Chapter 5 HYGIENE IN GENERAL

Section I-The Fifteen Rules of Hygiene

The aids to health discussed in the preceding chapters may be summarized in specific formulas classified under the four heads, Air, Food, Poisons, and Activity, corresponding to the four chapters, and under fifteen sub-heads, corresponding to the fifteen sections.

Air. 1. Ventilate every room you occupy.

2. Wear light, loose and porous clothes.

3. Seek out-of-door occupations and recreations.

4. Sleep out, if you can.

5. Breathe deeply.

Food. 6. Avoid overeating and overweight.

7. Eat sparingly of meats and eggs.

8. Eat some hard, some bulky, some raw foods.

9. Eat slowly.

Poisons. 10. Evacuate thoroughly, regularly and frequently.

11. Stand, sit and walk erect.

12. Do not allow poisons and infections to enter the body.

13. Keep the teeth, gums and tongue clean.

Activity. 14. Work, play, rest and sleep in moderation.

15. Keep serene.

The application of these rules to one's daily life must be varied with each individual. The most practical method is for the individual to begin the improvement he would seek by constructing a typical day's program in which time is provided for, say, breathing and other exercises in bed, bath, toilet, walk to business, meals, amusement, etc., with special notes and memoranda as to the particular faults of omission and commission to be corrected. One might also, as Benjamin Franklin records in his autobiography, keep a daily record for a week as to how nearly the program is lived up to. By dint of such and other stimuli, the transition in habits can be made, after which the "rules" cease to be rules, as carrying any sense of restriction, and become automatic like putting on or taking off one's clothes.

Section II-The Unity of Hygiene

The Rules Interrelated

The above rules embody our preachment on individual hygiene. We have stated them as fifteen separate kinds of procedure. In actual life, however, our acts can not be so separated. The neglect or observance of one rule carries with it, to some extent, the neglect or observance of other rules. For instance, one can not take muscular exercise without, to some extent, taking breathing exercises. Swimming serves as a means of cleanliness, of skin gymnastics, of general exercise and of amusement. A game of tennis implies the practise, to some extent, of at least five of the fifteen rules.

The human body is a "harp of a thousand strings," which are intended to harmonize. If one of them is out of tune, it is likely to cause discord throughout, while to tune up one helps the harmony of all.

Medical Specialists

Any one ailment has a far-reaching effect throughout the system. It is because of this far-reaching effect that the "one idea" specialist in medicine has so often thought his particular specialty to be the one and only gateway to all therapeutics and hygiene. The oculist is liable to look at all ailments as related to the eyes; the dentist as related to the teeth; the mental hygienist as related to wrong attitudes of mind. If we examine their claims, we find that they are usually right in their affirmations, though wrong in their denials. It is their affirmations in which we are here interested. They find that the ailments within their own special province extend in unsuspected ways, and to a surprising degree into seemingly remote fields; and that to remedy the special defect which they can treat, will often go a long way toward remedying numerous other ailments.

Remote Effects of Ailments

It has already been noted that eye-strain leads to an astonishing number of serious nervous affections, and that corrective eyeglasses will often work wonders for remedying those ailments and improving the general health. There may be other unhygienic conditions equally responsible for these symptoms, and the correction of which may produce equally wonderful improvement. Vertigo may be due to eye-strain, or it may be due to wrong posture or to pressure of wax on the ear-drum. Diabetes may be aggravated by too much sugar, by infected tooth-sockets, or by too much worry. Tuberculosis may be due jointly to indoor-living, lack of exercise, wrong diet, wrong posture, sexual excess, alcohol, nerve-strain, and numerous other preconditions, besides infection with the tubercle bacillus. The social evil can be fought not only directly by attack on prostitution, and by appeals to self-control and moral ideals, but also indirectly by diminishing the consumption of alcohol and other drugs, for alcohol not only produces abnormal sexual desire but reduces the strength of will by which that desire is repressed. Forel asserts that the social evil can not be controlled until the use of alcohol as a beverage is abolished.

Popular Delusions

It is not uncommon for people to attribute their ailments to the less important rather than the more important cause, and so fail to get the best benefits of hygiene. Many people bemoan the fact that they sat in a draft and "therefore" caught cold, when what they most needed was not to keep out of drafts but to keep in such condition that drafts would do them good, not harm. Benjamin Franklin, a century ago, believed, what we now know to be true, "that people who live in the forest, in open barns, or with open windows, do not catch cold, and that the disease called 'a cold' is generally caused by impure air, lack of exercise, or overeating."

So-called "Overwork"

Most people who are "overworked" are, more properly speaking, simply the victims of bad air, bad diet, poisons, or worry. They believe that because they are tired it must be work which is hurting them. The man who breaks down in middle life commonly imagines that he has ruined his health by overwork. The college girl thinks she has ruined her health by study. All these "overworked" people prove their case by showing that they improve in health when given a vacation. This simply shows that a bad condition can often be remedied by improving the general health in any way whatever, even if the primary source of the difficulty is not reached. They are undoubtedly working beyond their working capacity; but their working capacity is only a fraction of what it would be if they took exercise, were not constipated, did not eat too much, abjured alcohol, or ceased to worry continually. If they lived hygienically in these respects, the work which was a drag might be an inspiration. A physician of wide experience says that every day men come to him broken down in health, invariably telling him that they have overworked; and yet upon questioning them he finds that none of them works as hard as he. Their breakdown was due to the terrible load of unphysiological habits which they had been carrying-a load so great that scarcely any work could be carried in addition.

An All-round Regime

Other examples might be given of ascribing ailments and disabilities to the less important instead of the more important causes. The error is almost always made of resting the blame on only one cause. In consequence most health-seekers make the mistake of making only one correction in their daily regime of life. One will cease alcohol drinking, another will give up tobacco smoking, another will give up coffee; a third will cease using all "red meats," another turns vegetarian, another adopts a raw food diet; another takes up outdoor sleeping; another adopts a daily game of golf; another embraces a mental healing cult; another takes up mastication. But great and permanent results require the adoption of an all-round, well-balanced regime.

Section III-The Obstacles to Hygiene

Effort of the Will

It is not enough that the individual should know how to live. Knowledge is of no avail without practise. Mr. Moody, the evangelist, once said of religious conversion, "Merely to know is not to be converted. I once boarded a train going in the wrong direction. Some one told me my mistake. I then had knowledge, but I did not have 'conversion' until I acted on that knowledge-seized my traveling-bag, got off that train, and boarded one going in the opposite direction." Many people are on the wrong train in hygiene, as in religion, and know it. They are traveling fast to that kind of perdition which in the end unhygienic living always brings. In fact, a great many people practise unhygienic habits more through indifference than through ignorance. Most people have acquired, by imitation of their neighbors, a great number of unhygienic habits and have continued in these habits for so many years, that they can not get rid of them, except through a great effort of will. This effort they are usually unable or unwilling to put forth unless very strong incentives are brought to bear. Often-in fact, if the truth were known, usually-they wait until ill health supplies the incentive. The man who is most receptive on the subject of health conservation, is, in the majority of cases, the man who has just had some ominous warning of coming ill health; although there is now a small but increasing number who do not wait so long, men who pride themselves on keeping "in the pink of condition." These are the men who are rewarded for their efforts by enjoying the highest reaches of working-power.

Cost of Good Health

The ordinary man, in ordinary good health, does not want or thinks he does not want to live hygienically. He sees all sorts of imaginary objections to adopting a hygienic life, and closes his eyes to its real and great advantages. One of the objections often trumped up is that the practise of hygiene costs too much-that it can only be a luxury of the rich. It is quite true that here, as elsewhere in human life, wealth confers great advantages. The death-rate among the rich is always less than that among the poor. And yet the rich have unhygienic temptations of their own, while the poor, on their part, are far from living up to their opportunities.

Missionaries

There are really only two material disadvantages from which the poor suffer in their opportunities to live a healthy life: One is unhygienic housing, both at home and at work; the other is unhygienic toil. It must be admitted that millions of unfortunates are unable individually to remedy these two disadvantages in their lot in life. Yet they can, even in these two respects, accomplish much if they take an intelligent interest in hygiene. The graduates of tuberculosis sanatoria are largely among the poor and they are doing much good missionary work in securing better ventilation, both in the home and in the workroom. They find this possible partly by insisting on more open windows in home and workshops, partly by changing their home to one better equipped with windows or situated in the suburbs instead of in the city, partly by changing their occupations, partly by getting the cooperation of their employer or simply by cooperating with him when he is ready to do his part. The workman can also accomplish something through the Trades Unions, especially in regard to hours of work. Employers will increasingly cooperate in this movement, as they come to realize that the securing of efficiency in their workmen is to their interest, and that monotony, long hours, and other unhygienic elements which are now, through sheer carelessness, often imposed on their workmen, bring back in the end big financial losses on themselves.

Except for the evils mentioned-those of housing and working conditions-there are few people so poor that they can not buy the means of living a healthy life. In fact, hygiene is one of the few precious gifts which can be had almost for the asking. Most people can sleep out-of-doors, if they will-if in no other way than by the so-called indoor window-tent-or can take deep-breathing exercises without cost. It costs nothing to stand, sit, and walk erect, to evacuate thoroughly, regularly, and frequently. It costs less than nothing to avoid overeating and overweight, and to be totally abstinent from alcohol and tobacco.

Cost of Food

Almost all can allow enough time for meals to eat slowly. Coarse and raw foods are always to be had and are usually cheaper than the conventional soft, concentrated cooked foods. In fact, meat, eggs, and like foods are among the most expensive and the least desirable. If we compare the cost of flour and of the other cheapest food materials, with the cost of oysters, one of the dearest, we find that the latter is fifty times as expensive as the former for the same food value. This takes no account, of course, of the expenses involved in cooking either of them. It has been proved by actual experience that one can live in the best of health on food costing as low as ten cents a day, exclusive of the labor of preparing, cooking and serving. Mrs. Richards, in her "Cost of Food," says that this is possible anywhere in America within fifty miles of a railroad. The only real objection to living on this minimum expense is the lack of variety. The following is a brief list of foods in ascending order of cost per 100 calories of food value, the cheapest being at the beginning and the dearest at the end: glucose, corn-meal, wheat-flour, oatmeal, cane-sugar, salt pork, rice, wheat bread, oleomargarine, beans, peas, potatoes, butter, milk, cheese, beef-stew, ham, mutton-chops, beef, eggs, and oysters. If the foods in this list be looked up in the table given in the Supplementary Notes for their protein, fat, and carbohydrate contents, it will be seen that a well-balanced ration is possible without the use of expensive foods. In fact, among the cheap foods are some consisting mostly of protein, some consisting mostly of fat, and some consisting mostly of carbohydrate. For instance, cheap sources of protein are skim milk, beans, cheese, and peanuts. Cheap sources of fat are oleomargarine and cottonseed-oil. Cheap sources of carbohydrate, i.e., starch and sugar, are bread, bananas, potatoes, glucose, and even ordinary sugar. If a diet, selected for cheapness, is not at first well balanced, a judicious admixture of one or more of the foods just mentioned, will restore equilibrium. A cheap bulky food is cabbage.

Repaid Cost

Most of the rules of hygiene cost nothing to observe. But even when hygiene is costly at first, the cost is usually repaid in the end many times over. To ventilate a house in winter always costs a certain additional expenditure for coal, but it is better to pay the coal bill than the doctor's bills. To sleep out-of-doors costs some extra blankets, bedding, clothing, and roll curtains, but these not only save the cost of heating an indoor sleeping-room, but save also the cost of ill-health. There is no better economy than to keep one's working-power. To lose it means to lose its earnings and to have, in addition, the heavy expenses of medical attendance, medicines, and nursing, and often to lose life itself with its potential earnings of every sort. In short, an unhygienic life, for the sake of economy, is "penny-wise and pound-foolish."

"I Have No Time"

Many busy men object to hygiene because, they say, they have no time for it. They imagine that to devote an hour each day to exercise or relaxation is a waste of time and that they are really economizing their time by working that hour instead. We are here referring, not to those who can not control their working-time, but to those who deliberately choose to work when hygiene would require them to play. It is often those who fix their own working-hours, rather than those whose working-hours are fixed for them, who overwork the most. If these could know the suffering which sooner or later follows inevitably as the consequence of this mistaken policy, they would not pursue it for a single day. A slight loss of working-power comes immediately. A careful observer of mental workers found that an hour invested in exercise in the afternoon often pays for itself within a day, by rendering possible more rapid work. He also found an improvement in the quality of his work. The razor-edge of the mind needs daily honing through physical exercise. The same principle applies to all work. It is just as necessary to stop, at intervals, our physical and mental machinery for oiling and repairs, as to stop the machinery of a factory.

"Too Much Trouble"

Another objection is that the practise of hygiene is "too much trouble." It is undoubtedly true, that no one who has unhygienic habits can overcome them without a certain amount of "trouble." The people who get the best results are those who are never deterred by trouble so long as the trouble is worth while. For those who have not the necessary enthusiasm or self-control to break their unwholesome habits by sheer will power, the best advice is to so arrange their lives as to make the practise of hygiene inevitable. One physician in Chicago deliberately got rid of his automobile and other means of locomotion in order to force himself to walk to all his patients, and so secure enough physical exercise. Another man in New York City, with the same object in view, selected the location for his dwelling so that there was no rapid transportation available to take him to his office, making the walking back and forth a necessity from which he could not escape.

Simplicity of Hygienic Living

The only difficulty lies in overcoming the inertia of acquired habits. After one has changed his habits, it is just as easy to live rightly as to live wrongly. The rules of hygiene are not restrictive, but liberating. They may seem at first restrictive, for they prohibit many things which we have been in the habit of doing; but they are really liberating, for the things we were doing were unrealized restrictions on our own power to work, to be useful, or even to enjoy life. The "rules" of hygiene are thus simply the means of emancipating us from our real limitations. These so-called rules, when tried, will prove to be not artificial but natural, not difficult but easy, not complicated but simple. They are almost as simple as the direction to bathe in the river Jordan. It is, in fact, their very simplicity and availability to which is largely due their deplorable neglect and the failure to realize the wonderful benefits following their careful and continued observance.

The Evil of Romancing

Not only a healthy mental attitude toward life, but a healthy mental attitude toward one's own unhygienic habits is essential. It is a very common thing for a man to romance over his shortcomings, or his unhealthy physical conditions, to make humor of them to his friends. Very often the first step toward a better physical condition is a change in this mental attitude.

Section IV-The Possibilities of Hygiene

The Preventability of Disease and Death

Certain it is that more people would practise hygiene if they could be made to realize in some vivid way how much they needed it. Few persons, even when they read and accept the statistics on the subject, really have a picture of the imperative need of hygiene as an integral part of every human life. It is not brought home to them how widespread is illness, how numerous are preventable deaths, how many are the tendencies toward individual and racial deterioration.

The report of the Roosevelt Conservation Commission on National Vitality, indicates that annually there are in the United States over 600,000 deaths which might be prevented if existing knowledge of hygiene were properly applied; that at least half of the 3,000,000 and more sick-beds constantly kept filled in the United States are unnecessary; that the financial loss from earnings cut off by preventable disease and premature death amounts to over $1,500,000,000 annually; and that over 15 years are lost to the average life through the lack of application of knowledge which already exists but which simply has not yet been disseminated and applied.

Impairments Unsuspected

The health examinations of the Life Extension Institute have revealed unsuspected ailments in persons who considered themselves well, and to an extent which has astonished even those who have long been familiar with these subjects. Among large groups of clerks and employes of banks and commercial houses in New York City with an average age of 27 and all supposedly picked men and women, only 1 per cent. were found free of impairment or of habits of living inviting impairment. Of those with important physical impairments, 89 per cent. were, prior to the examination, unaware of impairment; 16 per cent. of the total number examined were affected with organic heart trouble, 42 per cent. with arterial changes, ranging from slight thickening to advanced arteriosclerosis, 26 per cent. with high or low blood pressure, 40 per cent. had sugar, casts, or albumin in the urine, 24 per cent. had a combination of urinary and other serious impairment, 47 per cent. had decayed teeth or infected gums, 31 per cent. had faulty vision uncorrected.

Among industrial groups, not exposed to any special occupational hazard or poisoning, the figures were as follows: With an average age of 33, none were found to be free of impairment or habits of living inviting impairment. Of those with important physical impairments, 89 per cent. were, prior to the examination, unaware of impairment; 3 per cent. of the total number examined were affected with organic heart trouble; 53 per cent. with arterial changes, ranging from slight thickening to advanced arteriosclerosis; 23 per cent. with high or low blood pressure; 45 per cent. had sugar, albumin or casts in their urine; 26 per cent. had a combination of urinary and other serious impairment; 69 per cent. had decayed teeth or infected gums; 41 per cent. had faulty vision uncorrected.

Minor Ailments

There are few persons in America to-day who reach the age of forty sound and normal in every part of the body, especially if we include among abnormalities the minor ailments. The extent to which minor ills are prevalent among those who pass for "well" people is not generally appreciated. Once we penetrate beneath conventional acquaintance we almost invariably learn of some functional trouble, such as impairment of heart, circulation, liver, kidneys, stomach; or gallstones, constipation, diarrhea; or insomnia, neurasthenia, neuritis, neuralgia, sick-headache; or tonsillitis, bronchitis, hay fever, catarrh, grippe, colds, sore throat; or rupture, enlarged glands, skin eruptions; or rheumatism, lumbago, gout, obesity; or decayed teeth, baldness, deafness, eye ailments, spinal curvature, flat foot, lameness; or sundry other "troubles."

These ailments, though regarded as "minor," should be recognized promptly and accepted as the signal that the person is moving in the wrong direction. There is no need for alarm provided this warning is heeded. Otherwise disaster is almost certain sooner or later to follow. The laws of physiology are just as inexorable as the laws of physics. There is no compromising with Nature. No man can disobey the laws of health to which he has been bred by Nature without paying for it-any more than a man can sign a check against his bank account without reducing the amount. He may not be immediately bankrupt, and until he exhausts his account he may not experience any inconvenience from his great extravagance, but Nature keeps her balances very accurately, and in the end all claims must be paid.

The Personal Equation

It is true, of course, that some persons have greater resistance than others. If we had a convenient barometer by which to measure daily the state of our vitality, we might register the effect of every unhygienic act. But it is so seldom that endurance is accurately measured that few people appreciate the enormous differences in people and the variations of the same person at different times. These differences and variations have a range of many hundred per cent. Some people can not walk upstairs or run across the street without being out of breath, while others will climb the Matterhorn without overstrain. The fact that certain people have lived to the century-mark in spite of unhygienic living is sometimes cited to prove that hygiene is ineffective. One might as well cite the fact that certain trees are not blown down in a gale or are not quickly destroyed by insect-pests to prove that gales have no tendency to blow down or insects to destroy trees.

Over-confidence

The truth is that a person who has so much vitality as to lead him to defy the laws of health and to boast that he pays no price no matter how he lives, is likely to be the very man to exhaust his account of health prematurely. There was, a few years ago, a famous American, possessed of prodigious bodily vigor. He ought to have lived a century. Unfortunately he had this "insolence of health." He was warned several times against overwork, lack of sleep, and abuse of his digestion. But he merely smiled and claimed that such warnings were for others, not for him. He met an untimely end, due as his physicians believed and as he himself acknowledged, when too late, to his abuse of the great powers with which Nature had endowed him and to the neglect of personal hygiene.

Possible Health Attainment

Conversely, an observance of the laws of hygiene affords wonderful results in producing vitality and endurance. Insurance companies are discovering that even weak and sick people, will, if they take good care of themselves, outlive those with robust constitutions who abuse them.

To those unfamiliar with the subject in its larger aspects, the possibilities seem almost beyond belief. As an example of the wonderful gains which can be secured by obeying the laws of hygiene may be cited the case of a young man who a few years ago was scarcely able to drag himself into the sun in Colorado, where he was endeavoring to rid himself of tuberculosis. He not only succeeded, but subsequently, by dint of following substantially all of the rules of hygiene here laid down, became an athlete and capable of running twenty-five miles for sheer love of sport and apparently without the overstrain experienced by "Marathon" runners. Kant and Humboldt are cases typical in different fields of achievement of many of the world's most vital men who have actually made over their constitutions from weakness to strength. Cornaro says that it was the neglect of hygienic laws which made him all but a dead man at thirty-seven, and that the thoroughgoing reform of his habits which he then effected made him a centenarian. His rules, drawn up four hundred years ago and described in his interesting work "The Temperate Life," are, so far as they are explained, almost identical with those given in this book. It is difficult to assign a limit to the good which can be accomplished by practising these rules and so minimizing the poisons which usually narrow and shorten our lives.

Immortal Animal Cells

So far as science can reveal, there seems to be no principle limiting life. There are many good and bad reasons why men die, but no underlying necessary reason why they must die. The brilliant Carrel has kept tissue cells of animals alive outside of the body for the past three years. These cells are multiplying and growing, apparently unchanged by time, to all appearances immortal so long as they are periodically washed of poison and nourished in a proper medium. If we could at intervals thoroughly wash man free of his poisons and nourish him, there seems to be no reason why he should not live indefinitely.

Section V-Hygiene and Civilization

In view of the vast extent of human misery from ill health, the question naturally arises, How does it happen that the world is burdened with so colossal a load? Is it no more than is biologically normal? Is it true that in other organisms, animals and plants, ill health is the rule rather than the exception? Are all races of men subject to the same heavy load?

Natural Adjustments Upset

These questions have not yet received sufficient attention. The answer seems to be that man is suffering from his own mistakes made unconsciously and in ignorance. He has upset the equilibrium which Nature had established among the various powers and activities of his body, and between himself and the outside world. Man has done mischief for his own body similar to what he has done for the natural resources on which he lives. In Professor Shaler's epoch-making little book, "Man and the Earth," he shows, for instance, that the little layer of soil on the surface of the earth from which plants and animals derive their nutriment was, before the advent of man, replenished quite as fast as it was washed away, but that after man had put his plow into it and had taken off the protective mat of vegetation, he unconsciously despoiled the accumulation of ages. "In a plowed field, an hour's torrential rain may wash off to the sea more than would pass off in a thousand years in the slow process of erosion which the natural state of the earth permits." He also shows that the constant croppings of the soil rob it of nitrogen, phosphorus, and other elements faster than Nature restores them. The problem of conservation is to reestablish the balance which has been lost through the depredations of man, for instance, to lessen soil-wash by terracing, and to restore to the soil the lost elements by supplying nitrates and phosphates and by other methods of scientific farming.

In the same way man has upset his pristine animal mode of living and needs to find scientific ways to restore the equilibrium. Most of the present-day problems of hygiene arise from introducing, uncompensated, the effects of certain devices of civilization. The inventions of civilization have done so much for man that he is apt to unduly glorify them and to overlook the injurious by-products. These by-products are often of prodigious significance to the race. The invention of houses introduced the problem of house hygiene; the invention of clothing, the problem of clothing hygiene; that of cooking, the problem of food hygiene; that of division of labor, the problem of industrial hygiene; and so on. To make these statements more concrete, we may consider some of them in more detail.

Houses Artificial

The invention of houses has made it possible for men to live in all climates, yet this indoor living is responsible for much disease. The houses give comfortable shelter and warmth and protect us from the elements and from wild animals. But the protection has been overdone. Like his cousin, the anthropoid ape, man is biologically an outdoor animal. His attempt at indoor living has worked him woe, but so gradually and subtly has it done so that only recently have we come to realize the fact. At first, dwellings were really outdoor affairs, caves, lean-tos, tents, huts with holes in the roof and the walls. These holes served to ventilate, though they were not intended for that purpose. The hole in the roof was to let out the smoke and the holes in the walls to let in the light. Gradually the roof-hole developed into a chimney with an open fireplace, which, in turn, gradually changed into a small flue for stoves whereupon it almost ceased to serve any ventilating function. The stove in turn has largely gone and is replaced in many cases by the hot-water or steam radiator, without any attempt at ventilation. The holes in the wall gave way, after the invention of glass, to windows which let in the light without letting in the air. Weather-strips, double windows, vestibule-doors, interior rooms, completed the process of depriving man of his outdoor air, shutting him into a cell in which he now lives-a sickened but complaisant prisoner-often twenty hours of the twenty-four. Tuberculosis, one of the worst scourges of mankind, is primarily a house disease. It is prevalent as indoor living is prevalent, and reaches its maximum in the tenement quarter of a great city.

Effects on Different Races

Only by generations of natural selection could we expect to make man immune to the evils of bad air. The robust Indian and the Negro, whose races, until the last generation or two, roamed in the open, fell easy prey to tuberculosis as soon as they adopted the white man's houses and clothes. The Anglo-Saxons who have withstood the influence of indoor living for several generations have, probably by the survival of the fittest, become a little better able to endure it, while the Jews, a race which has lived indoors longer than any other existing race, are now, probably by the same law of survival, the least liable to tuberculosis, except when exposed to especially unfavorable conditions of life.

Compensation for Civilization

But we, of this generation, can not afford to wait for natural selection to fit the race to an indoor environment; hence the supreme importance to us of air hygiene. We must compensate for the construction of our houses by insisting on open windows, or forced drafts, or electric fans, or open-air outings, or sleeping porches, or the practise of deep breathing, or all of these things.

Clothing Artificial

In the same way, clothing has protected our bodies from the cold but enervated or constricted them as well. The aboriginal tribes, even in cold climates, seldom used clothing. The Eskimo is an exception. The tribes toward the South Pole in similarly cold climates often have little more clothing than a blanket which they hang over their shoulders toward the wind. The weak, pale skin-to whose lack of adaptability we owe the chilling preceding a cold-the bald head, the distorted foot, the corns upon it, the cramped waist, are among the results of clothing ourselves wrongly. Hence we are discovering the need of restoring, as far as we can, the original conditions by making our clothes more light, more loose, and more porous, and, when possible, by taking the "barefoot cure," or the air bath.

Cooking Artificial

We come next to foods, and note that civilization has invented cooking and artificial foods. These inventions have greatly widened the variety of man's diet, but the foods of civilization are largely responsible for the decay of our teeth and the abuse of our digestive and eliminating organs.

Soft Foods Artificial

Judging from man's teeth and digestive apparatus as well as his general kinship to the anthropoid ape, it is reasonable to believe that, before fire was discovered, man was primarily a frugivorous animal, whose ordinary diet consisted of fruits, nuts, and tender shoots. While man still uses these fruits, nuts, and salads, his chief reliance is on prepared food, bread, butter, meat, and cooked vegetables. The diet of our progenitors must have been largely one requiring chewing, consisting, as it did, of hard fruits and stalks and perhaps also grains and flesh. Observation of manlike apes shows that they chew their food more thoroughly than man. Doubtless nuts constituted a considerable part of primitive food and required cracking by the teeth. The work we now do in flour-mills or the kitchen or with the knife and fork, was then done with the teeth. We even have our cook mash our potatoes and make puddings and pap of our food after it reaches the kitchen. Having already shirked most of the task of mastication by softening and cutting our food before it reaches our mouths, we shirk the rest of it by washing it down with water, or worse. An Italian dentist, who has had a wide range of observation, says that the knife and fork have committed "unpardonable crimes" by robbing the front teeth of their work of cutting. He sometimes prescribes for loose teeth the task of cutting a pound of bread daily. Whether any of it is swallowed or not is not important, but he insists that it must be cut by the teeth.

Concentrated Food Artificial

The deplorable lack of residue in modern food is one of the consequences of civilized life, for the bulky foods have been crowded out by concentrated foods, and, in many cases, the concentrated foods have been formed by getting rid of residue. Instead of chewing the sugar-cane, we use sugar, a concentrated extract which leaves no residue. We crush the juices from our fruits and throw away the pulp. We take the bran out of our grain and with it the vitamins essential to health. The bulky foods-fruits and fibrous vegetables-are often dropped from our menus.

Hurry Artificial

The hurry habit, another unfortunate by-product of civilized life, is one of the chief promoters of indigestion. In civilization we live by the clock. We schedule our trains and crowd our meal-time to catch them. We make engagements in neglect of the requirements of digestion. We have, in consequence, as one of the institutions of civilization, the "quick-lunch counter." At first we bolted a meal purposely and consciously. Later we formed the habit of food-bolting, and it now seems quite natural.

Use of Flesh Food

Misled Appetites

To the door of the hurry habit may also be laid the excessive use of flesh foods. Carnivorous animals bolt their food. Frugivorous animals, to which class the human race properly belongs, eat slowly. But when, through the perversions of civilized life, frugivorous man is forced to eat as fast as the carnivores, he instinctively adopts a similar diet. As someone has expressed it "when we eat as fast as a dog, we naturally crave the food of a dog." Our apelike progenitors had few, if any, flesh foods and only those which they could catch with the hand and eat raw. Our eliminating organs, the liver and the kidneys, have been framed to meet the demands of man's natural diet, but not adapted to handle the diet of civilized men in the excessive use of flesh foods and the use of alcohol. These organs are, fortunately or unfortunately, provided with a large factor of safety and can stand a great deal of abuse, but the cumulative effect of this abuse, especially when combined with an unhygienic life in general, sooner or later leads to disaster. Our tastes have also been perverted. The appetite is very likely to be innocently misled by the delicacies which civilization has invented, as well as by the tricks of cooking, seasoning, and preparing. For this reason, we can not trust, as thoroughly as we would like, the ordinary leadings of taste. The solution of this problem of nutrition, like the solution of the housing problem, must be sought by retaining the advantageous food customs which we now find about us and substituting scientific customs for the disadvantageous ones.

Other Evils of Civilization

It would be impossible to enumerate all the inventions of civilization which have brought us difficult problems of individual hygiene. We shall name only a few more. The invention of chairs, though adding to human convenience, has tended to produce wrong posture, from which spinal, nervous and digestive disturbances follow. The invention of the alphabet and of printing has made possible the accumulation of knowledge, but has promoted eye-strain with a great train of attendant evils. The device of division of labor has created much wealth, but destroyed the normal balance of mental and physical work, recreation and rest. From this follow occupational diseases of overstrain, bad posture, industrial poisons, and a craving for narcotics. A combination of conditions has lessened the opportunities for prompt discharge of the body waste, and so led to dulling of the reflex which promotes defecation. We are only just beginning to realize how serious are the consequences.

