these difficult movements may be performed with the least expenditure
of nerve and muscle force. Exercising a muscle develops it up to
its physiologic capacity, but if a muscle is habitually overworked,
pathologic results occur, and instead of a quick, sharp contraction
of the muscle, the contractions will be weak and uncertain, and, if
carried too far, the muscle may eventually atrophy from overwork.

Exercises of endurance include walking, running, swimming, and
rowing—the range of movement in these is much more limited than
in exercises of effort. In these, each movement is well within
the individual’s powers, yet, by increasing the rapidity of the
movements, or by their prolonged continuance, the total amount
of muscular work accomplished may be very great. Normally, the
contraction and relaxation of the muscles are comparatively slow,
so that the poisonous waste matter producing fatigue is continually
being removed from the tissues, and not allowed to accumulate;
whereas, in exercises of effort, there is no time allowed for the
scavengers to work, and fatigue of the most active muscles sets in
rapidly.

Fatigue may appear in several forms, depending on the character of
the exercise which produced it. When the exercise is sufficiently
active, the amount of waste matter thrown into the circulation is
greater than can be eliminated by the lungs; breathlessness and
palpitation of the heart result; so soon as the equilibrium between
waste production and elimination is established, the individual
is said to have gotten his second wind. Or, again, a slow pace,
too long kept up, will produce exhaustion, so that the products of
tissue waste accumulate, the beat of the heart is fast, irregular and
weak, the nervous system becomes stupefied, and the muscles fail,
to respond to the normal physiologic stimulus. This is a form of
fatigue not infrequently found among zealous housewives, in which the
demands made upon the nervous system by continual and carking family
cares, added to the very strenuous work of the household, exhausts
both nervous and muscular systems.

Recovery from this form of fatigue takes a much longer time than
the preceding. The individual is too tired to sleep, the night is
troubled by disturbed dreams, there is a soreness and stiffness of
the muscles and joints which remain for some days. There may be an
actual rise in temperature, and the urine passed has a high specific
gravity, with sometimes even albumin.

If, now, this overwork is continued over prolonged periods of time,
without allowing sufficient time for the necessary recuperation,
there follows a slow and profound exhaustion, which is much more
difficult to overcome. In this condition the temperature becomes
subnormal, the weight decreases, the skin and muscles become flabby,
and the skin is pale, the eyes are dull and listless, and the
individual is without ambition to rouse herself from her lethargy.

During a contraction each muscle-cell shortens and thickens, giving
off some of its substance into the lymph-space which surrounds it,
and absorbing food, consisting of carbohydrates and oxygen, from the
surrounding plasma. Exercise improves nutrition by the rhythmic,
automatic massage caused by the contraction and relaxation of the
muscles on the vessels which they contain, while warmth favors the
elimination of waste matter.

It has been proved by Hawk, of the University of Pennsylvania, in
his experiments on the blood-count of an athlete in training, that
various forms of active muscular exercise produce an average increase
of 16.8 per cent. in the number of red corpuscles. When exercise
is long-continued, the rate of increase lessens, and, further, the
number may be decreased in greatly prolonged violent exercise. The
explanation of this is that a large number of cells lie inactive
in various tissues of the body until they are brought into the
circulation by muscular exercise.

[Illustration: PLATE III

Senegalese woman. (From Stratz, after Dr. Rykens, in Shufeldt’s
“Studies of the Human Form.”)]

Athletic training has been called “mainly heart training.” Exercises
of endurance do not require supreme efforts, but they do accelerate
the action of the heart and lungs, and the aggregate of work done is
very much greater than in exercises of strength, but the exercise
must be sufficiently active to provide for the free circulation of
lymph, which is carried on mainly through the massage of muscular
contraction.

If a walk be so listless that there is not sufficient movement of the
muscles to overcome the pernicious influence of gravity acting on
the column of blood contained in the veins of the abdomen, thighs,
and legs, the vessel-walls may become permanently overstretched and
varicose. The exercise must be sufficiently active for the muscular
contractions to empty the lymph-spaces and hasten the circulation. It
usually raises the general bodily, as well as the local, temperature
of the parts, and so facilitates the removal of the waste-products.

The acquirement of skill lies in the training of the nerve rather
than the muscle. A simple movement requires only a nerve impulse to
the acting muscle, while a complicated movement requires a wave of
impulses to the accessory and antagonistic groups of muscles which
control and steady the movement. It is easy to see how, in the first
efforts to perform complicated movements, the contractions of the
muscles will be jerky and inaccurate, many useless muscles will be
employed, and the expenditure of nervous energy will be out of all
proportion to the result, and these first attempts at new feats of
skill rapidly exhaust the attention. This is well illustrated in the
first efforts of a child learning to walk.

Exercises of strength and skill train that alertness of mind so
essential in ordinary life. They shorten the period between thought
and action, producing what is known as “presence of mind.”

=The Relative Proportions of a Perfect Female Form.=—The relative
proportions of a perfect female form, as deduced by modern sculptors
from the Greek statues, are as follows: With a height of five feet
five inches, the weight should be one hundred and thirty-eight
pounds. The woman should, with the arms extended, measure from tip
to tip of the middle finger, five feet five inches; that is, exactly
her own height. The length of the hand should be one-tenth, the foot
one-seventh, and the diameter of the chest one-fifth that of the
height. The distance from the perineum to the ground should measure
the same as from the perineum to the top of the head. The knee should
be exactly midway between the perineum and the heel. The distance
from the elbow to the little finger should be the same as the
distance from the elbow to the middle of the chest. The measurement
from the top of the head to the chin should be the same as the length
of the foot, and there should be the same distance between the chin
and the armpits. A woman of this height should measure twenty-nine
inches around the waist, thirty-four inches around the bust, if taken
under the arms, and forty-three inches if measured over them. The
upper arm should measure thirteen inches and the wrist six inches.
The calf of the leg should measure fourteen and one-half inches, the
thigh twenty-five inches, and the ankle eight inches.

The table on page 297, compiled by Dr. Weisse, the Medical
Statistician of the New York Life Insurance Company, “A Table of
Standard Weights for Women,” is based on the average weights of
over 58,000 insured women, and is given to show the normal relation
between the height and weight. A point of extreme interest in the
table, and one that is not generally recognized, is the variation in
weight, independent of the height, at different ages.

[Illustration: PLATE IV

Juno.]

[Illustration: PLATE V

Venus de Capua.]

  —————————+——————+——————+——————+——————+——————
  Ages     | 15-19| 20-24| 25-29| 30-34| 35-39
  Heights  |      |      |      |      |
  —————————+——————+——————+——————+——————+——————
  4’-11”   |  111 |  113 |  115 |  117 |  119
  5’-0”    |  113 |  114 |  117 |  119 |  122
  5’-1”    |  115 |  116 |  118 |  121 |  124
  5’-2”    |  117 |  118 |  120 |  123 |  127
  5’-3”    |  120 |  122 |  124 |  127 |  131
  5’-4”    |  123 |  125 |  127 |  130 |  134
  5’-5”    |  125 |  128 |  131 |  135 |  139
  5’-6”    |  128 |  132 |  135 |  139 |  143
  5’-7”    |  132 |  135 |  139 |  143 |  147
  5’-8”    |  136 |  140 |  143 |  147 |  151
  5’-9”    |  140 |  144 |  147 |  151 |  155
  5’-10”   |  144 |  147 |  151 |  155 |  159
  —————————+——————+——————+——————+——————+——————
  Combined |      |      |      |      |
  Heights  |  123 |  126 |  129 |  132 |  136
  —————————+——————+——————+——————+——————+——————

  —————————+——————+——————+——————+——————+————————
  Ages     | 45-49| 50-54| 55-59| 60-64|Combined
  Heights  |      |      |      |      |  Ages
  —————————+——————+——————+——————+——————+————————
  4’-11”   |  125 |  128 |  128 |  126 |  118
  5’-0”    |  128 |  130 |  131 |  129 |  120
  5’-1”    |  131 |  133 |  134 |  132 |  122
  5’-2”    |  134 |  137 |  137 |  136 |  125
  5’-3”    |  138 |  141 |  141 |  140 |  128
  5’-4”    |  142 |  145 |  145 |  144 |  131
  5’-5”    |  147 |  149 |  149 |  148 |  135
  5’-6”    |  151 |  153 |  153 |  152 |  139
  5’-7”    |  154 |  157 |  156 |  155 |  143
  5’-8”    |  158 |  161 |  161 |  160 |  147
  5’-9”    |  163 |  166 |  166 |  165 |  151
  5’-10”   |  167 |  170 |  170 |  169 |  155
  —————————+——————+——————+——————+——————+————————
  Combined |      |      |      |      |
  Heights  |  142 |  145 |  144 |  142 |  133
  —————————+——————+——————+——————+——————+————————


Dr. Weisse found the average height of women to be five feet four
inches, and the average weight one hundred and thirty-three pounds,
and that the average male height was three inches greater than that
of the female.

Women should range in weight from one and eight-tenths to two and
two-thirds pounds to each inch in height. In order to determine your
own factor in this respect divide your weight in pounds by your
height in inches. Any weight above two and one-half pounds to the
inch in stature may be considered as excessive, inasmuch as it adds
nothing to one’s mental or physical efficiency, and is frequently the
forerunner of obesity, the remedy for which is to live on a selected
diet and to burn up more through exercise.

In an ideal condition there is a sufficient quantity of fat to
give a pleasing rotundity of outline. In women the tendency is
for fat to accumulate, especially after forty years of age, about
the waist, abdomen, and upper part of the thighs. In addition to
the unsightliness which this gives to the figure, it is often the
indication of the fatty degeneration of the muscles, and the heart
is liable to become involved, and fatty degeneration of the heart is
one of the frequent causes of death. The lack of use of the muscles
in these regions of the body, which is caused by wearing corsets, is
the reason for the accumulation of fat here. It can be reduced by the
proper exercises and regulated diet.

[Illustration: PLATE VI

Venus de Medici.]

[Illustration: PLATE VII

Venus de Milo.]

=The Muscular System.=—The bony skeleton forms simply the framework
of the body, and, while it determines the general outlines and height
for the most part, the weight and general size of the body depend
upon the muscular development and the amount of adipose tissue. The
bones are not only padded about with muscles, but the muscles are
inserted into the bony sheaths in such a way that a development of
the muscles causes a development of the bones as well. Again, the
stature is increased by the erect position of the spinal column, and
this can only be attained by great strength of the muscles which
hold the spine erect. The inequalities of the muscles are filled
out with adipose tissue, giving a pleasing contour to the face and
figure.

[Illustration: Fig. 21.—The skeleton (Lewis).]

There are some five hundred muscles in the human body; these muscles
vary in size and form, according to their situations in the body and
the functions which they are called on to perform.

Nearly all the muscles in the body are arranged in two different or
antagonistic sets, and are placed on the opposite sides of the part,
so that in acting—that is, by their contractions or shortening—they
move the limb in opposite directions, and it is by the alternate
contraction, or shortening and relaxation of the two sets of muscles,
that the movements of the body are accomplished. The muscles which
bend the joints are called flexors, while those that extend the
joints are called extensors, so that in order to perform their work,
which is that of contraction, the muscles must exert enough force
to elongate the opposing muscles, overcome the tonicity of the
antagonizing muscles, and lift the weight of that portion of the limb
into which they are inserted. It is by the action of the muscles that
the body is held upright.

[Illustration: Fig. 22.—Muscular fibers, highly magnified.]

[Illustration:

  Fig. 23.—Different directions of fibers in the three layers of
  abdominal muscles.
]

_Action of the Muscles of the Abdomen._—The trunk is maintained from
falling backward by the action of those huge muscles on its anterior
surface. The space between the pelvis and the thorax is called the
abdominal cavity. Its walls are almost wholly composed of muscles.
There are several important facts to be noted about these muscles.
First, that they extend from the brim of the pelvis, into which they
are inserted, to the ribs and breast bone, to which the other ends
of these muscles are attached; that there are three layers of these
muscles; and, lastly, that the fibers of the different layers run
in different directions, so that they cross each other, as shown
in the figure. The reënforcement of the layers, the arrangement of
their fibers, and the manner in which they dovetail into the adjacent
groups of fibers give a structure of the greatest possible strength.

[Illustration: Fig. 24.—Muscles of the anterior surface of the trunk
(left side, superficial; right side, deep).]

_Action of the Muscles of the Back._—The trunk is kept from falling
forward by the action of the muscles of the back. These are arranged
in six layers. The cut shows the direction of the fibers. The first,
or outside layer, consists of the trapezius and latissimus dorsi, or,
in other words, the broad muscle of the back. On the one side these
muscles are attached to the spines of the vertebræ; the sharp ridge
which is felt in the middle of the back, and the broad attachment to
the pelvis afford a firm base of support. There are other muscles
which run parallel with the spinal column, whose function it is to
hold the spinal column erect.

[Illustration: Fig. 25.—Muscles of the posterior surface of the trunk
(left side, superficial; right side, deep).]

Standing erect calls into action almost all the muscles of the lower
extremities, trunk, and neck. So long as the line of gravity falls
within the line of the feet, the muscular effort required is so
slight that it is little more than the tonicity contained in all
living muscle. The greater the displacement of the line of gravity,
the greater the muscular effort required to maintain the equilibrium
of the body.

_Muscular Energy._—The muscles of the body, even when at rest,
are under a slight degree of tension. When stimulated, the muscle
contracts—that is, it becomes shorter and thicker. A muscle can only
remain in a state of contraction for a few seconds, because the force
of the muscular fibers is more or less exhausted during contraction.
The more rapid the contractions, the sooner does fatigue manifest
itself.

Like the steam engine, the muscles of the body, in performing their
work, produce heat and motion. The fuel which supplies this force
is taken into the body in the shape of food; it is prepared for use
in the intestinal tract, and from there carried by the blood, to be
stored up in the muscles and various tissues as latent force. The
muscles contain one-fourth of all the blood in the body.

_Heat Production._—By watching a muscle when contracting, we see
that there is not only a change of shape, but a dilatation of its
blood-vessels, that is, more blood passes through a muscle when it
is contracting than when it is at rest, and this increased flow
continues for some little time after the contraction has ceased;
there is also a rise of temperature. Nearly three-fourths of the
heat developed in the body is produced in the muscles at the actual
moment of muscular contraction. Hence, we learn that the whole body
is heated by muscular exercise; the even temperature of the various
parts is maintained through the circulation of the blood. This
combustion, going on throughout the entire economy, is the source
of all force or energy in the body. In every movement, every breath
taken, in the change even of a muscle of expression or the conception
of a passing fancy, combustion has occurred and potential force has
been liberated.

_Muscular Fatigue._—The fatigue produced by muscular contraction may
be due to the consumption of the readily available material present
in the muscle, to the consumption of the supply of oxygen, or to the
presence of the products of combustion, and, if Weichardt’s theory is
correct, to these must be added the presence of a definite “fatigue
toxin.”

During repose the internal changes of the tissue manufacture new
explosive material out of the comparatively raw material already
present in the fiber, and the directly hurtful products of the act
of combustion are either carried off, or undergo changes by which
they are converted into comparatively inert bodies. A stream of fresh
blood may exert its restorative influence, not only by quickening
both of these events, but also by carrying off the immediate
waste-products, while, at the same time, it brings new raw material.

Every movement of the body depends as much upon the proper
coördination of the muscles for its accuracy, grace, and force as
upon the strength of their contraction, and while the fatigue, of
which we are conscious in our own bodies after prolonged or unusual
exertion, arises partly from the exhaustion of the motor nerves,
it is chiefly from the exhaustion of the central nervous system
concerned in the production of voluntary impulses. A man who feels
absolutely exhausted may, under excitement, perform a very large
amount of work with his already wearied muscles. The will rarely, if
ever, calls forth the greatest amount of contraction of which the
muscle is capable.

=Passive Exercise: Massage.=—Massage has been defined as the
systematic manipulation of the surface of the body by the hands
of the operator in movements of stroking, pinching, kneading, and
striking. The passive movements consist of flexions, extensions,
rotations, and other movements of joints and limbs by an operator or
machine without the coöperation or resistance of the patient.

Massage takes the place of voluntary muscular movement, in promoting
the flow of lymph and the flow of venous blood toward the heart, if
the proper direction, that of rubbing toward the heart, be followed;
while, on the contrary, rubbing down a limb or from the heart
actually retards the process which it is meant to facilitate. Gentle
rubbing of any part of the body promotes growth, while vigorous
rubbing removes superfluous fat.

Massage finds its widest field of usefulness in conditions of
fatigue, where the elimination of waste matter must be assisted, and
where the nutrition of a part is impaired or destroyed. Muscles can
be improved in size, tone, and nutrition; ligaments can be stretched
and lengthened, the general circulation accelerated, and overloaded
veins made to disgorge their blood. The digestive tract can be
stimulated, and overwrought nerves soothed and relieved of their
hypersensibility.

The nourishment of the muscle-cell is improved by forcing out the
products of fatigue and keeping it bathed in a constantly renewed
stream of arterial blood. This alone is sufficient to prevent wasting
of substance in conditions where active movements are impossible.

Massage relieves the nervous system by maintaining the nutrition
of the muscles, without the expenditure of nerve force required to
make them contract. It acts on the central nervous system through
the nerves of sense, stimulating or soothing them, according to the
nature and the amount of the manipulation.

Mosso and Maggiora, of Turin, have proved, by their experiments as to
the effect of massage on the muscles, that muscles were capable of
doing twice as much work after massage. It was also discovered that
extending of the period of the massage did not produce any greater
results in the capacity for work; the full effect was obtained in
five minutes.

The action of massage in improving muscle tone, in postponing the
onset of fatigue, and hastening recovery from it has long been
recognized by athletic trainers. After a hard race or other contest,
it is a matter of knowledge among trainers that a five minutes’
treatment will enable an athlete to repeat or continue a performance
otherwise impossible.

Massage is the most economic form of exercise on the nervous system.
Its potency is shown by the increase of the red-blood corpuscles
and hemoglobin, and by the increased rate and force of the heart’s
beat without a corresponding change in the arterial tension. It
accomplishes these results by decreasing the resistance in the
peripheral vessels, by the removal of the products of oxidation, and
by mechanically moving the blood-current forward in the lymph-spaces
and venous channels. It is thus shown to stimulate the circulation,
the respiration, nutrition, and excretion.

Mezger describes four principal manipulations: _First_, _stroking_ or
_effleurage_, in which the hand is passed lightly over the skin, with
the pressure from the periphery to the center, following the course
of the venous circulation, and the long direction of the muscles from
their insertion to their origin. It may be performed by stroking with
the palm of one or both hands, with the thumb or tips of the fingers.
The two hands are used upon the large fleshy parts of the thighs and
buttocks, the back, chest, and neck.

_Second, Friction._—This is a deep circular movement, performed with
the thumbs and tips of the fingers, or by one hand open or clenched.
The products of fatigue collecting in deep muscular tissues are thus
thrown into the circulation, the gentle manipulations of stroking
carrying them into the superficial veins. The friction should proceed
in the same direction as the stroking movements.

_Third_, _petrissage_, also described as _pinching_ and _grasping_,
is performed by picking up the skin and subcutaneous tissues between
the thumb and fingers, and manipulating it with an amount of force
not sufficient to cause pain. In this procedure the skin moves with
the hand of the operator, and the underlying structures are thus
massaged by it under the pressure of the fingers. The thumb and
fingers are used to reach the individual muscles and small groups.
The movements should proceed from the periphery toward the center. It
is used to improve muscular nutrition in case of fatigue, in atrophy,
in obesity, and other forms of muscular degeneration.

_Fourth, Striking, Tapôtement, or Percussion._—Other names are
clapping, beating, knocking, or hacking. It has a stimulating action
on the skin, superficial nerves, and vessels. Hacking is performed by
the ulnar border of the hand, and is used along the nerve-trunks.

_Fifth, Shaking or Vibration._—Shaking involves movements of the
whole body or region to be treated, while vibration is a lesser
motion in which the body or region remains at rest, while the surface
and the structures immediately beneath it are affected.

General massage is best given at an hour midway between meals, and
never immediately after eating. The parts are at first lubricated
with cocoa-butter or vaselin, to avoid the irritation which may
follow the friction of the surface.

The first process of massage is the simple stroking to empty out
the lymph-channels; the next process is directed to the deeper
tissues. This is deep kneading, and skill is particularly required
here. As the result of this, the muscles are toned up and the nerves
are soothed, so that the total effect is that of sedation, and is
followed by the removal of the fatigue toxins, so that if necessary
it will be possible to undertake work after the massage that would
have been impossible before.

The operator starts with the feet. After both surfaces of the foot
have been well covered, the foot is firmly grasped and all the
natural movements of the toes and ankles are gone through with.
Next the region of the ankle, the leg, which is treated by circular
friction by the fingers, by deep grasping of the areolar tissues,
and, last, by deep pinching of the larger muscle masses. At brief
intervals upward stroking is given from the ankle to the knee, to
favor the venous flow of blood-currents. The same process is gone
through with in the case of the hands and arms. Especial care is next
given to the muscles of the loins, back, and neck. The abdomen is
then treated. Massage of this region concludes with deep kneading
by the heel of the hand in the direction of the colon. The chest is
manipulated upward, from the sternum along the line of the pectoral
muscles. The face is not usually treated in general massage, but the
sides of the neck are stroked from above downward, along the course
of the internal jugular veins. Each part operated upon should be
carefully covered as soon as finished.

There is a constant rise of temperature after the treatment, and
there should be a rapid improvement in the tone and reaction of the
whole muscular system.

The usual fault in giving massage is that too much is given at one
time; the maximum effect on a part is obtained in five minutes.
Another mistake is to employ too heavy a hand. A patient should never
feel bruised or exhausted after the treatment; there should be simply
a pleasant lassitude and feeling of drowsiness.

While massage is not essential for the health, it aids materially in
maintaining good health, but, in order to be efficient, a skilful
masseuse is necessary, as a considerable amount of manipulative skill
is essential, which can only be acquired by proper training. Massage,
especially when taken in connection with the Turkish bath, is most
valuable to remove weariness of nerves and muscles, as well as slight
aches and pains.

=The Balance and Carriage of the Body.=—The erect position of the
body is maintained through the exertion of more or less muscular
force. The base of the erect human body is the soles of the feet; the
smaller the base, the more danger of a fall. The base is the smallest
when one stands on the toes.

The way in which the spinal column is carried by the pelvis
determines the way in which the whole body is carried. An erect and
graceful carriage in standing and walking is not only desirable from
an esthetic point of view, but it is most essential to good health.
Without a proper development of the chest, it is impossible to
secure a normal development of the lungs and vigor of the heart.

It is upon the erectness, suppleness, and strength of the spinal
column that most of the power and grace of the body depend. In
the proper carriage the natural lines of the spinal column form a
graceful and undulating line, and the body stands erect without any
particular effort.

The curves of the spinal column are of great value in protecting the
brain, as they weaken the force of any shock, which may be caused by
striking the bones of the feet.

=Common Defects in the Carriage of the Body.=—Owing to the common
faulty position of school children at their desks, the sedentary
occupations of women, and their lack of physical training, curvature
of the spine is very common. A stooping carriage is the most common.
The head is bent forward, the chest is sunken, the back is round,
the shoulder-blades hang outward, the inner edges standing out
like wings, and the abdomen is protuberant. The muscles are poorly
developed and are weak and flabby.

This stooping carriage interferes with the freedom in breathing, and
prevents the proper development of the upper part of the chest and
lungs. Hence, it predisposes to lung diseases and tuberculosis, a
weak heart, poor circulation, shortness of breath, inability to take
proper exercise, and thinness of the blood (anemia).

_Spinal Curvatures._—The spinal column is normally directly in the
middle of the back; any deviation of this column to either side is
abnormal, and the lungs become cramped in a small and non-distensible
bony cage. This spinal curvature is most apt to take place in young
girls or in adult women after a severe illness, when the muscles
of the back have become particularly flabby, and, while still in
this condition, improper attitudes are assumed at the desk or other
sedentary occupations.

Preventive measures are of the utmost importance. First of all, comes
the general strengthening of the body, and of the muscles and bones
in particular, by plenty of exercise in the open air.

The habitual attitude at the desk and work should always be carefully
observed, and in all sedentary occupations the work should be
frequently interrupted to take systematic breathing exercises before
an open window.

Where spinal curvature has actually taken place, especial exercises
must be taken under the supervision of a physician and instructor.
Gymnastic exercises must be supplemented by outdoor games and sports.

=The Heart’s Need of Exercise.=—The first essential for the
maintenance of health, capacity for work, and power of resistance of
disease is a normally developed and strong heart. First, there must
be secured a vigorous circulation of the blood, and the two greatest
helps to this are exercise and deep breathing. In the sedentary
posture the heart works at a disadvantage.

For the young, exercise of the heart is the chief object of physical
exercises; this object is best attained by exercises of speed,
especially in the form of games which require rapid movement. In
youth the recuperative powers of the heart and lungs are at the
highest.

An adult cannot race and scamper about like a child who plays for
hours together, and a disturbance of the heart’s action brought about
by strenuous exercise to the point of fatigue of the heart is not so
quickly compensated. On the other hand, severe exercises of strength
and endurance are not so apt to prove injurious after the completion
of growth as they are in the growing youth. Up to the age of eighteen
years no feats of strength or of endurance should be attempted. From
eighteen to thirty years is the period of life when any kind of
athletic exercise can be taken, not only without any injurious, but
with beneficial, results. After the period of youth new conditions
begin to make themselves felt, and more care must be exercised in the
demands made upon the heart. In some persons obesity sets in before
they have reached thirty and impedes the action of the heart. About
the fortieth year the walls of the arteries begin to lose their
elasticity, they become more rigid, and chalk salts are deposited in
them. Golf and lawn-tennis are now excellent.

And now it is most essential that exercise be kept up; the heart
must still be trained and practised. The fibers of every muscle
degenerates when their work is reduced to a minimum.

Proper health without proper breathing is a physical impossibility.
It is necessary that those portions of the lungs which do take part
in ordinary breathing, and which would atrophy from lack of use,
should be fully developed and kept ready for suitable exercise. As
soon as the lungs grow weary and the power of breathing is exhausted,
the most powerful muscles of the body give way. The pleasure of
vigorous walking, especially in mountainous places, is alone for
her who can respond easily and readily to the enormously increased
demands on the power of the respiration.

The direct result of exercise is an increased demand for oxygen by
the tissues, and, to meet this demand, respiration is deepened and
quickened, and the beat of the heart is more rapid and more forcible.
But the phenomena of increased breathing power and increased heart
action benefit other parts of the body. At the commencement of an
exercise the contraction of the voluntary muscles called into action
compresses the blood-vessels, and impels the venous blood actively
toward the heart, which, thus stimulated, contracts vigorously, and
propels the blood in increased quantity toward the lungs. Stimulated
by the pressure of a large amount of venous blood, the inspiratory
muscles contract and elevate the bony structure of the chest, the
diaphragm pushes down the abdominal contents, and the air rushes in
to fill the vacuum thus produced and to supply the oxygen necessary
for the purification of the blood. Supplied with this life-giving
element, the blood is returned to the heart, to be distributed again
throughout the system, and to restore the loss incurred in the
original muscular movements.

In this manner are not only the voluntary muscles enlarged and
strengthened, but also the involuntary muscles, particularly the
heart and the diaphragm. The increased activity of the circulation
stimulates other organs to increased activity. The quantity of
perspiration from the skin is more than doubled, the appetite is
increased, digestion is more perfect, absorption is more rapid, the
hepatic circulation is more active, and the abdominal circulation is
carried on more vigorously.

But, on the other hand, actual harm may be done if any one who has
been accustomed to lead a sedentary life, or who is not vigorous,
suddenly engages in the more violent forms of exercise. In this
extreme exertion the heart may be embarrassed by the respiratory
action. At the end of deep inspiration the increased pressure of the
lungs impedes the flow of blood from the right side of the heart,
while the compression of the heart itself by the distended lungs
tends to overfill the large veins, and to further endanger the right
side of the heart.

During general muscular contraction the arterial pressure is
increased at the outset of exertion, before the arteries have become
relaxed, and this in turn may lead to the engorgement of the left
side of the heart and the circulation through the lungs. To these
conditions may be added still another; that is, the exhaustion of
the respiratory muscles, partly because of the unusual amount of
labor thrown upon them, and partly from the inadequate supply of
properly oxygenated blood. If the disturbance of the pulmonocardiac
equilibrium be severe and the condition unrelieved, general
prostration ensues long before the muscles engaged in the work are
exhausted. If, on the other hand, the equilibrium be restored,
or when the heart and lungs have been trained to accomplish the
restitution, the distress disappears, and the individual is said to
have gotten his second wind.

=The Gymnasium in the Campaign against Disease.=—Women, generally
speaking, do not take sufficient exercise. The trend of the present
day is for girls of the richer classes to lead an outdoor life,
but the women of the middle and lower classes do not obtain enough
variety of exercise or enough fresh air, and to the lack of proper
outdoor exercise is due their anemic condition, pallor, flabby
muscles, and generally ill-nourished appearance.

With the division of labor and the increase of wealth it has become
possible for a large proportion of the community to live without much
all-round mental or physical activity. As a consequence, there are
faulty circulation and defective nutrition, the vital resistance of
the body is lowered, and some of its various organs or tissues are
ever ready to take on disease. The lowering of the tone of the body
through dissipation, want of fresh air and sunshine, insufficient
sleep, lack of proper occupation or recreation, also increases the
susceptibility of the body to disease.

Senile decay is by no means only a matter of years, but the manner
of life led. And very many people over forty years of age fall
into a condition of senile decay, merely because they do not take
a sufficient amount of active exercise. In consequence the joints
stiffen, the muscles relax, and the arteries harden prematurely. The
prime of life would be very greatly extended, and old age delayed, if
women only continued their active interest in work and systematically
kept up gymnastic exercises and outdoor sports.

For all classes of women provision must be made, and sufficient
time afforded, to be devoted to some form of mental and physical
recuperation and systematic physical training.

=Gymnastic versus Athletic Training.=—The actual experience of the
past few decades has proved that the most effective way of developing
the mental and physical powers and the constitutional vigor is
through a judicious system of gymnastics, athletics, and carefully
supervised plays, sports, and games.

To show which of the two contestants was the “better man” was the
primary object of all contests, and this is the fundamental source
of the love of games and athletics. England has relied for her
physical training upon a large variety of games and sports, instead
of an elaborate system of gymnastics. The Englishwomen live an
outdoor life, are great walkers, horseback riders, and go in for
athletics and sports, and we find that the English women have a much
more vigorous physique and healthy and ruddy appearance than their
American sisters.

In Norway, Sweden, Denmark, Finland, France, Germany, and Italy
more stress is laid on the gymnastic training, and in the Olympic
contests, held in London in 1908, the twenty-five women from Denmark
afforded a revelation to many of the Americans present.

Medical gymnastics had their origin in Sweden, and are practised
largely in that country and on the Continent.

In gymnastic exercises the work done on each piece of apparatus
must be tried repeatedly, in order to be learned, and then must be
practised assiduously, in order to be well performed. This is what
makes gymnastics so valuable as a means of physical training and
development. The first essential is to learn to handle one’s own
weight, and to have the muscles of the body under complete control,
and much of the interest and fascination found in practising heavy
gymnastics come from this acquired power over one’s own body, and
the ability to make it do the feats and stunts which one desires it
to do. This is one reason why children love to climb fences, trees,
etc., and test their ability to handle and master themselves in new
and untried situations.

But, in order that good and not actual harm may be done, gymnastics
must be carried on under medical supervision. Bodily exercises
should, as far as possible, occupy the mind at the same time. The
fact that gymnastic training is being taken up in our high-schools
and colleges for girls is a great gain, not only to the individual,
but to the race as well.

The proper development of the body, the clear skin and eye, the
upright and graceful carriage, the free swing of the body and limbs
when they move, give happiness to the possessor as well as to the
onlookers. The esthetic advantages of health are very considerable.

Among the mental and moral advantages to be derived from the practice
of exercises and games are a greater amount of self-control,
persistence, regularity, promptness, and of general self-confidence.
In the playing of games there is opportunity for originality as
well as for observation. The unwritten code of honor, the need of
accuracy—all these qualities are essential for a successful and happy
issue in the great battle of life.

The ideal physical training requires that systematic gymnastic
exercises should be supplemented by outdoor games and sports.
Gymnastics are not sufficient for an all-round means of development,
because the movements are too regular, too expected, and too
deliberate, but they are invaluable for health and physical
development, for the correction of physical deformities, as a
foundation for many games and sports, and for supplementing the same.
Many games are so one-sided that gymnastic exercises are essential
to prevent the body from becoming unsymmetrically developed, and,
further, gymnastic exercises must invariably be the foundation for
all games; no games can do what they are really capable of doing
without the firm foundation of the best gymnastic training.

Those exercises and games should be selected which are the most
fundamental and the most healthy, which will cause the all-round
development of the body, the muscles, heart, lungs, chest, a good
condition of the blood, good circulation, breathing, digestion, and
the getting rid of the waste-products.

Such exercises should teach obedience to law, self-control,
regularity, promptitude, and readiness to meet fresh conditions or
emergencies, persistence, pluck, and the ready coöperation of nerves
and muscles.

The aim of gymnastic exercises should be to secure a symmetric
development of all the muscles the body, to correct one-sidedness,
spinal curvatures, and other physical defects, and to strengthen all
the muscles of the body. In the gymnasium especial attention must
always be given to the development and strengthening of the muscles
of the back and chest, as these are the ones that are apt to be the
most poorly developed in women, since they are less called into play
in walking, which is the only exercise that most women take, and
on their good development and strength depend the upright carriage
of the body, a good chest capacity, and, hence, good respiratory
capacity, a vigorous heart, and good circulation.

=Exercise after Eating.=—Severe mental and vigorous bodily exercise
immediately after a meal retards gastric digestion. The entrance
of food into the stomach excites the free flow of gastric juice,
which, like all the secreting processes, is dependent upon a flux of
blood to the secreting glands. Other parts of the body, notably the
brain, suffer from temporary anemia, and hence the great tendency
to drowsiness after eating a hearty meal. At such a time severe
mental work or vigorous bodily exercise must necessarily cause a
corresponding withdrawal of blood from the alimentary canal to
the brain, or, in the case of physical labor, to the extremities,
in order to furnish the amount of blood necessary for the proper
performance of the functions of these parts. The withdrawal of blood
from the digestive organs has the effect of inhibiting gastric
digestion, since there has been an interruption of a free flow of
gastric juice.

We are safe then in believing that digestion is favored by rest of
the stomach before eating, by gentle exercise of the mind and body
after eating, and by an undisturbed mental condition.

An athletic training is productive of a more complete oxidation of
the nitrogenous materials of the body, and, therefore, of a more
economic utilization of these substances. In those cases in which
there is lack of physical training, sudden muscular exertion is
followed by a waste of nitrogenous matter.

=The Effect of Brain Fatigue on Body Fatigue and Vice Versa.=—Brain
fatigue makes the sense of touch less delicate. Similarly, muscle
fatigue affects brain power; severe muscular exertion may bring a
disinclination and incapacity for brain work. Hard exercise uses
up nerve force, and also causes the circulation of waste-products
in the blood, and so the action of the brain is hindered. On the
other hand, many people who do a great deal of brain work know that
an early morning walk, a pull on the river, is most refreshing and
stimulating, and actually makes them more capable of doing good brain
work; that is, if they are in fair training and do not take enough
exercise to make them tired.

It is beyond question that a dull gymnastic drill, coming after hours
of hard school work, may be a very heavy tax on the brain and nerves,
and can hardly be a relaxation. Outdoor exercises, which require
practically no brain work and a good deal of muscular exercise, would
do good, such as walking, running, jumping, and various kinds of
games; while, on the contrary, exercises of skill would be a serious
tax.

The suggestion has been widely accepted, that brain work should
occupy the morning hours, while technical education, such as singing,
drawing, and physical training, should be given in the afternoon.

=Marks for Physical Efficiency.=—The tests suggested some fifteen
years ago by Sir Francis Galton, the eminent English scientist, for
assigning marks for physical qualifications were the following:
First, breathing capacity; second, strength tests, both of them to
be regarded with reference to the stature and the weight; third,
quickness of response to a signal, made either to the eye or ear;
fourth, keenness of eye-sight; fifth, keenness of hearing; sixth,
color sense.

Dr. Sargent, realizing the usefulness of these tests in measuring
physical efficiency, included them in the physical examinations of
the Harvard students. The strength tests consist in the strength of
each forearm, of the back of the legs, the dip, the pull up, and the
lung capacity. The combination of these seven tests 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.

=The Advantages Derived from Athletic Sports.=—Nothing can take the
place of athletic sports to develop strong vigorous bodies in girls
and young women. While formal gymnastics have both an educational and
corrective value, and lay the foundation for athletic sports, they
cannot take the place of outdoor sports to develop organic vigor,
physical and moral courage, self-reliance, judgment, self-control,
decision, and ethical training, a consideration for the rights of
others, and a relaxation, particularly from mental work. Athletics
are to youth what play is to children. Groos tells us that a function
of play is to furnish an outlet for exuberance and animal spirits in
the young.

=The Ethical Value of Sports for Women.=—First come the benefits to
the individual and second the benefits to the community, and it is a
self-evident fact that that which promotes the highest development of
the individual raises the standard of the community.

The benefits accruing to the individual are physical, esthetic, and
psychologic; and as the result of the development of the individual
along these lines will result the fourth benefit, the social or the
“community good.”

Municipal governments are beginning to recognize the fact that the
maintenance of public playgrounds not merely promote the good of the
individual, but lessen the death-rate, the poverty rate, the criminal
rate, and it has been found that the working capacity of the people
depend in some way upon the recreation afforded them.

Sports for women are essential, not only to better fit the individual
for her place in life, but as an offset to the deadly monotony of her
work. The predominating note of sports should be joy, exhilaration,
and the social features of games.

Women’s sports, like women’s clubs, are and should be run along
different lines from men’s. The object of women’s games are for their
development and individual good, and should, therefore, never be
played before indiscriminate audiences who pay an admission fee.

Women have the same necessity as children and men for a wholesome
physical outlet for the exuberance of animal spirits and energy.

The esthetic value of games has been found to be expressed in the
improvement of the personal habits and appearance, which indicates a
higher standard of living.

And the psychologic value has been found to be a development of the
mental and the moral qualities, and so the individual is the better
enabled to direct her efforts wisely and so more successfully in
life’s activities.

All of this is not a matter of theory, but it is the universal
testimony of the directors of the various athletic associations for
women all over the country.

Among other developments along the physical line are endurance,
skill, precision, and coördination. To be able to do physical things
well has an ethical value in the individual’s attitude toward life in
all its phases.

The esthetic value lays stress upon the beauty and good form of
games. It is essential in playing games that women should stand well,
walk well, run well, throw well, and have a neat appearance. The
manners and habits of the players on the field are also part of the
esthetic training.

It has also been noted that for reasons largely beyond her control
the primitive occupations of women have been taken out of her hands,
and have forced her, in order to secure a maintenance for herself,
or those depending on her for support, out of the home into the
industries and occupations of the world, together with a fierce
competition which this necessitates. In other words, success is based
upon competition, and competition is the keynote of organized games.
So that one of the values of games is to maintain fair, economic,
and coöperative rules of competition. Other things being equal, the
athletic man or woman who has played according to the rules of the
games is likely to be fairer than he who knows nothing of clean sport.

Some of the mental qualities developed are observation, attention,
concentration, memory, imagination, initiative, reason, and will
power. These qualities are most highly developed in the various
ball games, from its simplest forms to team work, as baseball and
basket-ball.

The moral qualities developed are self-control, unselfishness, a
sense of honor, self-sacrifice, self-confidence, fairness, democracy
of spirit, modesty, and decision. One of the qualities which
characterizes a good player is that she will do the things which are
assigned her. Promptness and obedience to order are the first laws
in any game. Throughout the game self-confidence is taught. Each
player has her own responsibilities, decisions must be quickly and
accurately made, while overconfidence brings a sure defeat.

If competition underlies all games, it is equally true that
unselfishness is the basis of all team work. The ability to work
together requires at every point unselfish adjustment. One of the
first things learned is to appreciate another’s ability, and the
individual egotism, so marked in the beginning of the work, is
rapidly toned down.

Closely allied with unselfishness is the spirit of fair play, and
closely linked with fairness is loyalty and a sense of honor, the
lack of which makes girls the contempt of boys and women the despair
of men. It has been averred that the social position of woman and her
dependence upon her lord and master have lead her to become indirect
and devious, hence her lack of perfect truthfulness and sense of
honor, so that when put upon her honor she does not realize her
responsibility.

Another great advantage that games possess for women is that
many of them, from their weak physical condition, are abnormally
sensitive and introspective; they live too much on the subjective
side of life. While sports are primarily objective, they afford no
opportunity for analysis of feeling; the thought must be riveted
on the thing to be done. Every girl’s school and woman’s club which
provides opportunities for games and sports erect barriers against
nervousness, morbidity, and too much introspection. These qualities
which games develop are not masculine, but human; qualities needed
for human fellowship.