"Remedies" that are Worse than the Evils

We have described many of the unhygienic practises common to-day as direct results of upsetting Nature's equilibrium. Others are indirect results. These latter practises may be described as attempts to remedy the evils of the former, the "remedies," however, being often worse than the diseases. Much of our drugging, some of our wrong food habits and not a little of our immorality are simply crude and unscientific attempts to compensate for disturbances or deviations from a normal life. We wake ourselves up, as it were, with caffein, move our bowels with a cathartic, induce an appetite with a cocktail, seek rest from the day's fatigue and worries in nicotin, and put ourselves to sleep with an opiate. In these practises we are evidently trying in wrong ways to compensate respectively for insufficient sleep, insufficient peristalsis, indigestion, overfatigue, and insomnia-evils due, as previously explained, to upsetting Nature's balance, between work, play, rest and sleep.

So also our overeating is largely an unscientific effort to compensate for overconcentration of diet,-that is, an effort to get bulk. Again, too much protein is in large measure due to the need of compensating for rapid eating, for as has been remarked, protein is the one kind of food which can be eaten fast with impunity.

Again, a large part of our moral derelictions is due to an unbalanced life from which amusements are largely omitted. The "bad" boy in the city streets is usually following his instinct for amusement, of which the lack of playgrounds has deprived him. Dissipations of many kinds are explained in a similar way. It is largely because workmen are so often drudges and lack normal recreations that they seek amusement in the concentrated form they find in saloons, gambling places, dives and dance halls.

Finally those economic and social conditions of civilization which have resulted in deferring marriage beyond the best physiological age, lie behind prostitution and its terrible train of consequences including the venereal diseases.

The worst of it is that these wrong remedies, instead of helping, aggravate the disease. They become part of a vicious circle, which continues in an endless round.

Shortened Human Life

The combined effects of all the unhygienic modes of living are undoubtedly greatly to shorten human life. Most other mammals live about five times the growing period. In man, this would mean that the normal life-span should be about a century and a quarter, an age which is now reached only in one case out of millions.

No Return to Nature

Yet it would be foolish, even if it were possible, to attempt a complete "return to Nature" by abolishing all the ways and conventions of civilization. This would be throwing away our social inheritance and returning to barbarism. We must go forward, not backward. Just as the cure for the evils of Democracy is said to be more Democracy; so the cure for the evils of civilization must be more civilization. The equilibrium of Nature having been upset by civilization, science, one of the great products of civilization, must now work out the remedies. Just as the waste of the soil which civilization has brought is to be compensated by that great product of civilization, scientific agriculture, so the waste of vital resources is to be compensated by scientific hygiene. The saving of civilization depends on following not those who repudiate it, like Thoreau, but those who make use of it, like Pasteur. What the world needs is not to abolish houses, but to ventilate them; not to go naked, but to devise better clothes, which have all the advantages and none of the disadvantages of those we now wear; not to return to the diet of the anthropoid apes, but to remodel that which we have; not to give up chairs, but to improve the form of chairs; not to abandon reading, but to employ corrective eyeglasses and clear printing; not to abrogate division of labor, but to shorten the hours of labor and provide wholesome recreations and special compensating advantages when needed. When, in future centuries, these come to be reckoned among the great triumphs of civilization, we may expect human life to be longer and perhaps stronger than in any primitive state of Nature, just as where modern scientific forestry has been applied we find longer lived and better trees than ever grew in Nature's jungles.

Section VI-The Fields of Hygiene

Public Versus Individual Hygiene

The object of this book is primarily to instruct the individual as to what he can do to maintain his own individual health. But individual hygiene is only one particular branch of hygiene, and it is well for the individual, partly out of public spirit, partly in self-defense, to have some idea of the other important branches, namely, public hygiene, the hygiene practised by the health officer, semipublic hygiene, the hygiene of schools, institutions, and industrial establishments, and race hygiene or eugenics, the most important of all.

All these branches are so closely related that it is impossible to mark any exact dividing-line. But, in a general way, there is a broad distinction between eugenics, which is the hygiene of future generations, and the other two, which relate to the present generation, as also between these two themselves. Thus public hygiene is that which is practised by the government for its citizens, while individual hygiene is that which is practised by the citizens for themselves. Public hygiene consists chiefly in efforts by the government to maintain a wholesome environment in which to live, including good outdoor air-without smoke or foul odors-clean streets, pure water, good sewers, quarantine, and legal regulations concerning houses, schools, prisons, hospitals, and other public institutions, foods sold in markets, and conditions of employment. It is chiefly useful in preventing acute or infectious diseases, such as typhoid fever, scarlet fever, measles, whooping-cough, small-pox, yellow fever, and diphtheria, and in preventing accidents and occupational diseases. Individual hygiene is chiefly useful in preventing the chronic or degenerative diseases, that is, diseases of nutrition and of circulation, such as heart and kidney affections, nervous prostration, insanity.

Public hygiene has made much progress during recent years. In consequence, the number of deaths from the acute or infectious diseases has been greatly diminished. Health officers are beginning to demonstrate the truth of Pasteur's words, "It is within the power of man to rid himself of every parasitic disease."

It is this work which has reduced the general death-rate in civilized countries and sometimes cut it in two, as at Panama. The United States Public Health Service, on invitation of the Peruvian Government, recently cut the death-rate in two in one of Peru's disease-ridden cities.

Individual hygiene, on the other hand, has been greatly neglected, especially in the United States, and, doubtless largely as a consequence, the death-rates from the chronic or degenerative diseases are increasing rapidly. A further consequence is that, in the United States, while the death-rate in the early years of life (when infectious diseases do most of the killing) has been decreasing, the death-rate in later life (when the chronic diseases do most of the killing) is increasing. In Sweden, on the other hand, where individual hygiene is more generally applied, the death-rate is declining at all times of life. (See "Signs of Increase of the Degenerative Diseases," Supplementary Notes.)

Both public and individual hygiene are being invoked in the fight against tuberculosis, a disease at once infectious and chronic, due to germs and to wrong methods of living.

Cooperation Necessary

No matter how thoroughly an individual attempts to care for his own health, he will find it almost impossible to avoid infections, at times, without the organized help of the community in which he lives. A man may do his best to keep his windows open, to breathe deeply, to eat hygienically, to hold his activities within the limits of overfatigue, to screen his house against flies and leave no tin cans about his kitchen door to breed mosquitoes; but if the city in which he lives has no good air for him to breathe, if his city's water supply is contaminated, if neighboring malarial swamps are not drained or covered with oil, if flies alight on the food before it comes to his own house, if the food contains disease germs or dangerous preservatives, or if his next-door neighbor visits him and leaves infection behind him, mere personal defenses will hardly be adequate.

Even in so private a matter as moving the bowels, sometimes the fault lies partly with circumstances beyond the control of the individual. Unfortunately in most of our cities and small towns "Comfort Stations" are rare or unknown, and when they are available they are often in such an insanitary condition as to be a source of danger through the spread of communicable disease. Constipation, as we have seen, is a far more serious matter than it is sometimes thought to be.

It is therefore incumbent on the individual to contribute his share to the hygienic work of society as a whole, in particular to take an active interest in health legislation and administration. A man can not live to the best advantage in a life isolated from all social obligations, any more than could Robinson Crusoe, who was unable to launch his canoe in the ocean, after he had been at great pains to construct it, because he had no one to help him. Each man should take part in the great social hygienic struggle, if he is to reap the highest rewards in his own personal hygienic struggle. And he can do a great deal if he will be patient and persistent. If, for instance, he would always insist on suitable air conditions in public buildings, electric cars, theaters, and churches, and encourage others to do so, it would not take long to make air reform general.

The Consumer's Duty

In fact, it is the common public, constituting the consumer, who has it in his power to bring about most of the necessary reforms in public hygiene. When the consumer really values hygienic environment, the producer will supply it. The great improvement in recent years in drinking water was brought about through the appreciation, by the consumer, of the danger from impure water. His complaints produced the change. Hotels found it profitable to provide and advertise pure water. So also the education of the public as to the dangers of a common public drinking cup led to the invention of bubbling fountains and cheap individual cups and to the introduction of these conveniences in railway stations and other public places.

We need to concern ourselves particularly with the character of our public water supply, air supply and food supply, the number of bacteria in milk, the fitness for human consumption of the meat, fowl, fish, and shell-fish sold in the public markets, and the use of adulterants and preservatives in canned and bottled goods.

Quacks and Quackery

Quacks and quackery should be vigorously fought by laymen as well as physicians. Quacks live by lying and misleading advertisements. Every one should cooperate to encourage the movement by which newspapers and magazines are giving up quack and immoral advertisements and the advertisements of alcoholic beverages. Especially should we refuse to patronize the quack advertiser. When no one is deceived by him, he will cease to advertise. A more immediate method is to change from the newspaper containing such advertising to one which does not. We should also appeal to the editors to reform their advertising, as many of them are now doing.

Vaccination

Vaccination is now a known preventive against smallpox, typhoid fever, and other germ maladies. Its use should be advocated and the ignorant prejudice against it should be overcome.

Social Evil

Last but not least, the individual should cooperate in the great movement against the social evil.

As soon as an individual becomes interested in caring for his own health and for the health of his family, his interest will not cease at individual hygiene; he will wish to improve the efficiency of the public health service by increased appropriations, improved equipment and personnel; and to cooperate with the health officer.

Eugenics

Race hygiene or eugenics, which has been mentioned as the third and most important branch of hygiene, aims to conserve the health of future generations, through the action of those now living. Hygiene (individual and public) teaches us how to create for ourselves healthful conditions of living, but on every side we see evidences of the fact that we cannot entirely control conditions of health through hygiene only. Not all maladies by any means can be attributed to unnatural or unhygienic conditions of living. It is true that if followed out faithfully, the rules of hygiene will enable a man to live out his maximum natural life-span, with the maximum of well-being, and to run no risk of allowing any inherent weakness to be brought out. But some persons, even if they followed what is very nearly the normal code for the human being, would scarcely be able to avoid dire physical and mental fates. In short, we find that besides the hygienic factor in life which we may call environment, there is something else on which the health of the individual depends. This something else is heredity, or "the nature of the breed." Back of all the individual can do by hygiene lies his inheritance. To change this the individual can do nothing, but the parents of the individual can affect his inheritance, and we as parents can affect the inheritance of our offspring.

Trustees of the Racial Germ-plasm

First, we can carry through life uninjured the essential germ plasm which has been entrusted to our care. We should never forget that this germ plasm, which we receive and transmit, really belongs, not to us, but to the race; and that we have no right, through alcoholic or other unhygienic practises, to damage it; but that, on the contrary, we are under the most solemn obligation to keep it up to the highest level within our power. We are the trustees of the racial germ plasm that we carry.

Wise Combinations of Germinal Traits

Second, we can affect the life of our offspring by our choice in marriage. The basis of the development of desirable or undesirable tendencies or traits lies, of course, in the mating from which the individual springs. On the kind of combinations of germinal traits that are made by marriage depends whether or not undesirable traits shall reappear in the offspring. For instance, a man may inherit a defect from his father because his father married a certain type of woman. Had the father selected a different type, the children might not have inherited the father's defect. The importance of choice in marriage results from certain laws of inheritance, which make it clear that by proper combinations of individuals certain bad traits may be entirely "bred out."

Choice in Marriage

As soon as men and women acquire the knowledge that their choices in marriage largely determine whether or not their physical and mental faults and virtues will reappear in children, they feel a sacred responsibility in that act of choosing. A little conscious knowledge of what kind of combinations of traits bring about their reappearance in offspring can not help but modify a person's taste, and thus automatically direct the choice of a mate, which choice will still be, and rightfully, an instinctive one. Upon the wisdom with which choices in marriage are now made depends in large degree the health and efficiency of all the individuals who will constitute society in the coming generations. As the science of eugenics gathers a greater wealth of evidence and subjects it to vigorous analysis, its ability to guide the race to higher levels will become more positive and far-reaching. This can be done without surrendering the general principle of individual freedom. It will not reduce but increase the number of natural love-marriages. The errors of crude and superficial or overenthusiastic eugenists should not obscure the enormous possibilities of the science for the human race. Eugenic knowledge is, therefore, not only a personal advantage but a social necessity.

For society as a whole, a thoroughgoing eugenic program must include:

Social Progress

(1) The prevention of reproduction by the markedly unfit, such as the feeble-minded, by sterilization of the most unfit and by segregating the remainder in public institutions.

(2) The enactment of wise marriage laws.

(3) The development of an enlightened sentiment against improper marriages and the putting at the disposal of individuals contemplating marriage the data accumulated and principles worked out by eugenic students.

The Eugenics Record Office of Cold Spring Harbor, Long Island, N. Y., is now engaged in collecting such material.

For us of the present generation, hygiene is of immediate concern; but if we are to build for future generations, hygiene must give way to, or grow into, eugenics. The accomplishment of a true eugenic program will be the crowning work of the health movement and the grandest service of science to the human race. (For further comments on this subject see "Eugenics" in Supplementary Notes.)

* * *

SUPPLEMENTARY NOTES ON SPECIAL SUBJECTS

* * *

SECTION I

NOTES ON FOOD

Balancing the Diet

It will help to balance the ration and to avoid an excess of protein and also to avoid a deficiency of either fat or carbohydrate, if we take a bird's-eye view of the various common foods in respect to the protein, fat and carbohydrate they contain. For this purpose the following table has been constructed.

Common Foods Classified

COMMON FOODS CLASSIFIED

Poor in Fat. Rich in Fat. Very rich in Fat.

Very high in Protein White of Eggs

Cod Fish

Lean Beef

Chicken

Veal

High in Protein Shell-fish

Skim Milk

Lentils

Peas

Beans Most Fish

Most Meats

Most Fowl

Whole Egg

Cheese

Moderate or Deficient in Protein Most Vegetables

Bread

Potatoes

Fruits

Sugar Peanuts

Milk

Cream Soups

Most Pies

Doughnuts Fat Meats

Yolk of Eggs

Most Nuts

Cream

Butter

The foods given in the uppermost compartment are those "very high" in protein (above 40 per cent. of their total calories, or food value, being protein). Those in the two compartments next below are merely "high" in protein (20 to 40 per cent.), while the lowest three compartments contain those "moderate or deficient" in protein (zero to 20 per cent.).

The compartment farthest to the right contains a list of those foods "very rich in fat." The two compartments next to the left contain those "rich in fat," and the three compartments to the extreme left contain those "poor in fat."

With reference to carbohydrates (starch or sugar), we can say that the foods in the lower left compartment are very rich in carbohydrate. Those in the two neighboring compartments (the one beginning "shell-fish" and the one beginning "peanuts") are moderate, and those in the remaining compartments are those poorest in carbohydrate.

Thus, practically, the nearer the name of any food is to the upper corner of this triangular table, the more protein that food contains; the nearer it is to the right hand corner, the more fat; and the nearer to the remaining corner (lower left), the more carbohydrate (starch and sugar).

Ideal Food Proportions

An ideal proportion of the three food elements is to be had only in the middle compartment of the lowest row. But it is by no means necessary or advisable to confine one's diet to the few foods which happen to fall in that compartment, provided foods chosen from other compartments balance each other. Thus, fruit and nuts balance each other, the one being at the left and the other at the right of the ideal compartment. In the same way, potatoes and cream balance each other, as do bread and butter. Instinctively these combinations have been chosen, especially bread and butter. This combination is, however, slightly too low in protein, and a better balance is obtained by adding a little from the compartment vertically above the ideal. In this way we obtain the familiar meat-, egg-, or cheese-sandwich, constituting of itself a fairly well-balanced meal.

In short, in order to maintain a diet correct as to protein, it is only necessary to make our main choices from the lowest row and, in case the foods so chosen are near the bottom, to supplement these by a moderate use from the row above and a still more sparing use of those in the top compartment.

The following more detailed and specific table of food values will prove helpful to those who desire intelligently to balance their diet or to provide balanced menus for their families. A very little attention to this subject will enable one to acquire sufficient knowledge of dietetic needs to successfully govern the diet in a general way without weighing or measuring the food. In the following table the number of calories available in ordinary food portions is stated. Such a table should not, of course, be memorized, but an occasional reference to it will enable one soon to acquire a working knowledge of the food values of the main articles in the dietary.

TABLE OF FOOD VALUES

THE WEIGHT (IN GRAMS, OUNCES AND ROUGH MEASURE) OF A PORTION CONTAINING 100 CALORIES OF EACH FOOD AND THE NUMBER OF CALORIES IN THE 100 IN THE FORM OF PROTEIN, FAT AND CARBOHYDRATE.[A] Name of Food "Portion" Containing 100 Calories Roughly Described Wgt. of 100 Calories Percent of

Gram Ounce Protein Fat Carbo-

hydrate

VEGETABLES

[B] Artichokes, as purchased, average, canned 430 15. 14 0 86

[B] Asparagus, as purchased, average, canned 540 19. 33 5 62

[B] Asparagus, as purchased, average, cooked 206 7.19 18 63 19

[B] Beans, baked, canned Small side dish 75 2.66 21 18 61

[B] Beans, Lima, canned Large side dish 126 4.44 21 4 75

[B] Beans, string, cooked Five servings 480 16.66 15 48 37

[B] Beets, edible portion, cooked Three servings 245 8.7 2 23 75

[B] Cabbage, edible portion 310 17. 20 8 72

[B] Carrots, edible portion, average, fresh 215 7.6 10 8 82

Carrots, cooked Two servings 164 5.81 10 34 56

[B] Cauliflower, as purchased, average 312 11. 23 15 62

[B] Celery, edible portion, average 540 19. 24 5 71

Corn, sweet, cooked One side dish 99 3.5 13 10 77

[B] Cucumbers, edible portion, average 565 20. 18 10 72

[B] Egg plant, edible portion, average 350 12. 17 10 73

Lentils, cooked 89 3.15 27 1 72

[B] Lettuce, edible portion, average 505 18. 25 14 61

[B] Mushrooms, as purchased, average 215 7.6 31 8 61

[B] Onions, fresh, edible portion, average 200 7.1 13 5 82

[B] Onions, cooked Two large servings 240 8.4 12 40 48

[B] Parsnips, edible portion, average One and a half servings 152 5.3 10 7 83

Parsnips, cooked 163 5.74 10 34 56

[B] Peas, green, canned Two servings 178 6.3 25 3 72

[B] Peas, green, cooked One serving 85 3. 23 27 50

Potatoes, baked One good sized 86 3.05 11 1 88

[B] Potatoes, boiled One large sized 102 3.62 11 1 88

[B] Potatoes, mashed (creamed) One serving 89 3.14 10 25 65

[B] Potatoes, steamed One serving 101 3.57 11 1 88

[B] Potatoes, chips One-half serving 17 .6 4 63 33

[B] Potatoes, sweet, cooked Half of average potato 49 1.7 6 9 85

[B] Pumpkins, edible portion, average 380 13. 15 4 81

Radishes, as purchased 480 17. 18 3 79

Rhubarb, edible portion, average 430 15. 10 27 63

[B] Spinach, cooked, as purchased Two ordinary servings 174 6.1 15 66 19

[B] Squash, edible portion, average 210 7.4 12 10 78

[B] Succotash, canned, as purchased, average Ordinary serving 100 3.5 15 9 76

[B] Tomatoes, fresh, as purchased, average Four average tomatoes 430 15. 15 16 69

[B] Tomatoes, canned 431 15.2 21 7 72

[B] Turnips, edible portion, average Two large servings 246 8.7 13 4 83

Vegetable oysters 273 9.62 10 51 39

FRUITS (FRESH OR COOKED)

[B] Apples, as purchased Two apples 206 7.3 3 7 90

Apples, baked 94 3.3 2 5 93

Apples, sauce Ordinary serving 111 3.9 2 5 93

[B] Apricots, edible portion, average 168 5.92 8 0 92

Apricots, cooked Large serving 131 4.61 6 0 94

[B] Bananas, yellow, edible portion, average One large 100 3.5 5 5 90

[B] Blackberries, as purchased, average 170 5.9 9 16 75

Blueberries 128 4.6 3 8 89

[B] Blueberries, canned, as purchased 165 5.8 4 9 87

Cantaloupe Half ordinary serving 243 8.6 6 0 94

[B] Cherries, edible portion, average 124 4.4 5 10 85

[B] Cranberries, as purchased, average 210 7.5 3 12 85

[B] Grapes, as purchased, average 136 4.8 5 15 80

Grape fruit 215 7.57 7 4 89

Grape juice Small glass 120 4.2 0 0 100

Gooseberries 261 9.2 5 0 95

[B] Lemons 215 7.57 9 14 77

Lemon juice 246 8.77 0 0 100

Nectarines 147 5.18 4 0 96

Olives, ripe About seven olives 37 1.31 2 91 7

[B] Oranges, as purchased, average One very large 270 9.4 6 3 91

Oranges, juice Large glass 188 6.62 0 0 100

[B] Peaches, as purchased, average Three ordinary 290 10. 7 2 91

Peaches, sauce Ordinary serving 136 4.78 4 2 94

Peaches, juice Ordinary glass 136 4.80 0 0 100

[B] Pears One large pear 173 5.40 4 7 89

Pears, sauce 113 3.98 3 4 93

[B] Pineapples, edible portion, average 226 8. 4 6 90

Raspberries, black 146 5.18 10 14 76

Raspberries, red 178 6.29 8 0 92

[B] Strawberries, as purchased, average Two servings 260 9.1 10 15 75

[B] Watermelon, as purchased, average 760 27. 6 6 88

COOKED MEATS

[C] Beef, round, boiled (fat), 1099[D] Small serving 36 1.3 40 60 00

[C] Beef, round, boiled (lean), 1206[D] Large serving 62 2.2 90 10 00

[C] Beef, round, boiled (med.), 1188[D] Small serving 44 1.6 60 40 00

[C] Beef, 5th right rib, roasted, 1538[D] Half serving 18.5 .65 12 88 00

[C] Beef, 5th right rib, roasted, 1616[D] Small serving 32 1.2 25 75 00

[C] Beef, 5th right rib, roasted, 1615[D] Very small serving 25 .88 18 82 00

[C] Beef, ribs, boiled, 1169[D] Small serving 30 1.1 27 73 00

[C] Beef, ribs, boiled, 1170[D] Very small serving 25 .87 21 79 00

[B] Calves foot jelly, as purchased 112 4. 19 00 81

[B] Chicken, as purchased, canned One thin slice 27 .96 23 77 00

[B] Lamb chops, boiled, edible portion, average One small chop 27 .96 24 76 00

[B] Lamb, leg, roast Ordinary serving 50 1.8 40 60 00

[C] Mutton, leg, boiled, 1184[D] Large serving 34 1.2 35 65 00

[C] Pork, ham, boiled (fat), 1174[D] Small serving 20.5 .73 14 86 00

[C] Pork, ham, boiled, 1192[D] Ordinary serving 32.5 1.1 28 72 00

[C] Pork, ham, roasted (fat), 1484[D] Small serving 27 .96 19 81 00

[C] Pork, ham, roasted (lean), 1511[D] Small serving 34 1.2 33 67 00

[B] Turkey, as purchased, canned Small serving 28 .99 23 77 00

[C] Veal, leg, boiled, 1182[D] Large serving 67.5 2.4 73 27 00

CAKES, PASTRY, PUDDING AND DESSERTS

[B] Cake, chocolate layer, as purchased Half ordinary square piece 28 .98 7 22 71

[B] Cake, gingerbread, as purchased Half ordinary square piece 27 .96 6 23 71

[B] Cake, sponge, as purchased Small piece 25 .89 7 25 68

Custard, caramel 71 2.51 19 10 71

Custard, milk Ordinary cup 122 4.29 26 56 18

Custard, tapioca Two-thirds ordinary 69.5 2.45 9 12 79

[B] Doughnuts, as purchased Half a doughnut 23 .8 6 45 49

[B] Lady fingers, as purchased 27 .95 10 12 78

[B] Macaroons, as purchased 23 .82 6 33 61

Pie, apple, as purchased One-third ordinary piece 38 1.3 5 32 63

[B] Pie, cream, as purchased One-fourth ordinary piece 30 1.1 5 32 63

[B] Pie, custard, as purchased One-third ordinary piece 55 1.9 9 32 59

[B] Pie, lemon, as purchased One-third ordinary piece 38 1.35 6 36 58

[B] Pie, mince, as purchased One-fourth ordinary piece 35 1.2 8 38 54

[B] Pie, squash, as purchased One-third ordinary piece 55 1.9 10 42 48

Pudding, apple sago 81 3.02 6 3 91

Pudding, brown betty Half ordinary serving 56.6 2. 7 12 81

Pudding, cream rice Very small serving 75 2.65 8 13 79

Pudding, Indian meal Half ordinary serving 56.6 2. 12 25 63

Pudding, apple tapioca Small serving 79 2.8 1 1 98

Tapioca, cooked Ordinary serving 108 3.85 1 1 98

FRUITS (DRIED)

[B] Apples, as purchased, average 34 1.2 3 7 90

Apricots, as purchased, average 35 1.24 7 3 90

[B] Dates, edible portion, average Three large 28 .99 2 7 91

[B] Dates, as purchased 31 1.1 2 7 91

[B] Figs, edible portion, average One large 31 1.1 5 0 95

[B] Prunes, edible portion, average Three large 32 1.14 3 0 97

[B] Prunes, as purchased 38 1.35 3 0 97

[B] Raisins, edible portion, average 28 1. 3 9 88

[B] Raisins, as purchased 31 1.1 3 9 88

CEREALS

[B] Bread, brown, as purchased, average Ordinary thick slice 43 1.5 9 7 84

[B] Bread, corn (johnnycake) as purchased, average Small square 38 1.3 12 10 72

[B] Bread, white, home made, as purchased Ordinary thick slice 38 1.3 13 6 81

Corn flakes, toasted Ordinary cereal dishful 27 .97 11 1 88

[B] Corn meal, granular, average 27 .96 10 5 85

[B] Corn meal, unbolted, edible portion, average 26 .92 9 11 80

[B] Crackers, graham, as purchased Two crackers 23 .82 9 20 71

[B] Crackers, oatmeal, as purchased Two crackers 23 .81 11 24 65

[B] Hominy, cooked Large serving 120 4.2 11 2 87

[B] Macaroni, average 27 .96 16 2 83

[B] Macaroni, average, cooked Ordinary serving 110 3.85 14 15 71

[B] Oatmeal, average, boiled One and a half serving 159 5.6 18 7 75

[B] Popcorn, average 24 .86 11 11 78

[B] Rice, uncooked 28 .98 9 1 90

[B] Rice, boiled, average Ordinary cereal dish 87 3.1 10 1 89

[B] Rice, flakes Ordinary cereal dish 27 .94 8 1 91

[B] Rolls, Vienna, as purchased, average One large roll 35 1.2 12 7 81

[B] Shredded wheat One biscuit 27 .94 13 4.5 82.5

[B] Spaghetti, average 28 .97 12 1 87

[B] Wheat flour, entire wheat average 27 .96 15 5 80

[B] Wheat flour, graham, average 27 .96 15 5 80

[B] Wheat flour, patent roller process, family and straight grade spring wheat, average 27 .97 12 3 85

[B] Zwieback Size of thick slice bread 23 .81 9 21 70

DAIRY PRODUCTS

[B] Butter, as purchased Ordinary pat or ball 12.5 .44 .5 99.5 00

[B] Buttermilk, as purchased One and a half glass 275 9.7 34 12 54

[B] Cheese, American, pale, as purchased One and a half cubic in 22 .77 25 73 2

[B] Cheese, cottage, as purchased Four cubic in 89 3.12 76 8 16

[B] Cheese, full cream, as purchased One and a half cubic in. 23 .82 25 73 2

[B] Cheese, Neufchatel, as purchased One and a half cubic in. 29.5 1.05 22 76 2

[B] Cheese, Swiss, as purchased One and a half cubic in. 23 .8 25 74 1

[B] Cheese, pineapple, as purchased One and a half cubic in. 20 .72 25 73 2

[B] Cream One quarter ordinary glass 49 1.7 5 86 9

Kumyss 188 6.7 21 37 42

[B] Milk, condensed, sweetened, as purch. 30 1.06 10 23 67

[B] Milk, condensed, unsweetened (evap. cream) as purchased 59 2.05 24 50 26

[B] Milk, skimmed, as purchased One and a half glasses 255 9.4 37 7 56

[B] Milk, whole, as purchased Small glass 140 4.9 19 52 29

Whey, as purchased Two glasses 360 13 15 10 75

SWEETS AND PICKLES

[B] Catsup, tomato, as purchased, average 170 6. 10 3 87

[B] Honey, as purchased Four teaspoonfuls 30 1.05 1 0 99

[B] Marmalade (orange peel) 28.3 1. .5 2.5 97

[B] Molasses, cane 35 1.2 .5 0 99.5

[B] Olives, green, edible portion Seven olives 32 1.1 1 84 15

[B] Olives, ripe, edible portion Seven olives 38 1.3 2 91 7

[B] Pickles, mixed, as purchased 415 14.6 18 15 67

[B] Sugar, granulated Three teaspoonfuls or one and a half lumps 24 .86 0 0 100

[B] Sugar, maple Four teaspoonfuls 29 1.03 0 0 100

[B] Sirup, maple Four teaspoonfuls 35 1.2 0 0 100

NUTS

[B] Almonds, edible portion, average About eight 15 .53 13 77 10

[B] Beechnuts 14.8 .52 13 79 8

[B] Brazil nuts, edible portion Three ordinary size 14 .49 10 86 4

[B] Butternuts 14 .50 16 82 2

[B] Cocoanuts 16 .57 4 77 19

[B] Chestnuts, fresh, edible portion, average 40 1.4 10 20 70

[B] Filberts, edible portion, average Ten nuts 14 .48 9 84 7

[B] Hickory nuts 13 .47 9 85 6

[B] Peanuts, edible portion, average Thirteen double 18 .62 20 63 17

[B] Pecans, polished, edible portion About eight 13 .46 6 87 7

[B] Pine nuts (pignolias), edible portion About eighty 16 .56 22 74 4

[B] Walnuts, California, edible portion About six 14 .48 10 83 7

MISCELLANEOUS

[B] Eggs, hen's, boiled One large egg 59 2.1 32 68 00

[B] Eggs, hen's whites 181 6.4 100 0 00

[B] Eggs, hen's, yolks Two yolks 27 .94 17 83 00

[B] Omelet 94 3.3 34 60 6

[B] Soup, beef, as purchased, average 380 13. 69 14 17

[B] Soup, bean, as purchased, average Very large plate 150 5.4 20 20 60

[B] Soup, cream of celery, as purch., average Two plates 180 6.3 16 47 37

[B] Consomme, as purchased 830 29. 85 00 15

[B] Clam chowder, as purchased Two plates 230 8.25 17 18 65

[A] Abstracted from A Graphic Method of Practical Dietetics, Irving Fisher, Journal of A. M. A., Vol. xlviii, pp. 1316–1324.