=The Forms of Athletic Games Best Suited to Women.=—Dr. Sargent’s
conclusions as to the form of athletic games best suited to women,
coming from a man of his wide observation and great experience,
should be more generally known, and he says, without hesitation,
that there is no athletic sport practised in which some women cannot
enter, not only without fear of injury, but with great prospect of
success. But the feminine type of build, whether found in men or
women, is a handicap in many athletic contests. But these limitations
do not apply to girls between ten and fourteen years of age. During
this period girls, if properly trained, will often surpass boys of
the same age in any kind of athletic performance. Moreover, if girls
were given the same kind of physical training as boys receive all
through their growing and developing period, they would be able to
make a much more creditable showing as athletes when they became
adult women. In the early history of mankind the men and women lead
lives more nearly alike, and were consequently more alike physically
and mentally than they have become subsequently in the history of
highly civilized people.

From a physiologic standpoint, woman needs exercise just as much as
man does, but, in taking up athletics, these must be regulated on a
different basis. Women, as a class, cannot stand prolonged physical
or mental strain as well as men do, but give them frequent intervals
of rest and relaxation, and they will often accomplish as much in the
twenty-four hours as men do.

From her physical configuration and her inability to bear prolonged
physical and mental strain, there are certain athletic sports and
games that would be likely to prove injurious to most women if
played in the form in which they are played by men. In this group
are foot-ball, ice hockey, polo, basket-ball, boxing, fencing, pole
vaulting, and heavy gymnastics. If these sports and games should be
so modified as to meet the peculiar characteristics of women, there
are none of them that could not be played with reasonable hopes of
physical, mental, and moral improvement.

The athletic exercises and games to which women are best adapted, and
in which they are most likely to excel, are all forms of dancing,
calisthenics and light gymnastics, archery, lawn-tennis, swimming,
field hockey, lacrosse, sprint running, bicycling, rowing, canoeing,
golf, skating, fencing, basket-ball, and all gymnastic plays and
games.

In all athletic exercises in which women engage, good form, rather
than great records, should be striven for. Women may be excused for
not being as strong and enduring as men, but they cannot be excused
for not being more finished and graceful. Good carriage, perfect
poise, self-command, and exquisite grace and refinement should enter
into women’s athletic performances, and these qualities should be
taken into consideration by the judges in making their awards.




CHAPTER X

  SYMMETRIC DEVELOPMENT: GOOD CARRIAGE AND GRACE OF MOTION THROUGH
  GYMNASTICS AND ATHLETICS

  Gymnasiums, Baths, and Athletic Association: a Fundamental
  Part of a Woman’s College and a Model Woman’s Club; the Vassar
  College Gymnasium; the Standardized Percentage Table for Physical
  Efficiency; Special Medical Blank for Women; Self-made Good
  Physique through Physical Training; Rules for Taking Exercise;
  Gymnastic Dress; the Configuration of the Foot; Correct Attitude in
  Standing.

  Corrective Exercises: Exercises for Developing the Various Regions
  of the Body; Shoulder-blade Exercises; Respiratory Exercises;
  Exercise for Forward Projection of Chest and Retraction of Abdomen;
  Shoulder and Back Exercises; Leg Exercises; Squatting Exercises
  for Muscles of Spine and Abdomen; Alternate Kneeling; Abdominal
  Exercises; Balancing Exercises for Poise and Carriage; Balancing
  Exercises for Extending Depth of Chest; Lateral Trunk and Waist
  Exercises; Exercises for Muscles of Back; Exercises for Muscles of
  Abdomen; Swimming Exercises, for Back, Thighs, and Abdomen; Rope
  Pulling-exercises for Back, Chest, Waist, Legs, and Arms; Exercises
  in Trunk Flexions for Back, Abdomen, and Legs; Exercises with Chest
  Weights for Chest, Shoulders, and Arms; Boxing and Fencing; Classic
  and Esthetic Dancing an Essential Feature in Physical Training;
  Figures of the Dance with Some Simple Exercises.

  Outdoor Exercises: Effect of Walking on the Heart and Lungs;
  Running; Mountain Climbing; Swimming; Horseback Riding as an
  Exercise; Rowing.

  Athletic Sports: Croquet; Lawn-tennis; Golf; Hockey; Basket-ball.


=Gymnasiums, Baths, and Athletic Associations a Fundamental Part of a
Woman’s College and a Model Woman’s Club.=—It has been repeatedly and
conclusively proved, in a large series of cases, that the physique,
carriage, and health of woman can be wonderfully improved by regular
and systematic gymnastic exercises, combined with outdoor exercise
and athletic sports.

Briefly stated, the facts in the matter are these: the bony and the
muscular systems and the vital organs are the same in both men and
women, and hence the general scheme of physical training, which has
been found to be so highly beneficial to men, would, if properly
modified, be equally beneficial to women, and such a training for
women is urged by the most competent authorities of the day.

Two-thirds of the body weight consists of bones and muscles, and
the development, growth, nutrition, and vigor of the muscular and
bony system can only be maintained by such exercises as will call
into play the action of all of the muscles of the body, that is,
the stature, breadth of shoulders, and size of the chest, as well
as firm, hard muscles, are dependent on regular and systematic
exercises of every part of the body, and through the beneficial
effects produced through exercise on the respiration, circulation,
and digestion, etc., the brain, nerves, heart, lungs, in short, all
the organs and tissues of the body, are kept in a healthy condition.

The life of the masses of women to-day is being spent under
artificial and the most unhealthy conditions; for the most part in
overheated, ill-ventilated houses, with very little time spent in the
open air, and without any knowledge or practice in games and outdoor
sports.

The occupation, or lack of occupation, of the majority of women
scarcely calls into play the muscles of the upper part of the body.
This lack of use of the muscles about the shoulders and upper part of
the chest is fatal to the development of the chest and lungs.

Outside of housewives and domestics, the majority of professional,
business, and working women live under a very high nervous tension,
with but a very slight range of physical activity. What they all
need is a sufficient variety of exercises to call into play all the
muscles and the various regions of the body, together with plenty
of fresh air, amusements, and recreations. And already some of our
large, wide-awake, manufacturing establishments, convinced that the
practical application of these truths in their own factories would
both improve the health of their employees and be to the financial
interest of the firm, are now providing well-equipped gymnasiums,
under the direction of competent instructors, furnished with baths,
resting-rooms, restaurants, etc., for their employees, and these
experiments have demonstrated that the improved quantity and quality
of the work, the lessened amount of sickness among the employees,
more than compensate the employers for the expenditure of money and
the time consumed in physical recreation.

It is only within the past decade that the great benefits to be
derived from a systematic, gymnastic training, combined with athletic
sports for girls and women, has been generally recognized. To-day
all our best colleges for girls and young women have well-equipped
gymnasiums, with a corps of competent instructors, where a scientific
and systematic course in physical training is given during the winter
months, supplemented during the fall and spring months by outdoor
athletics and games. And, further, this course is obligatory during
the freshman, sophomore, and junior years.

The result of the gymnastic and athletic work done at Vassar College
for the past fifteen years shows a very great improvement in the
physical development, the lung capacity, and the general health of
the students. The average lung capacity for women is given as one
hundred and fifty cubic inches; at Vassar the average lung capacity
is one hundred and sixty-five cubic inches.

=The Vassar College Gymnasium.=—As Vassar College has a model
gymnasium, an unusually fine corps of instructors, and gives the
greatest attention to all the details of the physical training of
its students, it may very properly serve as a model for schools and
women’s clubs throughout the country.

The instructors all received their training at the Sargent Normal
School, Cambridge, under the direction of Dr. Dudley A. Sargent.
Hence, it is naturally run along the same lines.

Gymnasium work is carried on from the middle of November until the
end of March. The gymnasium is furnished with the usual apparatus for
light and heavy work. The entire student body is divided into four
classes; each class meets three times a week, and the period of work
in the gymnasium lasts forty-five minutes. This is followed by the
shower and needle baths.

The wands and dumb-bells used are wooden ones, and vary in
weight from three-fourths of a pound to two and a half pounds.
Other apparatus that might be used in the home gymnasium are the
chest-weights and the rowing machine with a movable seat.

Instruction in classic dancing is part of the regular gymnastic work.

The Vassar gymnasium is also furnished with a fine swimming pool. The
temperature of the water is kept at from 75° to 80° F. For beginners
it is necessary to have a much higher temperature than for expert
swimmers. Women will be greatly encouraged to learn to swim from the
fact of the incredibly short time in which the art is taught here.
Students learn to swim well in ten lessons of fifteen minutes each,
and the great popularity of these lessons renders it necessary to
limit the instruction to ten lessons. Later in the season, if there
is space in the pool, the lessons may be resumed.

Before entering the gymnasium the girl is first of all carefully
examined by the resident physician and gymnasium director, and the
results of these examinations recorded.

A detailed series of measurements and strength tests is made and
recorded on the gymnasium register. On completing the tests, the
following card is filled out and given to each girl. It has been
found that these cards, kept by the girls, increase the interest of
each in her development, and stimulate her to further exertion to
improve her physique.

[Illustration: PLATE VIII

Vassar College gymnasium.]

VASSAR COLLEGE GYMNASIUM.—RECORD OF PHYSICAL MEASUREMENTS

Miss. .. .. .. .

                            EXAMINATIONS
  ————————————————+———————+———————+———————+———————+———————+————————————
                  | First.|Second.| Third.|Fourth.| Fifth.|
  ————————————————+———————+———————+———————+———————+———————+————————————
  Height          |       |       |       |       |       |Centimeters.
                  +———————+———————+———————+———————+———————+
  Weight          |       |       |       |       |       |Pounds.
                  +———————+———————+———————+———————+———————+
  Lung capacity   |       |       |       |       |       |Cubic inches.
                  +———————+———————+———————+———————+———————+
  Girth, chest    |       |       |       |       |       |Centimeters.
                  +———————+———————+———————+———————+———————+
  Girth, chest,   |       |       |       |       |       |
  full            |       |       |       |       |       |     ”
                  +———————+———————+———————+———————+———————+
  Girth, chest,   |       |       |       |       |       |
  ninth rib       |       |       |       |       |       |     ”
                  +———————+———————+———————+———————+———————+
  Girth, chest,   |       |       |       |       |       |
  ninth rib,      |       |       |       |       |       |
  full            |       |       |       |       |       |     ”
                  +———————+———————+———————+———————+———————+
  Strength, back  |       |       |       |       |       |Kilos.
                  +———————+———————+———————+———————+———————+
  Strength, legs  |       |       |       |       |       |   ”
                  +———————+———————+———————+———————+———————+
  Strength, chest |       |       |       |       |       |   ”
                  +———————+———————+———————+———————+———————+
  Strength, right |       |       |       |       |       |
  forearm         |       |       |       |       |       |   ”
                  +———————+———————+———————+———————+———————+
  Strength, left  |       |       |       |       |       |
  forearm         |       |       |       |       |       |   ”
  ————————————————+———————+———————+———————+———————+———————+————————————

The instruments needed for making these tests are the spirometer and
two dynamometers, one to test the strength of the muscles of the back
and legs and the other to test the muscles of the arms.

Outdoor sports and athletics are begun in the fall, on the opening of
the college, and are continued as long as the weather permits. The
students then take up the regular gymnastic work until the spring of
the year, when athletics are again resumed. Here again three hours
a week are obligatory. It should be stated here that during the
menstrual period the girls are not only excused from gymnastics and
athletics, but absolutely forbidden to take part in these exercises.

The list of games include croquet, lawn-tennis, hockey, and
basket-ball. Rowing has always been a favorite outdoor sport at
Vassar. In 1909 horseback riding was again taken up; riding lessons
were begun in April, and two hundred girls took lessons. With the
exception of about twenty, they all rode astride. An ordinary man’s
saddle can be used, but a somewhat narrower saddle, with a higher
front, is more comfortable.

=The Standardized Percentage Table for Physical Efficiency.=—The
great importance of heredity on the life history of the individual
is now so generally recognized that its record becomes almost as
important as that of the woman herself.

The attention of medical examiners is called to the fact that more
stress must be laid upon the habits of dress in women as a frequently
predisposing cause of impaired physical weakness and tendency to
disease. This is emphatically so in the case of high French heels and
insufficient clothing. About 75 per cent. of the women of to-day wear
excessively high heels, and quite that number take practically no
exercise.

Because of the great variation in the height of the heel of the shoe,
from 1 to 3 inches, it is essential that the height should be taken
in the stocking feet; and since the weight of the clothing varies at
the different seasons of the year, the weight should be taken with a
minimum amount of clothing on. While the chest measurements should
be taken with a steel tape with all of the clothing of the chest
removed; care being taken that the tape does not slip down in the
back.

Difference of pulse in the horizontal and vertical positions should
not exceed 15 beats; and in strong hearts the rate is just the same.

For the proper completion of this examination it is most essential
that all of the endurance tests should be made.

_Hopping Test._—Heart is counted with the stethoscope at apex during
four consecutive 15-second periods immediately after hopping. Note
per cent. of increase from normal during first 15-second period;
second, per cent. of recovery from first 15-second period to fourth
15-second period.

The _ratings_ are as follows: I. For good heredity, personal history,
and good present condition, 10 per cent.; II. Normal condition of
heart and circulatory system, 10 per cent.; III. Normal conditions
of lungs and chest development, 10 per cent.; IV. Good condition of
digestive system, 10 per cent.; V. Normal condition of kidneys, 10
per cent.; VI. Normal condition of nervous system, 10 per cent.; VII.
Normal condition of generative organs, 10 per cent.; Normal condition
of muscular system, 10 per cent.; Tests of endurance, normal, 5 per
cent.; Normal ocular and aural tests, 5 per cent.; Normal working
efficiency, 10 per cent. Making for the normal total of physical
efficiency 100 per cent.

No applicant should be passed who falls below 7.5 per cent. in any
one group of tests, or who falls below 75 per cent. on the entire
examination.

This medical blank was made to gauge as accurately as possible the
physical condition of women, on which their working efficiency
depends. While we cannot measure the strength and adaptability of the
heart and blood-vessels with the same degree of accuracy as height,
weight, and chest measurements, yet with the physical examination and
the tests of endurance we can make a very fair estimate. And we are
entirely dependent for the history of heredity, personal history, and
that of the digestive and nervous systems upon the woman herself;
but the history of the present condition at least can be to a great
extent verified or annulled by the physical examination and by the
present condition.

By the quickness and conciseness with which the questions are
answered; the woman’s posture when she does not realize that it is
being studied; her movements as she goes from one test to another
and the way she conducts herself throughout this very rigid physical
examination, which working under high pressure with the aid of a
stenographer and office nurse, takes one hour to complete; one can
judge pretty accurately of her working efficiency.

The applicants should be graded into four classes:

Class A. Those having an excellent record in all tests.

Class B. Those having a good average record and no poor record in any
test.

Class C. Those having a fair average record and who are free from
organic defects.

Class D. Those having some definite organic disease which, in the
judgment of the examiner, would make it dangerous for the individual
to undertake any confining or laborious occupation.

Only those who come under Class “A” or “B” should be recommended
for any confining or laborious occupation. By suitable methods for
the correction of faulty habits of hygiene and systematic physical
training for one year those in Class “C” should be able to gain
admittance to one of the first two classes.

To be most beneficial to the candidate, after the physical
examination is completed, there should follow a brief personal talk,
making suggestions for the correction of faulty personal hygiene; and
where medical treatment is indicated, instructions to place herself
under the care of a physician. This has from the first been the
policy of the board and of the medical examiner.

And on their part, the candidates are now beginning to thoroughly
realize that these examinations are decidedly to their advantage
and regard them as a privilege to which they are entitled. And the
majority of them go out with the determination to get and keep well
and strong.


SPECIAL MEDICAL BLANK FOR WOMEN

  Report of Medical Examiner

  In the case of
  Address,
  Place of birth,
  Age,      Occupation,

  =I.= =Heredity: Adverse Family History.=
      Tuberculosis?
      Insanity or tendency to nervous exhaustion?
      Cancer?
      Heart disease?
      Kidney disease?

    =Personal History.=
      Acute diseases since childhood?
      Number of days lost in past year through illness?
      Notable increase or decrease of weight during the past year?

    =Present Condition.=
      Nutrition, color, and condition of skin?
      General appearance, as indicative of health?
      Dress: Habits of: 1 inch heels?

  =II.= =Heart and Circulatory System.=
      Temperature?
      Size of heart?          Force of apex-beat?
      Murmurs?
      Blood-pressure: Maximal?      Minimal?
      Pulse at rest? Horizontal?      Vertical?   After strength tests?
      Pulse, Character: Normal?     Intermittent?
            Irregular?      Unequal?
    Blood examination.—
      Absence of varicose veins and hemorrhoids?

  =III.= =Lungs and Chest Development.=
      Respiration: Frequency? Normal? Shallow? Deep?
      Auscultation?      Adventitious sounds?
      Girth of chest: Repose? Forced insp’n? Forced exp’n?
        Ninth rib: Repose? Forced insp’n? Forced exp’n?
        Normal, in relation to height?
      Depth of chest: Repose? Forced insp’n? Forced exp’n?
      Lung capacity, measured by spirometer?
      Girth of waist?
      Nose: Normal?      Obstructed?
      Throat: Normal?      Catarrh?      Tonsils: R.?      L.?

  =IV.= =Digestive System.=
      Teeth: Good?      Fair?      Poor?
      Tongue: Clean?      Coated?      Pale?
      Breath?
      Functional derangement of stomach?
          ”           ”      ”  intestines?
          ”           ”      ”  liver?
      Normal size of liver and absence of tenderness?
      Normal size and position of stomach and intestines?
      Regularity of stools with normal color and consistence?
      Constipation?      Diarrhea?
      Appendicitis?

  =V.= =The Kidneys.=
      Quantity of urine for twenty-four hours?
      Frequency of urination?
      Specific gravity and reaction?
      Indican?
      Albumin?
      Sugar?
      Casts?
      Position of kidneys?

  =VI.= =The Nervous System.=
      Tendency to headache?
      Character of   ”
      Pain or tenderness of spinal cord?
      Number of hours that can now be spent in study daily?
      Tendency to nervous exhaustion?
      Character of sleep: Insomnia?
      Mental poise?

  =VII.= =Generative Organs.=
      Position and size of uterus?
      Inflammation of uterus?
      Position and size of ovaries?
      Inflammation of ovaries?
      Menstrual flow: Quantity?      Frequency?
      Pain: Before?      During flow?      Length of time?
      Vaginal discharge?

  =VIII.= =The Muscular System.=
      Height?      Weight?      Normal?
      Stretch of arms? Breadth of shoulders? Breadth of hips?
      Posture: Sitting?      Standing?      Walking?
      Figure?
      Shoulders: Round?      Sloping?      Scapula prominent?
      Spine?      Lateral curvature?
      Abdomen: Normal?      Protuberant?
      Feet: Weak ankle: R.?      L.?      Weak arch: R.?      L.?
            Flat: R.?      L.?
      Strength of right forearm?      Of left forearm?
      Strength of back?      Strength of legs?
      Strength of upper arms (push up)?
      Strength of upper arms (pull up)?

  =IX.= =Tests of Endurance.=
      How long a time is spent daily in physical exercise?
      What form?
      What is the average rate of speed in walking?
      Does hill climbing cause shortness of breath?
      What outdoor sports are practised?
      Length of time required for test walk of three miles?
      Pulse before?      After?
      Heart reaction to exercise: Hopping 100 feet?

    =Ocular Tests.=
      Distant vision: Right?      Left?
      Astigmatism?

    =Aural Tests.=

  =X.= =General Impression of Working Efficiency.=
      Temperament?
      Personality?
      Self-control?
      Initiative?
      Capability?

  =Suggestions for Faulty Personal Hygiene.=

  =Indications for Medical Treatment.=

  =Remarks.=

  =Signature of Medical Examiner=,    , =M. D.=

    =Address=,

  =Date=,

=Self-made Good Physique Through Physical Training.=—It has not
infrequently happened that, by outdoor life and physical training,
young men and women of frail constitutions have developed into
strong, robust, and even physically powerful men and women.

While membership in a well-appointed gymnasium and athletic
association offers the most favorable conditions for the symmetric
and fullest development of the body, and when possible it is advised
always to take at least a short course in physical training under the
direction of a competent instructor, yet every woman has it in her
power to very greatly improve her physical condition without these
aids.

Systematic physical training should be begun in childhood and
continued all through life.

Before twelve years of age physical training should be the same for
both sexes, and girls and boys should have their sports and games
together. The beneficial influence of this will be manifest for
both—girls will grow stronger, less timid, and more resourceful, and
boys will grow more refined and thoughtful.