[B] Chemical Composition of American Food Materials. Atwater and Bryant. U. S. Department of Agriculture Bulletin, No. 28.

[C] Experiments on Losses in Cooking Meats. (1900103, Grindley, U. S. Department of Agriculture Bulletin, No. 141.)

[D] Laboratory number of specimen, as per Experiments on Losses in Cooking Meat.

Cost of Ready to Serve Foods

The following table, adapted from one compiled by Gephart and Lusk ("Analysis and Cost of Ready to Serve Foods"), shows in convenient form the relative energy values and cost of the more commonly used articles of food.

A brief glance at this table will show how easily one might slowly starve on very expensive food, and yet how easily the energy food needed can be secured at a very low cost.

It would, of course, be a great mistake to regulate the diet solely with regard to fuel value. Digestibility, as well as protein, mineral and vitamin requirements, must also be considered. Nevertheless, the main requirement is for fuel, and this, as the table shows, can be secured at a surprizingly low cost.

Name of Food. No. of

Calories

in One

Order.[E] Cost of

One Order

"Quick Lunch"

Restaurant.

Napoleon 418.6 $0.05

Crullers 416.6 .05

Cabinet pudding and vanilla sauce 416.6 .05

Cocoanut pie 357 .05

[F][G] Roast beef sandwich with roll 357 .05

Bath buns 357 .05

Bread custard pudding 357 .05

Pineapple pie 357 .05

Corn muffins 357 .05

Apple pie 357 .05

New England pudding with vanilla sauce 312.5 .05

Chocolate spiced cakes. 312.5 .05

Walnut layer cake with marshmallow icing 312.5 .05

Milk crackers 312.5 .05

Bread pudding with vanilla sauce 312.5 .05

Pumpkin pie 312.5 .05

[G] Lamb croquettes and mashed potatoes 833.3 .15

Coffee cake 277.7 .05

Rhubarb pie 277.7 .05

[G] German meat cakes and French fried potatoes 833.3 .15

Old-fashioned molasses cake 277.7 .05

Lemon pie 277.7 .05

[F][G] Vienna roast with French fried potatoes 833.3 .15

Butter cakes 277.7 .05

Minced ham sandwich 277.7 .05

Pork and Boston beans 833.3 .15

Cornmeal cakes with maple cane sirup 500 .10

[G] Ham croquettes 500 .10

Cold rice pudding 277.7 .05

Ham sandwich with roll 250 .05

Banana layer cake 250 .05

[F][G] Creamed chipped beef on toast 833.3 .15

Cocoa 250 .05

[F][G] Roast beef cutlet with tomato sauce 833.3 .15

[F][G] German meat cakes with lyonnaise potatoes 833.3 .15

[F][G] Swiss cheese sandwich 250 .05

[F] Boston baked beans 500 .10

[G] Vienna roast, spaghetti and potatoes 625 .15

Chocolate cornstarch with cream 227.2 .05

Wheat cakes with maple cane sirup 500 .10

Milk crackers and milk 500 .10

[F][G] American cheese sandwich 227.2 .05

[F] New York baked beans 500 .10

Hot corn bread 416.6 .10

[F][G] Country sausage 227.2 .05

Indian pudding with maple sauce 227.2 .05

[F][G] Minced tongue sandwich with tea biscuits 227.2 .05

Cream roll 227.2 .05

[G] Beef cakes with brown gravy and macaroni 625 .15

[F] New York beans, on the side 227.2 .05

Graham crackers 227.2 .05

[G] Broiled ham 833.3 .20

[G] Roast beef hash, browned 625 .15

Oyster pie 625 .15

[F][G] Minced chicken sandwich 227.2 .05

Apple tapioca pudding 227.2 .05

Potato salad 416.6 .10

Chocolate layer cake 208.3 .05

[F][G] Breaded veal cutlet and tomato sauce 833.3 .20

Egg plant fried in butter 625 .15

Buckwheat cakes with maple cane sirup 417.6 .10

[G] Roast beef croquettes with macaroni 625 .15

[G] Fried bacon with French fried potatoes 833.3 .20

[G] Sardine sandwich 208.3 .05

[F][G] Minced ham sandwich with olives 208.3 .05

[F][G] Ham and New York Beans 625 .15

Vanilla cornstarch with cream 208.3 .05

[F][G] Roast beef cutlet and mashed potatoes 625 .15

[G] Lamb cutlet and mashed potatoes 625 .15

Cocoanut cake 208.3 .05

Cream cheese walnut sandwich 208.3 .05

[F] New York baked beans with tomato sauce 416.6 .10

[G] Ham and Boston beans 625 .15

[G] Liver and onions with French fried potatoes 833.3 .20

[F][G] Beef stew 625 .15

[F][G] Pork and New York beans 625 .15

[F][G] Ham sandwich 192.3 .05

Rice croquette with bacon 625 .15

Baked apple with cream 416.6 .10

[G] Frankfurters and potato salad 625 .15

Baked beans with macaroni 625 .15

Cup of coffee (containing cream and sugar) 192.3 .05

[G] Mince pie 417.6 .10

[F][G] Lamb stew 625 .15

[F][G] Broiled salt mackerel with mashed potatoes 833.3 .20

Cherry pie 357 .10

Pound cake 357 .10

[G] Chicken cutlet and mashed potatoes 625 .20

[F][G] Shredded wheat and milk 357 .10

Cream tapioca pudding 192.3 .05

Soda crackers and milk 357 .10

Strawberry pie 357 .10

Chocolate eclair 192.3 .05

[F][G] Baked lamb pie (individual) 625 .15

[F][G] Corned beef sandwich 192.3 .05

[G] Broiled bacon 833.3 .20

Rice cakes with maple cane sirup 625 .15

[G] Cold ham 500 .15

[G] Roast beef croquettes and spaghetti 500 .15

[F][G] Chipped beef and scrambled egg 833.3 .20

[G] Minced ham with scrambled eggs 833.3 .20

Peach pie 357 .10

[G] Baked macaroni and cheese 357 .10

Huckleberry pie 357 .10

French toast with maple cane sirup. 625 .15

[F][G] Corned beef and New York beans 500 .15

Blackberry pie 357 .10

[F][G] Veal pot pie with dumplings 500 .15

[F][G] Creamed codfish on toast 500 .15

[G] Vienna roast with stewed tomatoes 500 .15

[F][G] Tomato omelet 625 .20

[G] Small oyster fry 625 .20

Hot rice with cream 500 .15

[G] Plain oyster fry with bacon 625 .20

[F][G] Hamburger steak 625 .20

[G] Corned beef hash, browned in pan 500 .15

[G] Corned beef hash, steamed 500 .15

Cream 500 .15

[F][G] Chicken wings on toast 625 .20

[G] Country sausage and French fried potatoes 500 .15

[F][G] Corned beef and Boston beans 500 .15

[F][G] Two fried eggs 500 .15

[F][G] Ham omelet 625 .20

[F][G] Plain omelet 500 .15

[F][G] Fried liver and mashed potatoes 500 .15

[F][G] Creamed chipped beef 500 .15

[G] Large oyster fry 833.3 .25

Apple fritters with fruit sauce 312.5 .10

[G] Fish cakes with tomato sauce 500 .15

French fried potatoes, extra order 312.5 .10

Chocolate cornstarch with whipped cream 156.25 .05

Shredded wheat and cream 416.6 .15

[G] Chicken croquette and French fried potatoes 500 .15

[F][G] Corned beef hash with poached egg 625 .20

[F][G] Ham and eggs 833.3 .25

[G] Ham and potato salad 625 .20

[F][G] Baked shad and dressing 625 .20

[F][G] Hamburger steak with Spanish sauce 625 .20

Charlotte russe 156.25 .05

[F][G] Creamed eggs on toast 625 .20

[G] Bacon and eggs 833.3 .25

Strawberry fruit jelly with whipped cream 156.25 .05

[F][G] Buckwheat cakes with country sausage 625 .20

[G] Oyster sandwich 312.5 .10

[F] Chicken giblets on toast 625 .20

Hot rice with butter 312.5 .10

Pimento olive cheese sandwich 156.25 .05

[F][G] Liver and bacon with lyonnaise potatoes 833.3 .25

[F][G] Corned beef hash, browned, with two poached eggs 833.3 .25

Buttered toast 312.5 .10

[F][G] Liver and bacon 833.3 .25

[F][G] Chicken hash 416.6 .15

[G] Two scrambled eggs 416.6 .15

[F][G] Milk 277.7 .10

Apple sauce with whipped cream 147.05 .05

Hot rice with poached egg 416.6 .15

[F][G] Corned beef with potato salad 416.6 .15

Fish cakes with poached egg 625 .20

[F][G] Cold roast beef 416.6 .15

[G] Hot rice with milk 277.7 .10

[F][G] Small steak 833.3 .30

Baked apple 138.8 .05

Baked apple with ice cream 277.7 .10

[G] Two lamb chops 833.3 .30

[G] Chicken salad sandwich 277.7 .10

[F][G] Corned beef hash, steamed, with poached egg 500 .20

[F] Boston beans on side 131.57 .05

Tomato sandwich 131.57 .05

[G] Lamb chops, breaded, with mashed potatoes 500 .20

[F][G] Maple flakes with milk 277.7 .10

[F][G] Corned beef 416.6 .15

[F][G] Bulgarzoon 131.57 .05

[G] Spanish omelet with French fried potatoes 625 .25

Baked apple custard with whipped cream 250 .10

Boiled rice, side order 131.57 .05

[F][G] Fried egg sandwich 250 .10

[F][G] Onion omelet 500 .20

[F][G] Baked weak fish with dressing 500 .20

[F][G] Sirloin steak 1250 .50

Fresh cooked oatmeal with cream 416.6 .15

[F][G] Fish cakes with macaroni 500 .20

Sliced bananas with cream 250 .10

[F] Macaroni, side order 125 .05

[F][G] Roast sirloin of beef and mashed potatoes 500 .20

[G] Tomato omelet with potatoes 625 .25

[F][G] Two boiled eggs 357 .15

[F][G] Fish cakes with spaghetti 500 .20

[F][G] Macaroni omelet and tomato sauce 625 .25

[F][G] Small steak with onions 833.3 .35

[F][G] Fish cake sandwich 227.2 .10

[F][G] Egg salad 500 .20

[F][G] Parsley omelet 500 .20

Green split pea soup 227.2 .10

Vanilla ice cream 227.2 .10

[F][G] Tenderloin steak with onions 1250 .55

[F][G] Cornflakes and milk 227.2 .10

Strawberry tart 227.2 .10

[F][G] Tuna fish salad 500 .25

[F][G] Sirloin steak with onions 1250 .55

Pineapple fruit jelly with whipped cream 108.69 .05

[F][G] Cup custard 227.2 .10

[F][G] Roast beef with potato salad 500 .25

[F][G] Tenderloin steak 1250 .60

[G] Milk toast 312.5 .15

Strawberry cornstarch with whipped cream 104.16 .05

Strawberry ice cream 208.3 .10

[F][G] Clam chowder 416.6 .20

[F] Chicken soup 312.5 .15

[F][G] Crab meat salad 416.6 .20

Vegetable soup 192.3 .10

Stewed rhubarb 92.59 .05

[F][G] Creamed chicken on toast 357 .20

Strawberries with cream 277.7 .15

Strawberry short cake 277.7 .15

[F][G] Chicken omelet 416.6 .20

[F][G] Deviled crab 277.7 .20

Sliced bananas 89.28 .05

[F][G] Spaghetti and cheese 178.57 .10

[F][G] Fried ham 416.6 .25

[G] Minced chicken sandwich with lettuce 166.66 .10

[F] Bean soup with croutons 166.66 .10

[F][G] Hot roast beef sandwich 250 .15

[F][G] Club sandwich 416.6 .25

[F][G] Sliced chicken sandwich 156.25 .10

[F][G] Poached eggs on toast 500 .20

Strawberries with ice cream 192.3 .15

[F] Cream of wheat 125 .10

Blackberries and cream 113.63 .10

Stewed corn 52.08 .05

[F] Creamed asparagus on toast 192.3 .20

Watermelon 125 .15

[F] Tomato soup with rice 73.52 .10

Sliced pineapple 35.21 .05

Grape Fruit 78.12 .15

[F][G] Raw oysters 55.55 .15

Sliced tomatoes with lettuce 50 .15

[F] Sliced tomatoes 30.48 .10

Tomatoes and lettuce with dressing 53.19 .20

Cantaloupe 36.23 .15

Champagne[H] 357 1.00

[E] These values cover the whole portion as served, including bread and butter.

[F] Contains 15 per cent. or over of heat in protein.

[G] contains the protein of meat, milk, eggs or cheese.

[H] Not purchased in the restaurant.

The Minimal Cost of Food

Professor Graham Lusk has very kindly contributed the following comments and additional table, derived from this material:

"The above are analyses of 350 different samples of foods purchased over the counters of a company which maintains a chain of restaurants in New York City, and obtained without knowledge on the part of these restaurants that the analyses were contemplated.

"One may reliably assume that for the man of ordinary size, who lives without doing any special muscular exercise, the fuel requirement of the body each day amounts to 2,500 calories of heat. Translated into common terms, this is the quantity of heat which would be required to raise about 25 quarts of water from the freezing to the boiling point. Miss Cauble, a special investigator of the Association for the Improvement of the Condition of the Poor, kindly estimated the cost at wholesale prices of the ingredients of different portions sold in the restaurants. These are given in Table 9 beginning on page 64 of the pamphlet from which the above table was derived. The data enable one to construct a new table which gives the estimated wholesale cost of 2,500 calories in the various familiar forms of food sold in the restaurant. This represents the minimum cost of fuel for the support of an adult during twenty-four hours without taking into consideration labor, fuel or rent which, in the case of the restaurant, must be included in the cost of the foods when they are eaten. It represents the minimal cost of food in the home.

"It appears from the table given below that the cost of 2,500 calories in the wholesale market varies from $.04 in the case of boiled rice to $.61 for shad. About half of the dishes can be obtained at wholesale at a price less than $.25 for 2,500 calories, or less than a cent per hundred calories, a cost which is the standard striven for in school lunches. The table is given on the next page.

ESTIMATED WHOLESALE COST OF THE UNCOOKED INGREDIENTS OF 2500 CALORIES CONTAINED IN STANDARD FOODS ARRANGED ACCORDING TO THEIR INCREASING COST. Apple tapioca pudding $.04

Rice, boiled (side order) .04

Bath buns .06

Pie, apple .07

Pie, rhubarb .08

Apple, baked .09

Pie, strawberry .09

Cocoa .09

Crullers .10

[I] Fish cakes with tomato sauce .13

Muffins, corn .13

[I] Lamb croquette and mashed potatoes .14

[I] Beans, Boston baked .15

[I] Beef, corned .15

Pie, lemon .15

Chicken wings on toast .16

Napoleon .16

[I] Salad, potato .16

Toast, buttered .16

Cream roll .17

[I] Beef, creamed, chipped, on toast .18

Cakes, butter .19

[I] Roast, Vienna, and spaghetti and potatoes .19

Pudding, tapioca, creamed .20

Sandwich, oyster .20

[I] Veal cutlet, breaded and tomato sauce .20

[I] Beef, corned, hash browned in pan .21

[I] Liver and bacon .21

[I] Roast, Vienna, with French fried potatoes .21

[I] Stew, lamb .21

[I] Beans, New York, baked .22

Cakes, buckwheat, with maple cane sirup .22

Coffee, cup of (contained cream and sugar) .22

Pudding, bread, with vanilla sauce .24

[I] Beef, corned, hashed, steamed .25

Oatmeal, fresh cooked, with cream .25

[I] Stew, beef .25

Pie, oyster .26

Potatoes, French fried, extra order .26

[I] Sandwich, ham .26

[I] Beef, creamed, chipped .27

[I] Sandwich, corned beef .27

[I] Beef, corned, hashed, steamed, with poached egg .28

[I] Mackerel, broiled salt, with mashed potatoes .28

Milk .29

Pudding, rice, cold .29

[I] Rice, hot, with poached egg .29

Soup, bean, with croutons .29

[I] Sandwich, minced chicken .30

Cornstarch, chocolate, with cream .31

Ice cream, strawberry .31

[I] Omelet, ham .32

Sandwich, cream cheese walnut .32

[I] Omelet, plain .33

Cornstarch, vanilla, with cream .34

[I] Omelet, onion .34

[I] Oyster fry, small .34

[I] Eggs, fried (2) .35

[I] Sandwich, fried egg .35

Sausage, country .35

[I] Chicken croquette and French fried potatoes .36

[I] Eggs, creamed, on toast .36

[I] Omelet, parsley .37

[I] Omelet, Spanish, with French fried potatoes .37

[I] Sandwich, tomato .39

[I] Eggs, scrambled (2) .40

[I] Lamb chops (2) .40

Sandwich, club .40

[I] Salad, tuna fish .41

Custard .43

[I] Sandwich, chicken, sliced .43

[I] Steak, tenderloin .43

[I] Ham, fried .44

[I] Sandwich, roast beef, hot .44

Strawberries with cream .44

Toast, milk .45

[I] Eggs, boiled (2) .47

[I] Omelet, chicken .47

[I] Sandwich, minced chicken with lettuce .49

[I] Eggs, poached on toast (2) .59

[I] Shad, baked, and dressing .61

[I] These orders contained bread and butter, which are figured in the food values. Of the orders containing bread the fractional part of the nutritional energy of the order from this source averaged 43.7 per cent. of the total.

"Contemplation of these results may be made after the housekeeper has carefully gone through the monthly hills for food, divided the cost of the total food by the number of days in the month and then divided this figure by the number of people in the family, counting children between five and fifteen years of age at two-thirds of an adult.

"It would be interesting to know whether the cost of food for the adult as determined in this fashion was $.25, $.50 or $1.00 per day. Wherever the higher values are reached it is certain that extravagant profits are paid to middlemen or great waste exists in the kitchen.

"The theme might still further be elaborated, but the essential data for those interested in food economics can be obtained from the table itself. Wholesale prices are used for the reason that retail prices are subject to great variation. The fluctuation of retail prices does not make it feasible to give their equivalents for the wholesale list, but the relationship can be judged by noting the equivalents for the extremes. In this table, for example, the retail price of 2500 calories of rice would be about 13 cents as against 4 cents wholesale, and for shad about $1.50, retail as against 61 cents wholesale."

CALORIES OF FOOD CONSUMED DAILY[J]

[J] Skandinavisches Archiv für Physiologie XXXI. Band. 1., 2 u. 3. Heft, Leipzig, Verlag Von Veit & Comp., 1914.

The following table is derived from data produced by Becker and Hamalainen of the University of Helsingfors, Finland, from actual experiment with individuals alternately resting and working at their respective trades while in the "respiration calorimeter."

Occupation Age Height

Ft.–Ins. Wgt.

Lbs. During Rest During Work Total Calories per Day (8 Hrs Work, 16 Hrs. Rest)

Calories per Hour Calories per Hour per Lb. of Body Weight Calories per Hour

MEN

Shoemaker 56 5–0 145 73 .50 172 2544

Shoemaker 30 5–8 143 87 .60 171 2760

Tailor 39 5–5 141 72 .50 124 2144

Tailor 46 5–10? 161 102 .63 135 2712

Bookbinder 19 6–0 150 87 .58 164 2704

Bookbinder 23 5–4? 143 85 .59 163 2664

Metalworker 34 5–4 139 81 .58 216 3024

Metalworker 27 5–5 130 99 .76 219 3336

Painter 25 5–11 154 104 .67 231 3512

Painter 27 5–8 147 111 .79 230 3616

Joiner 42 5–7 154 81 .50 204 2928

Joiner 24 5–5? 141 85 .60 244 3312

Stone-worker 27 5–11 156 90 .57 408 4704

Stone-worker 22 5–8 141 85 .60 366 4288

Sawyer 42 5–5 167 86 .50 501 5384

Sawyer 43 5–5 143 84 .59 451 4952

WOMEN

Hand-sewer 53 5–3 139 75 .54 83 1864

Hand-sewer 35 5–6 143 64 .45 88 1728

Machine-sewer 53 5–3 139 75 .54 103 2024

Machine-sewer 19 5–3 110 64 .58 119 1976

Wash-woman 43 5–3 125 75 .60 285 3480

Wash-woman 19 5–3 110 64 .58 186 2512

Waitress 43 5–3 125 75 .60 228 3024

Waitress 19 5–3 110 64 .58 143 2168

Bookbinder 22 5–4 105 70 .65 98 1904

Bookbinder 22 5–3 112 61 .54 127 1992

For example, for sawyers (an active occupation), the heat production and consequent requirement in calories worked out as follows:

During rest 84 calories × 16 h. 1344

During work 451 calories × 8 h. 3608

Total calories 4952

The tailor (sedentary occupation) showed the following heat production and calorific requirement:

72 calories × 16 h. 1152

124 calories × 8 h. 992

Total calories 2144

These figures show the wide variation in food requirements according to age, weight and occupation.

Basal Metabolism

Francis G. Benedict and his co-workers at the Nutrition Laboratory of the Carnegie Institution of Washington, and Prof. Graham Lusk of Cornell University, have also made a large number of experiments to ascertain what is termed the basal metabolism or heat production of the body at perfect rest, and also that under varying degrees of activity. The results are closely in agreement with the above.

Benedict has lately produced evidence to show that the basal metabolism, or heat production, at rest is not governed entirely by such factors as body weight and body surface, but by the amount and activity of the active protoplasmic cells of the body-the cells that compose the organs and muscles and blood. The condition of these cells when the measurements are taken (which may be influenced by age, sleep, previous muscular exercise and diet) materially affects the amount of heat production and the requirements in energy food. Such experiments show why a man must literally burn up his own body, if he takes in no fuel in the form of food. Benedict's views also account for the higher energy requirement of men as compared to women, who, as a rule, have more fat and less muscular tissue than men.

Diet and Endurance

We have quoted Rubner (vide page 38) as condemning the very old popular idea that meat is very "strengthening." Actual experiments on this point have shown exactly the opposite to be the case. Meat eating and a high-protein diet instead of increasing one's endurance, have been shown, like alcohol, to actually reduce it.

An experiment was made by one of the authors to determine this question. The experiment consisted of endurance tests made on 49 persons representing the two types of dietetic habits. The persons experimented upon constituted three classes: first, athletes accustomed to high-protein and full-flesh dietary; second, athletes accustomed to a low-protein and non-flesh dietary; third, sedentary persons accustomed to a low-protein and non-flesh dietary. The subjects consisted of Yale students and instructors, a Connecticut physician, and several other physicians and nurses. All of the low-protein and non-flesh subjects except one had abstained from flesh foods for periods of 4 to 20 years, and 5 of them had never eaten such foods.

The experiments furnished a severe test of the claims of the flesh-abstainers. Two comparisons were planned, one between flesh-eating athletes and flesh-abstaining athletes, and the other between flesh-eating athletes and flesh-abstaining sedentary workers. The results would indicate that the users of low-protein and the non-flesh dietaries have far greater endurance than those who are accustomed to the ordinary American diet.

In the absence of any exact mechanical method of measuring endurance, simple endurance tests were employed, such as holding the arms horizontally as long as possible and deep knee bending. The tests were made before witnesses.

The comparison for arm holding shows a great superiority on the side of the flesh-abstainers. Only 2 of the 15 flesh-eaters succeeded in holding their arms out over a quarter of an hour, whereas 22 of the 32 abstainers surpassed that limit. None of the flesh-eaters reached half an hour, but 15 of the 32 abstainers exceeded that limit. Of these 9 exceeded an hour, 4 exceeded 2 hours and 1 exceeded 3 hours.

In respect to deep knee bending, if we take the number 325 for reference, we find that, of the 9 flesh-eaters only 3 surpassed this figure, while of the 21 abstainers, 17 surpassed it. Only 1 of the 9 flesh-eaters reached 1,000 as against 6 of the 21 abstainers. None of the former surpassed 2,000 as against 2 of the latter.

Similar results have been found in other investigations. It is probable that the inferiority of meat-eaters in staying power is due primarily to high protein, not to meat per se.

In 1906, nine Yale students under the direction of one of the authors experimented with Mr. Horace Fletcher's method of thorough mastication and instinctive eating. The experiment began with an endurance test on January 14, and consisted mainly of two parts, each of which lasted about ten weeks.

The object of the first half of the experiment was to test the claims which have been made as to the effects upon endurance of thorough mastication combined with implicit obedience to appetite. Our conclusion in brief is that these claims, so far as they relate to endurance, are justified.

The method may be briefly expressed in two rules.

1. Mastication.-Thorough mastication of all food up to the point of involuntary swallowing, with the attention directed, however, not on the mechanical act of chewing, but on the tasting and enjoyment of the food; liquid foods to be sipped and tasted, not drunk down like water. There should be no artificial holding of food in the mouth beyond the time of natural swallowing, even if, as is to be expected at the start, that swallowing is premature. It is not intended to "count the chews," or to hold the food forcibly in the front of the mouth, or to allow the tongue muscles to become fatigued by any unnatural effort or position, or in any other way to make eating a bore. On the contrary, every such effort distracts one from the natural enjoyment of food. Pavlov has shown that without such attention and enjoyment of the taste of food, the secretion of gastric juice is lessened. The point of involuntary swallowing is thus a variable point, gradually coming later and later as the practise of thorough mastication proceeds, until the result is reached that the food remains in the mouth without effort and becomes practically tasteless. Thus the food, so to speak, swallows itself, and the person eats without thought either of swallowing or of not swallowing it; swallowing is put into the same category of physiological functions as breathing, which ordinarily is involuntary.

2. Following instinct.-Never to eat when not hungry, even if a meal (or more than one, for that matter) is skipped. And when a meal is taken, not to be guided by the quantity of food offered, or by past habit, or by any theories as to the amount of food needed. The natural taste or appetite is alone consulted, and the subject selects, from the food available, only those kinds and amounts which are actually craved by the appetite. After practise, the appetite gradually becomes more definite and discriminating in its indications.

During the second half of the experiment the two rules above mentioned were continued in force, but a third rule was added, namely, when the appetite was in doubt, to give the benefit of that doubt to low-protein and non-flesh foods. In other words, the influence of suggestion was invoked to hasten the change which had been inaugurated by arousing the natural appetite. Suggestion was introduced merely because the experiment was limited in time. In no case was it allowed to override the dictates of appetite.

Careful records of the amount of food taken and the constituents in (1) protein, (2) fats and (3) starches and sugars, were kept for each man for each day. In order to avoid weighing the food at the table and the annoyance which such a procedure involves, the food was all weighed in the kitchen and served in definite portions of known food value. From the records thus supplied, it was easy, by means of a "mechanical diet indicator" devised for the purpose, to find the proportions of food elements. The first result of the experiment was a reduction in the amount of protein consumed.

During the first four weeks, the men consumed an average of from 2,760 to 3,030 calories per day, of which 120 to 240 were in the flesh foods, such as meats, poultry, fish and shell-fish, and that 2.4 to 2.7 calories of protein were ingested for each pound of body-weight. Translating Professor Chittenden's figures for the physiological requirement of ingested protein, we find it to be from 1.3 to 1.7 calories per pound of body-weight. Thus the men were at this time consuming nearly double the Chittenden allowance. During the last four weeks of the experiment all these magnitudes were lower. The per capita calories ranged from 2,220 to 2,620, of which only 40 were in flesh foods, and the protein had fallen to 1.4 to 1.9 calories per pound of body-weight, which corresponds closely to the Chittenden standard.

Gymnasium tests were made at the beginning, middle and end of the experiment. These tests were of two kinds-tests of strength and tests of endurance.

During the first period there was a slight increase in strength (from an average "total" strength of 1,076 to 1,118), and during the second period a slight fall to 995, which is about 12 per cent. from the mid-year's 1,118, and about 8 per cent. from the original 1,076. Thus the strength of the men remained nearly stationary throughout the experiment.

It is fortunate that the strength of the men remained so nearly stationary; for it demonstrates the more clearly that the increase in endurance which will be shown below was an increase in endurance per se, and not in any degree due to an increase in strength. Strength and endurance are entirely distinct and should be separately measured. The strength of a muscle is measured by the utmost force which it can exert once; its endurance by the number of times it can repeat a given exertion well within its strength.

After much consideration and consultation it was decided not to place reliance on the ordinary ergographs as a means of measuring endurance. Instead, seven simple gymnastic tests of physical endurance were employed, and one of mental endurance. The seven physical tests were:

(1) Rising on the toes as many times as possible.

(2) Deep knee bending, or squatting as far as possible and rising to the standing posture, repeating as often as possible.

(3) While lying on the back, raising the legs from the floor to a vertical position and lowering them again, repeating to the point of physical exhaustion.