But even the case of the adult woman, where not only physical
training but most of the laws of health have been neglected, is far
from hopeless. A poorly developed chest, round shoulders, a beginning
spinal curvature, a poor carriage, bad skin, poor circulation,
indigestion, constipation, and low vitality, with poor powers of
resistance to changes in the weather and environment, are not
insurmountable obstacles. But a woman in this condition cannot manage
her own case. She must consult and place herself under the care of a
competent physician.

Two charts should be made out; the first should be a detailed outline
of her present condition; to the Vassar chart already given should be
added the physical defects needing correction, as round shoulders,
poor chest development, palpitation of the heart on exertion, length
of walk that can be taken comfortably, also the time required per
mile. As the strength of the heart and lungs increases, as shown
not only by the actual tests, but also by the increased powers of
endurance, this first chart will be a matter of great encouragement
to the woman and a great incentive to further effort. In a parallel
column to the defects should be written the corrective measure for
those defects. The second chart should contain the ideal measurements
and strength tests for a woman of her height and weight.

=Rules for Taking Exercise.=—The first things to be aimed at are the
proper ventilation of the lungs, together with their development, and
the strengthening of the heart. During the exercise the windows must
be thrown wide open, or the very object of the exercise is defeated.

Always begin with the simplest exercises and stop at the first sign
of fatigue. The very first exercise will, therefore, be the simple
respiratory exercises, taken in bed until one acquires some control
of the muscles; they are then taken standing before a mirror, to
insure the exercises being taken correctly, and after this they
should be taken before an open window. The respiratory should be
alternated with the abdominal exercises, and all of these should be
taken for twenty minutes at a time, at least twice a day, on rising
and immediately before retiring.

Two hours should be spent out-of-doors every day. If the woman is
weak and unused to taking exercise, she should walk until she feels
the first signs of fatigue, rest, and then continue her walk. If
the weather is too cold for sitting out-of-doors the woman should
preferably take two short walks each day, one in the morning and the
other in the afternoon. For invalids about ten in the morning and
two in the afternoon are the best hours in winter, because of the
greater warmth of the sun at those times. To be effective, exercise
out-of-doors must be taken every day without regard to the weather,
since the system, when in a state of activity, is less susceptible to
sudden changes of temperature than when at rest.

Exercise should not be taken after long fasting; hence, never before
breakfast, nor immediately after a hearty meal. An hour after
breakfast or a light lunch, or two hours after dinner, is the best
time for regular exercise.

A certain amount of daily exercise is essential for the preservation
of the health. A healthy woman should be able to walk five miles a
day, at the rate of three miles an hour, without feeling any sense of
fatigue.

In order to secure the greatest amount of benefit from exercise, the
mind should be entirely free from care during the exercise, so that
the woman should leave her cares at home and give up her mind and
body to recreation while she is out-of-doors.

Regularity in taking exercise is absolutely essential to secure good
physical development and to maintain the body in a condition of
health. A fixed hour should be set aside for this purpose every day.

No definite rules can be given for the exact amount of exercise to be
taken at one time, but the occurrence of fatigue is the signal for
rest; after a five minutes’ rest, exercise may be again resumed, to
be stopped again at the same signal of fatigue. Perhaps three periods
of exercise, alternating with rest, may be taken, but, in order to
do good and not harm, the individual must always stop before she is
tired.

A period of free exercises should begin with a twenty minutes’
practice, including movements for arms, legs, back, chest, and
abdomen, with especial emphasis on the correct poise and carriage of
the body and deep breathing, and it should terminate with running;
or, if in a class, with a running game.

For those of mature age and sedentary habits especial care must be
taken not to overtax the heart, always beginning with the simplest
movements and stopping at the first signs of fatigue.

In the gymnasium the periods of exercise generally cover forty-five
minutes, with frequent intervals of rest in between. Even here an
invariable rule should be never to exercise to extreme weariness.

All exercise should be followed by a shower or needle bath, and a
vigorous rubbing with or without alcohol. Very delicate women who
have been unaccustomed to taking exercise should rest on the couch
or bed for one hour before proceeding to dress. It is well to sleep,
if possible, and in this way they will find the good effects of the
exercise very greatly increased.

=Gymnastic Dress.=—The usual and best style of gymnastic dress is a
bloomer costume, the bloomers coming above the knees, long stockings,
and thin, flat-soled shoes without any heels. The dress must be loose
at the neck and waist, or it may be cut low in the neck. The sleeves
are preferably short elbow sleeves.

If the exercises are taken at home, the woman may wear a combination
undersuit, with stockings and broad-soled heelless slippers. The
lighter the dress, the better, so that there shall be no sense of
weight or restriction about the neck, waist, or shoulders.

By putting on her bedroom slippers any one can easily convince
herself of the greater grip the foot has on the floor when so clad,
and of the greater ease and sureness of the foot in walking.

For outdoor athletics a short skirt, coming just below the knees, may
be worn over the bloomer costume. Tennis shoes should always be worn.

All rooms used for exercise, gymnasiums, and ball-rooms must be
thoroughly ventilated before the assemblage of the people. The air
must be kept cool, between 50° and 60° F., and proper arrangements
must be made to keep the room well ventilated while in use without
causing direct drafts.

Well-waxed, hard-wood floors are the best, because they can be kept
freest from dust. Students should never be allowed to enter the
gymnasium with their street shoes on, as they carry with them much
dust that will be thrown in motion and inhaled during the performance
of the various exercises, and there follows not only the irritation
caused by the inhalation of the particles of dust, but also the
danger of inspiring all kinds of germs of disease with which the air
is laden.

[Illustration: Fig. 26.—Upper surface, bones of foot (Allen).]

=The Configuration of the Foot.=—No study of the correct attitude
of the body at rest or in motion would be complete without some
knowledge of the structural arrangement of the foot. The feet form
the base of support for the entire body, and at every step are
subjected to a pressure of from one hundred to two hundred pounds.

This base is in the form of two arches, a transverse and an
anteroposterior. The latter is the most important, and has been
subdivided into two by an imaginary line, drawn between the third and
fourth metatarsal bones. The inner portion of this arch is much more
curved than the outer, and forms the instep. The arch is supported
by two piers. The posterior pier is formed by the os calcis, or heel
bone, and the posterior part of the astragulus. It is shorter, has
but one joint, is more curved, and is, at the same time, more solid
than the anterior pier, and receives the greater part of the weight
of the body. The anterior pier includes all the bones in front of the
astragulus to the junction of the three metatarsal bones with the
toes. It is much the longer, is less curved, and has many joints,
giving it greater elasticity, and also enabling it to diminish the
force of shocks transmitted to the arch. The summit of the arch is
the ankle.

It is evident that the superincumbent pressure, by flattening the
arches, both lengthens and broadens the foot. The anteroposterior
arch is further lengthened by a turning upward of the toes, which
form a hinge-joint with the instep.

In extension the foot normally rests upon the heel, the tips of
the metatarsal bones, and the outer side of the sole. In walking,
running, or dancing the direction of the weight upon the arches is
constantly changing, and it is only through the action of certain
muscles that the normal arches are conserved. This healthy condition
of the plantar arch can only be maintained by the evenly balanced
action of those muscles which surround and strengthen the weak parts
of the arch.

Dr. Busey’s description of the foot in walking, and the injurious
effects of the high-heeled shoe, is as follows: “In walking the heel
touches the ground first, and supports the whole weight of the body
for a moment. A little later the point of the foot touches, and
assists in preserving the equilibrium by increasing the base. During
the second movement of walking the heel is raised (see Fig. 27, 2),
and the weight of the body is shifted more and more to the center of
the foot and toes, the latter spreading and pushing the body forward.
This last is the movement which displays to the greatest advantage
the suppleness and elasticity of the articulations of the foot, and
the adaptation of the arch to receive the weight of the body, and to
transfer it to the distal pier, while the body is being moved forward
by the same act. It is the execution of this movement which gives to
the gait of woman that elegance and those graceful undulations which
are so attractive.

[Illustration: Fig. 27.—The natural and artificial positions of the
foot (Camper).]

“The narrow high-heeled shoe, on the other hand, by displacing the
supporting base, causes both piers of the double-spanned arch to
strike at the ground simultaneously. In consequence of which the
gait, instead of being undulating, is stiff and hobbling, and the
body advances by jerks.

“When standing on the heel bone (_NLM_, Fig. 27, 1), the joint at
_K_, and the great toe _C_, touch the support upon the line _A-B_.
When the feet are shod according to the present fashion, the line
_A-B_ is made to assume the concave form shown in Fig. 27, 3, by
_BTu_. The instep is made more convex and rounded, and the foot is
actually shortened (see _a-b_, Fig. 27, 3). The constant elevation of
the heel places the body of the pedestrian in the same position as
when standing upon an inclined plane. Again, the heel is so shaped
and located that it forces up the keystone of the arch and weakens
the whole structure.”

=The Correct Attitude in Standing= (See Fig. 28).—The heels are
placed nearly together, the toes pointed very slightly outward, the
legs are rigid, the trunk and head are held erect, and the shoulders
somewhat back, so that the chest shall expand freely. The arms should
hang easily at the sides; the fingers are slightly bent, with the
thumbs in front. This position of “attention” can only be maintained
comfortably for a very short length of time, since the actively
contracting muscles soon tire.

If the standing position has to be maintained for any great length of
time, one foot should be placed slightly in advance of the other, the
weight being borne upon the straight leg and the active supporting
foot, the other being relatively passive. This asymmetric position
has the important advantage that the two extremities may be brought
alternately into play.

The most common defect in standing is that the entire weight is
usually borne upon the same leg, generally the right one, while
the left, being inactive, is placed out to one side; the habitual
maintenance of this position leads, as we shall see later, to a
tilting of the pelvis to one side, with a consequent spinal curvature
and lowering of one shoulder.

Persons with strong feet, especially primitive unshod feet,
mountaineers, runners, and young children, walk with the inner
borders of the feet nearly parallel to each other and the direction
of motion. The best sculpture, both ancient and modern, shows the
straight supporting foot, which in standing is not necessarily
parallel with its mate, since the resting foot may assume almost any
angle of divergence.

The influence of the stability of a correct base is well illustrated
by standing on one foot and swinging the other leg backward and
forward, which is much more difficult if the supporting foot be
turned to one side. A runner finds it very difficult to run with the
toes turned out, although the heels never touch the ground.

=Corrective Exercises.=—Many of the most common defects, such as
a drooping head, round shoulders, flat chest, beginning spinal
curvature, etc., result from a weak and relaxed condition of the
muscles, whose function it is to move and support these parts. If the
head is constantly bent forward in studying and writing at the desk,
the muscles at the back of the neck gradually lose their tone, and
stretch out like a piece of elastic that is constantly kept on the
strain.

The exercises selected must be such as will strengthen these
particular groups of muscles, and, while taking the exercises, the
entire attention must be concentrated on the part being exercised.

Any lack of symmetry in the chest, spinal curvature, or actual
weakness of the lungs will necessitate the prescribing of special and
carefully selected exercises.

As to the exercises themselves, they should be so arranged as to
bring into play in a methodic manner all the muscles. All special
and corrective work must be supplemented by general work, which will
increase the organic vigor of the heart, lungs, and chest necessary
to meet the vital demands of the whole system. Games are, of course,
most useful for this purpose, but the games should not be too violent.

In most free exercises the limbs are used for weights of resistance.
In a man weighing one hundred and fifty pounds the arms usually
weigh about ten pounds each and the legs twenty pounds.

_The Causes of Round Shoulders._—The general conditions are those
that produce muscular or constitutional weakness, as rapid growth,
overwork, the impure air of ill-ventilated rooms, acute illness,
near-sightedness uncorrected by glasses, lack of proper exercise, and
the wearing of clothing supported by suspenders bearing on the points
of the shoulders, tending to pull them downward and forward, or even
to produce a painful deformity of the scapula.

It is the rule rather than the exception to find, with round
shoulders, some inequality in the height. The right shoulder is apt
to be the lower, owing to the carrying of burdens on the right arm.
Habitual standing with the weight on the right leg contributes to a
good many cases. Games in which the right arm is almost exclusively
used is another cause.

[Illustration:

  Fig. 29.—The spinal column (Church and Peterson).
]

_The Causes of Spinal Curvature._—The spinal column forms the central
support of the body, and, for grace and suppleness of motion, its
thirty-four joints should be constantly exercised, as well as the
muscles which hold it erect and support the head upon it, as well as
attach the shoulders, hips, and legs more or less closely to it. In
brief, all the muscles of the back need varied and regular exercise
to maintain the erect position of the body, and from early childhood
especial attention should be given to develop and strengthen this
region of the body.

The normal movements of the spinal column are flexion, extension,
side bending, and torsion. Flexion and extension take place, for the
most part, in the lumbar and cervical regions.

Gould believes that astigmatism is a prominent factor in the
causation of spinal curvature; the curvature is affected by the
tilting of the head to one side in reading or writing.

But a faulty postural habit is probably the most frequent cause
both in standing and at the desk. When the weight is supported
by the right leg, the left being used merely as a prop; there is
a marked =C=-shaped curve produced, with a lowering of the right
shoulder and prominence of the right hip. This position is assumed by
school children for long periods of time, and there is a consequent
overstretching of the ligaments of the spine and hip. These cases are
generally accompanied by round shoulders and flat chest, protrusion
of the abdomen, and rotation of the vertebræ.

A muscle can be developed only by the active contraction and
relaxation of its fibers. Continuous tension quickly tires and lowers
its tone, so that exercises given for increasing muscular power
should be comparatively quick and frequently repeated, while those
that aim at the stretching of muscles and ligaments should be slow
and long maintained.

In all cases where corrective treatment is needed the first thing
to be attended to is the general condition, and the best hygienic
conditions must be provided, the general health inquired into and
attended to. In all cases the eyes should be examined by a competent
oculist.

All exercises and stretching movements should be given daily, with
a period of rest after three or four movements, and they should be
so alternated and combined that no two, employing the same muscles
in the same way, should follow one another, and so cause excessive
fatigue.

_The Muscles of the Abdomen._—These muscles are most important for
breathing and therefore for health, for the retention in their normal
position of the various abdominal viscera, for good digestion and
regularity of the evacuation of the bowels. Sluggish digestion and
constipation are among the commonest evils in life, and they are
generally connected with relaxed abdominal walls and flabbiness of
the abdominal muscles. Active pressure of the abdominal muscles on
the viscera massages the liver and presses onward the contents of the
intestines.

The protuberant abdomen may either be due to a faulty position
in standing or an excess of fat in the great omentum, a membrane
intended to protect the bowels. This excess of fat may be in turn due
to lack of exercise or an excess of sweets and starchy foods, and the
reduction of this superfluous fat by suitable exercises, properly
taken, together with the attention to the diet, _not starvation_, is
the only common sense and safe way for a woman to reduce her size.

The abdominal muscles are used in bending, in stooping forward, in
raising up from the recumbent position, somewhat in climbing, and in
many other movements. Trunk bending forward and backward; lateral
flexions of the trunk; bending of the knees down to a squatting
position, together with torsions, and all exercises derived from
these types, bring into play and exercise the abdominal muscles.


EXERCISES FOR DEVELOPING THE VARIOUS REGIONS OF THE BODY

The following list of free exercises has been selected primarily for
developing the lungs and chest and correcting deformities, such as
round shoulders, stooping attitude, and beginning spinal curvature,
when due _only_ to muscular weakness and faulty attitude in standing,
sitting, and walking.

[Illustration: Fig. 28.—Correct attitude in standing.]

[Illustration: Fig. 30.—Correct attitude in walking. First position.]

[Illustration: Fig. 31.—Correct attitude in walking. Second
position.]

[Illustration: Fig. 32.—Shoulder-blade exercise. First position.]

[Illustration: Fig. 33.—Shoulder-blade exercise. Second position.]

While each exercise calls into play many other muscles than the ones
for whose development the exercise is given, the exercise is classed
under the group for the region which it is especially designed to
benefit.

=Shoulder-blade Exercises= (Fig. 32).—_First Position._—Stand erect,
with the feet nearly together, and the palms of the hands brought
together above the head in the manner shown in the figure.

_Second Position_ (Fig. 33).—Throw hands and forearms backward,
keeping the arms on a line with the shoulders, the elbows bent,
and turn the palms forward, as represented in the second position
of the figure. Return to the first position, and repeat ten times.
These exercises strengthen particularly the muscles between the
shoulder-blades, whose function it is to hold the shoulders back.

The first point in taking each exercise is to learn the correct
attitude before a mirror; after this has been mastered, the exercises
should be taken with a considerable amount of rapidity and force, but
not so forcibly that the collar-bone projects at its junction with
the breast-bone. In throwing the hands and forearms back, the force
of the motion should come at the elbows, not at the hands, and the
shoulders should be carried as far back as possible.

=Shoulder-blade Exercises, Number 2= (Fig. 34).—Stand erect, with the
feet nearly together, and with the hands clasped behind the neck, as
seen in the figure. Then force the head and elbows strongly back.
Relax, letting the elbows come forward. Repeat ten times.

It will be readily seen that these shoulder-blade movements are
exercises for the arms and chest as well. The object being to raise
and broaden the chest.

=Respiratory Exercises= (Figs. 35, 36, 37).—_First Position._—Stand
with the feet nearly together, the chin down, the arms extended
downward, with the backs of the hands touching, as shown in the
figure.

=Second Position.=—The chin should be raised with the arms, so that
in the second position the head is held erect.

_Third Position._—The movements of the hands are carried upward still
further and separated as shown in the figure. From this position the
hands should be brought downward in the large sweep of a circle to
the original position.

When these various movements have been accurately acquired, forcible
respiratory movements should be added. Begin to inhale forcibly as
the hands are raised, and hold the breath as long as possible while
the hands are held above the head, and exhale forcibly while the arms
are being brought down. These exercises bring into play the muscles
of natural and forced respiration.

=Exercises for Forward Projection of the Chest and Retraction of the
Abdomen= (Figs. 38, 39).—_First Position._—Stand erect, with the arms
behind the back, the hands resting in the small of the back, the
fingers interlocked, and the palms facing backward.

_Second Position._—Straighten the arms, turn the palms inward and
then downward, and lastly out, all the while keeping the fingers
interlocked. Roll the shoulders and arms into supination, and extend
the neck, as in the attitude of the second position of the figure.
Retain this position for a moment, then reverse slowly back into the
first position.

When the fingers cannot be held in this position, start by holding a
loop of cord in the hands, instead of interlocking the fingers.

This exercise is particularly valuable for projecting the chest
forward, stretching the shortened ligaments, and drawing in the
abdomen. Care should be taken to have the chin pressed backward when
the arms are brought downward and turned outward.

=Shoulder and Back Exercises= (Figs. 40, 41).—_First Position._—Stand
erect, with the feet together, and both arms extended on a plane with
the shoulders, so that in the first position the left arm is extended
directly in front of the body and the right arm on the same plane
directly behind the body. The arms must be held rigidly on the same
plane.

[Illustration: Fig. 34.—Shoulder-blade exercise. Number 2.]

[Illustration: Fig. 35.—Respiratory exercise. First position.]

[Illustration: Fig. 36.—Respiratory exercise. Second position.]

[Illustration: Fig. 37.—Respiratory exercise. Third position.]

[Illustration: Fig. 38.—Exercise for forward projection of chest and
retraction of abdomen. First position.]

[Illustration: Fig. 39.—Exercise for forward projection of chest and
retraction of abdomen. Second position.]

[Illustration: Fig. 40.—Shoulder and back exercises. First position.]

[Illustration: Fig. 41.—Shoulder and back exercises. Second
position.]

[Illustration: Fig. 42.—Leg exercises. First position.]

[Illustration: Fig. 43.—Leg exercises. Second position.]

[Illustration: Fig. 44.—Squatting exercises for muscles of spine and
abdomen.]

_Second Position._—By a circular movement, the position of the left
arm is assumed by the right, and vice versa. During the entire
movement the feet must be kept firmly planted on the floor, pivoting
at the hips only, while making the continuous circular movement of
the arms.

These movements consist in a torsion of the body around the axis of
the spinal column, and to these can be added deep inspirations from
left to right, with expirations from right to left. In addition to
the effect on the circulation, the respiratory movements keep up the
nutrition and efficiency of the lungs, which in old age undergo a
kind of atrophy, and also maintain the elasticity of the chest-walls,
which are apt to become stiff through disuse, and so interfere with
the movements of the lungs and pleura.

=Leg Exercises= (Figs. 42, 43).—_First Position._—Stand erect, with
the hands resting on the hips and the legs crossed at the knees, with
the right foot in front, as shown in the figure.

_Second Position._—Swing the right leg outward and around back to
about eighteen inches back of the left foot, as is shown in the
second position. Then swing the right leg outward and around, back to
the first position.

Reverse the position of the feet, and perform the same movements
with the left leg. The weight of the body must always be thrown on
the advanced leg, and perfect poise and balance should be maintained
throughout the entire movement.

Leg exercises are useful for purposes of relieving the engorged veins
of the fatigued leg, because the movements of such large masses
of muscles as those of the legs and thighs demand large supplies
of blood, and consequent quick action on the part of the heart to
supply it, and this blood, pouring swiftly back to the lungs for
purification, requires frequent and deeper inspirations on their part
to effect the purification; leg exercises cause greater development
of the chest than do arm exercises.

=Squatting Exercises for Muscles of the Spine and Abdomen= (Fig.
44).—Stand erect, with the feet near together and the hands resting
on the hips, rise upon the toes, then sink the body to the floor,
bending the knees sharply, until the thighs and legs are doubled upon
each other and the weight of the entire body is supported by the
toes. The trunk must be maintained perfectly erect throughout the
movement. Then return to the original position. Repeat ten times.

These exercises strengthen the muscles of the spine and abdomen, and
aid in reducing superfluous abdominal fat. They also strengthen the
ankles and increase the flexibility of the knee-joints.

=Alternate Kneeling; Abdominal Exercise= (Fig. 45).—While these
exercises also strengthen the muscles of the spine and legs, they are
primarily abdominal exercises, and are given for the strengthening of
the abdominal muscles and improving the circulation in the abdominal
viscera.

_First Position._—Kneel on the left knee, with the face directed
forward, the right arm extended perpendicularly up at the side of the
head, and the left hand resting on the hip. The head and entire trunk
are then turned slowly to the left, the right arm all the while being
held rigidly up at the side of the head, then returns slowly to the
original position.

_Second Position._—Kneel on the right knee, with the face looking
directly forward, and the left hand extended above the head, and the
right hand resting on the hip. The head and entire trunk are then
turned slowly toward the right, and the position maintained for a
moment, then return to the original position. Repeat five times for
each leg.

These exercises strengthen the abdominal muscles, those at the side
of the waist, and groins.

=Balancing Exercises for Poise and Carriage= (Fig. 46).—These
exercises, for maintaining the equilibrium of the body while it is
poised upon the smallest possible base, are among the most difficult
positions to maintain, requiring a high degree of coördination of
movement. They are given to improve the poise and carriage of the
body.

[Illustration: Fig. 45.—Alternate kneeling; abdominal exercise.]

[Illustration: Fig. 46.—Balancing exercise for poise and carriage.]

[Illustration: Fig. 47.—Balancing exercise for extending depth of
chest. First position.]

[Illustration: Fig. 48.—Balancing exercise for extending depth of
chest. Second position.]

[Illustration: Fig. 49.—Lateral trunk and waist exercise. First
position.]

[Illustration: Fig. 50.—Lateral trunk and waist exercise. Second
position.]

The position of the right foot in the figure is incorrect, since
the object of the movement is to have the body balanced throughout
on the toes _only_. Stand erect on the tiptoes, with the arms and
hands extended at the sides and above the head, as shown in the
figure; then walk in the same position, with the hands carried up
perpendicularly at the sides of the head.

Further benefits in the carriage of the body may be obtained
by carrying light weights upon the head while performing these
exercises, as a light book.

These exercises, when properly performed, expand the chest and
bring into play all the extensors of the back and elevators of the
shoulders. They also round out the muscles of the throat and neck.

=Balancing Exercises for Extending Depth of Chest= (Figs. 47,
48).—_First Position._—Stand erect, with the heels together and the
hands resting on the hips. Straighten out the right arm, and extend
it perpendicularly up at the side of the head, and at the same time
carry the left leg outward and upward as far as possible, according
to the pose assumed in the figure. Then lower the leg and arm,
returning to the original position.

_Second Position._—Stand erect, with the heels together and the hands
resting on the hips, as in the first position. Then take the same
movements with the left arm and right leg as were taken in the first
position. The arm and leg should be raised and lowered simultaneously.

All these exercises increase the vertical diameters of the chest, and
strengthen the muscles of ordinary and forced respiration.

These movements also relieve the engorged veins of fatigued legs.

=Lateral Trunk and Waist Exercises= (Figs. 49, 50).—_First
Position._—Stand with the feet nearly together and the arms extended
above the head; the arms are relaxed at the wrists and elbows, so
that a slightly curved line is formed, as is shown in the figure.
First sway to the left, bending at the waist line as far as possible,
and return to the original position.

_Second Position._—The attitude is the same as in the first position;
sway to the left in the same manner.

These exercises strengthen the muscles on the sides of the abdomen
and the lower part of the back, and are an excellent means to reduce
the size of the waist in case of corpulency.

=Exercises for the Muscles of the Back= (Fig. 51).—These exercises
may be taken lying prone on the floor, with the feet caught under
any piece of furniture which is strong and low enough to act as a
cross-bar, as a lounge or dressing case. No one but an athlete could
take this exercise without having the feet held down.

The feet should be held firmly down, and the hands may be at the
sides or clasped behind the waist; the body is then slowly raised and
carried backward to the half-sitting posture, then gradually lowered
to the original position. These movements should be taken slowly and
not repeated more than five times in the beginning.

In case of stooping or round shoulders, the hands should be clasped
at the back of the neck instead of at the waist.

Raise the head and extend the spine, pressing the elbows backward.
This exercise is a severe one on the extensors of the back and the
rotators of the shoulders.

=Exercises for the Muscles of the Abdomen= (Fig. 52).—Lie supine on
the floor, with the feet firmly fixed under a cross bar, or a piece
of furniture which will answer this purpose, and the hands resting
on the hips, as shown in the figure; slowly raise the body to the
upright position, maintain for a moment, and return to the first
position.

This and the preceding exercise are both excellent for strengthening
the abdominal muscles and reducing an excessive accumulation of fat
in case of obesity of this region.

[Illustration: Fig. 51.—Exercises for muscles of back.]

[Illustration: Fig. 52.—Exercises for muscles of abdomen.]

[Illustration: Fig. 53.—Swimming exercises: for back, thighs, and
abdomen. First position.]

[Illustration: Fig. 54.—Swimming exercises: for back, thighs, and
abdomen. Second position.]

[Illustration: Fig. 55.—Rope-pulling exercises: for back, chest,
waist, legs, and arms. First position.]

[Illustration: Fig. 56.—Rope-pulling exercises: for back, chest,
waist, legs, and arms. Second position.]

[Illustration: Fig. 57.—Exercises in lateral trunk flexions: for
shoulders, chest, hips, and legs. First position.]

=Swimming Exercises: for Back, Thighs, and Abdomen= (Figs. 53,
54).—_First Position._—The movements given here are those for the
breast-stroke in swimming. Stand with the feet about eighteen inches
apart, with the right foot advanced and the right leg straight; the
weight is thrown on the left leg, and the arms bent at right angles,
ready for the beginning of the stroke, as shown in the pose.

_Second Position._—Shoot the arms directly forward, incline the whole
body forward, straighten the left leg, and throw the weight on the
right, which should be bent, as shown in the second pose. Then sweep
the hands and arms outward in a horizontal plane, until the arms,
trunk, and legs are brought into the original position.

Then take the same exercises, reversing the positions of the right
and left legs.

In taking these exercises the arms, body, and legs must work
simultaneously. Special stress must be placed on the alternate
flexion and extension of the front and rear leg and the inclination
of the body forward with each stroke.

While these exercises strengthen the muscles of the arms, shoulders,
and chest, they are especially intended for the extensor muscles of
the back and thighs and muscles of the abdomen.

=Rope-pulling Exercises: for Back, Chest, Waist, Legs, and Arms=
(Figs. 55, 56).—_First Position._—Stand with the feet about eighteen
inches apart, the arms extended out in front of the body and well
out from the sides; the right foot is advanced, and the weight rests
mainly on the right leg.

_Second Position._—Clinch the hands tightly, as though grasping a
rope, and sway to the left side, at the same time straightening the
right leg; bend the left knee, and pull the hands toward the waist,
as though pulling the rope in; then extend the arms and return to the
first position.

Repeat the exercise with the position of the legs reversed.

The arms must be extended well out from the sides, bending at the
waist-line, so as to increase the reach, and the swaying back and
forth must be done with perfect regularity.

This is a good all-around exercise, as it brings into play and
strengthens the adductors of the thighs, calves, and extensors of the
legs, the broad muscles of the back, the muscles of the chest, waist,
and the flexors and extensors of the arms.

=Exercises in Lateral Trunk Flexions: for Shoulders, Chest, Hips, and
Legs= (Figs. 57, 58).—_First Position._—Stand with the feet eighteen
inches apart, with the right arm extended upward and the left
downward, and the weight of the body thrown on the right leg, while
the left leg is extended directly to the side.

_Second Position._—Change the weight to the left leg, and bend the
left knee while the right leg is extended. At the same time bring the
right arm down and carry the left up and sway the body at the hips to
the right side. The feet are kept flat on the floor during the entire
exercise, and it will be noticed that the arm, which is extended
downward, is on the same side as the extended leg.

These exercises increase the flexibility of the chest, strengthen
the muscles at the sides of the waist, and cause some massage of the
liver.

=Exercises in Trunk Flexions: for Muscles of the Back, Abdomen, and
Leg= (Figs. 59, 60).—_First Position._—Stand with the feet about six
inches apart, the body bent well forward at the waist-line, while the
legs are rigidly extended at the knees. Increase the bend gradually
at the waist until the tips of the fingers touch the floor between
the feet, as shown in the pose.

_Second Position._—From the first position carry the arms directly
forward, upward, and backward until they reach the position shown in
the second pose, with the knees and ankles flexed; bend the trunk as
far backward as possible, while the arms are extended over the head.
Maintain for a moment, and return to the original position.

[Illustration: Fig. 58.—Exercises in lateral trunk flexions: for
shoulders, chest, hips, and legs. Second position.]

[Illustration: Fig. 59.—Exercises in trunk flexions: for back,
abdomen, and legs. First position.]

[Illustration: Fig. 60.—Exercises in trunk flexions: for back,
abdomen, and legs. Second position.]

[Illustration: Fig. 61.—Chest weight exercises for arms and
shoulders. First position.]

[Illustration: Fig. 62.—Chest weight exercises for arms and
shoulders. Second position.]

[Illustration: Fig. 63.—Chest weight exercises for shoulders and
chest expansion. First position.]

[Illustration: Fig. 64.—Chest weight exercises for shoulders and
chest expansion. Second position.]

[Illustration: Fig. 65.—Chest weight exercises for extending depth of
chest. First position.]

[Illustration: Fig. 66.—Chest weight exercises for extending depth of
chest. Second position.]

[Illustration: Fig. 67.—Chest weight exercises for chest expansion.
First position.]

[Illustration: Fig. 68.—Chest weight exercises for chest expansion.
Second position.]

[Illustration: Fig. 69.—Figures of the dance. First position of the
hands and feet.]

These movements must all be taken slowly, and in the beginning do not
attempt to go far back of the vertical line. Nearly all the muscles
on the front and back of the body are involved in these exercises,
but the greatest strain comes on the muscles of the back and abdomen
and the muscles on the back of the thighs. The bending and rising
bring into powerful action the extensors of the back and neck and the
retractors of the shoulders.

After this exercise has been mastered, it can be used to still
further expand the lungs, by forcible inspiration when the chest is
in the most favorable position for expansion; retain the breath while
the trunk is flexed, forcing the air into the cells of the lungs
under pressure. This last feature of the exercise should _not_ be
attempted by any one with weak lungs.

=Boxing and Fencing.=—Boxing and fencing are both excellent exercises
for the lungs, for both sides of the body, for balance, for rapidity,
for endurance, variety, promptitude, and sudden adaptation; for
originality, up to a certain point, as well as for self-reliance and
fearlessness. They have the advantage of cheapness, and are best
practised in the open air.

=Exercises with Chest Weights: for Chest Expansion, Shoulders, and
Arms.=—These exercises are excellent for developing the muscles
of the upper part of the chest, and for rounding out the chest,
shoulders, and arms. They are also good flesh-reducing exercises.

The weights should be fairly light at first, beginning with perhaps
two and one-half pounds, and gradually increasing until five pounds
are used. The weights should only be increased with the increase of
the strength of the individual. All the movements should be performed
consecutively from ten to twenty times each; then proceed to the next
movement.

In taking any heavy exercise great care must be used not to
overfatigue the muscles, or more harm than good will be done. As
soon as the muscles have become too tired to perform any exercise
vigorously, it should be discontinued, and a rest of a few minutes
taken, when the exercise may be resumed. When a point is reached at
which the muscles feel tired at the commencement of the exercise stop
at once for the day.

=Chest Weight Exercises for Arms and Shoulders= (Figs. 61,
62).—_First Position._—Face the chest weights, grasp the handles
firmly, and hold the arms straight out in front of the chest. Stand
with the heels nearly together, and far enough away from the weights
to raise them a little distance from the floor.

_Second Position._—Draw the two handles to the chest and almost under
the armpits, letting the elbows and shoulders go well back; then
extend the arms. Repeat ten times.

=Chest Weight Exercises for Shoulders and Chest Expansion= (Figs. 63,
64).—_First Position._—Hold the arms straight out in front.

_Second Position._—Then, still keeping them in a horizontal position,
throw them back as far as possible.

=Chest Weight Exercise for Extending Depth of Chest= (Figs. 65,
66).—_First Position._—Stand with the back to the chest weights,
palms forward, arms straight.

_Second Position._—Let the arms go past the sides, back and up as far
as possible; then bring them down and forward and return to first
position.

=Chest Weight Exercise for Chest Expansion= (Figs. 67, 68).—_First
Position._—Stand with the back to the chest weights, holding the arms
straight out in front.

_Second Position._—Then, keeping them straight and in a horizontal
position, throw them back as far as possible. With the arms still
extended on a straight line with the shoulders, bring them forward
until the hands meet in front. This is an excellent exercise to
expand and develop the chest.

=Classic and Esthetic Dancing: an Essential Feature in Physical
Training.=—From earliest antiquity the dance has been of universal
practice among all peoples of the earth, both savage and civilized,
and it has been made to express all the emotions of which the mind
is capable of feeling. Dancing held a prominent position among the
gymnastic exercises of the Greeks.

The teachers of physical training have long felt that even the
combination of gymnastics and athletic sports left much to be
desired in the carriage and movements of the body, so classic and
esthetic dancing, which stands between the two, more closely allied
to gymnastics in its movements and to games in its spirit, was
introduced as an additional gymnastic exercise, to harmonize the
movements of the body, and to produce an ease of manner with a grace
of beauty and of motion.

_Society Dancing._—A sharp distinction must be made between the
modern gymnastic dancing and society dancing. In the latter, the
waltz and the two-step always require a partner. The dancing is
ordinarily confined to the ball-room, with its poor ventilation and
overheated air; add to these the constriction of the waist, so that
the free action of the heart and lungs is interfered with, and under
these conditions it may even prove a dangerous pastime to the young
woman with weak heart or lungs. As a physical exercise, the waxed
floor of the ball-room still further reduces its value.

_Gymnasium or Classic and Esthetic Dancing._—For the gymnasium
dancing there must be, first of all, the loose dress and heelless
slippers, and an abundant supply of fresh air at a proper
temperature, while the foot grips the floor as tenaciously as in
boxing or fencing; a smooth floor renders an artistic execution
impossible. The floor should be rough or covered with canvas, when
dancing becomes as good a developer of the heart and lungs as running
or swimming.

Girls in good physical condition can keep up esthetic dancing for
an hour with very few rests or pauses. The work done in one hour is
about equivalent to a walk of ten miles.

The first steps in the attainment of grace of motion is to avoid
short, angular, jerky movements, and to learn to do everything, even
the most difficult exercises, with the least expenditure of power
and energy. This implies considerable muscular strength and great
muscular endurance and control. As soon as the dancer loses her
balance or poise, holds one arm too straight, and bends the other one
at too sharp an angle, or puts too much stress on this movement and
too little on that, or makes too much effort, the harmony is lost and
gracefulness is not attained.

The modern gymnasium dancing conforms more completely with the
requirements of good exercise than ball-room dancing, because the
trunk, arms, and legs are brought more generally into action.
While the exercises of the feet and calves are not so intense or
so concentrated as in ballet dancing, the range and the extent of
the movement are much greater. Not only are the shoulder, back, and
chest muscles considerably developed by the free use of the arms,
but so many of the muscles of the lower part of the back, abdomen,
and thighs are used that greater respiratory power is acquired to
sustain the extended action; hence, the chest-walls are expanded by
the effort, and the abandonment of the corset during dancing gives
the utmost freedom to all respiratory movements.

Statistics show that some of the benefits accruing from a
conscientious study and practice of aesthetic dancing are, that
it raises and develops the chest, lengthens the waist, and also
reduces its circumference; the hips are reduced in size, the thighs
and calves are enlarged, while the ankles are made smaller and the
insteps are raised and given a higher arch. Properly applied and
directed, dancing exercises are even a cure for flat-foot.

The improvement noted in thirteen young ladies during twenty-five
days by M. B. Gilbert is as follows: The average increase in the
normal chest measure, from half an inch to one and a half inches;
with the chest inflated, from half an inch to one and three-fourth
inches.

The foundation for this coördinate work, from which an unlimited
variety of the most valuable developing exercises is formed, consists
of the long-established five positions of the feet and five positions
of the arms, together with positions of the whole body, known as
attitudes, arabesques, poses, elevations, groupings, etc. From these
precepts are established, whereby steps, attitudes, and motions are
systematically arranged, according to the method, and in strict
harmony with time and cadence of music.


[Illustration: Fig. 70.—Figures of the dance. Second position of
hands; second position of right foot.]

[Illustration: Fig. 71.—Figures of the dance. Third position of
hands; third position of right foot.]

[Illustration:

  Fig. 72.—Figures of the dance. Third position (“amplified”) of
  hands; fourth position of right foot, in _front_. N. B.—When the
  arms are not in motion, the palms must be turned down.
]

[Illustration: Fig. 73.—Figures of the dance. Fourth position of
hands; fourth position of right foot, in back.]

[Illustration: Fig. 74.—Figures of the dance. Fifth position of
hands; fifth position of right foot.]

[Illustration: Fig. 75.—Figures of the dance. Forward balance.]

[Illustration: Fig. 76.—Figures of the dance. Backward balance.]

[Illustration: Fig. 77.—Courtesy.]

[Illustration: Fig. 78.—Highland fling.]

[Illustration: Fig. 79.—Hornpipe step “on heels,” pulling down the
small ropes.]

[Illustration: Fig. 80.—Swedish step from “Kulldansen.”]

[Illustration: Fig. 81.—Circles with hands, from Spanish dances.]

[Illustration: Fig. 82.—Combination of dance steps. First position.]

[Illustration: Fig. 83.—Combination of dance steps. Second position.]

[Illustration: Fig. 84.—Combination of dance steps. Third position.]

[Illustration: Fig. 85.—On the toe tips.]

The freedom given by such dancing softens the crude awkward positions
so universal among young people; the general carriage invariably
improves as the head goes up and the shoulders go back; a more
elastic tread and an easier propelling of the body in walking is
gained. Not only is the chest broadened and deepened, and fat removed
from waists and hips, and weak backs strengthened, but students gain
in quickness of perception, coördination, and judgment, as well as in
agility and power to keep their feet in correct rhythm.

Esthetic dancing is particularly recommended in all factories,
stores, and schools where there are any large number of girls and
women as a recess exercise, because in this way they get a great
deal of vigorous exercise in a very short time. It brings all the
large muscle groups into action, causes a rapid circulation of the
blood, aërates the lungs, and it affords the best possible sort of
a contrast to their monotonous and cramped positions; it is most
exhilarating and it is good fun. It is an excellent mental tonic and
physical invigorator; it brightens the day, and enables the women to
do better work.


FIGURES OF THE DANCE WITH SOME SIMPLE EXERCISES

=Fundamental Positions of the Hands and Feet= (Fig. 69).—_First
Position of the Hands and Feet._—Stand erect, resting on the balls
of the feet, with the chin up and the chest high; arms straight
down almost touching the body; hands about 6 inches apart, slightly
curved, palm toward palm; the thumb opposite the middle finger,
elbows held slightly away from the body as in the figure. Stand with
the heels together and the feet turned out so as to form a right
angle.