(4) Raising a 5-lb. dumb-bell (with the triceps) in each hand from the shoulder up to the highest point above the head, repeating to the point of physical exhaustion.

(5) Holding the arms from the sides horizontally for as long a time as possible.

(6) Raising a dumb-bell (with the biceps) in one hand from a position in which the arm hangs down, up to the shoulder and lowering it again, repeating the motion to the point of physical exhaustion. This test was taken with four successive dumb-bells of decreasing weight, viz., 50, 25, 10 and 5 lbs. respectively.

(7) Running on the gymnasium track at a speed to suit the subject, to as great a distance as possible.

The mental test consisted of adding specified columns of figures as rapidly as possible, the object being to find out whether the rapidity of performing such work tended to improve during the experiment.

PERCENTAGE OF IMPROVEMENT IN ENDURANCE (EXACT OR UNDERSTATED) OF EIGHT MEN. Average.

B Lq. Lw. M P R T W

Jan.–Mar. 33+ 36 50 - 26 18+ 66+ 33

Jan.–June 84+ 84+ 181 29 56+ 89+ 80+ 107+

The figures of this table show an undoubted increase in endurance, both for the first half and more especially for the whole period of the experiment.

Three methods of estimating the increase of endurance between January and June were used. These may be put together in the following table:

PERCENTAGE OF INCREASE OF ENDURANCE, JANUARY TO JUNE, BY THREE METHODS. Average Six Tests.

B E Lq. Lw. M P R T W

85 13 194 95 212 56+ 73 66 109

Omitting Doubtful Cases "+"

84+ ... 84+ 181 29+ 56+ 89 80 107+

"Pure" Endurance of Biceps.

... ... 62 ... 50 ... 170 200 100+

The first line of this table tells us the average of the recorded improvement in endurance shown for each man. The average of these averages is 101 per cent. for the entire club, and is probably within the truth; for most of the individual figures which go to make up this result are understatements, not overstatements.

The second line shows the average improvement in tests in which there is no doubt that the figure is at least not too high, though it may be too low. The average of these is 89 per cent., and is therefore certainly too low an estimate of the average improvement for the eight men who improved at all.

The third line shows the increase of pure endurance (that is, endurance considered apart from strength) for the five men for whom the figures were available. The average of these is 116 per cent.

We are quite safe in saying, therefore, that the average improvement of the eight men who improved was 90 per cent.

The phenomena observed during the experiment may be summarized as a slight reduction of total food consumed, a large reduction of the protein element, especially of flesh foods, a lessened excretion of nitrogen, a reduction in the odor, putrefaction, fermentation and quantity of the feces, a slight loss of weight, a slight loss of strength, an enormous increase of physical endurance, a slight increase in mental quickness. These phenomena varied somewhat with different individuals, the variations corresponding in general to the varying degree in which the men adhered to the rules of the experiment.

That we are correct in ascribing the results, especially in endurance, to dietetic causes alone, cannot reasonably be doubted when it is considered that no other factors of known significance were allowed to aid in this result.

While the results of the present experiment lean toward "vegetarianism," they are only incidentally related to its propaganda. Meat was by no means excluded; on the contrary, the subjects were urged to eat it if their appetite distinctly preferred it to other foods.

The sudden and complete exclusion of meat is not always desirable, unless more skill and knowledge in food matters are employed than most persons possess. On the contrary, disaster has repeatedly overtaken many who have made this attempt. Pavlov has shown that meat is one of the most and perhaps the most "peptogenic" of foods. Whether the stimulus it gives to the stomach is natural, or in the nature of an improper goad or whip, certain it is that some stomachs which are accustomed to this daily whip have failed, for a time at least, to act when it was withdrawn.

Nor is it necessary that meat should be permanently abjured, even when it ceases to become a daily necessity. The safer course, at least, is to indulge the craving whenever one is "meat hungry," even if, as in many cases, this be not oftener than once in several months. The rule of selection employed in the experiment was merely to give the benefit of the doubt to the non-flesh food; but even a slight preference for flesh foods was to be followed.

REFERENCES

Adami, J. G.: Autointoxication and Sub-Infection, British Medical Journal, January 24, 1914, p. 177; Jour. A. M. A., XII, No. 9, p. 701.

Benedict, F. G., and Carpenter, Thorne M.: The Metabolism and Energy Transformation of Healthy Man During Rest, Carnegie Institution of Washington, D. C., 1910.

Benedict, F. G.: The Nutritive Requirements of the Body, Amer. Jour. of Physiology, 1906, XVI, pp. 409–437.

Benedict, F. G.: The Factors Affecting Normal Basal Metabolism, Proc. Nat. Acad. Sc., 1915, I, p. 105.

Benedict, F. G., and Smith, H. M.: The Influences of Athletic Training upon Basal Metabolism, Proc. Nat. Acad. Sc., 1915, I, p. 102.

Benedict, F. G., and Emmes, L. E.: A Comparison of the Basal Metabolism of Normal Men and Women, Proc. Nat. Acad. Sc., 1915, I, p. 104.

Benedict, F. G., and Cathcart, Edward P.: Muscular Work, Carnegie Institution of Washington, D. C., 1913.

Bryce, Alexander: Modern Theories of Diet, New York, Longmans, Green & Company, 1912; London, Edward Arnold, 1912.

Cannon, Walter B.: Bodily Changes in Pain, Hunger, Fear and Rage, D. Appleton & Company, New York and London, 1915.

Chittenden, Russell H.: Physiological Economy in Nutrition, Frederick A. Stokes & Company, New York, 1904.

Chittenden, Russell H.: The Nutrition of Man, Frederick A. Stokes & Company, New York, 1907.

Editorial: Newer Aspects of Metabolism, Jour. A. M. A., 1915, LXIV, p. 1327.

Fisher, Irving: A Graphic Method in Practical Dietetics, Jour. A. M. A., 1907, XLVIII, pp. 1316–1324.

Fisher, Irving: The Effect of Diet on Endurance, Transactions of the Connecticut Academy of Arts and Sciences, 1907, XIII, pp. 1–46.

Fisk, Eugene Lyman: A Sensible Diet for the Average Man and Woman, New York Medical Journal, July 4, 1914.

Gephart, F. C., and Lusk, Graham: Analysis and Cost of Ready-to-Serve Foods, Press of the American Medical Association, Chicago, 1915.

Gouraud, F. X.: What Shall I Eat? Rebman Company, New York, 1911.

Hall, Winfield S.: Nutrition and Dietetics, D. Appleton & Company, New York and London, 1910.

Higgins, Robert: Is Man Poltophagic or Psomophagic? The Lancet, London, 1905, I, pp. 1334–1337.

Hindhede, M.: What to Eat and Why, Ewart, Seymour & Company, Ltd., London, 1914.

Hutchison, Robert: Food and the Principles of Dietetics, William Wood & Company, New York, 1911, third edition.

Kinne, Helen, and Cooley, Anna M.: Foods and Household Management, The Macmillan Company, New York, 1914.

Lusk, Graham: The Elements of the Science of Nutrition, W. B. Saunders & Company, Philadelphia and London, 1909, second edition.

Mendel, Lafayette B.: The Relation of Foodstuffs to Alimentary Functions, Amer. Jour. of Med. Sciences, 1909, CXXXVIII, pp. 522–526.

Pavlov, I. P.: The Work of the Digestive Glands, Charles Griffin & Company, Ltd., London, 1910, second English edition, translated by W. H. Thompson.

Rose, Mary Swartz: A Laboratory Hand-Book for Dietetics, Macmillan & Company, New York and London, 1914.

Sherman, H. C.: Chemistry of Food and Nutrition, The Macmillan Company, New York, 1913.

Sherman, H. C.: Food Products, The Macmillan Company, New York, 1914.

Stiles, Percy Goldthwaite: Nutritional Physiology, N. B. Saunders Company, Philadelphia and London, 1912.

Tigerstedt, Robert: A Text-Book of Human Physiology, D. Appleton & Company, New York and London, 1906, third German edition, translated by John N. Murlin.

Taylor, Alonzo Englebert: Digestion and Metabolism, Lea & Febiger, Philadelphia and New York, 1912.

Von Noorden, Carl: Metabolism and Practical Medicine, William Heinemann, London, 1907.

* * *

SECTION II

NOTES ON OVERWEIGHT AND UNDERWEIGHT

How many people after age 35 have a conformation of body that is in accord with proper ideals of health and symmetry? The average individual, as age progresses, gains weight until he reaches old age, when the weight usually decreases.

This movement of weight is so universal that it has been accepted as normal, or physiological, whereas it is not normal, and is the result of disease-producing and life-shortening influences.

The standards for weight at the various ages and heights have been established by life insurance experience, but these standards, which show an increase in weight as age advances, by no means reflect the standards of health and efficiency. They merely indicate the average condition of people accepted for life insurance, whose death rate-while covered by life insurance premiums-is yet far above that obtaining among people of the best physical type, who live a thoroughly hygienic life.

MEN-OVER AVERAGE WEIGHTS

Experience of 43 American Companies-1885–1908.[K]

Number of Policyholders 186,579 Ages at Entry Overweight,

5 to 10 lbs. Overweight,

15 to 20 lbs. Overweight,

25 to 45 lbs. Overweight,

50 to 80 lbs.

Death Rate Below Stand-

ard.[L] Death Rate Above Stand-

ard. Death Rate Below Stand-

ard. Death Rate Above Stand-

ard. Death Rate Below Stand-

ard. Death Rate Above Stand-

ard. Death Rate Below Stand-

ard. Death Rate Above Stand-

ard.

20–24 4% ... 4% ... ... 1% ... 3%

25–29 7% ... 10% ... ... 12% ... 17%

30–34 1% ... 14% ... ... 19% ... 34%

35–39 0% ... ... 1% ... 31% ... 55%

40–44 6% ... ... 10% ... 40% ... 75%

45–49 ... 3% ... 9% ... 31% ... 51%

50–56 ... 2% ... 21% ... 24% ... 49%

57–62 ... 2% ... 25% ... 12% ... 38%

The heaviest mortality (75 per cent. above the standard), is found among those aged 40 to 44 who are 50 to 80 pounds overweight.

[K] Medico-Actuarial Mortality Investigation, Volume II, page 13, compiled and published by The Association of Life Insurance Medical Directors and The Actuarial Society of America.

[L] The standard death rate is that experienced by average insurance risks of the same age, according to the Medico-Actuarial Committee.

It seems reasonable to deduce from these figures that the usual gain in weight with advancing years is not an advantage but a handicap. We should endeavor to keep our weight at approximately the average weight for age 30, the period of full maturity, as experience shows that those so proportioned exhibit the most favorable mortality. This weight, for the various heights, is shown in the following table:

Age 30-Men Height. Pounds. Height. Pounds. Height. Pounds.

Ft. In. Ft. In. Ft. In.

5 126 5 7 148 6 1 178

5 1 128 5 8 152 6 2 184

5 2 130 5 9 156 6 3 190

5 3 133 5 10 161 6 4 196

5 4 136 5 11 166 6 5 201

5 5 140 6 172 .......... .........

5 6 144 ....... ...... .......... .........

Age 30-Women Height. Pounds. Height. Pounds. Height. Pounds.

Ft. In. Ft. In. Ft. In.

4 8 112 5 2 124 5 8 146

4 9 114 5 4 127 5 9 150

4 10 116 5 4 131 5 10 154

4 11 118 5 5 134 5 11 157

5 120 5 6 138 6 161

5 1 122 5 7 142 .......... .........

In fat people, the number of working cells is relatively less in proportion to the weight than in thin people, as fat cells do not work. Also, there is less body surface exposed in proportion to the body weight, and consequently less heat loss. Likewise, fat people are less active, and their little cell-engines do not call for so much fuel; but in most cases the fuel is furnished right along in the ordinary diet, and what is not burned up is stored up.

Diet for Overweight

For extreme overweight, diet should be prescribed accurately by the physician to suit the needs of each individual case. Certain general principles may be stated, however, as applicable to the average case.

Meals should be light and frequent, rather than hearty and infrequent. A little fruit may be taken on rising and a glass of hot water.

A light breakfast is advisable; one or two poached eggs, no sugar, bread and butter in small quantity.

For dinner, choice may be made of chicken, game, lean meat, fish not cooked in fat, in moderate portions, and of such vegetables as celery, spinach, sea-kale, lettuce, string beans, cucumbers, carrots, tomatoes, cabbage, Brussels sprouts, turnips, bulky vegetables of low food value. Tapioca or similar pudding may be used for desserts, and melon, and other cooked unsweetened fruits.

A glass of hot water on retiring is advisable.

It is surprising what an enormous fuel value certain foods have which are eaten very carelessly, and what a very low fuel value others have which are quite satisfying to hunger. For example: One would have to eat $9.00 worth of lettuce and tomato salad to furnish 2,500 calories, the amount of fuel for the day's requirements (Lusk), while about 30 cents' worth of butter, or 10 cents' worth of sugar would furnish the same amount of energy. No one would think of feeding exclusively on any one of these foods, but it is easy to see how the elimination of butter and sugar and the introduction of such foods as lettuce, tomatoes, celery, carrots, spinach and fruits, all of which have a low fuel value, would enormously reduce the available energy and therefore the fat-forming elements in the diet, yet fill the stomach and satisfy the hunger-craving. Hunger is largely dependent upon the contractions of the empty stomach and not upon a general bodily craving for food.

Fat Forming Foods That Should, as a Rule, be Avoided by Overweights

Foods to avoid, in cases of overweight, are sugar, fats, milk as a beverage, salmon, lobster, crabs, sardines, herring, mackerel, pork and goose, fat meats, nuts, butter, cream, olive oil, pastry and sweets, water at meals. Alcohol, which is not a food, although often so called, should be avoided, as it is a fuel. It is good to burn in a stove, but not in the human body.

Exercise for Overweight

Walking, swimming, golf, billiards, hill-climbing, are all beneficial forms of exercise for the middle-aged and elderly, who are chiefly affected by overweight.

Irksome and monotonous forms of exercise, while difficult to follow regularly, are usually of more benefit, as they are less likely to create an appetite. Simple exercises, if repeated from twenty to forty times, night and morning, will accomplish much. No apparatus is required, and any movements that bring into play the entire muscular system, and especially the muscles of the trunk, with deep breathing, are sufficient. (See "Setting-up" exercises described in the "Notes on Posture," page 221.) The main reliance should be upon dietetic regulation rather than upon exercise. A very moderate increase of exercise and a persistent adherence to a proper diet will work wonders in weight reduction.

Avoidance of Sudden Reduction

It is unwise to attempt a sudden reduction in weight. Profound nervous depression may be caused by too rapid reduction in people of nervous temperament, especially if they have long been overweight. By gradually modifying the diet and moderately increasing the exercise, the results can be obtained with mathematical precision and without undue hardship. It may be necessary to forego certain pet dietetic indulgences, but such indulgences, are, after all, a mere matter of habit and a liking for new forms of food can usually be acquired. One can not have the cake and penny too. One can not safely reduce one's weight by any mysterious method that will leave one at liberty to continue the indulgences, whether of sloth or of appetite, that are responsible for its accumulation.

Summary

The reduction of weight is really a very simple matter. No mysterious or elaborate "systems" or drugs are needed.

If a reduction in the amount of energy food and an increase in the amount of exercise is made, no power on earth can prevent a reduction in weight.

Even a sedentary worker uses up about 2,500 calories a day. By reducing the food to 1,200 calories (this can be done without decreasing its bulk) and increasing the exercise to the point of burning up 3,000 calories, the tissues are drawn upon for the difference, and a reduction in weight must be experienced just as surely as a reduction in a bank account is made by drawing checks on it.

MEN-UNDER AVERAGE WEIGHT

Experience of 43 American Companies

Duration of Experience, 1885–1908

Number of Policyholders, 530,108[M] Ages at Entry Underweight,

5 to 10 lbs. Underweight,

15 to 20 lbs. Underweight,

25 to 45 lbs.

Death Rate Below Stand-

ard.[N] Death Rate Above Stand-

ard. Death Rate Below Stand-

ard. Death Rate Above Stand-

ard. Death Rate Below Stand-

ard. Death Rate Above Stand-

ard.

20–24 ...... 7% ...... 15% ...... 34%

25–29 1% ...... ...... 8% ...... 16%

30–34 ...... 4% ...... 0% ...... 8%

35–39 9% ...... ...... 3% ...... 2%

40–44 15% ...... 13% ...... 3% ......

45–49 3% ...... 1% ...... 11% ......

50–56 10% ...... 8% ...... 9% ......

57–62 7% ...... 18% ...... 19% ......

The most favorable mortality (19 per cent. below the average) is found among those aged 57 to 62 who are extremely light in weight, compared with the average weight for those ages. The next lowest mortality in any other age group (15 per cent. below the average) is among those aged 40 to 44 who are 5 to 10 pounds under the average weight.

[M] Medico-Actuarial Mortality Investigation, Volume 11, page 10.

[N] The standard death rate is that experienced by average insurance risks of the same age, according to the Medico-Actuarial Committee.

Diet for Underweight

Thin people lose heat more readily than stout people, as they have a larger percentage of active tissue and expose more skin surface in proportion to the body weight. They require, therefore, an abundant supply of energy food, or fuel foods, fats, starch and sugar. Butter and olive oil are better than other fats and less likely to disturb the digestion. Sugar is a valuable fuel food, but should not be taken in concentrated form into an empty stomach. Sweets are best taken at the end of a meal, but in such cases the teeth should be well cleansed. Fruit at the end of a meal tends to prevent any injury to the teeth from sugar and starches.

Potatoes, cereals, bread and all starchy vegetables are fattening, but should be well chewed and tasted before swallowing. Thin, anemic people derive much benefit from egg lemonade or egg-nogs (without alcohol) made from the yolks, which contain fat, iron and other valuable elements.

Exercise for Underweight

Overfatigue and exhausting physical exertion should be avoided.

Moderate systematic exercises, with deep breathing, and sleeping out of doors, or approaching as near to it as one can, are advisable. At middle life and after, underweight, unless extreme or accompanied by evidence of impaired health, should not give any concern. Other things being equal, the old motto "A lean horse for a long race," holds good.

* * *

SECTION III

NOTES ON POSTURE

Corrective Exercises for Faulty Posture

Among simple exercises recommended for strengthening the abdominal muscles and restoring the organs to normal position are the following:

Lie flat on the back and rise to a sitting posture; squat until the thighs rest upon the calves of the legs. Lie flat on the back, head downward on an inclined plane (an ironing board, uptilted, will do) and make a bridge at intervals by arching the abdomen and resting on shoulders and heels.

From the fundamental standing posture described in this section, a number of exercises can be developed.

1. Yard-arm.-While deeply inhaling (through the nose) slowly raise the arms to horizontal position, straight out from the sides; let the arms fall slowly to the sides while exhaling. The chest should be well arched forward, hips drawn backward and arms hung back of thighs while performing this exercise.

These movements should be performed at the rate of about 10 per minute.

3. Tree-swaying.-While in the standing position, thrust the arms straight above the head, then sway from side to side, moving from the hips upward, the arms loosely waving like the branches of a tree. (Sargent.)

4. Leg-lifting.-Assume the standing position, but with hands resting on the hips. Raise the right thigh until at right angles with the body, leg at right angles with thigh, thrust the leg straightforward to a horizontal position, then sweep the leg back to standing posture. Repeat with the left leg. (Sargent.)

5. Signal Station.-Assume the standing posture with hands on hips. Thrust the right arm straight upward, while lifting the left leg outward and upward and rigidly extended. Lower the limbs and repeat on other side. (Sargent.)

6. Crawling Position.-Rest on hands and knees, thighs and arms at right angles to the body, spine straight. Reach forward with arm and follow with thigh and leg of same side; repeat on other side. Knee protectors can be worn during this exercise.

Corrective Exercises for Flat Foot

Draw two parallel chalk lines about three-fourths the length of one foot apart and practise walking on them until the habit of toeing straight is acquired.

When standing, do not keep the heels together and toes out, as in the ordinary attitude prescribed by athletic manuals, and the military attitude of "attention." Correct posture is more like the military attitude "at rest"-namely, heels apart, toes straight forward, the sides of the feet forming two sides of a square. This attitude gives stability and poise and insures a proper distribution of the weight of the body upon the structures of the feet.

This straightforward direction of the feet with heels apart is also noted in Spartan sculpture.

Those who stand a great deal should avoid distorted positions, such as resting the weight on the sides of the feet, or on one foot with the body sagging to one side. The body weight should be kept evenly supported on both feet.

Consult Specialist

When the condition of flat foot is found, the advice of an Orthopedic surgeon (specialist on bone deformities, etc.) should be sought, as often a plaster cast of the foot is required in order that a proper brace be adjusted to assist in the cure. In some cases, operative treatment may be needed.

The condition is one which should be treated by a physician or surgeon, and not by a shoemaker. The ordinary arch supports supplied by shoemakers do not cure flat foot. Shoes for such feet should be made to order, and have a straight internal edge.

All such measures must be supplemented by proper exercises, and the correction of faulty position of the feet while walking.

Unless "toeing out" is corrected by exercise and a proper shoe, an arch brace will do more harm than good.

The disturbances of health due to weak feet are manifold, just as are those due to eye-strain. Pain in the feet, legs and back, often mistaken for rheumatism, and improperly treated with drugs and liniment, chronic general fatigue and nervous depression are often due to this rather common affection.

Detecting Weak Feet

To detect weak feet, note whether there is a tendency to toe out when walking, and a bending inward of the ankles when standing or walking, or a disposition to walk on the inner side of the feet, as shown by the uneven wearing of the shoe. This condition may be present with a high instep, and no evidence of flat foot. As flat foot develops the inward bend of the ankle is easily apparent. The inner hollow of the foot disappears and the entire sole rests flat upon the ground when the shoes are removed.

The earlier in life this condition of weak feet is detected, the better for the individual. After middle life, a cure, especially in extremely heavy people, may be difficult or impossible, if the arches are completely broken down. Much relief, however, can be afforded by proper braces, fitted scientifically, by means of a plaster cast.

In young people, a cure can almost invariably be effected, and after a time braces and supports are not needed.

It is a very grave mistake to suppose that in such cases so-called arch supports will either cure flat foot or that people with weak feet are necessarily condemned to wear such supports throughout life.

The cure is sometimes effected in a short time, but it may take a year or two, and with proper management it can usually be accomplished, unless there is some unusual complication.

The prevention of flat foot consists largely in affording due exercise of the leg and foot muscles and tendons by plenty of walking and running, especially in childhood, and especially on rough ground. Flat pavements are, indirectly, one cause of flat foot.

* * *

SECTION IV

NOTES ON ALCOHOL

The influence of alcohol on longevity can be most satisfactorily determined by the records of life insurance companies wherein the death-rates among those abstaining from alcohol have been computed as compared to those of the general class of insured lives. In considering such figures it is well to bear in mind that the general or non-abstaining class comprises only those who were accepted as standard healthy risks and so far as could be determined were moderate in their use of alcohol. Such experiences have been carefully compiled by the following companies:

United Kingdom Temperance and General Provident Institution of London;[1][O] The Sceptre Life;[2] The Scottish Temperance Life of Glasgow;[3] The Abstainers and General Life of London;[4] The Manufacturers' Life of Canada;[5] Security Mutual Life of Binghamton, N. Y.[6]

[O] The notes ("[1]" etc.) refer to the publications listed at the close of the section.

Comparative Mortality Among Abstainers and Non-Abstainers

The comparative mortality among abstainers and non-abstainers in several of these companies is shown in the charts exhibited in this section.

It is probable that the heavier mortality among non-abstainers as compared to abstainers is not wholly due to the chemical effect of alcohol on the tissues, but in some degree to collateral excesses (especially those resulting in infection from the diseases of vice) and a more careless general manner of living engendered by alcoholic indulgence; that, furthermore, those who indulge in so-called moderation are open to greater temptation to increased indulgence and final excess than those who abstain altogether.

It has often been alleged, however, that the lower mortality among abstainers was due solely to a more conservative habit of living, and that this class is largely composed of people in favorable or preferred occupations, such as clergymen and teachers.

The experience of the Security Mutual of Binghamton, N. Y., does not support such a postulate. During a twelve years' experience the mortality among the abstainers was one-third that of the tabular expectation, and their occupations were classified as follows:

Clergymen 4 per cent.

Farmers 19 " "

Clerks 15 " "

Miscellaneous (earning $15 to $25 per week) 62 " "

Mr. Roderick McKenzie Moore, Actuary of the United Kingdom Temperance and General Provident Institution,[7] has this to say regarding the abstainers' class in that company:

The total abstainer class was not "nursed" or favored to produce a low mortality. So far as could be determined (and many of the risks came in personal contact with the officers) they were of the same general class as the non-abstainers. They were written by the same group of agents, for the same kind of policies, for the same average amounts, and were in the same general walks of life, and of the same general financial condition. They were almost equal in numbers to the general class and did not form a small high grade section of the policyholding body. On the contrary, greater care was exercised in the selection of the non-abstainers because of the less favorable experience anticipated on them, and many borderline risks were accepted in the abstaining class because of a feeling that their abstinence would neutralize some unfavorable factor.

UNITED KINGDOM TEMPERANCE AND GENERAL PROVIDENT INSTITUTION OF LONDON

HEALTHY MALES-WHOLE LIFE POLICIES

1866–1910

EXPECTED MORTALITY

* * *

100%

NON-ABSTAINERS, RATIO ACTUAL TO EXPECTED MORTALITY – – – – – – 91%

[P]ABSTAINERS, RATIO ACTUAL TO EXPECTED MORTALITY - - - - - 66%

MORTALITY AMONG NON-ABSTAINERS-STANDARD RISKS-37.7% HIGHER THAN AMONG ABSTAINERS

[P] THAT IS, WHERE-ACCORDING TO THE MORTALITY TABLES UPON WHICH PREMIUMS ARE BASED-100 WERE EXPECTED TO DIE, ONLY 66 ACTUALLY DIED.

SCEPTRE LIFE ASSOCIATION OF LONDON

WHOLE LIFE POLICIES

1884–1911

EXPECTED MORTALITY

* * *

100%

NON-ABSTAINERS, RATIO ACTUAL TO EXPECTED MORTALITY – – – – – – 80%

ABSTAINERS, RATIO ACTUAL TO EXPECTED MORTALITY - - - - - 52%

MORTALITY AMONG NON-ABSTAINERS-STANDARD RISKS-51.8% HIGHER THAN AMONG ABSTAINERS

THE LIFE EXTENSION INSTITUTE, INC.

THE SCOTTISH TEMPERANCE LIFE ASSURANCE CO. OF GLASGOW

HEALTHY MALES-WHOLE LIFE POLICIES

1883–1912

EXPECTED MORTALITY

* * *

100%

NON-ABSTAINERS, RATIO ACTUAL TO EXPECTED MORTALITY – – – – – – 66%

ABSTAINERS, RATIO ACTUAL TO EXPECTED MORTALITY - - - - - 48%

MORTALITY AMONG NON-ABSTAINERS-STANDARD RISKS-43.5% HIGHER THAN AMONG ABSTAINERS

COMPARATIVE MORTALITY AMONG USES OF ALCOHOL 43 AMERICAN LIFE INSURANCE COMPANIES 1885–1908

DEATH RATE AMONG INSURED LIVES GENERALLY-MEDICO ACTUARIAL TABLE 100 |||||||||||||||||||||||||

DEATH RATE AMONG POLICYHOLDERS USING 2 GLASSES OF BEER OR 1 GLASS OF WHISKEY DAILY 118 ||||||||||||||||||||||||||||||

DEATH RATE AMONG POLICYHOLDERS GIVING HISTORY OF PAST INTEMPERANCE, BUT APPARENTLY CURED 150 ||||||||||||||||||||||||||||||||||||||

DEATH RATE AMONG POLICYHOLDERS USING MORE THAN 2 GLASSES OF BEER OR 1 GLASS OF WHISKEY DAILY, BUT, REGARDED AS TEMPERATE & STANDARD RISKS 186 |||||||||||||||||||||||||||||||||||||||||||||||

Now that accurate laboratory evidence is available regarding the physiological effect of alcohol in so-called moderate doses the insurance experience seems consistent, and the higher mortality among so-called moderate drinkers is only what we would naturally expect to find in the light of the most recent knowledge regarding its effects upon the human organism, not only in the direct causation of disease, but in lowering the defense to disease and increasing the liability to accident, and the tendency to careless living.

Medico-Actuarial Mortality Investigation

In the recent medico-actuarial investigation[8], including forty-three American life insurance companies, the combined experience on users of alcohol has been compiled, with very interesting results. It may be subdivided as follows:

First: Those who were accepted as standard risks but who gave a history of occasional alcoholic excess in the past. The mortality in this group was 50 per cent. in excess of the mortality of insured lives in general, equivalent to a reduction of over four years in the average lifetime of the group.

Second: Individuals who took two glasses of beer, or a glass of whisky, or their alcoholic equivalent, each day. In this group the mortality was 18 per cent. in excess of the average.

Third: Men who indulge more freely than the preceding group, but who were considered acceptable as standard insurance risks. In this group the mortality was 86 per cent. in excess of the average. In short, we find the following increase of mortality over the average death rate among insured risks generally:

Steady moderate drinkers but accepted as standard risks 86 per cent.

Having past excesses 50 " "

Very moderate drinkers 18 " "

This means that steady drinkers who exceed two glasses of beer or one glass of whisky daily are not, on the evidence, entitled to standard insurance, but should be charged a heavy extra premium.

In these groups, the death rates from Bright's disease, pneumonia and suicide were higher than the normal.

Consumption of Alcohol

The per capita consumption of alcohol has greatly increased in the United States in recent years, while in the United Kingdom it has materially decreased, as shown in the following table. This factor must be considered in assigning a cause for the increasing mortality from degenerative diseases in this country as compared to a decreasing mortality from these maladies in Great Britain.

ANNUAL PER CAPITA CONSUMPTION (IMPERIAL GALS.) OF ALCOHOL IN VARIOUS COUNTRIES 1896–1912[9] 1896–1900. 1908–1912.

Beer. Wine. Spirits. Total. Beer. Wine. Spirits. Total.

Germany 25.4 1.37 1.66 28.43 22.4 1.09 1.29 24.78

United Kingdom 31.6 .39 1.05 33.04 26.65 .26 .71 27.62

France 5.5 19.9 1.7 27.1 8.6 24.7 1.42 34.72

United States 13.01 .30 .81 14.12 16.62 .52 1.02 18.16

Laboratory and Clinical Evidence Relating to the Physiological Effects of Alcohol

To interpret correctly the mortality statistics relating to moderate drinkers and total abstainers, one must have some knowledge of the physiological effects of alcohol in so-called moderate doses, a knowledge which is often lacking in those who assume to interpret such statistics.

For example: If it could be shown that small doses of alcohol produce no ascertainable ill effects upon the human organism, the higher mortality among the moderate drinkers as compared to total abstainers might have to be explained as due to some as yet unrecognized cause or causes other than alcohol. But if laboratory and clinical evidence shows that alcohol in so-called moderate quantities (social moderation) produces definite ill effects, such as lowering the resistance to disease, increasing the liability to accident and interfering with the efficiency of mind and body and thus lessening the chances for success in life, to say nothing of any toxic degenerative effect upon liver, kidneys, brain and other organs, the excess mortality that unquestionably obtains among moderate drinkers as compared to total abstainers must be ascribed chiefly to alcohol.

It is not possible here to give all the evidence, but the following items will serve to clarify these questions.

Effect on Brain and Nervous System

Kraepelin[10] and his pupils have contributed most extensively to our knowledge on this subject. According to such authorities, a half to a whole liter of beer is sufficient to lower intellectual power, to impair memory, and to retard simple mental processes, such as the addition of simple figures. Habitual association of ideas, and free association of ideas are interfered with.

As far back as 1895, Smith demonstrated the influence of small doses of alcohol in impairing memory, and these results have been confirmed by Kraepelin and quite recently by Vogt[11] in experiments on his own person-15 cc. (about 4 teaspoonfuls) of whisky on an empty stomach, or 25 cc. with food, being sufficient to distinctly impair the power to memorize.

Careful and exact experiments have shown the influence of moderate doses of alcohol in lessening the amount of work performed by printing compositors. There has also been shown a disturbance in the sequence of ideas. The time that elapses between an irritation and the beginning of a responsive movement can be measured within one one-thousandth of a second. According to Aschaffenburg,[12] under the influence of even very small doses of alcohol this reaction period is disturbed and shortened. It is below the normal, the acceleration being attained at the expense of precision and reliability. Indeed, the reaction is often premature, and constitutes a false reaction-"the judgment of the reason comes limping along after the hasty action."

It is now conceded that alcohol is not a real brain stimulant, but acts by narrowing the field of consciousness. By gradually overcoming the higher brain elements the activities of the lower ones are released, hence the so-called stimulation and the lack of judgment and common sense often shown by those even slightly under the influence of alcohol. The man who wakes up under alcohol is really going to sleep, as far as his judgment and reason are concerned. Complete abolition of consciousness is brought about by sufficient doses as when ether or chloroform is taken.

Under moderate doses, muscular efficiency is at first increased a little and then lowered, the total effect being a loss in working power, as shown by the experiments of Dubois, Schnyder,[13] Hellsten,[14] and others.

Influence on Bodily Resistance to Disease

Muller, Wirgin and others[15] have shown that alcohol restricts the formation of antibodies (the function of which is to resist infection in the blood) in rabbits, and Laitinen[16] has shown that the prolonged administration of small doses in men (15 cc.) is sufficient to lower vital resistance, especially to typhoid fever.

Rubin[17] has demonstrated that alcohol, ether and chloroform, injected under the skin, render rabbits more vulnerable to streptococcus (blood poison) and pneumnococcus infection (pneumonia); Stewart,[18] that small amounts lower the resistance to tuberculosis and streptococcus infection; Craig and Nichols,[19] that moderate doses of whisky were sufficient to cause a negative Wassermann reaction in syphilitic subjects; Fillinger[20] found the resistance of red blood cells much reduced after the administration of champagne to healthy human subjects. Similar results were found in dogs and rabbits.

Weinburg[21] confirmed these results by the same methods, showing that 20 per cent. of the red cells lose their resistance after the administration of 450 cc. of champagne.

Parkinson,[22] in a series of careful tests, failed to establish any influence on phagocytosis (capacity of the white blood cells to destroy bacteria), except when large doses or continuous moderate doses were taken.

Effect on Circulation

On the heart and circulation, alcohol acts as a depressant, increasing the rate, but not the force, of the pulse. It causes depression of the nerve center controlling the blood vessels and thus lowers blood pressure. Large doses cause paralysis of these nerves and of the heart.

Miller and Brooks[23] found from small doses (6 to 12 cc. absolute alcohol) an increase in blood pressure in conscious (unanesthetized) animals, contrary to the findings of Crile,[24] Cabot,[25] Dennig,[26] Hindelang and Grünbaum, Alexandroff[27] and others, in man; but the amounts were small and variable, according to individual susceptibility, thus showing the drug to be, even on such evidence, uncertain and unserviceable as a heart stimulant.

Food Value

Atwater and Benedict,[28] and Beebe[29] and Mendel,[30] have shown that alcohol is a "protein sparer," and can, to some extent, take the place of fats and carbohydrates. This is what is meant by calling alcohol a "food." Always, however, it fails to pass some test by which true foods are measured. Apart from its effect on the nervous system, among which must be figured its action on the blood vessels which causes a loss of body heat, Mendel has shown that in moderate doses (96 cc. daily) it increases the output of uric acid and allied (purin) bodies derived from the tissues, a fact which distinguishes it from all other foods. These poisonous or drug effects must always be considered, together with any alleged nourishing effects. Alcohol is still used by some as a rapidly available fuel-food in fevers, and when ordinary foods cannot be readily digested and made available. But this is done to a much less degree than formerly, now that its narcotic and poisonous effects are more fully understood. Sugar and water often serve quite as useful a purpose.

It seems reasonable, on the evidence herein presented, to class alcohol among the narcotic or "deadening" drugs, such as ether or chloroform. Indeed, Aschaffenburg[31] has recently called attention to the growth of the ether habit in eastern Germany, where this drug is used as a so-called stimulant, while in reality the effects are well known to be narcotic, or deadening.

The laboratory and the life insurance records simply give exact expression to what has long been a matter of common knowledge to the employer of labor and to leaders and commanders of men; to wit, that the influence of alcohol on any large group of men, whether they be artisans or soldiers, is harmful and lowers the efficiency of the group. Individual susceptibility varies, but the man who thinks he is an exception and can indulge with safety may find that he is mistaken only after serious damage to the body has been done and perhaps a definite loss sustained in happiness and achievement.

Effect on Offspring

Stockard,[32] in his experiments on animals, has demonstrated conclusively that the germ cells of males can be so injured by allowing the subjects to inhale the fumes of alcohol that they give rise to defective offspring, although mated with vigorous untreated females. The offspring of those so treated when reaching maturity are usually nervous and slightly undersize. These effects are apparently conveyed through the descendants for at least three generations. Such evidence establishes at least the probability of the transmission of serious ill effects to human offspring through alcoholic indulgence of the male parent.

Much of the statistical evidence that has been produced on both sides of this question of the transmissibility of the effect of alcohol is misleading unless very critically analyzed, but the results of exact laboratory experiments can hardly be gainsaid.

Those who trifle with alcohol should at least take the precaution to be periodically examined in order to detect the earliest signs of ill-effect. One's own feelings are not safe guides, and may fail to warn of danger until serious damage has been done.

In 1914, at the annual meeting of the National Council of Safety, at which there were present representatives from several hundred large industries, the members unanimously voted to abolish liquor from their plants. It has been well stated by Quensel[33] that "work and alcohol do not belong together, especially when the work demands wideawakeness, attention, exactness and endurance."

The restrictive and prohibitive measures of the French and Russian governments, the well known opposition of the Kaiser to alcohol and the warnings uttered by Lord Kitchener and leading British statesmen, are sufficient evidence that the condemnation of alcohol represents the deliberate judgment of the world's strong men.

REFERENCES

[1] United Kingdom Temperance and General Provident Institution of London, Annual Report, 1910.

[2] Sceptre Life Association, Annual Report, 1912.

[3] Scottish Temperance Life Assurance Company, Annual Report, 1912.

[4] The Abstainers and General Insurance Company, Ltd., Annual Report, 1912.

[5] McMahon, T. F.: The Use of Alcohol and the Life Insurance Risk. Proceedings of the Association of the Life Insurance Medical Directors of America, 1911, Twenty-second Annual Meeting, p. 473; Medical Record, LXXX, p. 1121.

[6] Lounsberry, R. L.: Proceedings of the Life Assurance Medical Directors. October, 1913.

[7] Moore, Roderick McKenzie: On the Comparative Mortality Among Assured Lives of Abstainers and Non-Abstainers from Alcoholic Beverages. Transactions of the Institute of Actuaries, 1913, XXXVIII, pp. 248–272.

[8] Report of Medico-Actuarial Mortality Investigation, IV, pp. 11–13.

[9] Statistical Abstract for the United Kingdom, Sixty-first Number, 1809–1913 (Wyman & Sons), London, 1914, p. 173; Statistical Abstract for the Principal and Other Foreign Countries, 1901–1912, Thirty-ninth Number, pp. 505, 506, 507; Statistical Abstract of the United States, Thirty-sixth Number, 1913, p. 516.

[10] Kraepelin, Emil: Ueber die Beeinflussung einfacher psychischer Vorg?nge durch einige Arzneimittel, Verlag von Gustav Fisher, Jena, 1892; Aschaffenburg, Gustav: Praktische Arbeit unter Alkoholwirkung, Psychologische Arbeiten, 1896, I, pp. 608–626; Kurz, Ernest, and Kraepelin, Emil: Ueber die Beeinflussung psychischer Vorg?nge durch regelm?ssigen Alkoholgenuss, Psychologische Arbeiten, 1901, III, pp. 417–457; Mayer, Martin: Ueber die Beeinflussung der Schrift durch den Alkohol, Psychologische Arbeiten, 1901, III, pp. 535–586; Rudin, Ernst: Ueber die Dauer der psychischen Alkoholwirkung, Psychologische Arbeiten, IV, pp. 1–44.

[11] Vogt, R.: Om virkningen af 15–50 cm3 koncentrert spiritus paa erindringsevnen, Norsk. Mag. f. Laegevidensh., 1910, LXXI, pp. 605–626; The Lancet (London), 1910, II, p. 1040.

[12] Aschaffenburg, Gustav: Crime and Its Repression, Little, Brown & Company, Boston, 1913, p. 84.

[13] Schnyder, L.: Alkohol und Muskelkraft, Archiv für Physiologie, 1902–3, XCIII, p. 451.

[14] Hellsten, A. F.: Ueber den Einfluss von Alkohol, Zucker und Thee auf die Leistungsf?higkeit des Muskels, Munchen Med. Wchnschr., 1914, LI, pp. 18–94.

[15] Bastedo, Walter A.: Materia Medica Pharmacology and Therapeutics, W. B. Saunders Company, Philadelphia and London, 1913, p. 333.

[16] Laitinen, T.: The Norman Kerr Lecture on The Influence of Alcohol on Immunity, Med. Rec., LXXVI, 1909, pp. 445–446. Read before the Twelfth International Anti-Alcoholic Congress, held in London, July, 1909; Uber die Einwirkung der kleinsten Alkoholengen auf die Widerstandsf?higkeit des tierischen Organismus mit besonderer Berücksichtigung der Nachkommenschaft, Ztschr. f. Hyg. u. Infections-krankheiten, LVIII, 1907–8, p. 139.

[17] Rubin, George: The Influence of Alcohol, Ether, and Chloroform on Natural Immunity in its Relation to Leucocytosis and Phagocytosis, Jour. Infct. Dis., 1904, I, pp. 425–444.

[18] Stewart, Chas. E.: The Influence of Alcohol on the Opsonic Power of the Blood, Mod. Med., 1907, XVI, pp. 241–246. Read before the American Society for the Study of Alcohol and Drug Neuroses, Atlantic City, June 4, 1907, and published in the Jour. of Inebriety.

[19] Craig, Chas. F., and Nichols, Henry J.: The Effect of the Ingestion of Alcohol on the Result of the Complement Fixation Test in Syphilis, Jour. A. M. A., 1911, LVII, pp. 474–76.

[20] Fillinger, F. V.: Weitere Mitteilungen über Resistenzverminderung der Erythrozyten nach Alkoholgenuss, Deutsch. Med. Wchnschr., 1912, XXXVIII, p. 999.

[21] Weinburg, W. W.: The Lowering of Stability of Erythrocytes in Alcoholic Intoxication, Russky Vratch, 1912, II, p. 1324; New York Med. Jour., 1912, XCVI, p. 1040.

[22] Parkinson, P. R.: The Relation of Alcohol to Immunity, The Lancet (London), 1909, VII, pp. 1580–82.

[23] Brooks, Clyde: The Action of Alcohol on the Normal Intact Unanesthetized Animal, Jour. A. M. A., 1910, LV, pp. 372–73. Read in the Section on Pathology and Physiology of the A. M. A. at the Sixty-first Session, St. Louis, June, 1910.

[24] Crile, George W.: Blood Pressure in Surgery, J. B. Lippincott Company, Philadelphia, 1903. Cartwright Prize of the Alumni Ass'n of the College of Physicians and Surgeons, New York City.

[25] Cabot, Richard C.: Studies of the Action of Alcohol in Disease, Especially upon the Circulation, Med. News, LXXXIII, 1903, pp. 145–153. Read before the Association of American Physicians, May 13, 1903.

[26] Dennig, Hindelang und Grünbaum: Uber den Einfluss des Alkohols auf den Blutdruck und die Herzarbeit in pathologischen Zust?nden, Namentlich beim Fieber, Deutsch. Arch. f. klin. Med., 1909, XCVI, pp. 153–162.

[27] Alexandroff, Emilie: Ueber die analeptische Wirkung des Alkohols bei pathologischen Zust?nden, Cor. Bl. f. schweiz. Aerzte., 1910, XL, pp. 465–475; Action of Alcohol During Febrile and other Pathologic Conditions, Jour. A. M. A., 1910, LV, p. 174.

[28] Atwater, W. A., and Benedict, F. G.: An Experimental Inquiry Regarding the Nutritive Value of Alcohol, National Academy of Science, 1902, Sixth Memoir.

[29] Beebe, L. B.: The Effect of Alcohol and Alcoholic Fluids Upon the Excretion of Uric Acid in Man, Amer. Jour. Physiol., 1904, XII, pp. 13–37.

[30] Mendel, L. B., and Hilditch, Warren W.: The Influence of Alcohol Upon Nitrogenous Metabolism in Men and Animals, Amer. Jour. Physiol., 1910, XXVII, pp. 1–23.

[31] Aschaffenburg, Ibid.

[32] Stockard, C. R.: A Study of Further Generations of Mammals from Ancestors Treated with Alcohol, Proc. Soc. Exper. Biol. and Med., 1914, XI, p. 136.

[33] Quensel, Ulrik: The Alcohol Question from a Medical Viewpoint-Studies in the Pathology of Alcoholism, Year Book, United States Brewers' Association, 1914, p. 168.

* * *

Bastedo, Walter A.: Materiel Medico, Pharmacology and Therapeutics, W. B. Saunders Company, Philadelphia and London, 1913, p. 318.

Bertillon, Jacques: On Mortality and the Causes of Death According to Occupations, Proceedings of the Fifteenth International Congress on Hygiene and Demography, Washington, 1912, I, p. 345.

Boos, William F.: The Relation of Alcohol to Industrial Accidents and to Occupational Diseases, Proceedings of the Fifteenth International Congress on Hygiene and Demography, Washington, 1912, I, p. 829.

Cabot, Richard C.: The Consumption of Alcohol and of Other Medicines at the Massachusetts General Hospital, Boston Med. Jour., CLX, 1909, pp. 480–81.

Dixon, W. E.: Alcohol in Relation to Life, The Nineteenth Century, 1910, LXVII, pp. 516, 523.

"Ethyl Alcohol," The Dispensatory of the United States of America, J. B. Lippincott & Company, Philadelphia, 19th edition, p. 102.

Ewald: Alcohol in Relation to Infectious Diseases, Med. Rec., 1913, LXXXIV, p. 75. Read before the Fourth National Congress on Physiotherapy, Berlin, March 26, 1913.

Horsley, Sir Victor: Discussion on Alcohol in Therapeutics, Med. Rec., 1912, LXXI, p. 951. Read before the Hunterian Society.

Hunter, Arthur: Can Insurance Experience be Applied to Lengthen Life? Proceedings of the Association of Life Insurance Presidents, Eighth Annual Meeting, 1914, pp. 27–37.

Kelynak, T. M.: The Drink Problem, London, Methuen & Company, 1907.

Landau, Anastazy: Beitrage zur hehre vom Purinstoffwechsel und zur Frage über den Alkoholeinfluss auf die Harnsaureausscheidung, Deutsch. Arch. f. klin. Med., XCV, 1908–9, pp. 280–328.

Miller, Joseph L.: The Physiologic Action, Uses and Abuses of Alcohol in the Circulatory Disturbance of the Acute Infection, Jour. A. M. A., 1910, LV, pp. 2034–2037. Read in the joint session of the Sections of Practice of Medicine and Pharmacology and Therapeutics of the A. M. A., Sixty-first Annual Session, held at St. Louis, June, 1910.

Neff, Irwin H.: The Problem of Drunkenness, Proceedings of the Fifteenth International Congress on Hygiene and Demography, Washington, 1912, IV, p. 510.

Phelps, Edward Bunnell: The Mortality from Alcohol in the United States, Proceedings of the Fifteenth International Congress on Hygiene and Demography, Washington, 1912, Vol. I, p. 813.

Proceedings: Association of Life Insurance Medical Directors, October, 1911.

Report of the Committee of Fifty on: Physiological Aspects of the Liquor Problem, Houghton, Mifflin & Company, two volumes, 1903.

Togel, O., Brezina, E., and Durig, A.: Ueber die kohlenhydratsparende Wirkung des Alkohols, Biochem. Ztschr., 1913, I, 296; Editorial, Jour. A. M. A., 1913, LXI, p. 967.

Williams, Henry Smith: Alcohol, How it Affects the Individual, the Community and the Race, The Century Company, New York, 1909.

Woods, Robert A.: The Prevention of Inebriety: Community Action, Proceedings of the Fifteenth International Congress on Hygiene and Demography, Washington, 1912, IV, p. 517.

Additional Notes on Alcohol

Nutrition Laboratory Experiments

There has lately been undertaken at the Nutrition Laboratory of the Carnegie Institution at Washington a very broad and comprehensive study of the effect of moderate doses of alcohol on the healthy and normal human body. The immense scope of the investigation planned may be judged by the fact that under the physiological division of the research, as laid out by Professors Raymond Dodge and E. C. Benedict, there are seven main sections and one hundred and sixty subdivisions. The program has been arranged after conferences, either in person or by letter, with the leading physiologists of the world, and may take ten years to complete.

Psychological Effects

The psychological program, carried out with the co-operation of Dr. F. Lyman Wells, has already been completed and the results recently published.[34] These results must be accepted as the testimony of pure science, free from all bias or even remote suggestion of propaganda. They were based upon experiments with moderate doses of alcohol (30 cubic centimeters, or about 8 teaspoonfuls, and 45 cubic centimeters) upon ten normal subjects, very moderate users of alcohol, and may be summarized as follows:

Lower Levels Spinal Cord

A very simple reflex act, the "knee-jerk," a nervous mechanism controlled by a center at the lower level of the spinal cord, was markedly depressed, the time of response being increased 10 per cent. and the thickening of the muscles concerned in the act decreased 45 per cent. In some subjects the larger dose, 45 cubic centimeters, practically abolished the knee-jerk.

The eye-lid reflex, elicited by a sudden noise, showed the next largest effect, the time of response being increased 7 per cent. and the degree of movement decreased 19 per cent.

Higher Levels

Other nervous mechanisms, or reflex arcs, at the higher levels of the cord, were next investigated: (1) eye-reaction to suddenly appearing stimulus, and (2) speech reaction to visual word stimuli. Dose A (30 cubic centimeters), accelerated the eye-reaction, while dose B (45 cubic centimeters) positively depressed it, agreeing with the simple reaction experiments of Kraepelin. This was the only instance of acceleration of movement of the voluntary muscles through alcohol, all the other tests showing it to be a consistent depressant. The speech reaction showed a positive depressant effect of 3 per cent.

Memory

Free association of ideas and memory tests were also made, and showed practically no effect from alcohol, but, unfortunately, the smaller dose only was used in these tests.

The sensitiveness to electrical stimulation was decreased 14 per cent.

Motor co-ordination, as evidenced by eye-movements in fixating seen objects, was next investigated. The velocity of these movements was decreased 11 per cent. Finger-movements, measured in an exceedingly delicate way, were reduced in speed 9 per cent.

Heart and Pulse

The effect on the pulse while these tests were made was observed, and electrocardiograms taken. The pulse was found to be accelerated, but not increased in force, that is, the "brake" was taken off the heart, but no driving force supplied by alcohol. The condition of the circulation was impaired by the narcotic effect of alcohol on the cardio-inhibitory center which holds the heart action in check.

Decreases Organic Efficiency

According to the investigators, the effect is to "decrease organic efficiency." This should shut off such little debate as still persists with respect to alcohol having any value as a heart stimulant.

Always a Depressant

While these investigations only confirm in part the contention of the Kraepelin school that alcohol first acts by depressing the higher centers, and tend to show that its first and most profound effect is on the lower levels of the spinal cord and the simpler nervous mechanisms, it confirms the view of these and other investigators, that the total effect of alcohol is that of a narcotic, depressing drug, even in the smallest doses usually taken as a beverage.

Resistance of Higher Brain Function

The possible reactions are more complex than those supposed by Kraepelin, and there is evident in the higher centers (the effect on highest brain functions, were not measured by Dodge and Benedict) a power of "autogenic reinforcement," which is well exemplified by the ability of a half-intoxicated person to sober up under some shock or strong incentive. When social conditions do not stimulate this reinforcement, but, on the contrary, dull and retard it, as in convivial company, there is reinforcement of the lower, more animal mechanisms of the nervous system, and we have exhibited revolting and foolish reactions to alcohol, which are consistent with these findings.

Explanation of Memory Effects

The slight effect on memory and free association is explained partly by the methods used in the laboratory (difference in time of recognizing words suddenly exposed a second time), which are more in the nature of "short cuts" and perhaps not so accurate a reproduction of normal memorizing as those employed by Kraepelin and Vogt (memorizing numbers and verse), and partly by the power of "autogenic reinforcement," which it is difficult to eliminate in a laboratory test.

This, the latest contribution of science to the study of alcohol, gives added proof that the higher mortality among so-called moderate users of alcohol is largely due to the unfavorable effect on the protective mechanism of the body.

Lower Resistance

This has been further emphasized by the studies of Reich[35] at the University of Munich, who found that the resistance of blood cells to salt solution and to typhoid bacilli was less among alcohol users than among total abstainers.

Konrádi[36] has found that comparatively few antibodies against cholera germs develop in persons who consume alcohol daily in fairly large quantities and who had been inoculated against cholera. Pampoukis[37] has observed that alcoholics are not favorable subjects for inoculation against rabies. The Pasteur Institute in Budapest has made similar observations, based on twenty-five years' experience.

Additional References

[34] Benedict, E. C.: The Psychological Effects of Alcohol, The Carnegie Institution, Washington, D. C., 1916.

Benedict, E. C.: The Psychologic Effect of Alcohol on Man, The Journal A. M. A., 1916, lxvi, p. 1424.

[35] Reich, H. W.: Ueber den Einfluss des Alkoholgenusses auf Bakterizidie, Phagozytose und Resistenz der Erythrocyten, beim Menschen, Arch. f. Hyg., 1916, lxxxiv, 337.

[36] Konradi: Ueber den Wert der Choleraschutzimpfungen, Centralbl. f. Bakteriol., I. O., 1916, lxxvii, 339.

[37] Alcohol and Immunity, Jour. A. M. A., 1916, lxvi, p. 962, p. 1122.

* * *

SECTION V

NOTES ON TOBACCO

It is the purpose of this section to present as fairly as possible the evidence relating to the effects of tobacco on the human body, so that those who smoke may correctly measure the probable physical cost of the indulgence. The extremes of opinion on this subject are well expressed in the following verses:

"Hail! Social Pipe-Thou foe to care,

Companion of my elbow chair;

As forth thy curling fumes arise,

They seem an evening sacrifice-

An offering to my Maker's praise

For all His benefits and grace."

Dr. Garth.

"A custom loathsome to the eye, hateful to the nose, harmful to the brain, dangerous to the lungs, and the black stinking fume thereof nearest resembling the horrible Stygian smoke of the pit that is bottomless."

James I.

What it Is

Tobacco is a plant, Nicotiana Tabacum of the order Solanace?, which includes Atropa Belladonna, or "Deadly Nightshade," Hyoscyamus, or "Henbane," Solanum Dulcamara, or "Bitter Sweet," all powerful poisons, and likewise the common potato and tomato, which are wholesome foods. The cured leaves are used for smoking and chewing, or when powdered, as snuff.

History

Prior to the middle of the 16th Century, the use of tobacco was confined to the American Indians. In 1560 the Spaniards began to cultivate tobacco as an ornamental plant, and Jean Nicot, the French Ambassador at Lisbon, introduced it at the court of Catherine de Medici in the form of snuff. Smoking subsequently became a custom which spread rapidly throughout the world, although often vigorously opposed by Governments. In the 17th Century, smoker's noses were cut off in Russia.

Composition

Tobacco contains a powerful narcotic poison, nicotin, which resembles prussic acid in the rapidity of its action, when a fatal dose is taken.

The percentage of nicotin present varies according to the brand and the conditions under which it is cultured.

The following figures have been given by the various authorities.

London Lancet[38] .64 to 5.3 per cent.

French Dept. of Agriculture[39] .22 to 10.5 " "

Connecticut Agricultural Experiment Station[40] 2.89 " "

(Home grown-after fermentation.)

U. S. Dept. of Agriculture[40] .94 to 5. " "

(Domestic.)

Aside from nicotin it also contains small quantities of related substances-nicotellin, nicotein, a camphoraceous substance termed nicotianin, said to give tobacco its characteristic flavor, and likewise a volatile oil developed during the process preparation. On heating, pyridin (a substance often used to denature alcohol), picolin, collidin, and other bases are formed, as well as carbolic acid, ammonia, marsh gas, cyanogen and hydrocyanic acid, carbon monoxide (coal gas) and furfural. Furfural is a constituent of fusel oil, which is so much dreaded in poor whisky. The smoke of a single cigaret may contain as much furfural as two ounces of whisky.

The complex constitution of tobacco and the smoke from its combustion has caused much debate as to the substances that are responsible for its charm and its ill effects, which are to be described. No one can doubt the serious injurious effects from such a powerful poison as nicotin if taken in any but the most minute quantities (one to three milligrams have produced profound poisoning in man).

It has been maintained by some that nicotin is practically destroyed in the process of smoking, and that the effects of tobacco are limited to the decomposition products resulting from the burning tobacco, especially pyridin. But pyridin is also formed in the burning of cabbage leaves, and cabbage leaves do not possess any attractions for smokers, neither do they produce the well-known effects that smoking and chewing tobacco produce. No doubt pyridin and furfural are factors in the drug effects of tobacco, but recent painstaking experiments by high authorities have shown the presence of nicotin in tobacco smoke, and when we reflect that there is sometimes sufficient nicotin in an ordinary cigar to kill two men, it is not strange that enough of it may be absorbed from the smoke passing over the mucous membranes of the nose, throat and lungs to produce a distinct physiological effect.

Investigators who claim to show by experiments the absence of nicotin from tobacco smoke must explain why the palpable effects of smoking, in those who have not established a "tolerance," are those of nicotin poisoning, and why the symptoms produced by chewing tobacco are identical with those following the smoking of tobacco, which are: mild collapse, pallor of the skin, nausea, sweating, and perhaps vomiting, diarrhea, muscular weakness, faintness, dizziness, and rise in blood pressure followed by lowered blood pressure.

Nicotin is undoubtedly decomposed by burning, but it may become volatilized by heat and a certain amount absorbed before decomposition takes place.

Lehmann,[41] in 1908, found in tobacco smoke the following percentages of the nicotin contained in the tobacco:

Cigaret smoke 82 per cent.

Cigar smoke 85 to 97 " "

The London Lancet[42] (1912) gives the following figures:

Cigaret smoke 3.75 to 84 per cent.

Pipe mixture smoke, smoked as cigarets 79 " "

Pipe smoke 77 to 92 " "

Cigar smoke 31 to 63 " "

The United States Department of Agriculture[43] found in tobacco smoke about 30 per cent. of the nicotin originally present in the tobacco.

Contrary to general opinion, Havana cigars contain less nicotin than the cheaper brands, which augurs ill for the large class of people who cannot afford to smoke higher priced brands. Many of the cheaper grades do, however, show a low percentage of nicotin.