_Second Position of the Hands and Feet_ (Fig. 70).—Move the hands
and arms away from each other until the hands are about 3 feet apart
as in the figure. Move the right foot directly to right in line with
left foot and about 12 inches away from it; toe touching floor,
instep well arched, heel raised and kept turned toward left heel as
in Fig. 70. Counterpart for left.

_Third Position_ (Fig. 71).—Bring the elbows up until they and the
hands are in line with the shoulders, fingertips almost touching
across chest, palms toward the body as in the figure. Move the right
foot forward until the right heel is in the hollow of the left foot
and at right angle to it as shown in the figure. Then move the right
foot back of the left until the hollow of the right foot is back of
the left heel. Notice that the feet should touch closely and the legs
be very straight. Counterpart for left foot.

_Third Position of Hands Amplified_ (Fig. 72).—Extend the hands to
the sides in a straight line with the shoulders; if this position
is to be maintained turn the palms toward the floor, with the thumb
under the middle finger.

_Fourth Position of the Right Foot in Front_ (Fig. 72).—Move the
right foot directly forward about 12 inches in front of the left
foot, as in the figure, toe touching the floor, heel raised; instep
arched. Counterpart for left foot.

_Fourth Position of Hands_ (Fig. 73).—Move hands and arms up until
the hands are about 3 feet apart above the head; palms toward each
other, arms nearly straight as in the figure.

_Fourth Position of Right Foot in Back_ (Fig. 73).—Move right foot
about 12 inches back until in line with left foot, toe touching
floor, heel raised as in the figure. Counterpart for left foot.

_Fifth Position of Hands and Feet_ (Fig. 74).—Move hands more closely
together until about 6 inches apart; palms toward each other and the
arms very slightly bent as in the figure.

The right toe touches the left heel in back, or right heel touches
left toe in front as in the figure. The feet are at right angles.
Counterpart for left foot.

_Elevated Position of the Feet._—The second and fourth positions
may be elevated by extending the leg and foot at right angles to
the body. See Figs. 70, 72, 78, 82, 83, and 84. The third and fifth
positions become elevated by raising the foot, toe pointed to the
floor, as in combination of steps, Figs. 78 and 82.

N. B.—In elevated positions the toe must be extended so that the foot
and leg form a straight line.

=Simple Exercises Using the Fundamental Positions.=—Stand with feet
in first position; hands in first position (Fig. 69).—_Exercise
1._—Move right foot to second position (Fig. 70), and back to first
position four times. Left foot the same.

_Exercise 2._—Move right foot from fourth position in front (Fig. 72)
to fifth position in front (Fig. 74). Repeat four times. Right foot
in back (Fig. 73), fourth to fifth, four times. Left foot in back,
fourth to fifth, four times.

_Exercise 3._—Move right foot from second position to third in front,
to second, to third in back. Repeat four times. Left foot the same.

To make the exercise more difficult, hold the skirt extended with the
hands in the second position (see Fig. 77). Or arms extended in third
position amplified, palms down, which is very difficult.

Music in 6/8 time will add interest.

=Arm Movements.=—_Exercise 4._—Move hands from first position to
second and back to first. Repeat four times. N. B.—Draw the hands
away from each other by the wrists, and toward each other by the
wrists. The hands should move as though trailed through water.

_Exercise 5._—Move the hands from the third position, to the third
position amplified, and back again to third (Figs. 71, 72). Repeat
four times. N. B.—Move to third position from first position. Do not
go directly from the first position to third position amplified, but
through third position in front.

_Exercise 6._—Move hands from fourth to fifth position, four times.

_Exercise 7._—Move right hand to fourth position, left hand to second
position, starting from third in front, back to third position.
Repeat four times. Change hands, moving right to second, left to
fourth position.

Use slow rhythmic waltz music for exercises 4 to 7.

=Combination of Hand and Foot Movements.=—Waltz music at first and
later 6/8 time.

_Forward Balance_ (Fig. 75).—Step forward on right foot, left foot
extended in fourth position back; right hand in fourth position, left
hand in second.

_Backward Balance_ (Fig. 76).—Step back on the left foot, raising the
right foot in elevated third position in front; right hand in third
position in front of waist, left hand in fifth position. Counterpart,
starting with left foot.

_Courtesy_ (Fig. 77).—Grasp the skirt lightly at either side between
the fingers, keeping the backs of the hands forward; hands in second
position. Point the right toe in second position. Count, “One, Two.”
Lifting the heels, turn on both toes until you face toward the left.
Count, “Three, Four.”

Place the left foot in fourth position back of right foot, bending
both knees as if you were sitting down. Count, “Five, Six.” Slightly
spread the skirt. N. B.—Keep the body erect from the waist up.

Rise to the standing position, drawing the right foot backward into
the first position. Count, “Seven, Eight.”

Counterpart for Courtesy to the left. Music, Gavotte or Schottische
played slowly.

_Highland Fling Step_ (Fig. 78).—Point right foot to second position,
right arm is bent at elbow and wrist, left arm is almost in fifth
position. Hop on left foot, at the same time bringing right foot in
very elevated fifth position back of left knee. Hop on left foot
bringing right foot in front of knee; hop on left foot bringing
right foot back of knee again. Repeat to the left with hands in
corresponding positions.

_Hornpipe Step_ (Fig. 79).—Keeping feet in first position, walk
forward on the heels very quickly, taking steps of about 1 inch in
length. Look up and with the hands keep pulling down an imaginary
rope, moving one hand constantly above the other.

_Swedish Step from “Kulldansen”_ (Fig. 80).—Place right heel in
second position, arms in second position modified. Bow to the right,
bending at the waist. Repeat to the left with the left heel in the
second position, right foot in first position. Repeat several times.

_Spanish Circle with Hands_ (Fig. 81).—Kneel on the left knee. With
both hands make circles going from left to right, sweeping from third
position at floor level to fifth position and back again, four times.

_Combination of Dance Steps—First Position_ (Fig. 82).—Left foot in
fifth position front. Swing the left foot in circle to fifth position
in back. Right hand holding skirt in third position in front, left
hand holding skirt in third position amplified.

_Second Position_ (Fig. 83).—As left foot arrives in back of right,
swing arms to third position amplified. Move the left foot to second
position.

_Third Position_ (Fig. 84).—Move the left foot to the fifth position
in front, kicking the right foot in second position elevated. Right
hand in third position; left hand in third position amplified.

_Pose on Toe Tips_ (Fig. 85).—Rise on the tips of the toes, the feet
as close together as possible, bringing the hands from the first to
the fifth position.

When the pupil has mastered these very skilfully arranged series of
dancing poses, steps, and exercises _she has learned how to dance_;
that is, she is in a position, after watching any new dance for a
short time, to go on the floor with a leader.

Women in the prime of life will be interested to know that in twenty
lessons of one-half hour each, given at the Women’s University Club
under the able instruction of Miss Rabinovitz,[8] to a class of women
ranging in age from thirty to fifty years, two-thirds of whom had
either never learned to dance or who had not danced since childhood,
not only learned the above various dancing steps and exercisers, but
also the following dances.

The Folk Dances were: The Tantouli (Swedish); Ace of Diamonds
(Danish); Reap the Flax (Swedish); and the Sailor’s Hornpipe
(English). This last dance was especially for the very excellent
exercise which it afforded. The Minuet was taught for form, grace of
movement, and exercise. There were also taught the Hesitation Waltz,
the Maxixe, and the Lulu Fado.

=Outdoor Exercise.=—Outdoor exercise must be regarded as one of the
essentials to good health, and as such must be classed with food,
clothing, bathing, and sleep.

In addition to the beneficial effects of exercise on the muscles,
circulation, and all the functions of the body, are the soothing
effects of outdoor life on the nerves. It is only out-of-doors, in
the parks, in the country, or by the sea that one is soothed into
entire oblivion and forgetfulness of the cares of life, and to such a
degree that the individual may be said to be hypnotized by the powers
of nature, so that the mind is almost as perfectly at rest as in a
sound sleep.

The time spent out-of-doors should not be less than two hours daily.
Actual experience of busy workers will prove that not only is this
time not lost, but that actually more and better work can be done
in the day, and that the resulting improvement in the general
health will be so great that much less time will be lost through
indisposition and actual sickness, so that the daily outdoor exercise
will be found to be a great economic gain.

Outdoor exercises, such as walking, running, swimming, and hill and
mountain climbing, possess the very great advantage that indulging in
them demands no expense, and are, therefore, open to all. All these
exercises develop the lungs and chest and strengthen the heart, and
are, therefore, classed under exercises of endurance.

=The Effect of Walking on the Heart and Lungs.=—In a slow walk the
respiratory action is almost double the ordinary amount; in walking
at an ordinary pace, that is, about three miles an hour, it is four
times as great; while in a vigorous or hasty walk, that is, at a rate
of from four to six miles an hour, it is from seven to nine times as
great.

The change of speed from three to five miles an hour elevates an
automatic, listless occupation into a vigorous exercise, employing
many new muscle groups and stimulating the heart, lungs, and skin,
while the change from a smooth, level road to the broken ground of
the mountain-side may be dangerous for many a one who is able to walk
at a moderate speed on level ground.

In walking the clothing must be sufficiently loose not to interfere
with the more rapid respirations and the increased action of the
heart. When the heart cannot keep pace with the demanded speed of the
circulation, a “stitch” ensues, and getting one’s second wind means
that the heart has succeeded in accommodating itself to the strain.
Too great a “stitch,” resulting in absolute breathlessness, is a
warning that must not be disregarded.

This increase in the respiratory action is important, as compared
with the brief and transient increase from exercise with apparatus,
because a quick walk can easily be kept up for several hours.

The fatigue is small, because, in the first place, of the abundant
supply of oxygen; the will is scarcely used, and walking is almost
automatic, partly because the muscle areas used are large, and each
movement prepares for the next. Walking is a heart and lung exercise
of a very excellent sort.

_The Effect of Walking on the Movements of the Blood in the
Legs._—The circulation of the blood depends on the pumping of the
heart, which is in turn affected by the suction action of the lungs
and the muscular movements of contraction and relaxation which go
on rhythmically. While in prolonged standing the veins of the legs
become fuller, and the circulation of blood in them more sluggish,
and by the laws of gravitation the blood is kept down in them. Hence
also in walking slowly with short steps the legs remain overfull of
blood and become heavy. Instead of being quickened, the circulation
is actually hindered, for the waste-products are not carried away
quickly enough. Hence, slow walking soon causes a feeling of fatigue,
while the vigorous walker, going along with long strides, keeps fresh.

_Rules for Long Walks._—In walking, not only the distance should be
taken into account, but the character of the road and the incline
of the ascent. A distance that could be easily covered on a smooth,
level highway may mean double the expenditure of muscle and nerve
force if the ground is sandy or very damp. Other hindrances to be
taken into consideration are opposing winds, not only because of the
resistance, but also because of the inhalation of dust and rain.

The walk should be occasionally broken for short periods of rest. The
pauses should be short, about five minutes, and during this time the
body should be erect. Experience proves that sitting down makes one
more tired on getting up again. A short halt should be made before
climbing a steep ascent, so as to begin with fresh strength and easy
breathing, as this means increased work for the heart and lungs.

In starting out for a walk, one should begin slowly, and gradually
increase the pace, and in returning the same rule should be observed.

=Running.=—The force exerted in running is enormous. In running it is
the length of the step more than anything else which increases the
speed of the run; hence, the runner should learn to take long steps.
But the greatest speed can only be kept up for a limited time; the
distance is one hundred yards.

Running is the most effective of all exercises of speed, and, like
all exercises of speed, can be changed into one of endurance by a
certain moderation in the pace. By running the heart and lungs are
developed more than by any other exercise.

_Age Limit for Running._—All ages are not equally well adapted for
running: they do not all share in its good results. Running is best
for all young people, before and at the age of puberty. Running is
then quite a necessity. The growing child is always ready for a run.
From the fortieth year on running, as an exercise of speed, becomes
less and less desirable, and, when the organs of circulation or
breathing are impaired, it must be absolutely forbidden.

In running always begin slowly—running moderately, for instance, for
fifty feet; then increase the speed gradually, but when running for
exercise, never speed to the utmost, as this is not necessary for
the benefits of the exercise. Always close the run with the same
moderation with which it was commenced; that is, never stop short, as
this sudden arrest of action gives a most undesirable shock to the
heart. The movements of running may easily be imitated in the house,
while standing in one place, and simply lifting the feet in the same
quick alternation from the floor.

=Mountain Climbing.=—The advantages of mountain climbing are
manifold. The weight of the body has to be carried up a certain
height. To accomplish this the work of the muscles is increased;
the breathing must be deeper to satisfy the increased demands for
oxygen; fresh air is admitted into the apices of the lungs, which do
not, as a rule, participate in respiration. A more powerful action
of the heart takes place, but care must be taken that this is not
carried too far. Slow climbing, without any unnecessary waste of
energy and with appropriate pauses, to allow the heart to recover,
is advantageous. One should not talk too much while climbing. The
dress should be suitable; the neck must be free and the shoulders not
heavily weighted, so that they may be drawn back and the chest fully
expanded.

=Swimming.=—Of all outdoor exercises for women, swimming is one of
the most perfect. It not only calls into vigorous action most of
the muscles of the body, but spares many of those muscles which are
so commonly overworked, most of the work being performed by muscles
which are so little used as to have become weak and flabby.

For instance, the extensors of the fingers and the hand, that are
so constantly stretched in sewing and writing, are in constant use
in swimming, while the corresponding flexors, the slaves of the
needle and the pen, are relaxed. Again, the muscles passing from the
shoulder-blades to the trunk, on which depends much of the erect
carriage and strength of the chest, which have become wasted from
disuse while the woman sat at the desk or bent over her sewing, are
the very muscles by which the movements of the upper half of the
body are executed, while all the muscles of the lower extremity are
brought into use. Of especial value is the free movement of the
hip-joint, a joint that is seldom moved with any degree of freedom
from the time a girl leaves climbing trees, unless she has the
advantage of special gymnastic training. The vigorous action demanded
of the respiratory muscles greatly increases the chest capacity.

The body is lighter than the water, and is perfectly supported by it,
so the weight is taken off the spine, and the muscles of the back
are relieved from their normal state of tension. The head is the
only part of the body that is held up by muscular action, and, in
floating, even this is supported by the water.

The disadvantages arise from the fact that the temperature of the
water is very much below that of the body, so that there is a greatly
increased conduction of heat from the body, and, unless this loss is
made good by exercise, there is very great danger of a chill. In most
persons a prolonged stay in cool or cold water produces a liability
to cramp.

During the month of August the temperature of the ocean reaches its
maximum of 66.65° F. This is about 32 degrees below the temperature
of the body. Upon entering the water the first effect noticed
is a sensation of cold; this varies with the susceptibility of
the individual, and the difference between the temperature of the
water and the surrounding air. The skin assumes the appearance of
“goose-flesh,” the face is pale and anxious, and the lips are blue;
the pulse decreases in frequency, a sense of oppression is manifest,
and there may be spasmodic shivering; that is, the first effect of
immersion is to cause a contraction of the blood-vessels of the
surface of the body. This should be quickly followed by a secondary
reaction, in which there is a sensation of warmth, a quickened pulse,
and an increase of energy. When, by taking the proper precautions,
this reaction does not occur, it is a contraindication to sea-bathing
and swimming.

If the immersion has been too prolonged, there is a second sensation
of chilliness, a signal that the bather must leave the water at once.

The best time for bathing is between eleven o’clock in the morning
and four in the afternoon, depending on the tide. No one should
go into the water within two hours after meals, nor should she on
leaving the bath proceed at once to the table, since digestion draws
the blood from the periphery to the stomach, and to eat immediately
after bathing is to lose most of the benefit of the saline treatment.

All should avoid cold-water bathing when fatigued, and swimmers ought
to pay especial attention to this point, on account of the demand
they are going to make on their muscular system; and on no account
must one enter the water when in a perspiration; a moderate walk
along the shore should be taken until the perspiration has subsided.
These precautions are of the highest importance, and disregard of
them may prove fatal.

Enter the water quickly until it reaches the waist, then plunge
headlong, or cover the body to the neck. Care should be taken to wet
the chest and abdomen immediately on entering the water, since these
parts are the most sensitive to the impression of cold.

Every one should learn to swim, and those who cannot must move the
arms and legs about vigorously. The duration of the bath should
depend on the state of the health of the individual, on the state of
the weather, and on whether the water is rough or calm. The average
duration of the time spent in the water should be from three to
fifteen minutes, the latter being the maximum time for any one. No
benefit will accrue from spending a longer time than this in the
water, and much harm may result.

The sea-bath should be followed by moderate exercise, in order to
insure a perfect reaction, and to aid in expending the superfluous
energy which sea-water imparts.

Swimming and sea-bathing should be avoided by persons who have weak
hearts and a poor circulation, in whom the reaction after a plunge
into cold water is never well established. Also by persons with heart
or kidney disease, and by all feeble and old persons.

Persons with feeble constitutions, but with no actual disease, as in
various forms of nervous disorders, insomnia, etc., generally derive
marked benefit from sea-bathing.

Persons who are weak should walk and not plunge into the water. As in
all other exercises, a determination on the part of the weak to equal
the strong is a fertile cause of mischief.

=Horseback Riding as an Exercise.=—The advantages claimed for
horseback riding are that it acts on nearly every muscle of the
body, while the mind is interested and refreshed. An insuperable
disadvantage to the majority of women living in large towns and
cities is the enormous cost of the exercise.

The value of horseback riding for women has been greatly diminished
by the very faulty position caused by the side-saddle, which produced
a cramped position of the body and a tendency to lateral curvature
of the spine. Then, too, women ride too tightly corsetted, thereby
preventing much good that would otherwise accrue to the circulation
and digestive organs.

When the woman rides astride, the body is held erect and in a
natural position, and she sits much more firmly on her horse and,
if not corsetted, it becomes an exhilarating and delightful form of
exercise. The best results will probably be found in a neurasthenic
class of women, who are not strong enough to take more active
exercise, and for them it will be of decided therapeutic value to
both mind and body.

=Rowing.=—This is one of the most beneficial of exercises; it has
the advantages of scenery, freedom from dust, and companionship; it
exercises equally both sides of the body and most of the muscles. It
is an excellent exercise for strength, rapidity, and endurance.

In correct and graceful rowing there is a pendulum-like movement from
the hips. The rower should sit with the trunk fully extended, the
head up, the eyes to the front, the chest thrown forward, and the
weight of the trunk equally distributed upon the two sides of her
seat. The feet rest against the stretcher, the two hands should be
near together, and should be held symmetrically at an equal distance
from the body.

_Stretching._—The body and extended arms are brought forward as far
as possible. The spinal column should be kept extended, not bent so
as to make a crooked back, and the trunk should be thrown forward
from the hip-joints. When the stretch has reached its forward limit,
the oar is dipped into the water just far enough to cover it; then
immediately the pull begins, and it must be continued evenly to the
end.

_The Pull._—The body rises erect from the hips and swings backward.
The hands should not reach the front of the chest until the body
has passed the perpendicular and is sinking back. When the pull is
finished, the hands are dropped and suddenly bent toward the wrists.
This lifts the oar out of the water, and keeps its lower surface
parallel with it; during the stretching forward, the oar is kept
parallel with the water, so that it has not much resistance from the
air.

The muscles brought chiefly into play are the long muscles of the
back in the backward swing, and the abdominal muscles in the forward
swing. But the muscles of the pelvis, thighs, and legs all have to
work, likewise the muscles of the arms, chest, and shoulders. And
it is one of the best exercises for developing the lungs and chest,
as well as of strengthening the heart. Fatigue will be felt most in
the muscles of the legs, hips, and arms, but the exertion is so well
distributed that it causes much less fatigue than would otherwise be
the case.

=Athletic Sports.=—Athletic sports possess three distinct
advantages—they are played out-of-doors, and give an incentive to
taking the proper amount of exercise; they are all team games, and so
develop the social and coöperative spirit; and last, but by no means
least, they afford a great deal of amusement and real recreation.

Formal and systematic gymnastics are essential for the development
of the body and the correction of its defects; out-of-door exercise
is excellent, but the solitary walk, climb, swim, or row leaves
much to be desired, while in walking especially the mind is free
to pursue the same trains of thought which with it was occupied at
the desk, and so it fails to be properly refreshing to the mind and
body. Whereas in all athletic sports the ego has to be pushed into
the background, with all its interests; the day’s work left behind,
and the entire attention concentrated on the play. This is a very
distinct advantage to the individual.

Women at all ages take themselves and life too seriously. This is in
all probability due to a defective early education; between the long
school hours, home study, housework, and sewing, they had neither
time nor opportunity to cultivate a love for play and games, and so
the play instinct was not developed, and if not developed in youth,
the chances are that it never will be. In middle and advanced age,
when the stress and storm are at their height, nothing is so sure
a restorative to overtaxed brains and overwrought nerves as games,
sports, and a love of fun.

As a result of our unnatural mode of life in youth, it has come to
pass that American women especially have been defrauded out of their
birthright of the love of games and sports. Athletic games and sports
are as essential to a scheme of education as are reading, writing,
and arithmetic.

Other distinct advantages accruing to athletic games are that here
the individual becomes acquainted with her powers and weaknesses.
In formal gymnastics the movements follow each other in a regular
sequence, through lines already carefully laid out; in games, on the
contrary, no two plays or combination of plays are exactly alike.
One can never tell what her opponent is going to do, and yet what
one’s opponent does is so vital to the success or failure of the game
that the player must decide quickly and accurately how that move in
the game can best be met, so that intense concentration, quickness,
alertness, prolonged attention, self-control, and even self-sacrifice
are called for, for in the team game the individual interests must
be submerged, in order that the side may win; and so the individual
power, sense of responsibility, and an _esprit de corps_ are
developed, in a manner almost impossible in the same degree in any
other way.

The principal outdoor games for women are croquet, lawn-tennis,
hockey, golf, hand-ball, basket-ball, baseball, boxing, and fencing.

=Croquet.=—Of all these games, croquet is the mildest, and for that
reason is a good beginning game for a woman who has always led a
sedentary life, or for a woman who has become enfeebled through
serious illness. It is also an excellent game for old age.

To be beneficial and not detrimental, the exercise must be very
gradually increased, both in the length of time occupied and in the
vigor of the movements. The muscles must be slowly built up and
improved in tone, the lungs developed, and the heart strengthened.

Another advantage of croquet is that it is inexpensive and requires a
limited amount of ground.

=Lawn-tennis.=—Tennis is a much more violent exercise than croquet,
and is a game for young people and youth. Now, as to just what
constitutes youth: it is altogether a question of the condition of
the arteries, heart, and muscular system, and is not a question of
years _per se_.

The game is moderately expensive; played with four, it is not at all
violent. It is an excellent game for social purposes, and can be kept
up until late in life, but it cannot be begun late in life. It has
just the proper amount of variety, activity, and endurance to suit
hundreds of people for whom croquet would be too mild, and for whom
ball-games would be too severe.

=Golf.=—Golf is deservedly a very popular game at all ages. Perhaps
the greatest drawback for the city dweller is the inaccessibility of
the golf links and the great expense of the game.

It combines scenery, walking for several miles, some hill climbing,
and a considerable amount of exercise for the right side of the body,
particularly for the right arm, and the muscles of the right side of
the back and chest. The great drawback, from the physical standpoint,
is an overdevelopment of the muscles of the right side of the body,
which, in the majority of people, are already better developed than
those of the left side; the muscles of the left side of the body are
brought very slightly into play.

While the distinct advantages of the game are combined with walking,
the healthy body swings, the accuracy needed in making the drives,
the distance of the drives, the variety of implements as well as of
stroke, and many other features, and, further, it is a game that
keeps one pleasantly employed in a company of one’s choosing for
several hours.

=Hockey.=—Hockey is among the finest of games for most young people,
and should rank at least third among games. It has most of the
advantages of foot-ball, and many of the advantages of cricket. It
involves a considerable amount of running and a great deal of real
sport and fun.

=Basket-ball.=—This is another of the most popular games for young
people, and possesses in a very great degree all the advantages
of a team game. The confidence that follows a successful throw
proves of considerable value, unless it leads to the carelessness
of overconfidence. Faith in the ability to get out of a desperate
situation in the tossing increases with success. This leaves the
attention imperturbed, and one does not go to pieces. According
to Mosso, movements develop the brain, and it has been repeatedly
noticed that intelligence in animals increases with the increased
motility of their extremities.


FOOTNOTES:

[8] Superintendent of Dancing, New York Public Schools.




INDEX


  Abdomen, protuberant, 344
    causes of, 344
    treatment, 45, 52, 298, 344

  Abdominal exercises, 344, 346, 348
    muscles, 344
      development of, 344, 346, 348
      flabby, 147
      function of, 146, 344

  Ablutions, 33, 34
    cold, 34
    hot, 33

  Acne, 65-67
    causes of, 65
    treatment, 66

  Air, amount breathed daily, 145
    “bouquet” of, 149
    chemical properties of, 149
    country, 149
    degree of moisture for house, 155, 156
    impurities in, causes of, 152
      cumulative effects of, 152, 153
      injurious effects of, 153
    indoor, 151
    infection of, 150
    overheated, injurious effects of, 155
    pure, test of, 153
    town, 149

  Air, vitiation of, from combustion of lights, 152
      from respiration, 152
      from unhygienic conditions, 152

  Alcohol, 127-135
    absorption of, 129
    anemia from use of, 131
    as a food, 127, 128
    cumulative effects of, 128
    narcotic effects of, 128
    physiologic action of, 127-130
      obesity caused by, 132
      on blood, 130
      on brain activity, 134, 135
      on digestion, 129
      on heart and blood-vessels, 132
      on kidneys, 133
      on liver, 130
      on metabolism, 129
      on muscular system, 133
      on nervous system, 127, 134, 193
      on oxidation, interference with, 131
      on self-control, 135
    rub, directions for, 35

  Alcoholic beverages, amount of alcohol in, 128

  Alimentary canal, 80
    microörganisms of, 220

  Ambition, excessive, 234, 244

  American men, improved physique of, 287
    women, inferior physique of, 284

  Amino-acids, 94, 105

  Ammonia, aromatic spirits of, dose of, 218

  Amylase, 94

  Amylopsin, 94

  Anabolism, 99

  Anemia, causes of, 153

  Anger, injurious effects of, 245

  Animal food, 110

  Anxiety, injurious effects of, 246

  Arteries, description of, 139
    effect of cold on caliber of, 29, 30, 140
      of muscular work on caliber of, 139

  Astigmatic chart, 208

  Astigmatism, correction of, 208
    injurious effects of uncorrected, 208, 343
    test for, 208

  Athletic games and sports, 318, 322, 370-373
    advantages derived from, 318, 370-373
    and municipal governments, 318
    basket-ball, 373
    benefits of, 319, 320
    best suited for women, 321, 322
    croquet, 371
    ethical value of, 318-321
    hockey, 372
    lawn-tennis, 371

  Attitude, correct, at desk, 165
    in standing, 340
    faulty, injurious effects of, 164, 342, 343

  Auto-infection, 170

  Auto-intoxication, 102

  Autosuggestion, 244

  Avocation, 198-200
    nature of, 198
    physiologic necessity for, 200


  Back, muscles of, 301, 302
    exercises for, 345, 346, 350, 351
    function of, 301, 302

  Bacteria, action of sunlight on, 151
    intestinal, 97
    rôle played by, 150

  Bacterial flora, 159, 220

  Baldness, causes of, 72
    treatment for, 72-74

  Basket-ball, 373

  Baths, action of, in health, 23, 58
    alkaline, 37
    cold, 29-33
      contraindications to, 31, 37
      heat loss in, 30
      physiologic effects of, 29
      reaction after, 30, 31
      tonic effect of, 29, 32, 33
      training for, 59, 60
    dip, 36
      contraindications to, 37
      duration of, 36
      temperature of, 36
    effects of, 23
    electric-light, 44-46
      directions for, 44, 46
      indications for its use, 45, 222
    foot, 39
      directions for, 39
      indications for, 39
      mustard, 183
    friction after, 31
    hot, 28, 29
      effects of, 28
      reaction after, 29
      restorative effects of, 29
    neutral, effects of, 29, 33
      temperature of, 29
    proper time for, 59
    Roman, 43
    Russian, 42
      contraindications for, 43
      indications for, 43
    saline, 37
      as cleansing agent, 38
    salt ablution, 41
      indications for its use, 41
      method of taking, 41
    shower, or rain douche, 38, 39
      cold, 38, 39
      directions for, 38
      effects of, 39
      hot, 38
      indications for, 39
      neutral, 38
      temperature of, 38
    sitz, 40
      duration of, 40
      indications for, 41
      temperature, 40
    sponge, 33, 34
    tub, 34, 36
      full, 36
        contraindications to, 36
      half, 35
      temperature of cold, 36
      of hot, 36
      of neutral, 36
    Turkish, 42-48
      contraindications for use of, 44
      essential features of establishment, 42
      indications for its use, 44
      loss of weight from, 46
      method of procedure, 42, 43
      necessity for cold water drinking, 42
    varieties of, 33

  Bathtub hose, fallacy in use of, 39

  Bedrooms, ventilation of, 156

  Bile, action of, 92

  Bladder, 179
    capacity of, 179
    frequency of emptying, 179
    location of, 179

  Blood, 142
    corpuscles of, 130, 142
    distribution of, 142
    functions of, 26, 130, 142
    length of time for passage through body, 141
    thinness of. See _Anemia_.
    vascular areas of, 27, 29

  Body, balance and carriage of, 308, 322, 355
    common defects in, 309
    fatigue of, 193
    position of, 164, 165

  Boracic acid, solution of, 214

  Boxing, 353

  Brain and nervous system, 184-188
    blood supply, during sleep, 193
    development, of 189, 228-230, 233, 241, 295, 320
    fatigue of, 185
      effect of body fatigue on, 194, 221, 316, 317
    functions of, 184
    habit and automatism, 186
    master organ of body, 184
    physiology of, 187
    repair of, 185, 186
    rest of, 193, 197
    workers, average of life of, 233

  Brains vigorous and strong bodies, 290, 292

  Breathing, art of, 167
    difficult, treatment of, 167
    exercises. See _Respiratory_.
    normal, 166
    types of, 167

  Bromid mixture, prescription for, 218

  Bronchial tubes, 143

  Bronchitis, cause of, 150
    chronic, cure of, through exercise, 168, 169


  Capillaries, 139

  Carbohydrates, absorption of, in intestines, 95
    as protein protector, 100
    physiologically economic, 107

  Carriage, good, exercises for, 348, 354

  Cataract, 215

  Character, formation of, 231, 238, 241
    influenced by example, 228, 238
    mental poise, 234
    power of will, 242

  Cheese, indigestibility of, 112

  Chest, description of, 138
    development of, 344, 356, 362
      exercises for, 346, 349, 351, 353, 354
      importance of good, 147
    flat, causes of, 165, 261, 265, 309
      corrective exercises for, 165-168
    measurements minimum under arm, consistent with good health, 147
      relation between height, weight, and, 148

  Chest weights, exercises with, 353, 354
    for arms, 354
    for chest expansion, 354
    for shoulders, 354
    rules for taking, 353

  Chilliness, cause of, 146

  Chlorids, 101

  Chyme, 90

  Circulation, maintenance of equilibrium, 143
    mechanics of, 138-142

  Circulatory apparatus, 139
    system, 137

  Clothing, measurements for, 164
    suspension of, from shoulders, 164, 282

  Clouston, necessity for definite occupation, 248

  Clubs, literary, 199
    women’s, benefits of, 199

  Clysters, colo-, 53
    directions for, 53, 54

  Cold, effects of prolonged application of, 30
    physiologic effects of, 29-32, 139, 140
    reaction following, 30, 31
      condition unfavorable to, 31
      how promoted, 30, 31
      injurious effects following poor, 32
    tonic effects of, 32, 33

  Colds, causes of, 151, 153, 156
    common, 170
    contagiousness of, 163
    frequency of, 170
    reinfection from, 170
    relation of, to influenza, 169
      to pneumonia, 169
      to tuberculosis, 169
    treatment of, 145, 170, 171
      prescription for, 171
      quinin in, 171

  College life, advantages of, 232, 233
    discipline of, 233
    Vassar, 235
    woman’s medical, 235

  Coloclysters, directions for, 53, 54

  Colon, 96

  Color blindness, 215

  Complexion, 57, 58
    care of, 61-63
    good, 57, 58
    sallow, 64

  Conjunctivitis, causes of, 213
    granular. See _Trachoma_.
    symptoms of, 214
    treatment of, 214
      acute, 214
      chronic, 214

  Constipation, 102
    causes of, 103, 104, 344
    chronic, 104
      injurious effects of, 220
        appendicitis, 102
        autointoxication, 102
        hemorrhoids, 102
        uterine displacements, 102
    treatment, 52-54, 103

  Corns, treatment, 79
    varieties, 78

  Corsets, 255, 256, 275
    abdominal, 269, 270
    crusade against, 259
    curved front, 261, 262
    directions for adjusting, 274
    effect on lung capacity, 261, 262
      on muscles, 264-268
      on thorax, 260
    history of, 257-259
    hygienic, 269
    influence on female body, 260-270
    injurious effects of, 260-269
    relation to abdominal and pelvic disorders, 262-264
    straight front, 268, 269
    tight lacing and, 260, 261, 274
    wearing by young girls, 270-272
    what style is least injurious, 272-274

  Cosmetics for the face, 63, 64

  Cough, function of, 169

  Country folks, outings by, 200
    recreations for, 199

  Crampton, Dr., and school athletics, 287

  Croquet, 371


  Dance, arm movements, 359
    combination hand and foot movements, 360
    figures of, with simple exercises, 357
    fundamental positions of hands and feet, 357
    simple exercises, using fundamental positions, 359

  Dancing, 289, 326
    aim of, 354
    benefits of, 354-357
    esthetic and classic, 354-357
    requisites for, 354
    society, 355

  Dandruff, 70-72
    causes of, 70
    contagiousness of, 71

  Deafness, causes of, 163
    prevention of, 163

  Debility, signs of, 216

  Desk, correct attitude at, 165

  Development, necessity for good, 298, 311, 314
    symmetric, 292, 315

  Diaphragm, 141, 142, 144, 261
    relative importance of, 144, 147, 262

  Diet, balanced ration, 115
    finical, 172
    importance of fats in, 107, 112
      of varied, 116
    in sedentary occupation, 113
    in tropics, 121
    maintenance, 109
    practical facts for guidance, 115
    regulation of, with reference to minimum expenditure, 122
    relation to various conditions, 112
      brain workers, 113
      children, 113
      muscular work, 113
      sex, 113
      temperament, 113
      tuberculosis, 172

  Dietaries, balanced ration, 115
    in health, 66
    in tropics, 121
    practical facts for guidance, 115
    standard, 109

  Dietetics, defined, 109

  Digestion, defined, 80
    controlling factors in, 83
      mechanical, 87
      psychic aspect, 85
        tone, 87
    gastric, 89
      absorption of food, 92
      chemical changes, in, 98
      mechanics of, 90
    intestinal, 92
      absorption of food, 94
      bacteria, 97
      mechanics of, 96

  Digestive fluids, 92-94
      bile, action of, 92
      gastric juice, 89
      intestinal juice, 92
      pancreatic, 93
      saliva, 88
      succus entericus, 94
    system, 80
    tract, 80

  Discipline, 228, 229, 232

  Disinfectants, carbolic acid, 175
    formaldehyd, 174, 175
    sulphur, 174

  Disinfection after tuberculosis, directions for, 174, 175

  Douche, 46-48
    application of, mass, 47
      pressure, 47
      temperature, 47
    cold, contraindications to, 48
      long applications, 47, 48
      mechanical effects of, 47
      physician’s prescription for, 48
      physiologic effects of, 48
    fan, 47
    horizontal jet, 47
    neutral, indications for, 48
    rain, 38, 39
      directions for, 38
      effects of pressure in, 39
    rationale of, 47
    Scotch, 47
    temperature and its effects, 47
      neutral, 48

  Dress and woman’s physical deterioration, 252-282
    corsets, 257-275
    gymnastic, 336

  Dress, history of woman’s, 252-259
      French, 255-259
      Greek, 252-254
      mediæval, 254-256
      renaissance, 256, 257
      Roman, 253, 254
    shoes, 275-277
    street, winter, 282

  Drudgery, joyless, 198

  Dust, its relation to disease, 149


  Ear, 162
    ache, treatment of, 164
    description of, 162
    douching, 56
    wax, 163
      removal of, 163

  Eczema, 65
    chronic, 65
    seborrheic, 71
      causes of, 72
      symptoms of, 71
      treatment, 73, 74

  Education and the health of girls, 234
    college, 232
    discipline, 232, 233, 320
    effect on home, 237
      on physical health, 234, 236
    higher, of women, 234-237
      President Eliot on, 235-237
    mental development, 228-232, 320
      faculties, balancing of, 234
      habits, 186, 187
    moral sense, 230, 231
    physical, influence on health, 310-316, 324
    religious instincts, 231
    self-control, 229
    truthfulness, 228, 229

  Eggs, digestibility of, 110
    nutritive value of, 110

  Electric-light baths, 44, 46
    comparison of, with other heat procedures, 44
    description of cabinet, 44
    indications for use of, 45
    length of stay in, 44
    reduction of weight through, 46
    symptoms of too prolonged stay in, 46
    treatment, finishing, 45

  Eliot, President, on higher education of women, 235-237

  Emotional nature, 230, 231

  Emotions, depressing, 246
      physical effects of, 246
    the natural, 226, 227, 230, 231
    violent, 243

  Employees, care of, 324, 357

  Enemas, 53, 54
    injurious effect of daily, 54

  Energy, 99

  Environment, 237-240
    friends, 238
    harm done by bad, 238, 239
    literature, 239, 240
    toilet, 237, 238

  Enzymes, action of, 84
    defined, 84

  Erepsin, 94

  Eustachian tube, 162

  Exercise after eating, 316
    after fasting, 335
    and amusement, 357, 370
    benefits, of, 311 312, 313, 323-325
    effects of, on brain development, 291
      on character, 291, 320
      on heart and lungs, 295, 310
      on muscles and blood-vessels, 293, 294, 295, 312
    gradual training in, 312
    heart’s need of, 310
    increase of red blood-cells through, 294
    length of time for, 334, 362
    outdoor, horseback riding, 328, 368
      mountain climbing, 365
      rowing, 369, 370
      running, 341, 364
      swimming, 365-368
      walking, 362-364
    passive. See _Massage_.
    physiology and pathology of, 292, 311, 312
    regularity in, 288, 335, 362
    rules for taking, 334-336

  Exercises, corrective, abdominal, 346, 348, 350, 352
    alternate kneeling, 348
    arms, 351, 353, 354
    balancing, 349
    back, for muscles of, 346, 350-352
    carriage, 348
    chest, 351-354
      for developing various regions of the body, 341-354
      for extending depth of, 349
      forward projection of, 346
    hips, 352
    legs, 347, 351, 352
    poise, 348
    respiratory, 345
    rope pulling, 351
    shoulder-blade, 345, 346
    spine, 347
      squatting, 347
      standing, correct attitude in, 340
      swimming, 351
      thighs, 351
      trunk flexions, 352
        lateral, 349, 352
      waist, 349, 351
    exhaustion, recovery from, 293, 294
    free, rules for taking, 343
      of endurance, 292, 293, 295
      of strength and skill, 292, 293, 295

  Exhaustion, injurious results of, 193, 194, 197, 221
    recovery from, 294
    symptoms of, 194-196

  Eyes, 204-211
    care of, 212
    healthy, 209
    injuries to, 213
    interruption of work of, 209, 210
    protection of, 211
    removal of foreign bodies from, 213.
    See _Visual apparatus_.