Effects on Animals and Man

By means of an ingenious apparatus, Zhebrovski,[44] a Russian investigator, compelled rabbits to smoke cigaret tobacco for a period of 6 to 8 hours daily. Some died within a month, and showed changes in the nerve-ganglia of the heart. Others established a tolerance similar to that exhibited by habitual smokers, but upon being killed at the end of five months, degenerative changes similar to those produced by the injection of nicotin were found, viz., hardening of the blood vessels. There is, indeed, no difficulty in producing the characteristic effects of nicotin by administering tobacco smoke, either in man or in animals.[45]

Nicotin causes brief stimulation of brain and spinal cord, followed by depression. There is an increased flow of saliva, followed by a decrease (large doses diminish it at once) and often nausea, vomiting and diarrhea. The heart action is at first slowed and the blood pressure increased. Subsequently there is a depression of the circulation, with rapid heart action and lowered blood pressure. In habitual smokers, this preliminary stimulation may not occur. The stimulating effect on the brain is so brief that tobacco can not properly be termed a stimulant. Its effect is narcotic or deadening. Those who fancy that their thoughts flow more readily under the use of tobacco are in the same case with any other habitué whose thoughts can not flow serenely except under his accustomed indulgence. That a sound healthy man, who has never been accustomed to the use of tobacco, can do better mental or physical work with tobacco than without it has never been shown. Indeed, such experiments as have been made on students and others show to the contrary.[46]

The statistics presented by Prof. Fred. J. Pack are of interest in this connection.

In six educational institutions the students competing for places on the football team were grouped as follows:

Institution. Number

Competing

for Places. Number

Successful. Per Cent.

Successful.

Institution A.

Smokers 11 2 18.2

Non-smokers 19 11 57.9

Institution B.

Smokers 10 4 40

Non-smokers 25 17 68

Institution C.

Smokers 28 7 25

Non-Smokers 17 14 82

Institution D.

Smokers 28 11 39.3

Non-smokers 15 10 66.6

Institution E.

Smokers 10 7 70

Non-smokers 15 12 80

Institution F.

Smokers 6 0 0

Non-smokers 26 15 57.7

Scholastic Standing Institution. Smoker. Non-smoker. Institution. Smoker. Non-smoker.

A 65.2 69.8 G 74.0 75.0

B 64.7 74.6 H 75.2 79.4

C 78.8 81.1 I 81.6 88.4

D 75.8 77.6 J 78.5 81.3

E 84.6 84.8 K 74.0 84.6

F 69.6 71.3 L 77.3 77.6

The following table shows the relative scholastic standing of smokers and non-smokers:

Number

of Men. Total

Mark. Average

Mark.

Smokers 81 6,034 74.5

Non-smokers 101 8,021 79.4

Twelve institutions reporting:

Number

of Men. Highest

Marks. Lowest

Marks.

Smokers 81 4 12

Non-smokers 101 11 6

Number

of Men. Highest

Marks. Lowest

Marks.

101 non-smokers furnish 11 6

101 smokers would furnish 5 15

Number

of Men. Total

Conditions

and Failures. Average

Smokers 82 70 .853

Non-smokers 98 48 .439

Tobacco Smoking Athletes

Prof. Pack's conclusions were as follows:

Only half as many smokers as non-smokers are successful in the "try outs" for football squads.

In the case of able-bodied men smoking is associated with loss of lung capacity amounting to practically 10 per cent.

Smoking is invariably associated with low scholarship.

There have of course been many notable instances of high scholarship and prodigious mental achievement by heavy smokers. Such exceptions, however, do not affect conclusions derived from the study of average groups.

Hitherto figures on smoking and athletics have been open to question because comparisons were made between groups that are not of necessity of the same physical and mental type, having no important difference except in the use of tobacco. But Prof. Pack has sought to avoid this objection. As he points out, the football squad is probably as nearly a homogeneous group as it is possible to find. It seems reasonable to account for the inferior physical and mental work of these particular groups of smokers on the theory that in the main the well known toxic effects of tobacco are sufficient to create this difference.

Dr. George J. Fisher,[47] in a series of careful tests found:

Cigaret smoking caused an increase in the heart rate.

Cigaret smoking maintained a blood pressure which, under the circumstances of the experiment, would otherwise have dropped.

Cigar smoking caused a considerable increase in heart rate and blood pressure.

In a number of instances, in the cigar test, the heart was unable to maintain, with a vertical position, the increased blood pressure found in the horizontal position, showing a disturbance of the control of the blood vessels. This latter effect was more pronounced in tests taken on non-smokers.

It was also noted that smoking was not conducive to concentration upon the reading, which the men attempted during the tests.

Bush,[48] in a series of tests on each of 15 men in several different psychic fields found the following conditions among smoking students immediately after the period of smoking was completed:

A 10? per cent. decrease in mental efficiency.

The greatest actual loss was in the field of imagery, 22 per cent.

The three greatest losses were in the fields of imagery, perception and association.

The greatest loss, in these experiments, occurred with cigarets.

Bush ascribed these effects to pyridin, claiming that his experiments failed to reveal nicotin in the tobacco smoke, except in a very small proportion in that of cigarets.

Tests for nicotin in smoke are beset with many difficulties and possible fallacies which have in the past misled investigators into apparently determining that tobacco smoke contained no nicotin, but simply decomposition products.

Pyridin is unquestionably present in tobacco smoke, and is a poisonous substance, although less so than nicotin. It is not found, however, in chewing tobacco, and as the clinical effects of chewing tobacco are apparently identical with those of smoking tobacco, very strong and universally accepted chemical proof of the absence of nicotin from tobacco smoke must be awaited before accepting such a conclusion. (See [41], [42], [43] in bibliography.)

Cigaret smoking is a time waster; that is, it breaks up the power of attention, as few smokers are satisfied with one cigaret and the mere physical act of lighting a fresh cigaret disturbs the continuity of thought and work. Dr. W. J. Mayo[49] calls attention to the fact that according to his observations research scholars who smoke cigarets have not done well.

Insurance Experience on Tobacco Smokers

Only one insurance company, the New England Mutual,[50] has published any experience on tobacco users. This covered a period of 60 years and a body of 180,000 policyholders, as follows:

RATIO OF ACTUAL TO EXPECTED MORTALITY.[Q] Abstainers. Rarely Use. Temperate. Moderate.

Tobacco, 59% 71% 84% 93%

Alcohol, 57% 72% 84% 125%

[Q] The standard here used is the American Experience Table, which is largely an artificial table upon which premiums are based, but which provides for a much higher mortality than the average companies sustain. For example, the actual mortality of the New England Mutual in 1913 was 57 per cent. of the expected.

Interpretation

Fifty-nine per cent. of the expected mortality means that where, according to the premium tables, 100 were expected to die, only 59 actually died.

The general class of risks in this company were of excellent quality, as the figures show. Nevertheless, the abstainers exhibited a far lower mortality than that experienced by the general class.

Dr. Edwin Wells Dwight, who presented the figures, urged caution in their interpretation, suggesting that the low mortality among abstainers, both from alcohol and tobacco, might well be due to a more conservative habit of living. Furthermore, as the abstainers from alcohol were not separated from the abstainers from tobacco in this analysis a perfect comparison can not be made; but our knowledge of the toxic effects of both these narcotics and the preceding statistics of Doctor Pack justify us in assigning to tobacco a positively unfavorable effect.

Poisonous Effects

Experiments on animals with nicotin extracts from tobacco and inhalation of tobacco smoke have produced hardening of the large arteries. Clinical observation by some of the world's best authorities indicates that the same conditions are brought about in man by heavy smoking.[51]

Disturbance of the blood pressure, rapid heart action, shortness of breath, palpitation of the heart, pain in the region of the heart, are important effects. Tobacco heart is often lightly spoken of because the abandonment of the habit will often restore the heart to its normal condition, but tobacco heart sometimes causes death, especially under severe physical strain or in the course of acute disease, such as typhoid or pneumonia. Surgeons[52] have noted failure to rally after operation in tobacco users, who are, of course, deprived of their accustomed indulgence immediately before and after operation. It is probable that many such cases pass unrecognized, although the alcoholic is usually supplied the narcotic his system demands.

Cannon, Aub, and Binger[53] have also shown that nicotin stimulates the adrenal glands, small organs adjacent to the kidneys, which secrete a substance that in excess powerfully affects the blood vessels, constricting them and temporarily increasing the blood pressure. This influence may be partly responsible for the change in the blood vessels noted in heavy smokers.

Excessive smoking is often an important factor in causing insomnia.

Blindness or tobacco amblyopia, a form of neuritis, is not an uncommon affection among smokers. There is also often an irritant effect on the mucous membranes of eyes from the direct effect of the smoke.

Catarrhal conditions of the nose, throat and ear have also been noted.

Acid dyspepsia is a common affection among smokers.

Few people realize that so many ingredients in tobacco and tobacco smoke are deadly poisons. Few people know that one drop of nicotin on the unbroken skin of a rabbit will produce death.[54] Two drops on the tongue of a dog or cat will prove fatal; moreover, fatal poisonings have occurred in man from swallowing tobacco and even from external application of strong solutions. A case was recently reported from New Haven of fatal poisoning in a baby,[55] who had been fed from a milk bottle and milk-mixture in which some tobacco had been accidentally spilled.

SUMMARY

From the mass of evidence and opinion with which medical literature is loaded, a few salient facts stand out:

* * *

First: Tobacco and its smoke contain powerful narcotic poisons.

Second: It has never been shown to exert any beneficial influence on the human body in health, and it is not even included in the United States Pharmacop?ia as a remedy for disease, notwithstanding the claims that are made for its sedative effects and its value as a solace to mankind. If these benefits are real and dependable, they should be made available in exact dosage and applied therapeutically. If they are not real and dependable in a medical sense, they are not real and safe as a mere drug indulgence.

Third: The symptoms following tobacco-smoking are identical with the effects of tobacco-chewing among those not accustomed to its use; hence, any collateral psychic effect, such as the sight of smoke, the surrounding, etc., are of minor importance in establishing the habit. The main charm to the smoker is the drug effect, as in any other similar indulgence. Nicotinless tobacco is not popular, notwithstanding the efforts of the French and Austrian Governments to make it so.

Fourth: Fortunately, the sedative drug effect is so slight, as compared to that of other narcotics-opium, alcohol, cocaine, etc.-that the tobacco habit is less seductive and may be broken with comparative ease and is therefore less harmful morally. Men who have smoked or chewed steadily for 40 years have been known to give up the habit without experiencing much physical discomfort. Like any other habit, however, there is a tendency to increasing indulgence, and this is a risk that the smoker takes, just as does the alcohol user or the opium habitué who begins with so-called moderate indulgence.

Fifth: The well-known effects of tobacco on the heart and circulation should lead one to pause and consider the possible cost of this indulgence, especially as-

Sixth: It is difficult to determine, years in advance, whether or not one is endowed with sufficient resistance to render so-called moderate smoking comparatively harmless.

Seventh: The vital statistics show that diseases of the heart and circulation are rapidly increasing in this country in which-

Eighth: The per capita consumption has rapidly increased in recent years, while-

Ninth: In the United Kingdom, where these diseases are decreasing, there has been no material increase in the use of tobacco, and the per capita consumption is less than one-third that of the United States.

Increase of Smoking

In 1880 the annual per capita consumption of tobacco in the United States was about 5 lbs., while in 1914 it had risen to more than 7 lbs. In the United Kingdom the per capita consumption is about 2 lbs., and there has been no material increase in recent years.

The cigaret bill, in particular, has grown enormously, having more than doubled in the past five years, while there has been a slight increase in the consumption of cigars, smoking tobacco, chewing tobacco and snuff, as shown in the following table:[56]

Fiscal Year Cigars Cigarets Tobacco, Chewing

and Smoking Snuff

1910 8,213,356,504 7,884,748,515 436,608,898 31,969,111

1911 8,474,962,786 9,254,351,722 380,794,673 28,146,833

1912 8,350,119,103 11,239,536,803 393,785,146 30,079,482

1913 8,732,815,703 14,294,895,471 404,362,620 33,209,468

1914 8,707,625,230 16,427,086,016 412,505,213 32,766,741

Total 42,478,879,326 59,100,618,527 2,028,056,550 156,171,635

Tenth: The poetic effusions of the lovers of the weed are no safer guide than the exaggerated and intemperate denouncements of people who have idiosyncrasies against tobacco and simply hate it.

Eleventh: Those who now smoke should have a thorough physical examination to determine the condition of the heart and blood vessels. This examination should be repeated at least annually, in order to detect any adverse influence on the circulation.

REFERENCES

[38] The Toxic Factor in Tobacco, The Lancet (London), 1912, I, p. 944.

[39] French Department of Agriculture, Compt. Rend. Acad. de Science, CLI, p. 23.

[40] Garner, W. W.: The Relation of Nicotin to the Burning Quality of Tobacco, U. S. Department of Agriculture, Bureau of Plant Industry, Bulletin No. 141, Sept. 30, 1909, p. 15; A New Method for the Determination of Nicotin in Tobacco, U. S. Department of Agriculture, Bureau of Plant Industry, Bulletin No. 102, July 6, 1907, p. 12.

[41] Lehmann, K. B.: Untersuchungen über das Tabakrauchen, Munchen, med. Wchnschr., 1908, LV, pp. 723–25; The Physiological Action of Tobacco Smoke, Med. Rec., 1908, LXXIII, pp. 738, 739.

[42] The Toxic Factor in Tobacco, The Lancet (London), 1912, II, pp. 944–947.

[43] Garner, W. W.: The Relation of Nicotin to the Burning Quality of Tobacco, U. S. Department of Agriculture, Bureau of Plant Industry, Bulletin No. 141, Sept. 30, 1909, p. 15.

[44] Zhebrovsky, E. A.: The Effect of Tobacco Smoke upon the Blood Vessels of Animals, Russky Vratch, 1907, VI, p. 189; 1908, VII, pp. 429–431; Med. Rec, 1908, LXXXIV, pp. 408, 409.

[45] John, H.: Editorial, Jour. A. M. A., 1914, LXII, pp. 461–2; Ueber die Beeinflussung des systolischen und diastolischen Blutdrucks durch Tabakrauchen, Ztschr. f. exper. Path. u. Therap., 1913, XIV, pp. 352–365; Pawinski, J.: Ueber den Einfluss unmassigen Rauchens (des Nikotins) auf die Gef?sse und das Herz, Ztsch. f. klin. Med., Berl., 1914, LXXX, pp. 284–305.

[46] Pack, Frederick J.: Smoking and Football Men, Popular Science Monthly, 1912, LXXXI, p. 336.

[47] Fisher, George J. [Monograph not yet published.]

[48] Bush, Arthur D.: Tobacco Smoking and Mental Efficiency, N. Y. Med. Jour., 1914, XCIX, pp. 519, 529.

[49] Mayo, Wm. J.: Personal communication.

[50] Dwight, Edwin Wells: Proc. Assoc. Life Ins. Med. Dir., Oct., 1911, II, p. 474.

[51] Favarger, Heinrich: Experimentelle und klinische Beitr?ge zur chronischen Tabakvergiftung, Wien. klin. Wchnschr., 1914, XXVII, pp. 497–501; Experimental and Clinical Study of Chronic Tobacco Poisoning, Jour. A. M. A., 1914, LXII, p. 1764; Pekanovits. Effects of Tobacco Smoking, Jour. A. M. A., 1914, LXXII, p. 1907.

[52] Bangs, L. Bolton: Some Observations on the Effects of Tobacco in Surgical Practice, Medical Record, LXXIII, March 4, 1908, pp. 421–23–51.

[53] Cannon, Aub. Binger: Effect of Nicotin Injection on Adrenal Secretion, Jour. Pharm. and Exper. Therap., 1912, p. 381; Editorial, Nicotin and Adrenals, Jour. A. M. A., 1912, LXIII, p. 1287.

[54] Hare, Hobart Amory: Fiske Prize Dissertation, No. 34, p. 1884. Dixon, A. S.: Proceedings of the Academy of Natural Sciences, Philadelphia, Nov. 11, 1884.

[55] Reynolds, H. S.: Jour. A. M. A., May 30, 1914, LXII, p. 1723.

[56] Annual Report of the Commissioner of Internal Revenue, 1914, p. 34, Government Printing Office, Washington, D. C.

* * *

Bamberger, J.: Hygiene of Cigar Smoking, Abstr. Jour. A. M. A., 1904, XLIII, p. 706; Zur Hygienie des Rauchens, Munchen. med. Wchnschr., 1904, LI, pp. 1344–1345.

Current Comment: Some New Evidence on the Tobacco Question, Jour. A. M. A., 1912, LIX, p. 1798.

Editorial: The Pharmacology of Tobacco Smoke, Jour. A. M. A.. 1909, LII, p. 386.

Editorial: The Use of Tobacco, Jour. A. M. A., 1910, LX, p. 32.

Editorial: Tobacco-Smoking and Circulation, Jour. A. M. A., 1914, XLII, p. 461.

Hochwart, L. Von Frankl: Die Nerv?sen, Erkrankungen der Tabakraucher, Deutsch. med. Wchnschr., 1911, XXXVII, pp. 2273, 2321.

Index Catalogue of the Library of the Surgeon-General's Office, second series, XVIII, pp. 297–306.

Larrabee, R. C.: Tobacco and the Heart, Abstr. Jour. A. M. A., 1903, XLI, p. 50. Read before the Massachusetts Medical Society, June, 1903.

Pel: Un cas de psychose tabagique, Ann. med. Chir., 1911, XIX, p. 171.

* * *

SECTION VI

AVOIDING COLDS

Infection

Bacteria play a part in most colds. In some cases there is a general infection, with local symptoms, as in grippe; in others there is a local infection, with mixed classes of bacteria. It is probable that these various forms of bacteria are constantly present in the nasal secretions, but do not cause trouble until the local resistance or the general resistance is in some way lowered.

Nasal Obstruction

In many, the susceptibility to colds is due to abnormalities in the nose or throat. Nasal obstruction is a very common condition. The nose, like the eye, is usually an imperfect organ. These obstructions are often the result of adenoids in childhood, which interfere with the proper development of the internal nasal structures. Malformation of the teeth and dental arches in childhood are frequent and often neglected causes of nasal obstruction. Such malformations are caused by the arresting of the growth of the upper jaw and nasal structures. Correction of the deformity of the arches often renders nasal surgery unnecessary. Such conditions not only predispose to colds, but increase their severity and the danger of complicating infection of the bony cavities in the skull that communicate with the nose. They also increase the liability to involvement of the middle ear and of the mastoid cells which are located in the skull just behind the ear. The importance, therefore, of having the nose and throat carefully examined, and of having any diseased condition of the mucous membrane or any obstruction corrected must be apparent. All who suffer from recurrent colds should take this precaution before winter sets in.

General Resistance

If the nasal passages are put in a healthy condition, strict obedience to the rules of individual hygiene will almost wholly prevent colds. In fact, except where actual nasal defects exist, the frequency of colds is usually a fair indication of how hygienically a person is living. The following points need especial emphasis, though they repeat in some cases what has already been said in the text.

Skin Training

It is a familiar fact that exposure and chilling will often produce a cold. This is usually due to the fact that the nerve centers controlling the circulation of the skin are over-sensitive, and exhibit a sort of hair-trigger reaction to exposure, causing a disturbance of the circulation, and of the heat-regulating machinery of the body of which the spongy shelf-like turbinated bones in the nose are an important part. Skin training, then, appears to be the first hygienic steps toward establishing a resistance to colds.

Such training for the skin may be secured by various means. One should first accustom himself to a gentle draft.

Cool bathing, to a point that produces a healthy reaction, is another important feature of skin training.

Cold bathing, by those affected with kidney trouble, is not advisable, but delicate individuals, who cannot react well to the cold bath, can greatly increase their resistance by graduated cool bathing performed as follows: Standing in about a foot of hot water, one may rub the body briskly with a wash cloth wrung out of water at about 80 degrees F. and reduced day by day until it is down to 50 degrees F. Following this the cold douche or affusion may be taken (water quickly dashed from a pitcher) beginning at 90 degrees F. and daily reducing until 50 degrees F. is reached, or just before the point where an agreeable reaction ceases to follow.

Light Clothing

The wearing of loose, porous clothing, and the air bath-exercise in a cool room without clothing-are also valuable measures in skin training. Very heavy wraps and fur coats should be worn only during unusual exposure, as in driving or motoring. Outer clothing should be adapted to the changes in the weather, and medium-weight underclothing worn throughout the winter season. Office-workers and others employed indoors are, during the greater part of the day, living in a summer temperature. The wearing of heavy underclothing under such conditions is debilitating to the skin and impairs the resisting power.

Overheated rooms should also be avoided for the same reason. In rooms where people are moving about, the temperature should not be allowed to rise above 65 degrees. In ordinary offices or dwelling rooms, the temperature should not be allowed to rise above 68 degrees and adequate ventilation should be provided.

Fresh Air

Living out of doors, especially sleeping out, gives the skin exercise, and further keeps fresh air in the lungs. It is one of the foremost methods of prevention against colds. Army men remark that so long as they are out of doors, even if exposed to bad weather, they almost never catch cold, but do so often as soon as they resume living in houses.

Long breaths taken slowly and rhythmically, say ten at a time and ten times a day are helpful.

Constipation

Constipation predisposes to colds, and should be vigorously combated by proper diet and exercise, and regular habits of attention to the bowel function.

Overeating

Overeating frequently leads to nasal congestion. Eat lightly, using little meat or other high protein foods such as white of eggs, and thoroughly masticate the food.

Fatigue

Avoiding undue fatigue will help greatly in preventing colds.

Nasal Toilet

The regular use of nasal douches is not advisable. The mucous membrane of the nose is intolerant of watery solutions, and a chronic congested condition or even infection of air cavities in the skull can be brought about by the constant use of sprays and douches. Where special conditions render it necessary, these should be used only on the advice of a physician. When the nose is clogged with soot or dust, a very gentle spray of a warm, weak solution of salt and water, in the anterior nostrils, may do no harm. Picking of the nose should be strictly avoided. This is a fertile cause of infection. In blowing the nose care should be taken to close one nostril completely and to blow through the other without undue force. Otherwise, infection may be carried into the ear passages or the cavities communicating with the nose and give rise to serious trouble. When suffering from a cold, gauze or cheese-cloth should be used instead of a handkerchief and burned after use. Sneeze into the gauze, and thus avoid spraying infection into the surrounding atmosphere.

Emergency Treatment of Colds

After one has actually caught cold the rules above given for preventing a cold are in most particulars reversed. One should then avoid drafts, variable temperature and any severe "skin gymnastics." The paradox, that exposure to drafts is preventive of colds, but is likely to add to the cold after it is caught, is not more surprizing than the paradox that exercise keeps a man well, but that when he is sick it is better to rest.

After a cold has actually been contracted, the great effort should be to keep the body thoroughly warm, especially the feet. To accomplish this it is often the wisest course for one who has a cold to remain in bed a full day at the outset.

Medical treatment by a physician can always mitigate and shorten the duration of a cold and lessen the danger of complications, the symptoms of which can not always be appreciated by the patient.

Among the most effective home remedies for a cold are the hot foot-bath, 110–115 degrees F., a hot drink (e.g. hot flaxseed tea), a thorough purge, and rubbing the neck and chest with camphorated oil. The hot foot-bath should usually last 20 minutes, and be taken in a very thorough manner, the body enveloped in a blanket. After taking the bath, the patient should go directly to bed, and not move about and neutralize its good results.

A general neutral bath not above 100 or below 95 degrees is very restful to the skin and nerves as they have absolutely nothing to do to cope with temperatures above or below that of the body, since the neutral bath has the same as that of the body. One can remain in such a bath even for hours, if one has the time, but in getting out, it is very important to be in a very warm room and to dress quickly. In fact there is very considerable danger of catching cold at this time if great care is not taken.

If one does not remain in bed, it is generally safer to keep indoors. The air of the room should be kept as fresh as possible without subjecting one's self to a draft and should also be kept humidified, especially in winter when it is apt to be exceedingly dry. Either excessive dryness or excessive moisture is a strain on the mucous membrane, which is the directly diseased organ in the case of a cold. If the day is still and sunny, being out of doors, if well protected from any chill, may help to get rid of one's cold, but on a damp windy day the chances are one will add to the cold.

As to eating, it is sometimes wise to absolutely fast by skipping a meal or two, using nothing but water or water with agar-agar, or food which has bulk but little food value, such as green vegetables or fruit. The common idea that one should "stuff a cold and starve a fever" is most erroneous and comes apparently from a misunderstanding of the meaning of this adage which, originally, it would appear, was not meant in the imperative sense at all, but as follows: "If you stuff a cold, you will have to starve a fever."

It should be added that whisky and heavy doses of quinine are distinctly deleterious and should be avoided, as should all quack remedies and catarrh cures; there are more effective remedies which carry no possibilities of harm.

When one is getting over a cold it is a good time to resolve to avoid catching colds altogether, which for the average person can be substantially accomplished by following the above suggestions. The tax on one's time thus required is far less than the tax required by the colds themselves. The authors of this book know of persons who have scarcely lost a day's work from colds or other ailments for decades at a time simply by using a little self-control and common sense at critical times.

* * *

SECTION VII

SIGNS OF INCREASE OF THE DEGENERATIVE DISEASES

The fact that in the United States the general death rate has steadily fallen for the past several decades, a phenomenon common to all civilized countries, is accepted by many as evidence of a steady gain in National Vitality. That there has been a gain in vitality in the younger age groups is unquestionably true, but this gain has served to mask a loss in vitality at the older age periods.

This latter phenomenon, a rising mortality in elderly life, is something almost peculiar to the United States. It is not exhibited in the mortality statistics of the leading European countries. In those countries the fall in the death rate has not been due solely to a reduction of mortality in infancy and adult life through the conquest of diseases of children, tuberculosis and other communicable diseases. England and Wales, Denmark, Norway, Sweden and Prussia show improved mortality at every age period.

The charts in this section show the trend of mortality in this country during 30 years at the various ages of life, and also the trend of mortality in the two great classes of diseases: the communicable, which affect more emphatically the young lives, and the degenerative or regressive class of diseases, which affect chiefly those in middle life and old age.

It seems evident that unless this increased mortality is due to some unknown biologic influence or to the amalgamation of the various races that constitute our population, it must be ascribed, in a broad sense, to lack of adaptation to our rapidly developing civilization.

Whether or not there is one principal cause that determines the unfavorable trend of mortality in this country as compared to other civilized nations has not yet been conclusively shown.

INCREASES AND DECREASES IN DEATH RATE BY AGE PERIODS

MASS. & N.J. 1880–1910

L.E.I. Inc.

ENGLAND & WALES IN BROKEN LINE

This chart exhibits the trend of the death rate from all causes, by age periods. The decreases are below the center line and the increases above it.

It will be noted that the American decreases in the younger ages were not as great as in England and Wales, that they changed to increases about age 45 and continued to increase in each age group thereafter, while in England and Wales the decline occurred at all ages.

Note.-Massachusetts and New Jersey are used as a basis because they were the only States in 1880 where sufficiently reliable comparative statistics could be had. These records were accepted by the national government, and these States really constituted the registration area in that year. There were also fifteen cities outside these States where comparisons were possible.

DEATH RATE REGISTRATION AREA

(PER 10,000 LIVING)

ORGANIC DISEASES

L.E.I. INC

ENGLAND & WALES DOTTED LINES

This chart shows that in the United States registration area, the mortality from diseases of the heart, blood vessels and kidneys increased 41 per cent. during the period 1890–1910, while in England and Wales (shown by the dotted lines) during the same period there was a decrease in the mortality from these maladies.

OCCUPIED MALES INCREASES-DECREASES FROM CERTAIN DISEASES

This chart comparing 1900 with 1890 (1900–1910 not yet available) shows the sharp upward trend in the mortality from organic disease among males in gainful occupations, and the downward trend in the mortality from communicable disease in the same group. This heavy and increasing loss from chronic disease occurs among our most valuable lives-those of the breadwinners.

* * *

SECTION VIII

COMPARISON OF DEGENERATIVE TENDENCIES AMONG NATIONS

DEATH RATE PER 1,000 OF POPULATION BY AGE PERIODS IN THE UNITED STATES[R] AND IN VARIOUS EUROPEAN COUNTRIES.[S] Ages U. S. Reg. Area 1900 P'sons Prussia 1900–01 France 1899–1902 Italy 1899–1902 Sweden 1891–00

Males Fem. Males Fem. Males Fem. Males Fem.

Under 1 165.4 221.8 189.4 ... ... 174.8 158.3 ... 101.6

1 46.6 ... ... ... ... ... ... ... ...

2 20.5 ... ... ... ... ... ... ... ...

3 13.2 ... ... ... ... ... ... ... ...

4 9.4 ... ... ... ... ... ... ... ...

Under 5 52.1 24.3 23.4 56.9 48.5 38.4 39.8 ... 36.9

5–9 5.2 4.9 5.1 4.6 4.6 6.1 6.7 ... 5.9

10–14 3.3 2.7 3.0 2.9 3.5 3.2 3.8 ... 3.6

15–19 5.2 4.2 3.7 4.9 5.2 4.6 5.4 4.6 4.7

20–24 7.5 5.8 4.7 7.8 6.4 6.8 7.0 6.7 5.7

25–29 8.6 5.8 6.0 8.0 8.0 6.7 7.6 6.6 6.1

30–34 9.4 6.7 6.7 8.5 7.8 6.7 7.9 6.7 6.5

35–39 11.0 9.0 7.8 10.5 8.8 7.5 8.6 7.6 7.2

40–44 12.2 12.1 8.6 12.7 9.7 9.3 9.1 8.8 7.9

45–49 15.2 15.9 10.0 15.1 10.9 11.4 9.6 10.7 8.6

50–54 19.1 21.2 13.8 19.1 14.5 15.7 12.9 13.7 10.9

55–59 26.3 28.3 20.4 26.6 20.5 21.0 17.7 18.6 14.3

60–64 35.1 39.5 31.4 37.4 30.5 33.5 30.9 26.1 21.3

65–69 52.2 57.8 50.3 54.5 47.1 50.2 48.8 39.5 33.8

70–74 75.2 87.0 78.9 86.9 77.7 85.4 87.4 62.0 54.8

75–79 110.5 132.5 125.3 130.7 120.6 134.3 138.5 101.3 90.1

80–84 165.8 199.3 186.6 ... ... 214.5 215.6 ... ...

85–89 241.3 283.6 271.4 221.9 219.8 317.1 307.3 197.8 179.6

90–94 339.2 395.2 345.6 ... ... ... ... ... ...