  Eye-strain, 204
    general symptoms of, 209
    local symptoms of, 209
    mechanism of, 209
    prevention of, 210


  Face as index of health, 57
    cleansing of, 61
    dryness of skin of, 62
    lotions, 62
    massage of, 67
    powders, 63, 64
    protection of, 63
    steaming, 67
    use of cosmetics, 63
    of soap, 62

  Facial blemishes, 65-67
    eczema, 65
      causes of, 65
      general treatment, 66
    freckles, 64
    liver spots, 64
    pimples and acne, 65
      causes of, 65
      treatment of, 66
    sallow complexion, 64
      treatment, 66
    wrinkles, 67-69

  Far-sightedness, 207

  Fat, 107, 112
    as protector of protein, 100

  Fatigue, undue, 294
    causes of, 199, 303, 304
    danger signal, 193
    economic waste of, 194
    effect of brain, on body fatigue, 316, 317
    effect of, on nerve cells, 192
    mental symptoms of, 192
    muscular, 303, 304
    normal, 192
    recovery from, 294
    toxins of, 190-192, 203
    treatment, 222, 305

  Fear, 227
    forms of, 227
    physical effects of, 227, 244
    universality of, 227

  Feet, care, of, 78
    corns, treatment of, 79
    ingrowing nails, 78
    perspiration of, 78
    protection of, 276, 277

  Female form, relative proportion of, 296
    generative organs, 179
      Fallopian tubes, 179
      function of, 179
      ovaries, 179
      physiology of, 179
      uterus, 180
        functions of, 180
        respiratory movements of, 180

  Fencing, 353

  Food, absorption of, from intestines, 94
      from stomach, 92
    amount required, 104
    animal, 110
    breads, defective method of preparation, 120
    carbohydrates, 107
      physiologically economical, 107
      potatoes, 111
      rice, 111
      wheat flour, 111
    chemical changes in, in stomach, 89
    classification of, 105
    digestibility of, 110
      beef, 110
      buttermilk, 111
      chicken, 110
      eggs, 110
      koumiss, 111
      milk, 111
      mutton, 110
      pork, 110
    economics, 122
      relation to social welfare, 114
    fat, 107, 112
    heat value and digestibility, 110
    indigestible combinations, 119
    influence of, on secretion, 98
    iron, 102
    mineral substances, 107
    preparation of, 119
    proteins, 105, 115
      foods rich in, 115
    values, 124-127
    variety of, 116
    vitamins, 108

  Food-stuffs, carbohydrates, 107
      as protein protectors, 100
    classification of, 105
    daily amount required, 66
    fats, 107, 112
      as protein protectors, 100
    mineral substances, 107
    proteins, 105
      as source of energy, 105
    salt, 101
    water, 100

  Foot, configuration of, 337, 338
    description of, in walking, 338-340

  Freckles, 64

  Friction, mechanical effects of, 31, 306

  Friends, choice of, 238
    molding effects of, 238, 239
    requirements for, 239


  Gaches-Sarraute, Madame, hygienic corsets, 269

  Games as supplement to gymnastics. See _Athletic games and sports_.

  Gastric juice, 89

  Golf, 372

  Greek costumes, 252-254

  Gymnasium in campaign against disease, 323-325
    Vassar College, 325

  Gymnasiums, 336, 337

  Gymnasiums against disease, 312, 313, 323-325
    and factories, 324, 325, 357
    and women’s colleges, 325

  Gymnastic dress, 336

  Gymnastics, benefits from, 314-316
    for symmetric development, 315
    medical, 314
    physical examination for, 326, 327
    practice of, 314
    versus athletics, 313


  Habit and automatism, 186

  Habits and disease, 244
    age limit for, 186, 187
    bad, 186

  Hair, 70-76
    brushing, 73
    care of, 72-74
    cutting of, 74
    dandruff, 70
    description of, 70, 71
    dressing, 74
    gray, 75
      causes of, 75
      treatment of, 75
    premature thinness of, 70
      treatment of, 72, 73
    scalp, dry, treatment of, 74
      massage of, 74
    seborrheic eczema, 71
    shampoo, 73
    treatment of, 73

  Hair-brush, 73, 74
    care of, 74

  Hancock, Dr., physical training for women, 286

  Hands, care of, 76, 77
    chapped, 76

  Hands, nails, care of, 76
    cleansing of, 77
    infection from lack of cleanliness, 77

  Headache, 216-219
    causes of, 209, 216, 217, 221
    symptoms of, 217
    treatment of, 217-219
    varieties of, 217
      neuralgic, 217

  Health, good, and vacations, 201, 202
    evidences of, 215

  Hearing, impairment of, causes of, 163

  Heart, description of, 139
    frequency of beat, 140
    functions of, 139
    location of, 139

  Heart’s need of exercise, 310

  Heat, animal, 26
    dissipation of, 26
    physiologic effects of, 27
    production of, 26, 27, 303, 308

  Height, weight, and chest measurements, relative proportion
        of, 148, 297

  Hemorrhoids, 102

  Hereditary predispositions, 225

  Heredity, influence of, on health, 224-226

  Hockey, 372

  Hormones, 89

  Horseback riding, 328

  Hot-water bottle, action of, 29

  Houses, degree of moisture of air of, 155
    disinfection of, after tuberculosis, 174, 175
    effects of gloomy, 238
    temperature of, 155
    ventilation of, 151-155

  Hydrotherapy defined, 23
    value of, 23. See _Baths_ and _Douches_.

  Hygiene of mind, 224-251

  Hygrometer, 156


  Idleness as cause of nervous prostration, 223, 247
    Thomas on ill effects of, 248, 249

  Industrial training of women, necessity for, 247

  Infectious diseases, 169-175
    bronchitis, 159, 160, 168, 169
    causes of, 149-151, 153, 169
    common colds, 159, 169-171
    influenza, 159, 169, 170
    pharyngitis, 151, 159, 160

  Influenza, 169
    cause of, 150, 159
    relation of, to pneumonia, 171
      to tuberculosis, 169, 173

  Ingrowing toe-nails, causes of, 78
    treatment of, 78

  Inhibition, 240-242
    importance of, 242
    training in, 241

  Insomnia, 196
    causes of, 194, 196, 220
    injurious effects of, 203, 219
    treatment of, 39, 204

  Intestinal bacteria, 97

  Invertase, 94

  Iron, 102

  Irrigations, vaginal, 54-56


  Katabolism, 99

  Kidneys, description of, 175
    diseases of, treatment of, 52
    function of, 175-179

  Kidneys, function of, relation of, to skin and lungs, 176

  Knee-chest position, description of, 53


  Lactase, 94

  Lamp shades, 211, 212

  Larynx, 143

  Laughter, physiologic necessity for, 200, 201

  Life, prolongation of, 132, 313

  Lighting, artificial, 211, 212
    natural, 212

  Lipase, 94

  Literature, 239, 240
    molding influence on the mind, 239
    taste for, formed in youth, 240

  Lungs, 143
    description of, 143
    frequency of diseases of, 137
    good development of, 137, 311
      exercises for, 165-168, 345, 349, 353
    hygiene of, clothes in relation to, 164
    relation of, to good health, 146
    secretion of, 145
    ventilation of, 165-168
    vital capacity of, 148
    weakness of, causes of, 137


  Maltase, 94

  Massage defined, 304
    benefits of, 304-306
    mode of procedure, 307
    movements of, 306
      friction, 306
      grasping and pinching, 306
      striking, 307
      stroking, 307
      vibration, 307
    rise of temperature after, 308
    time for giving, 307

  Mastication, 82, 88

  Meats, digestibility of, 110
    nutritive properties, 110

  Medical examination blank, 330

  Menstruation, 181-183
    anomalies of, 183
      painful, 183
      profuse, 183
      scanty, 183
      suppressed, 183
        treatment of, 182, 183
    hygiene of, 181
    normal, average duration of, 181
      character of, 181
      cold baths during, 181, 182
      exercise during, 182
    premonitory symptoms of, 181

  Mental activity, attitude and bodily function of, 242
    depression, 231
    development, 189, 190, 228-232, 233, 241
      and physical training, 290-292, 295, 315, 320
    disorders of adolescence, 231
    emotions, exhausting nature of, 245-247
    faculties, balance of, 234
    habits, 186, 187
    hygiene, 224-247
      hurry, effect of, 190
    qualities, 228

  Metabolism, 98
    cumulative effects of impure air on, 153
    effect of nitrogenous diet on, 99
    water and, 100

  Microörganisms in intestinal canal, 97

  Migraine, treatment of, 218

  Milk, digestion of, 111

  Mind hygiene, relation of, to physical health, 224-251, 320
    subconscious, 238

  Mineral substances, 107
    Vittel, 51

  Moral sense, 230, 231

  Mothers as educators, 224
    exhausted, 197

  Mountain climbing, 365

  Mouth, care of, 82
    cleansing of, 82

  Muscular system, 298-304
      action of muscles of abdomen, 300
        of back, 301
    coördination, 304
    development prevented by corsets, 260, 261, 264-268, 270, 271
    energy, 303
    fatigue, 303
    heat production, 303


  Nasal catarrh, causes of, 159
      general treatment, 151
      local, 160, 161
      prevention of, 160
    douche, 161
    passages, obstruction of, 158
    sprays, 160
      prescriptions for, 161

  Nature’s restoratives, 196-200
    recreation, 198, 200
    rest, 197
    sleep, 198, 202, 203

  Near-sightedness, causes of, 206, 207
    correction of, 207

  Nervous breakdowns, prevention of, 197, 199, 201
    disorders, causes of, 216
      functional, 215, 223
        headache, 216-219
        neurasthenia, 219
    system as balance of power, 184
      brain as master organ of body, 184
        function of, 184
        physiology of, 187
      cerebrospinal nerves, 187
      spinal cord, 187
      sympathetic, 188

  Nervousness, 196
    causes of, 196
    treatment of, 305

  Neurasthenia, 219-223
    causes of, 219, 220
    rational treatment, 221-223, 305
    symptoms of, 221

  Nitrogenous waste products, 106

  Nose, care of, 157
    functions of, 157


  Obesity, causes of, 132, 298
    treatment of, 45, 52, 298, 344

  Occupation, definite, a physical necessity, 247
    Clouston on, 248. See _Vocation_.
    sedentary, 165

  Optical defects and their correction, 206-209
    astigmatism, 208
    hyperopia or far-sightedness, 207
    myopia or near-sightedness, 206
      causes of, 207, 209
      treatment of, 207
    presbyopia or loss of accommodation, 207

  Outdoor exercise, 362
    daily length of time for, 362

  Overwork, 193, 194
    danger signals, 193
    signs of, 194-196
    stimulants in, 193
    worry and, 195

  Overworked class, rest treatment for, 222, 223

  Oxygen, importance of, 145


  Palate, soft, 158

  Pancreatic juice, 93
    rennin, 93

  Perspiration, daily amount of, 26
    effect of, on tone of skin, 29
    rate of increase in hot baths, 28

  Pharynx. See _Throat_.

  Physical efficiency, 11
      an exact science, 13
      marks for, 13, 317
      reflex effect of group impairment on organism, 19
      standardized percentage table, 14, 328
      statistical study, 15
      wisdom of, 11
    exercise, rules for, 334-336
    measurements, record for, 327, 334
    status of women of to-day, 19
    training among the ancients, 283, 284, 289
      before twelve years of age, 333
      dancing, 289, 326
      examinations for, 326, 327

  Physical training for invalids, 334
    improved physique from, 286, 325
    influence on life and health, 290
    key to health and beauty, 283-322
    of girls, 286, 289, 321, 333
    of Japanese women, 286
    report of Royal Commission on, 288

  Physique, good, through physical training, 333
    improved, of American women, 287
      of school children, 287

  Play, adult, 288

  Pleasure seeking as the object of life, 189, 247, 249

  Pneumonia following influenza, 169
    mortality from, 171

  Potatoes, 111

  Prosecretin, 92

  Proteins, 105

  Pulley weights, exercises with.
    See _Chest weights_.

  Pulse, frequency of, 140


  Reading, distance of book from eyes, 165
    fine type, 212
    hygienic precautions, 212, 213
    length of line, 212
    position of reader in, 212

  Recreation, necessity for, 220

  Religion, 232

  Religious instincts, 231, 232

  Rennin, pancreatic, 93

  Respiration during sleep, 166
    forced, benefits of, 165, 166
    impediments to normal, 164

  Respiration, mechanics of, 138, 141
    normal, relation to body heat, 146
    types of, 167
      costal, 167
      diaphragmatic, 167
      thoracic, 167
    vitiation of air in, 152

  Respiratory exercises, 165-168, 345
      beneficial results of, 311
      best time for, 166, 167
      dress for, 166
      frequency of, practice of, 166
    system, 137-157
      air cells, 143
      bronchial tubes, 144
      expiration, 143
      inspiration, 143
        forced, 144
        function of abdominal muscles, 146, 344
      larynx, 143
      lungs, 143
        hygiene of, and relation to general health, 146
        secretion of, 145
        vital capacity of, 144
      thorax, 138
      trachea, 143

  Rest, 197
    days of, 200, 201
    proper way to, 197, 198
    regularity of, 197

  Rice, 111

  Roman baths, 43

  Rowing, 369

  Running, 293, 364
    age limit for, 365
    benefits of, 310
    rules for, 341


  Saliva, 88

  Salt, common, 101
    normal, solution, 53
    sea, 41

  Sargent, Dr. Dudley A., 284, 285, 287, 317, 321

  Scalp, massage of, 74

  Sebaceous glands, function of, 25
    infection through, 25

  Secretin, 92

  Self-control, 229, 230
    difficulty of, 229
    standards aimed at, 229
    training in, 230

  Semiconstipation, 102

  Senility, causes of, 133

  Sewing, hygienic precautions in, 212, 213

  Shoe, 275-277
    compression of foot by, 275
    flat heels, 276
    French heels, 277
      awkward gait due to, 277, 339
      deformities caused by, 277
      injurious effects of, 277
    proper length of, 276
    soles of, 276

  Shoulder-blade exercises, 345

  Shoulders, round, and inequality of height of, 342
    causes of, 342
    corrective exercises for, 345, 346

  Sims’ position described, 53

  Skin, absorption through, 28
    care of, 57-69
    description of, 24, 25
    diseases, acne, 65
      eczema, 65
      treatment of, 66
    functions of, 25
      respiration through, 28
        rôle played in maintaining body temperature, 26
    sebaceous glands, 25
    sweat glands, 25
      perspiration, daily amount of, 26
    temperature of, 31
    tone of, 25

  Skirt, walking, 202-204

  Sleep, 202-204
    amount necessary, 196, 203
    dreamless, 204
    favorable conditions for, 204
    habits of, 198, 203
    physiologic necessity for, 185, 192, 193, 203

  Sleepiness, causes of, 203

  Soap, 58
    castile, 61
    sand, 61
    tincture of green, 73

  Social instincts, 226
    at school age, 226
    right training of, 241

  Sore throat, prevention of, 160
    treatment of, 160, 161

  Spinal cord center of reflex acts, 187
    curvature, 309
      causes of, 164, 342, 343
    general treatment for, 343

  Spine, muscles of, exercises for strengthening, 347

  Spirometer, 148

  Sponge as article of toilet, 33

  Spray apparatus, description of, 160
    liquids for, 161
    oil, formula for, 161

  Standing, common defects in, 340
    correct attitude in, 340

  Steapsin, 94

  Stocking supporters, 278

  Stockings, evils of short, 277

  Stomach, chemical changes in food in, 89
    description of, 89
    location of, 89

  Street dress, winter, 282

  Styes, treatment of, 215

  Success defined, 249
    elements of, 249
    lack of, 250
    mental condition and, 250
    psychology of, 249-251

  Succus entericus, 94

  Sugar, absorption of, in intestines, 95

  Sunlight, action on respiration, 149
    on tubercle bacillus, 151

  Swimming, 365-368
    contraindications to, 368
    exercises, 351
    pool, temperature of, 326
    rules for, 366-368

  Swift, Prof., theories regarding children, 228, 233
    fighting among boys, 233


  Tea, effect of, on digestion, 119
    proper way to make, 120

  Teeth, 82
    care of, 82, 83
    cleansing of, 83
    tartar, 83
    tooth-brush, 83

  Temperament, 225, 226
    arthritic, 226
    nervous, 225
      temptations of, 226
    phlegmatic, 226

  Temperature for house, 155
    normal body, 27, 28
      how maintained, 28
      mouth, 28
      rectum, 28
      surface, 31

  Thomas, Prof., on effect of idleness, 248
    on necessity of definite vocation, 249

  Throat or pharynx, 137
    bacterial flora in, 151
    description of, 158
    diseases of, causes of, 158
    effect of lowered vitality on, 151
    importance of healthy condition of, 151, 159
    pillars of, 158
    sore, prevention of, 160
      treatment of, 160, 161

  Toe-nails, ingrowing, 78

  Tonsils, chronic enlargement of, 159

  Trachea, 143

  Trachoma, 214, 215

  Tropics, dietary in, 121

  Trypsin, 93

  Tubercle bacillus, 150
    destruction of, 174

  Tuberculosis, causes of, 137, 150, 309
    diet in, 172
    disinfection after, 174, 175
    expectoration in, 150, 173
    infection in, 150, 173
      source of, 173
    mortality in, 137
    prevention of, 171-174

  Turkish baths, 42-44
      cold plunge, 43
      contraindications to, 31, 37
    contraindications for their use, 44
    essential features of establishment, 42
    harmful results of too prolonged stay in, 42
    indications for their use, 44
    methods of procedure, 42-44
    necessity for cold water drinking, 42
    physician’s prescription for, 43
    shampoo, 43
    steam room, 43
      contraindications for use of, 43


  Underclothing, combination suits, 280
    winter, 278-281
      equestrian tights, 280
      essential qualities of, 278

  Urea, 106

  Uric acid, 106
    treatment of, 45

  Urinary excretory apparatus, 179

  Urine, 178
    daily amount of, 178
    secretion of, 176
    specific gravity of, 178
    toxicity of, 178, 179
    urea, 178
    uric acid, 178
    value of study of, 178

  Uvula, relaxation of, 158


  Vacations and health, 201, 202
    resorts, requisites for, 202
    rules for, 202

  Vaginal irrigations, 54-56
    directions for, 54, 55
    indications for use of, 55

  Vassar College, 235
    gymnasium, 325-328

  Veils, 210

  Ventilation, 151-155
    method of, 154
    necessity for indoor, 151
      hourly amount of fresh air needed, 151
    of bed-clothes, 157
    of bedrooms, 156
    of houses, 151-155
    of lungs, 165-168

  Vision, defective. See _Optical defects_.

  Visual apparatus, 205, 206
    accommodation, mechanism of, 206
    conjunctiva, 205
    description of, 205
    eyeball, 205
    eyelashes, 205
    eyelids, 205
    image, formation of, 206
    iris, 205
      function of, 206
    lachrymal glands, 205
    tears, function of, 205

  Vitamins, 108

  Vocation, physiologic necessity for, 247
    Clouston on, 248
    Thomas on, 248, 249


  Waist exercises, 349, 351, 356

  Walk, listless, bad effects of, 364

  Walking, clothing for, 282, 363
    effect of speed in, 293
    on blood-vessels and muscles, 363
    effect of, on heart and lungs, 362
    position of feet in, 341
    skirt, 281
    proper length of, 281

  Walks, rules for long, 364

  Wash cloths, care of, 61
    danger of infection from, 61

  Waste products, nitrogenous, 106

  Water and metabolism, 100
    internal use of, 48-52
      action on digestion, 50
        on heart and blood, 50
      at meals, 50, 51
      boiled, 49
      classification of temperature of, 28
      cold, contraindications to, 52
      infection, vehicle for, 49
      mineral, 118
      physiologic effects of, 28
      therapeutic indications for, 50-52
      time required for its absorption, 50

  Weichardt, Dr., experiments on guinea-pigs, 191

  Weights for women, table of, relation between height and, 296, 297

  Weisse, Dr., table of weights, etc., 296, 297

  Will, education of, 241-245
    influence of, on conduct, 241, 242
    inhibition, 240-242
    obsessions, overcoming of, 241
    power of, and strong muscles, 291, 292
    training of, 241

  Women, American, cause of inferior physique of, 284-286
    average height of, 298
    higher education of, 234-237
    in business activities, 237, 248
    Japanese, 286
    non-occupation of, 248, 249
    noted sovereigns as mothers, 247
    physical status, 19

  Woolen undergarments, 279, 280

  Work, hygiene of, 188
    number of hours allotted to, 194
    philosophy of, 188
    physiologic necessity for, 189

  Worry, 195, 196
    defined, 245
    results of, 246

  Wrinkles, 67-69
    causes of, 67, 68
    results of, 68, 69

  Writing, use of typewriter, 165




  Transcriber’s Notes

  pg 93 Changed: the acidity of the gastic juice
             to: the acidity of the gastric juice

  pg 99 Changed: the only difference beteen man
             to: the only difference between man

  pg 112 Changed: weight, occupation, idisoyncrasies
              to: weight, occupation, idiosyncrasies

  pg 122 Changed: It is is better to take dinner
              to: It is better to take dinner

  pg 175 Changed: and the woodword repainted.
              to: and the woodwork repainted.

  pg 201 Changed: kind of place one choses
              to: kind of place one chooses

  pg 213 Changed: but if the susbtance lodges
              to: but if the substance lodges

  pg 247 Changed: excluding women, who are fulfiling
              to: excluding women, who are fulfilling

  pg 254 Changed: use of cosemtics was introduced
              to: use of cosmetics was introduced

  pg 267 Changed: take place at the hip-joints
              to: takes place at the hip-joints

  pg 272 Changed: is divided into three clases
              to: is divided into three classes

  pg 284 Changed: national games. Xenophen says
              to: national games. Xenophon says

  pg 284 Changed: husbands to war, and exhibited intances
              to: husbands to war, and exhibited instances

  pg 329 Changed: cheast measurements, yet with the physical
              to: chest measurements, yet with the physical