95–over 418.9 404.8 402.1 ... ... 391.7 369.1 ... ...

Note: In 1900 or thereabouts, the death rates at the middle ages of life were heavier in the United States than in Prussia, France, Italy, and Sweden. Since then the death rates in the United States at these ages have grown even greater.

In the foreign countries the death rate by persons can be approximated by adding the rates for males and females of same age and dividing by two.

[R] 12th Census. U. S., 1900, iii. Vital Statistics, p. LXXIX.

[S] F. Prinzing Medizinische Statistik, Verlag von Gustav Fischer in Jena, 1906.

ENGLAND AND WALES

Annual Standardized Death Rates, Death Rates at Twelve Groups of Ages, and Infant Mortality, 1841–1910.[T] Year All Ages (Stand-

ard-

ized) Deaths per 1,000 Persons at Subjoined Ages

0–5 5–10 10–15 15–20 20–25 25–30 35–45 45–55 55–65 65–75 75–85 85 and up-

wards Deaths of Infants under 1 yr. of Age per 1,000 Births

1841–45 20.6 63.7 8.7 5.0 7.2 8.8 9.7 12.1 16.1 28.7 62.0 137.1 295.3 148

1846–50 22.4 68.7 9.4 5.6 7.7 9.8 10.9 13.6 18.1 31.4 65.9 145.8 306.6 157

1851–55 21.7 68.9 8.6 5.2 7.4 9.0 10.1 12.7 17.2 29.6 62.9 143.2 299.5 156

1856–60 20.7 66.9 8.3 4.7 6.7 8.3 9.4 12.0 16.1 28.4 60.9 136.6 293.4 152

1861–65 21.4 69.1 8.4 4.7 6.6 8.4 9.8 12.6 17.1 30.2 62.4 139.1 298.8 151

1866–70 21.2 68.1 7.6 4.3 6.2 8.0 9.9 12.9 17.6 30.6 63.2 141.7 294.3 157

1871–75 20.9 64.9 6.9 4.0 5.8 7.7 9.6 13.1 18.0 31.6 65.3 141.6 305.2 153

1876–80 19.8 61.9 6.1 3.5 4.9 6.5 8.4 12.3 17.5 31.6 64.7 142.9 311.5 145

1881–85 18.7 56.6 5.7 3.2 4.6 6.0 8.0 11.8 17.2 31.0 63.5 136.1 277.7 139

1886–90 18.5 56.9 4.9 2.8 4.1 5.3 7.2 11.1 17.1 31.8 66.3 139.0 290.3 143

1891–95 18.5 57.8 4.6 2.6 4.0 5.0 6.8 11.0 17.3 32.5 67.3 140.8 274.1 151

1896–1900 17.6 57.6 4.1 2.4 3.5 4.5 6.0 10.1 16.2 30.5 64.1 133.6 267.5 156

1901–05 16.0 50.2 3.7 2.2 3.1 4.0 5.4 8.9 14.9 28.7 59.4 127.3 258.6 138

1906–10 14.4 41.7 3.4 2.0 2.9 3.6 4.8 7.8 13.7 27.5 58.1 127.0 262.4 117

Note improvement since 1890 in death rate at every age period of life.

[T] Seventy-fifth Annual Report of the Registrar General of the Births, Deaths, and Marriages in England and Wales, 1912, p. 28.

DEATH RATES CLASSIFIED BY SEX, AGE, AND GENERAL NATIVITY, NEW YORK STATE: 1900 AND 1910[U]

[U] Willcox, Walter F., Special Report on Vital Statistics, 33d annual report, State Department of Health, State of New York, 1912.

MALE Age Period. Native White. Foreign Born White. Coloured.

1900 Death Rate. 1910 Death Rate. 1900 Death Rate. 1910 Death Rate. 1900 Death Rate. 1910 Death Rate.

All ages 18.6 17.3 20.6 17.0 27.9 26.5

Under 1 180.3 154.9 166.6 104.6 410.5 313.2

1–4 23.0 17.5 31.6 21.7 57.0 46.6

5–9 5.0 4.0 5.3 3.4 11.0 7.4

10–14 3.0 2.3 2.5 2.5 8.1 7.1

15–19 4.6 3.9 4.9 4.3 10.2 11.3

20–24 7.4 5.9 6.8 5.2 13.8 11.2

25–29 9.4 7.5 7.9 5.6 14.0 11.8

30–34 11.3 9.6 9.3 6.9 15.5 19.6

35–39 12.4 12.3 12.2 9.8 15.1 19.8

40–44 13.6 13.7 15.0 13.2 19.3 23.9

45–49 14.7 16.6 19.8 17.7 30.9 28.7

50–54 17.2 19.6 26.0 23.6 32.0 32.4

55–59 22.3 27.0 34.3 35.4 43.8 45.3

60–64 31.0 37.4 43.4 46.9 40.5 57.4

65–69 46.3 53.5 61.9 65.6 72.4 76.5

70–74 67.5 72.3 82.2 85.2 90.2 77.5

75–79 109.4 118.1 119.4 115.7 125.0 130.6

80–84 156.1 163.9 182.4 190.7 163.1 163.5

85–89 243.8 246.0 239.0 243.3 122.8 183.7

90 &over 366.7 394.9 351.0 367.6 280.0 263.2

FEMALE Age Period. Native White. Foreign Born White. Coloured.

1900 Death Rate. 1910 Death Rate. 1900 Death Rate. 1910 Death Rate. 1900 Death Rate. 1910 Death Rate.

All ages 16.1 14.4 19.7 16.2 24.7 21.7

Under 1 149.7 128.7 160.1 92.0 335.6 265.0

1–4 21.0 16.3 30.5 18.6 49.6 40.1

5–9 4.8 3.8 5.0 3.9 10.1 8.6

10–14 2.9 2.3 2.7 2.4 12.3 7.2

15–19 4.5 3.2 3.6 3.2 8.8 9.7

20–24 6.8 4.9 5.8 4.0 8.8 10.9

25–29 8.1 6.1 7.6 5.3 10.1 10.4

30–34 8.9 7.0 9.3 6.6 12.4 11.4

35–39 9.3 7.7 11.0 7.9 15.1 14.3

40–44 10.1 9.6 13.3 9.9 19.7 20.2

45–49 12.4 11.3 16.9 13.5 19.1 20.8

50–54 14.9 15.0 22.2 19.1 25.4 29.8

55–59 19.4 19.8 31.3 28.8 39.3 36.4

60–64 25.4 27.5 41.7 41.0 52.2 49.8

65–69 38.2 42.7 57.0 59.4 62.0 69.6

70–74 58.7 64.5 83.1 85.2 86.3 49.7

75–79 93.4 96.0 117.5 115.0 110.7 96.0

80–84 148.7 152.7 167.5 170.2 136.8 131.7

85–89 224.2 223.9 246.9 242.1 117.6 175.8

90 & over 326.4 339.0 355.0 348.5 183.3 222.2

The tables on this and the opposite page show the same general trend of mortality in New York State that is exhibited in the Registration States generally and wherever reliable statistics are obtainable. It will be noted, however, that there is little change in the mortality rate among women until age sixty, when a decidedly increased mortality rate is shown comparing 1910 with 1900. It will also be noted that this unfavorable trend in mortality in later life is manifested among native whites, foreign born and colored citizens alike.

COMPARISON OF EXPECTATIONS OF LIFE, NEW YORK CITY, ENGLAND AND WALES, AND LONDON Ages New York City[V]

1909–1911. England and Wales[W]

1910–1912. London[W]

1911–1912.

Males Females Males Females Males Females

At birth 44.55 48.8 51.50 55.35 ... ...

10 46.95 50.4 53.08 55.91 ... ...

20 38.26 41.7 44.21 47.10 42.35 46.71

30 30.34 33.6 35.81 38.54 33.87 37.94

40 23.34 26.2 27.74 30.30 26.03 29.67

50 17.11 19.1 20.29 22.51 19.09 22.17

60 11.71 12.9 13.78 15.48 13.09 15.39

70 7.66 8.2 8.53 9.58 8.17 9.57

80 4.66 4.9 4.90 5.49 4.79 5.39

90 2.24 2.8 2.87 3.16 2.75 3.10

The above tables show, both among males and females, that the expectation of life is greater at every ago period in England and Wales and in London than in New York.

[V] Annual Report, Department of Health, City of New York, 1912, pp. 176–177.

[W] Supplement to the Seventy-Fifth Annual Report of the Registrar-General of Births, Deaths and Marriages in England and Wales. Part I-Life Tables, pp. 56–85.

DEATH RATE PER 1000 IN PRUSSIA BY AGE GROUPS

1875–80 TO 1901–1910 Ages 1875–1880.[X] 1881–1890.[X] 1891–1900.[X] 1901–1910.[Y]

Males Females Males Females Males Females Males Females

1–2 71.8 69.1 70.2 68.0 58.0 55.5 45.3 43.1

2–3 37.1 36.1 36.3 34.6 24.7 23.8 16.5 16.0

3–5 22.2 21.7 20.8 20.7 14.2 13.9 8.9 8.8

5–10 9.3 9.2 8.8 9.0 5.9 6.1 4.2 4.4

10–15 3.9 4.3 3.8 4.3 2.9 3.3 2.4 2.7

15–20 5.1 4.6 4.8 4.5 4.3 3.8 4.0 3.6

20–25 7.7 6.3 7.0 5.8 6.0 5.1 5.2 4.6

25–30 8.6 8.2 7.6 7.5 6.1 6.1 5.3 5.5

30–40 10.9 10.3 10.6 9.7 8.3 7.9 7.0 6.7

40–50 16.7 12.3 16.3 11.7 14.3 10.0 12.5 8.6

50–60 27.6 20.7 26.9 19.8 24.2 17.5 23.5 16.0

60–70 53.0 46.3 51.4 44.8 48.7 42.0 45.5 37.4

70–80 113.3 106.2 110.2 113.9 102.5 97.1 100.6 102.0

80 & over 236.4 227.2 238.2 229.0 233.1 223.3 214.4 202.6

Note that in both sexes there was a steady and substantial decline in the death rate at all age periods of life after 1875.

[X] K?niglich Statistisches Bureau in Berlin Preussische Statistik. Hft. 184, p. iv. ff., Berlin.

[Y] Zeitschrift des K?niglich Preussichen Statistichen Landesamts, Berlin, 1912, p. xvii.

DEATH RATE PER 1000 IN DENMARK BY AGE GROUPS 1880–1889-1890–1900 Ages 1880–1889 1890–1900

Males Females Males Females

0–5 53.1 46.0 48.5 40.8

5–10 7.2 7.7 5.6 6.0

10–15 4.4 5.6 3.6 4.6

15–20 4.9 5.8 4.5 4.7

20–25 7.0 6.1 6.0 4.9

25–30 6.5 7.4 5.5 5.6

30–35 6.8 7.9 6.1 6.5

35–40 7.8 8.4 7.7 7.5

40–45 9.8 9.3 9.3 8.2

45–50 12.6 10.2 11.6 9.1

50–55 16.8 12.2 15.7 11.8

55–60 22.6 17.0 22.0 16.4

60–65 33.3 26.1 30.7 24.2

65–70 46.9 39.2 44.7 36.7

70–75 70.0 58.3 74.5 65.0

75–80 104.9 92.9 115.0 98.9

80–85 178.7 157.4 169.4 151.6

85–90 246.7 210.9 250.1 226.5

90-over 392.3 350.1 425.6 373.2

Note the improvement in mortality at nearly every age period of life, in both sexes.

Befolkningsforholdene i. Denmark i. 19. Arrhundrede, p. 125. Denmark Statistiske Tabelvaerk, Ser. 5, Litra A. no. 5.

DEATH RATE PER 1000 IN SWEDEN BY AGE GROUPS[Z]

1801–10 to 1891–00 Ages 0–5 5–10 10–15 15–25 25–35 35–45 45–55 55–65 65 over

Years

1801–10 79.0 12.1 7.2 8.5 11.0 14.9 22.7 40.8 111.4

1811–20 76.0 9.7 5.6 7.2 9.9 14.3 21.0 37.6 102.9

1821–30 63.1 7.6 4.5 6.1 9.4 13.6 20.1 35.4 96.9

1831–40 60.3 7.5 4.7 6.0 9.8 14.3 20.8 35.6 102.1

1841–50 56.8 7.8 4.4 5.5 8.0 12.2 18.1 31.8 97.1

1851–60 60.5 10.9 5.5 6.1 8.4 11.9 17.9 32.1 91.6

1861–70 57.3 9.1 4.4 5.4 7.2 10.1 15.1 28.7 87.2

1871–80 52.3 8.5 4.2 5.3 7.4 9.3 13.1 23.6 79.4

1881–90 43.6 7.7 4.0 5.2 6.6 8.2 11.5 21.1 71.4

1891–00 36.9 6.0 3.6 5.4 6.5 7.8 10.9 19.7 71.3

Note the pronounced fall in the death rate at every age period during the past century.

[Z] F. Prinzing Medizinische Statistik, Verlag von Gustav Fischer in Jena, 1906.

The Remedies

The remedies, however, are plainly indicated:

Eugenics, to improve the stock.

Periodic physical examinations to detect the earliest signs of disease, and especially infective foci in the head, such as diseased gums, tooth sockets, tonsils, nasal cavities, etc.

The practice of personal hygiene along the lines of ascertained individual needs.

Cancer, another disease heavily on the increase in all civilized countries, may be combated by similar measures.

* * *

SECTION IX

EUGENICS

"How to Live" deals mainly with personal hygiene, that is, the proper care of the individual. Hygienic improvement is limited, however, to the attainment of the best of which an individual is capable. Eugenics deals with the even more vital subject of improving the inherent type and capacities of the individuals of the future. It has been but briefly touched upon in this volume.

Eugenic improvement is attainable through the control of heredity. By heredity is meant the action of elements which control the development of the individual, and determine his constitution or makeup. The laws of Nature governing this action are now known in part, so that advantage can be taken of them to bring about the hereditary improvement of the race, generation by generation.

What Eugenics is Not

Eugenics is not simply sex hygiene, as many have come to consider it, owing to the liberal use of the word Eugenics by the sex hygienists. Sex hygiene is, of course, one of the considerations in eugenic improvement.

Eugenics is not, furthermore, the science of improving the physical organism only, as has been erroneously assumed by certain uninformed publicists, a point of view which has been promoted by cartoonists, who find it good sport for their pens.

Eugenics does not require the old Spartan practise of infanticide, nor does Eugenics propose to do violence in any other way to humanitarian or religious feeling.

Eugenics does not mean, as some have imagined, compulsory or government-made marriages.

Nor is Eugenics the science of improving the human stock by matings that are academically ideal, but which lack the element of individual attraction and instinctive love.

Discovery of Hereditary Laws

There was a time when the inherent personality of a man, the color of his eyes, the capacity of his mind, the quality of his character, seemed clearly subject to the caprice of forces beyond the reach of mortal perception. In attempting to trace the source of a personality, hereditarily, no constancy could be detected in its relation to the lives from which it arose. A child was never absolutely like brother, sister, mother, father or grandparent.

An epoch-making discovery in 1865 by an Austrian monk named Mendel,[57] and later discoveries by a number of other scientists, revealed the subdivisibility of each individual into many distinct units or traits, the hereditary sources of which were clearly traceable, leading to various individuals of the family line, and not to one individual alone. Furthermore, it was found that the lack of a certain trait sometimes appears as a trait in itself, just as darkness seems like a condition in itself rather than as an absence of light.

These discoveries changed the whole current of thought regarding heredity, and the constancy of its action, as well as its controllability. It also emphasized the fact that it does make a difference whom one marries as to the character of the resulting offspring. Their makeup is not subject to the caprice of forces beyond human perception, but is in some degree subject to control.

Out of these discoveries has arisen the science of Eugenics. Sir Francis Galton, of England, was the first to start a world movement for its application toward conscious betterment of the human stock.

Rules of Eugenics

From the known laws governing the inheritability of unit-traits, it is apparently necessary, in the betterment of the race, to follow a few important rules:

Learn to analyze individuals into their inheritable traits-physical, mental and moral.

Differentiate between socially noble and ignoble traits, between social and educational veneer and sterling inherent capacity.

Do not expect physical, mental and moral perfection in any one individual, but look for a majority of sterling traits.

Observe the presence or absence of specific traits in individuals at all ages of successive generations and fraternities of a family line.

Learn how to estimate the inheritability of such traits in a family line, upon specific mating with another family line.

Join your family line to one which is strong in respect to the traits in which yours is weak.

But remember also that injuries can be inflicted on offspring by unhygienic living.

Inheritable Traits

Some of the characteristics in Man's complex known to act hereditarily and to be traceable to distinct sources on family lines are as follows:[58]

Physical Traits.-Character of the facial features, color of the eyes, hair and skin, stature, weight, energy, strength, endurance, quickness, commanding presence, vivacity of manner, general bodily soundness; also defects of many kinds, such as those of the nervous system, of the speech, eyes, ears, skin, also baldness, defects of the muscular system, blood, thyroid glands, vascular system, respiratory system, digestive system, reproductive organs; also defects and peculiarities of the skeleton, etc. This does not mean that all shortcomings are inherited. It does mean, however, that the type of organism is inheritable which lacks resistance to the germs and other precipitating factors in bringing about the disease.

Mental Traits.-Among the mental characteristics known to arise from traceable hereditary sources may be mentioned factors in musical ability, artistic composition, literary ability, mechanical skill, calculating ability, inventive ability, memory, ability to spell, fluency in conversation, aptness in languages, military talent, acquisitiveness, attention, story-telling, poetic ability; and, on the other hand, insanity, feeble-mindedness of many types, epilepsy. These are suggestive of the inheritability of many other mental traits not yet studied.

Moral Traits.-Among the moral traits known to possess inheritable elements are generosity, piousness, independence, industry, will-power, faithfulness, fairness, sociability, reliability, self-reliance, tendency to work hard, perseverance, carefulness, impulsiveness, temperance, high-spiritedness, joviality, benignity, quietness, cheerfulness, hospitality, sympathy, humorousness, love of fun, neighborliness, love of frontier life, love of travel and of adventure. The same may be said of immoral traits, such as criminality, pauperism, delinquency, irascibility, lying, truancy, superstition, clannishness, secretiveness, despondency, slyness, exclusiveness, vanity, cunning, cruelty, quickness to anger, revengefulness, etc.

Distribution of Traits

These physical, mental and moral peculiarities are not scattered evenly through the population, but exist on certain family lines only.

For instance, one-tenth of the deaths that occur in the United States are from tuberculosis. But this does not mean that one-tenth of all families die of the disease. On the contrary, some families lose more than half their numbers from it, while other families lose almost none at all. The 10 per cent. is simply the average of all. The percentage is high among the Irish, and low among the Jews. Life insurance companies take consideration of this fact in examining applicants for insurance. A family history of tuberculosis counts against even a healthy applicant, not because of a belief that tuberculosis is directly inheritable, but because non-resistant types, especially light-weights, are known to be transmitted. A profound influence toward checking this malady would evidently be exerted if the matings on the family lines exhibiting the characteristic of susceptibility were to cease, and thus the perpetuation of susceptible types checked.

The same is true of crime. The 80,000 prisoners constantly supported in the United States are recruited not evenly from the general population, but mainly from certain family breeds.[59] Criminality among "The Jukes" is a rule, among Jonathan Edwards' descendants, the exception. The same is true of mental abilities of different kinds. Galton showed that the prominent English judges, statesmen, chancellors, etc., were furnished by certain family lines only, and were not drawn evenly from all families.[60] The same is true of feeble-mindedness.[61]

Socially Noble and Ignoble Traits

The question of what traits are desirable and what traits are undesirable might seem, on first thought, rather a difficult matter to determine. Few of us would like to have our neighbor's taste in the matter constituted as a standard of judgment upon our own traits. There is one standard of judgment, however, that is so broad and impersonal and so founded on the elements in society to which all individuals are subject, that it can justly serve as a line of division between the desirability and undesirability, broadly speaking, of individual traits for perpetuation. This is the measurement by the standard of social worth and service commonly designated as "fitness."[62] Above this dividing line may be roughly grouped the genius, the specially skilled, the mediocre, who are a service to society, or at least not a burden. Below this line may be grouped those feeble-minded, paupers, criminals, insane, weak and sick, who are a burden, economically and socially. That is, a person's traits are desirable of perpetuation if so balanced as to render the individual not a burden to others.

It must undoubtedly be true that many families possess, inherently, traits of ability which have never had an opportunity to exhibit themselves. This may account for the apparently sudden appearance of great men and women without obvious hereditary background. It is plainly possible, furthermore, to bring about a special combination of two family lines, the mental traits on neither of which exhibit remarkableness, but which, when combined, bring an extremely happy result.

Mental ability does not depend upon education. Education can only enable an individual to utilize more fully his inherent ability; it cannot increase capacity.

The same is true, of course, of physical capacity. Sandow has an extraordinary muscular ability, developed by certain exercises. Similar exercises will not, however, develop all men into Sandows, no matter how constant their faith and persistent their efforts. Sandow was, we may assume, hereditarily gifted with a superior muscular capacity, which his exercises have enabled him to fully develop. It is true, however, that few people ever realize their full physical and mental capacities, owing to lack of opportunity, inclination, etc., and that there generally exist untold possibilities for improvement for those who wish to get the most out of themselves.

A Majority of Sterling Traits

It is apparent that the make-up of an individual is the result of a very complex combination of traits. For this reason, the makeup is not likely to fall heir to all "bad" traits, any more than it is to all "good" traits. Even the feeble-minded, who have fallen heir to such an intensely undesirable trait-or rather, to the lack of intensely desirable traits-in many instances have simultaneously inherited many desirable traits, such as kindness, gentleness and generosity, often lacking in those possessed of scholarly capacities. Many women of the border-line type of feeble-mindedness, where mental incapacity often passes for innocence, possess the qualities of charm felt in children, and are consequently quickly selected in marriage. If a mentally able man possess as an ideal of womanhood other traits than mental capacity, no amount of schooling for his child can make up for the difference between the mental capacity of the offspring of such a mating, and the offspring of a mating with an able-minded woman. Although the trait of able-mindedness is dominant, so that the mating of an able and a feeble mind will result in fairly able-minded offspring, who may even be above the average, mentally, such offspring carry in their own germ plasm the defect derived from their feeble-minded parent, which defect may then be passed on to future generations through the germ plasm from which their children get their inheritance. A mother's hereditary influence on the child is just as important a factor as the father's, generally speaking. Where feeble-mindedness exists on a family line, care should be exercised by the able-minded members of that line not to mate with another line possessing cases of feeble-mindedness, lest the offspring then fall heir to feeble-mindedness, which can skip a generation. An appreciation of what is feeble-minded, and a realization of its inheritability can not help but modify a man or a woman's admiration for the traits or lack of traits which it embraces.

Persons possessing weak physical makeups may possess strong mental capacities, and vice-versa. Persons of superior mental capacities may lack loftiness of character. It might happen that in so mating as to prevent the perpetuation of an undesirable trait, physical, mental or moral, a desirable trait would be lost along with it. In any mating transaction, therefore, choice must necessarily compromise upon the favorable hereditary action of a majority of the traits on the two family lines. One must relinquish any quest for perfection. After eliminating the individuals possessing the grossly unsocial traits below the dividing line of social fitness, one must choose with respect to a majority of socially fit traits, in addition to the elements of personal congeniality and affinity. The two last-named elements, however, generally serve as useful narcotics in blinding the mating individuals to the existence of the compromise, and the real becomes the ideal.

Successive Generations and Fraternities

Each trait in the mosaic of one person is transmitted or not transmitted to a child according to the mating of that particular trait-mating with trait or lack of trait-rather than according to the mating of the two persons as a whole. That is, when a man and woman marry and bear offspring, it is not the mating of two units, but it is the mating of myriads of pairs of units-the units being the constituent traits and lack of traits (contained in some mysterious way in the germ plasm), each trait-mating producing its own trait-offspring. The collection of these trait-offspring makes up the child.

It has been observed that traits differ with respect to their action in mating. Given a specific type of trait-mating, say of a trait with like trait, or trait with the lack of that trait, some types always reappear in the next generation or else are lost entirely from the family line unless reinfused, whereas other types of traits may not reappear in the next generation, but still appear in a generation further removed. Another type of trait is transmissible only by one sex of a family line, and can not be transmitted by the other sex.

From these facts, it is readily understandable how important becomes the consideration of the marriage of relatives, such as cousins,[63] who are, of course, individuals of the same family line, whose mating brings together like groups of traits, thus strengthening the existence of these traits, whether desirable or undesirable. Cousin marriages, when the family possess traits of mental ability, may result in children who are geniuses; but cousin marriages, when the family line possesses traits of mental inability, may result disastrously with respect to offspring. Family lines possessing traits of mental weakness should most assuredly join only to family lines possessing traits of strength in those regards.

In calculating the inheritability of traits, it is also necessary to consider that certain physical, mental and moral traits flower at the arrival of certain ages only. It is necessary to look along the whole line of a life, as traits may exist at one age and not at another. A boy's beard does not appear until puberty. Likewise, other physical and mental and moral traits sometimes do not manifest themselves until specific ages, according to the type of the family breed. Because a parent dies before the development of the trait does not preclude its transmissibility to his offspring. Huntington's chorea, an extremely undesirable trait, does not develop until middle life, but is transmissible to offspring even though the father dies from some other cause before the period when the disease in his own person would be expected to appear.

Results of Specific Matings

Andalusian Fowl

We can best understand the laws governing the inheritance of traits by taking a few concrete cases. The first case is that of an Andalusian fowl. We shall consider the two species, pure bred black and pure bred white, and confine ourselves to observing the inheritance of the single characteristic, plumage color. Of course, as long as the black mate only with the black their children will be black, and as long as the white mate with white the children will be white. But if a white mates with a black, the children will not be either black or white, but blue. All will be blue. But the most interesting facts appear in the next generation, when these hybrid blue fowls mate with black or white, or with each other. The original of the cross between the white and the black is an entirely new color blue, which may be considered a sort of amalgam of black and white. But a cross between the blue and the black will not be any new color, but will be either black or blue-and the chances are even. That is, in the long run about half of the children of the blue and black parents will be blue and half will be black. None of the children will be white. So also crossing the blue with the white will result in half of the children being blue and half, white. Still more curious is the result of mating blue with blue. One might imagine that in this case all the children would be blue, but only half will be blue, while a quarter will be black and a quarter white.

Laws of Chance

These laws are a curious mixture of chance and certainty. In certain circumstances, as we have seen, we can predict with certainty that the offspring will be black, white, blue, or whatever the case may be. In other circumstances we can only state what the chances are. But these chances can be definitely stated as one in two, one in four or whatever it may be, and where there are large numbers of offspring this amounts to a practical certainty that definite proportions will have this or that color, or other characteristics.

Two parents are like two baskets or bundles of traits from which the child takes its traits at random. In the wonderful play of Maeterlinck's, called the "Bluebird," we are taken to the "land before birth," where the children are waiting to be born, having selected their parents to be. Of course, this is only a pleasant fancy, like the advice of Oliver Wendell Holmes to children to choose good grandparents, but it is a useful fancy which will help us to understand the laws of heredity. The child of the Andalusian fowl takes its color from its two parents on the same principle as a lottery in which it would take two beans, white or black as the case might be, from each of two baskets. Every individual is a sort of basket containing two beans, as it were. It took one of these two beans from each parent and will give one to each child.

With this picture of a bean lottery before us it is very easy to understand how the colors of Andalusian fowls are inherited. When two black fowls mate, the offspring must be black, because in this case each parent basket contains a pair of black beans, so to speak, so that the child taking one black bean from each basket will necessarily have a black pair. For the same reason the child of two white fowls must be white, but when a black and white fowl mate, the child takes a white bean from one parent and a black from the other, its own color being resultant or amalgam of the two, which in the case of the Andalusian fowl is blue. Since every such hybrid child has this same combination of a white and a black bean, all these hybrids are alike. All are blue. It is important to remember that this hybrid blue is only a sort of mechanical mixture of black and white, and that the black and white are still separate beans, as it were.

But now suppose a hybrid or blue fowl to mate with a white. This means that the child takes from the white parent or basket one of the two white beans and from the blue parent or basket, one of the two beans, of which one is white and the other, black; the bean taken from the first or white basket must be white, but that taken from the second or blue or hybrid basket may be either white or black. It is a lottery with an even chance of drawing white or black. In the long run, half of the children will draw white and half, black. Those which draw the white will, since they also drew white from the other parent, be wholly white, but those which drew the black will be blue, since they will have one black and one white bean. We see, too, that the white child is just as truly white as though it had not had a hybrid parent; for of the two elements or beans which the hybrid carried, the black one was left behind untaken. We see that the blue child is a hybrid exactly like its hybrid parent, and not any new kind of cross between the blue and the white. In short, the children of a blue and white are either the one or the other and not a mixture. In the same way if a blue mates with a black, half of the children will be black and half blue.

Finally we come to the mating of a blue with a blue. Here the lottery is to pick a bean from two baskets, each basket containing both white and black beans in equal numbers. When at random one is taken from either of these two baskets there is an even chance that the bean from the father is white or black and an even chance that the bean from the mother is white or black.

Now, what is the chance that the child draws a white bean from both baskets? Evidently it is one chance in four; for there are four ways equally probable in which you can take these beans, viz.: (1) black from the father basket and black from the mother, (2) white from the father and white from the mother, (3) white from the father and black from the mother, (4) black from the father and white from the mother. So the children could draw both white once in four times, both black once in four, and a white and a black in the other two cases. And that is why from two blue Andalusian fowls, on the average you will have one-quarter of the children black, one-quarter white, and the other two-quarters, blue. Again let us stop to emphasize the fact that the black children of these hybrids are just as pure blooded as their black grandparent, and will mate with other pure-blooded black in exactly the same way as though there had never been any white in their ancestry. The white strain has been left behind, or been "bred out."

We have spoken of one character or characteristic-color. The same laws apply to other characters. Often different characters are inherited quite independently of one another. Each of us is a basket or bundle of very many qualities, each quality being a little compartment of the basket with two beans in it. There is, as it were, a pair of beans for every unit trait, whether that trait relates to color, to musical ability, or to any one of hundreds of other kinds.

To summarize the laws of inheritance of the unit character called color, in Andalusian fowl, we have really six ways in which we can consider mating of the three colored fowls (black, white, blue): (1) black may mate with black, in which case all the offspring will be black, (2) white may mate with white, in which case all the offspring will be white, (3) a black may mate with a white, in which case the offspring will all be blue-a hybrid containing both black and blue elements, (4) blue may mate with a black, in which case half the offspring will be pure bred black, and half hybrid blue, (5) a blue may mate with a white, in which case half the offspring will be white and half blue, (6) blue may mate with blue in which case a quarter of the offspring will be white, a quarter black and a half blue.

Guinea Pigs

These results are the fundamental laws discovered by Mendel. But the results are not always as clear as in the case of the Andalusian fowl. In that case the hybrids were not like either parent, but were a new color, blue, so that they were labeled at once and recognizable as hybrids-but this is not generally the case. Take, for instance, guinea pigs. What will be the result of mating an "albino" white with a black guinea pig? Quite exactly the same principle applies as in the case of the Andalusian fowl, but the principle is not as clear to see. All the offspring are hybrid, but they will not be blue: they will be black. They will look like the black parent, but they are different. The black color predominates; i.e., black is "dominant" over white, while the white recedes out of sight, or is "recessive." This hybrid black guinea pig is like the hybrid blue Andalusian fowl. It is a hybrid, a combination of white and black, but in the guinea pig the black covers up the white so that nothing in the color reveals the fact that it is a hybrid. Now if the hybrid black offspring of these black and white guinea pigs mate with each other, the result will follow exactly the same Mendelian law as applied to the Andalusian fowl. But this will not be so clear, because now we have two kinds of black instead of a black and a blue. One child in four will be pure bred black like the grandparent and two out of the four will be hybrid black. So to the eye we shall simply have, out of four children, one white and three black. But those three black are not all alike. One is a thoroughbred and two are half-breeds.

But how then are we to distinguish between the one pure bred black, the thoroughbred, and the two blacks that are hybrids so that we can be sure which is which? The only way they can be distinguished is to wait to see what their offspring will be in the next succeeding generations.

The one that is a thoroughbred will behave like a thoroughbred. For instance, if mated with white they will have nothing but black children. But if one that is hybrid black mate with one that is white, only half of the children will be white; these white children reveal the fact that their black parent was a half breed. Then we can put a tag on that black parent. If proper tags are put on the blacks so as to distinguish between the pure-blooded and the half-blooded-say a blue tag on the hybrids and a black on the thoroughbreds-we shall get exactly the same results as described in the case of the Andalusian fowl, in the six cases mentioned. The same principles apply to qualities of the guinea pigs other than color. Thus, if a long-haired guinea pig mates with a short-haired guinea pig, all the offspring will be short-haired, because short hair is dominant over long hair. Again, if a smooth-coated guinea pig mates with a rough-coated one, the result will be rough coated, because a rough coat is dominant over a smooth coat.

"Thoroughbred" Humans

The same principles undoubtedly apply to the human race, although as yet only a few traits have been carefully studied. Eye color is one of these. Imagine a marriage of a thoroughbred, black-eyed Italian with a thoroughbred, blue-eyed Irish. What will be the result? All the children will be black-eyed, black being dominant over blue; but these black eyes are not the genuine article that the Italian parent possessed. They are a blend, and it is only because the black element dominates over or conceals the blue element that we can not see on the surface that there is any blue there. But it may come out in the next generation; for, if these half-blooded individuals marry among themselves one-quarter of their children on the average will be blue-eyed. The other three-quarters will be black-eyed, but only one-quarter will be "really and truly" black-eyed, i.e., black-eyed like the Italian. The remaining half are hybrid black, like the parents. It is only a sort of imitation black so to speak.

The appearance of blue eyes in the second generation is the long observed but formerly mysterious "atavism," or reversion to the grandparent.

Suppose the children of an Italian and an Irish parent intermarry with pure bred Italians. We immediately know what will be the result. All the children will be black-eyed, but among a large number only half will be thoroughbred black-eyed. The other half will be "imitation" black-eyed. The case is just like the mating of hybrid black guinea pigs with thoroughbred black guinea pigs, or of the blue fowl with the black. Similarly, if the Irish-Italian hybrids marry with pure Irish, half the offspring will be blue-eyed and half will be hybrid black-eyed.

Dominants and Recessives

Black eyes are "dominant" over blue eyes because the black color is due to a pigment, while the blue color is due to the absence of this pigment. In general a quality which is due to the presence of some positive element is dominant over a quality due to the absence of that element. A child inheriting from a blue-eyed person simply draws a blank from that side in the lottery.

In order to understand how these principles of Mendel apply in any given case we need first to know what traits are "dominant" and what are "recessive."

Among traits known to be "dominant" are, besides pigmentation of the eye, certain peculiarities of the skeleton, such as short-fingeredness (two phalanges only on each digit), Huntington's chorea, presenile cataract, congenital thickening of the skin, early absence of hair, diabetes insipidus, stationary night-blindness, liability to periodic outbreak of temper, etc.

Among traits known to be "recessive" are albinism (or lack of pigmentation), a certain degenerative disease of the eye, deafmutism, imbecility, insanity of certain types, certain nervous diseases; also mental traits, such as musical ability.

Suppose now that a normal or "strong-minded" person, if we may use that term as distinct from feeble-minded, marries a feeble-minded person. Assuming that the "strong-minded" person is a "thoroughbred" all of the children will be apparently normal. None will be feeble-minded. "Strong-mindedness" is dominant over weak-mindedness. Yet all these children that seem to be perfectly normal lack something in their bodies. This deficiency is simply covered up but can crop out in later generations. If two of these hybrids between the weak-minded and the strong-minded marry each other, one-quarter of the children will be feeble-minded, one-quarter thoroughbred strong-minded and the remaining half, though apparently strong-minded, will carry the taint in them just as their parents did. They are half-breeds. On the other hand, if two feeble-minded people marry, all of the children will be feeble-minded. Certainly we can and ought to forbid and prevent such marriages.

But feeble-mindedness is a recessive quality, so that if the feeble-minded marry only with normal individuals, the feeble-mindedness does not blight the next generation, and if these apparently normal children of such marriages take pains to marry only really normal individuals, avoiding not only the feeble-minded but even those like themselves who have feeble-mindedness on one side of their family tree, there will be no feeble-mindedness cropping out in future generations.

Instances of Eugenic Improvement

But not all human abnormalities are recessive. Thus Huntington's chorea is dominant, so that every child of the unfortunate victim of this malady will contract it when it reaches the right age. Marriages of such people should, therefore, never be allowed, even with normal individuals.

But when we propose to restrict marriages or mating of those unfit to marry, people are apt to say, "That is a dream. It can't be done." But it can be done and it has been done. Every one has heard of the cretins in Switzerland. They are a kind of idiot who are short in stature and afflicted in all cases with goitre in the neck. Of course, many people have goitre who are not cretins, but there is no cretin who has not goitre. These cretins are peculiarly a feeble-minded people. They are common still in many towns of Switzerland; they are loathsome objects, helpless as children, with silly smiles, unable to take care of themselves in even the simplest toilet ways, and have to be looked after like domestic animals, or even more closely.

A gentleman very much interested in Eugenics visited Aosta, in Italy, just outside of Switzerland, once in 1900 and again in 1910. In 1900 he found many of these creatures among the beggars in the streets, in the asylums, in the home, in the orphan asylum-everywhere he ran across these awful apologies for human beings. But in 1910 he found only one! What had happened? Simply that a few resolute intelligent reformers had changed the entire situation. An isolation institution, or rather two institutions, one for the men and the other for the women, were established. In these the best care of the inmates was taken as long as they lived, and they do not live long. But pains were taken to see that by no possibility could marriage or mating of those people take place. They forfeited any such rights in return for the care that they received from the State.

Thus is it possible to apply the laws of heredity as laid down by Mendel in a thoroughly practical way and to get results immediately in one short generation. It seems, and it is, a colossal task to change average human nature one iota. Yet in the light of modern eugenics we could make a new human race in a hundred years if only people in positions of power and influence would wake up to the paramount importance of what eugenics means. And this could be done quietly and simply without violence to existing ideas of what is right and proper. It could be done by segregation of the sexes for defectives, feeble-minded, idiots, epileptics, insane, etc. By this kind of isolation we can save the blood-stream of our race from a tremendous amount of needless contamination.

And it is being done. The growing tendency to put defectives in institutions, though originally with no such object, will reduce the transmission of defects, especially when it is recognized that the sexes must be separated and that the inmates should be kept at the institution through the reproductive period of life.

Educational Influence

It is inconceivable that the average individual will deliberately and consciously make his calculations regarding the character of possible offspring before he allows himself to fall in love to the point of desiring marriage. Yet unconsciously an educational influence on love and on marriage selection has been operating through centuries. The sick, the feeble-minded, the immoral, and members of their families, have at all times been socially handicapped, and have always been the first to be eliminated in marriage selection. And it is conceivable that this already developed wisdom in mate-choosing can easily be augmented by a further knowledge of heredity which is now available. It unconsciously favorably modifies the individual taste.

Certain races of men, without consciousness of their action, have varied in the character of their choices (sex selection) in such a way as to bring about varied conditions in their races, with respect to resistance to disease, of mental capacity and to moral quality. The Mongolian differs from the Hebrew, the Anglo-Saxon differs from the African.

It depends largely upon the action of those now upon the earth, who are now making their choices of marriage, as to whether the races of the future shall be physical, mental or moral weaklings, or whether they shall be physically brave and hardy, mentally broad and profound, and morally sterling.

Summary

To summarize: There are three main lines along which eugenic improvement of the race may be attained:

(1) Education of all people on the inheritability of traits; (2) segregation of defectives so that they may not mingle their family traits with those on sound lines; (3) sterilization of certain gross and hopeless defectives, to preclude the propagation of their type.

There would seem to be great need of State Eugenic Boards, to correlate and to promote these activities, in the interests of the future population, and to give expert advice as to how to legislate wisely, and individual advice as to how to mate wisely. The latter function now falls entirely upon the Eugenics Record Office at Cold Spring Harbor, where the work is being carried on with great efficiency with the funds at command.

REFERENCES

[57] Darbishire, A. D.: Breeding and the Mendelian Discovery, Cassell & Company, Ltd., London, New York, Toronto and Melbourne, 1911.

[58] Davenport, Chas. B.: Heredity in Relation to Eugenics, Henry Holt & Company, New York, 1911.

[59] Dugdale, Robert L.: The Jukes, G. P. Putnam's Sons, New York and London, 1910.

[60] Galton, Francis: Hereditary Genius, D. Appleton & Company, New York, 1870.

[61] Goddard, Henry H.: The Kallikak Family, The Macmillan Company, New York, 1912.

[62] Kellicott, William E.: The Social Direction of Human Evolution, D. Appleton & Company, New York and London, 1911.

[63] Huth, Alfred Henry: Marriage of Near Kin, Longmans, Green & Company, London, 1887.

[64] Darwin, Charles: The Descent of Man, Thomas Y. Crowell & Company, New York, 1874.

For further bibliographic lists, see bulletins entitled "Books and Journals," and "Publications" issued by the Eugenics Record Office, Cold Spring Harbor, N. Y.

* * *

INDEX

A B C D E F G H I J K L M

N O P Q R S T U V W X Y Z

Abdominal muscles, beneficial effects of erect posture on, 57.

Acids, excess of, from overabundance of animal proteins in diet, 39; fruit and vegetable, in a mixed diet, 43.

Activity, necessary to living a hygienic life, 89; work and play the two great forms, of, 89.

Adulterants in foods, harmful, 65.

Advertising, measures of reform in, 162–163.

Agar-agar, a preventive of constipation, 52–53; for use in colds, 279.

Air, the first necessity of life, 7; motion, coolness, humidity, and freshness of, important features of ventilation, 7;

the matter of drafts, 8–9, 123–124, 274, 277;

securing fresh, through windows, 9–10;

prevention of stagnation of, by air-fans, 10;

action of different heating systems, 10;

importance of coolness of, 10–11;

securing proper degrees of dryness and humidity, 11–12;

lighting systems and, 13;

evils of tobacco smoke and of dust, 13;

bacteria in, carried by dust particles, 13–14;

benefits of sunlight, 14;

wearing of clothing which admits, 14–15, 275;

benefits of out-of-door, 18–20, 276;

outdoor sleeping, 20–24, 104, 220, 276;

deep breathing, 24–27.

Air-baths, taking of, 15–16, 148.

Air-fans, use of, 10.

Alcohol, modern movement against, 3; poisons in, 65, 241;

ill effects of, 67–68;

resistance to infectious diseases weakened by, 68;

social evil traceable to, 123;

to be avoided in cases of overweight, 216;

statistics of influence of, on longevity, 227–235;

per capita consumption of, in various countries, 235–236;

laboratory and clinical evidence relating to physiological effects of, 236 ff.;

effect on brain and the nervous system, 237–239;

influence on bodily resistance to disease, 239–240;

effect on heart and circulation, 240–241;

food value of, 241–242;

effect on offspring, 243;

attitude of National Council of Safety toward, 244;

condemnation of, shown by restrictive and prohibitive measures of governments, 244;

references on subject of, 244–249.

Alkaline dentifrices, 86.

Amusements. See Recreation.

Andalusian fowl, illustration from, of action of hereditary traits, 307–313.

Anglo-Saxon race, effects of indoor living upon, 147.

Animal cells, apparent immortality of, 142–143.

Apoplexy, death rates from, 284, 285.

Appetite, misleading of, by delicacies of civilization, 151–152.

Apples, food value of, 30, 177, 179.

Arch supports for flat foot, 224, 225.

Arteries, tobacco and diseases of the, 69, 263.

Arthritis deformans, caused by focal infection, 82.

Asparagus, food value of, 41, 175.

Asthenic droop, cause of, 58.

Athletes, effects of tobacco on, 68, 69, 257–259.

Athletics, ideals in, 96; injuries from college, 96.

Attention, control of, essential to securing equanimity, 115.

Autointoxication, meaning of, 81; intestinal intoxication distinguished from, 81–82.

Avocation, practise of an, 98.

Bacteria, carried on dust particles, 13–14; part played by, in colds, 272.

See Germs.

Balanced ration, classification of foods with view to a, 171, 175–183.

Bananas, food value of, 30, 177; digestibility of, 49;

a cheap source of starch and sugar, 131.

Bank employés, unsuspected impairments among, 136–137.

Basal metabolism of the body, ascertaining the, 196–197.

Baseball, value as all-round exercise, 98.

Bathing, importance of, for avoiding disease, 75–76; perspiring before, 76;

activity and relaxation combined in, 101–102;

as a means of skin training, 274–275.

Baths, different forms of, for different needs, 102; nervous relaxation induced by neutral, 102;

for colds, 278–279.

Beans, baked, food value of, 29, 175; a high-protein food, 38;

protein in, a possible objection, 39–40;

a cheap source of protein, 131.

Bedbugs, diseases spread by, 74.

Beds, hard preferable to soft, 104.

Beets, food value of, 41, 175.

Belts, constriction from, 16.

Benedict, F. G., experiments by, to ascertain basal metabolism, 196–197.

Berries, food value of, 41, 177.

Blindness among tobacco smokers, 264.

Blood pressure, influence of deep breathing on, 25.

Bowels, foods the best regulators of the, 52. See Constipation.

Brain, effect of alcohol on, 237–239.

Brain workers, eating habits of, 34–35.

Bread, food value of, 29, 180; stale and crusty preferable to soft fresh, 41;

a cheap source of starch and sugar, 131.

Breathing, deep, 24–25; influence of muscular exercises on, 26;

beneficial effect of singing, 26;

relation of, to one's mental condition, 26–27.

Bulk, a necessary quality in food, 41–42, 150.

Bush, A. D., tests by, as to smoking and mental efficiency, 260.

Butter, food value of, 30, 33, 181.

Cabbage, cellulose in, 41; food value of, 131, 175.

Cakes, table of food values of, 179.

Calories, fuel-units for measuring food, 28.

Cancer, measures for combating increase of, 292.

Candy, over-indulgence in, 48.

Cantaloupe, food value of, 30, 177.

Carbohydrate, function of, as a constituent of food, 35–36; examples of, in common foods, 36;

suitable proportion of, in diet, 40;

in cheap foods, 131;

list of foods rich, moderate and deficient in, 171.

Card-playing, mental recreation from, in moderation, 100.

Catarrh, sometimes caused by smoking, 264; avoiding quack cures for, 280.

Cathartics, avoidance of, 53.

Cauliflower, food value of, 41, 175.

Celery, cellulose in, 41; vitamins supplied by, 42;

food value of, 175.

Cellulose, a necessity in diet, 41.

Cereals, laxative quality of, 52; table of food values of, 180–181;

for underweight, 220.

Chairs, effect of, on sitting posture, 60–61; among the evils of civilization, 152.

Character, posture and, 63–64; influence of health on, 105–107.

Charts, showing comparative mortality among abstainers and non-abstainers, 230–233; of death rates in different countries and at different periods, 283–285.

Cheese, food value of, 29, 38, 131, 181.

Cheeses, putrefactive, among the worst foods, 48.

Chewing, necessitated by hard foods, 41; importance of thorough, 44–47.

See Mastication.

Children, results of faulty posture in, 62; sleep required by, 103;

effects of alcoholic indulgence by parents on, 243.

Choice of foods, effect of slow eating habits on, 47.

Cigaret smoking, special evils of, 261.

Cigars and cigarets, nicotin in, 254–255; physical and mental effects of smoking, 255–267;

increase in use of, 267–268.

Circulation, effect of alcohol on, 240–241; effect of tobacco on, 256, 259–260, 263, 267.

Circulatory system, death rates from diseases of the, 284, 285.

Civilization, hygiene and, 143–156.

Cleanliness, importance of, for avoiding infections, 75–76.

Clerks, unsuspected impairments among, 136–137.

Clothing, relation of, to ventilation, 14; hygiene of, 14;

desirability of porous, 14–15, 275;

evils of tight, 16;

choice of cotton, linen, and woolen, 17;

color of, 17–18;

artificial conditions as to, resulting from civilization, 147–148.

Cocktail drinking, a harmful habit, 67.

Colds, popular exaggeration of danger of, from drafts, 8, 123; usual origin of, in germs, 8–9, 70–71;

measures for avoiding, 9;

sometimes indirectly caused by constipation, 51;

popular delusions concerning, 123–124;

means of infection, 272;

sometimes due to abnormalities in nose or throat, 272–273;

prevention of, by attention to rules of individual hygiene, 273;

chief preventive measures, 273–277;

emergency treatment of, 277–280;

possibility of avoiding, altogether, 280.

Color of clothes, 17–18.

Concentrated foods, objection to, 41, 150.

Condiments, hot, to be used sparingly, 48.

Constipation, evils of, 51–52; effects of water-drinking habits on, 52;

foods which prevent, 52;

use of mineral oils for, 53;

avoidance of drugs, 53;

an enema a temporary expedient, 53;

value of massage of the abdomen, 53–54;

favored by high-seated water closets, 54;

importance of establishing proper habits, 55;

poisoning from decomposition of protein in the colon, and remedies, 56;

produced by a slouching posture, 57;

mental effects of, 106–107;

effects of, ascribed to overwork, 124;

predisposition to colds caused by, 276.

Consumptive stoop, ill effects of, 57.

Cooking, loss caused in certain foods by, 42; necessary for some foods, 43.

Corn, food value of, 29, 175; cellulose in, 41.

Cornaro, "The Temperate Life" by, 142.

Corsets, constriction from, 16.

Cost, of food, 129–131, 184–190; wholesale, of uncooked ingredients of standard foods, 192–193.

Cotton, use of, in clothing, 17.

Cottonseed oil, a cheap source of fat, 131.

Country life, advantages of, 18.

Cousins, marriage of, 305–306.

Crawling exercise for faulty posture, 222–223.

Cream, food value of, 30, 33, 181.

Crime, laws of heredity applied to, 299–300.

Cucumbers, cellulose in, 41; food value of, 175.

Daily rhythm, observance of a, 89–90.

Dairy products, table of food values of, 181.

Dampness of air, exaggeration of evils of, 19.

Dancing, question of hygienic value of, 99–100; an obstacle to efficiency when overdone, 100.

Death rate, lowering of, by public hygiene, 158–159; statistics of overweight, 213;

influence of alcohol on, 228–235, 262;

influence of tobacco on, 262;

fall of, in younger age groups, and rise at older age periods, in United States, 281;

cause of increase in, 282;

charts showing trend of, 283–285;

comparison of, among different nations, 286–291.

Defectives, segregation and sterilization of, 321–322, 323.

Degenerative tendencies among nations, comparison of, 286–292.

Delusions, certain popular, concerning diseases, 123–125.

Denmark, mortality statistics of, 291.

Dental clinic, beneficial results of, 88.

Dental decay, process of, 79.

Dental floss, use of, 85.

Desires, controlling intensity of one's, 117–118.

Desk, posture in sitting at a, 61.

Despondency, sometimes caused by a slouching posture, 57.

Desserts, table of food values of, 179.

Diabetes, in relation to focal infection, 82; aggravations of, 123.

Discontent, physical sources of, 105–106.

Diseases, caused by absence of vitamins from food, 42; carried by mosquitoes and flies, 71;

caused by focal infection, 82;

preventability of, 135–136;

relation between consumption of alcohol and increase in degenerative, 235–236;

effect of alcohol on bodily resistance to, 239–240;

caused by smoking, 263–264;

signs of increase of the degenerative, 281–285.

Disinfection of foods, 43.

Drafts, unreasonable prejudice against, 8; exaggeration of idea that colds are derived from, 8–9;

popular delusions concerning, 123–124;

exposure to, a means of skin training, 274;

avoidance of, after catching cold, 277.

Drugs, avoidance of, for constipation, 53; habit-forming, as poisons, 65;

alcohol to be classed among, 242.

Dryness of air, 11, 19; question of ill effects from extreme, 12.

Duodenum, ulcer of, caused by focal infection, 82.

Dust, air vitiation from, 13; methods of removing, 13;

bacteria carried by, 13–14.

Dusty trades, morbidity and mortality rates in, 13.

Dyspepsia among smokers, 264.

Eating, before retiring, 103; in case of colds, 279–280.

Eating habits. See Food.

Education on inheritability of traits, need of, 323.

Eggs, food value of, 29, 38, 183; for underweight, 220.

Emetin, use of, in treating pyorrhea, 85–86.

Emotions, exercise of the, 97.

Endurance, experiments to determine effect of different diets on, 197–199; experiments with mastication, and instinctive eating, 200–209.

Enema, use of, for constipation, 53.

England and Wales, trend of death rate in, 283–284; mortality statistics of, 287;

expectation of life in, 290.

Enjoyment of food, desirability of, 46–47, 201–202.

Enthusiasm in exercise, 95–96.

Equanimity, secret of, 115.

Ether, habit of using, as a stimulant, 242.

Eugenics, importance of, 157; distinction between other branches of hygiene and, 157;

aim of, 163–165;

implies right care of racial germ-plasm, 165;

and wisdom of choice in marriage, 165–166;

ability of science of, to guide race to higher levels, 166–167;

knowledge of, both a personal advantage and a social necessity, 167;

main features of thoroughgoing program of, 167;

importance for future generations, 167;

grandest service of science to the human race, 167–168;

a remedy for degenerative tendencies, 292;

scope of, 293;

correction of popular misconceptions, 293–294;

discovery of hereditary laws, resulting in science of, 294–295;

rules of, 296;

instances of improvement from application of principles, 319–322;

three main lines of eugenic improvement, 323;

need of State Eugenic Boards, 323–324;

references on, 324.

Exercise, times for taking, and benefits, 16; necessity for, to offset evils of a sedentary life, 94;

different forms of, 94;

after eating, 94;

outdoor, in winter, 95;

question of enthusiasm in, 95–96;

ideals in, 96;

of mind, will and emotions, 97–98;

dancing as, 99–100;

for overweight, 217;

for underweight, 220.

Exercises, breathing, 25–26; breathing, for correcting evils of bad posture, 58;

corrective, for faulty posture, 62, 221–223;

for flat foot, 223.

Expectations of life, comparison of, in different localities, 290.

Eye-strain, evils resulting from, 93; preventive measures, 93–94;

remote effects of, 122.

Fads, avoidance of, in matter of diet, 50.

Fans for keeping air in motion, 10.

Fat, function of, as a constituent of food, 35–36; examples of, in common foods, 36;

suitable proportion of, in diet, 40;

as laxative food, 52;

in cheap foods, 131;

list of foods poor and rich in, 171;

fat-forming food to avoid in cases of overweight, 216;

forms of, for underweight, 220.

Fatigue, cautions regarding eating in a state of, 35; relation of posture to, 57;

connection between colds and, 70, 276;

relaxation a remedy for, 101;

value of baths, for, 102;

avoidance of, in cases of underweight, 220.

Feet, misdirected, 59–60; correct position of, in standing and walking, 60;

exercises for the, 223;

disturbances of health due to weak, 224;

means of detecting weak, 224–225.

Figs, laxative quality of, 52; food value of, 179.

Fires, ventilation by wood or grate, 10.

Fish, a high-protein food, 38; special objections to an abundance of, 39.

Fisher, George J., smoking tests conducted by, 259–260.

Flat foot, cause of, 59–60; toeing-in and exercise of leg muscles as remedies for, 60;

corrective exercises for, 223;

consulting a specialist for, 223–224;

means of detecting, 224–225;

prevention of, 226.

Fleas, as spreaders of disease, 74.

Flesh eaters versus flesh abstainers, tests of, 197–199.

Fletcher, Horace, interest in mastication revived by, 46; experiment with method of, of thorough mastication, 200–209.

Flies, diseases carried by, 71; guarding against typhoid germs carried by, 73;

methods of destroying, 73–74.

Focal infection, as a cause of disease, 81; diseases traceable to, 82;

caution necessary in accepting principle too literally, 83;

physical examinations to detect, 292.

Food, quantity of, 28; measurement of, by calories, 28;

values of common foods, 29–30;

the daily amount needed per person, 30;

precautions regarding, in case of overweight, 32–33, 215–216;

rules regarding, in case of underweight, 33, 219–220;

diet in middle life, 33–34;

diet in hot weather, 34;

comparative amount needed by brain-workers, 34–35;

eating when fatigued, 35;

protein foods, 35–40;

advantages of hard foods, 40–41;

bulk a necessity in, 41–42, 148–150;

objection to concentrated, 41;

value of raw foods, 42;

cooking necessary for some, 43;

thorough mastication of, important, 44–47;

enjoyment of, desirable, 46–47;

choice of foods influenced by slow eating, 47;

"good" and "bad" foods, 47–48;

digestibility of so-called indigestible, 49;

avoidance of fads as to, 50;

consultation of physician regarding, 50;

regulation of bowels by, 52;

harmful preservatives and adulterants in, 65;

comparative cost of, 129–131;

drawbacks of civilization illustrated by, 148;

soft and concentrated foods artificial, 148–150;

the hurry habit and eating of, 150–151;

misleading of appetites for, 151–152;

tabular classification of common foods, 171;

ideal proportion of the three elements in, 173;

tabular list of values of, in daily diet, 175–183;

relative energy value and cost of ready-to-serve foods, 184–190;

minimal cost of, 190–194;

calories consumed daily by different classes of workers, 195;

experiments with mastication and instinctive eating, 200–209;

references on, 209–211;

negative value of alcohol as, 241–242.

Fowl, a high-protein food, 38; special objections to too great an amount of, 39.

France, consumption of alcohol in, 236; mortality statistics of, 286.

Franklin, Benjamin, views of, concerning colds, 124.

Fruit, to be eaten in middle life, 33; suitable for eating when fatigued, 35;

cellulose supplied by fibrous, 41;

vitamins supplied by, 42;

acids supplied by, 43;

among the best foods, 48;

a laxative food, 52;

value to teeth at end of a meal, 220.

Fruit acids, cleansing the mouth with, 86.

Fruits, table of food values of, 177, 179.

Fuel value, of common foods, 171, 175–183; of ready-to-serve foods, 184–190.

Galton, Sir Francis, identified with eugenic movement, 295.

Game as food, 48.

Games, for giving exercise, 95; advantages possessed by, as recreation, 99.

Garters, constriction from, 16.

Germany, consumption of alcohol in, 236. See Prussia.

Germs, origin of colds in, 8–9, 70–71, 272; destroyed by sunlight, 14;

clearing food of, 43;

infections through, 69–78.

Gladstone, W. E., noted for mastication of food, 46.

Glucose, a cheap source of starch and sugar, 131.

Gonorrhea, sterilizing influence of, 78.

Grate fires as ventilators, 10.

Greeks, high ideals of ancient, 4; perfect physical poise depicted in sculptures of, 59;

ideal of, in sports, 96.

Greens, laxative quality of, 52.

Grippe, avoidance of exposure to infection from, 70.

Guinea pigs, illustration from, of action of hereditary traits, 313–316.

Gums, cleansing the, 84–85.

Habits, as to defecation, 55; overcoming acquired, to lead a hygienic life, 134–135.

"Habitus enteroptoticus," posture called, 58.

Happiness, habit of, 115.

Hard foods, benefits of, 40–41.

Hats, ill effects of tight, 16.

Headache, sometimes caused by constipation, 51; sometimes due to a slouching posture, 57.

Health, present world-wide movement for conservation of, 2; influence of, on character, 105–107;

mental rewards from, 107–108;

influence of the mind on, 108–109;

cost of good, 127–128;

possibilities of attainment, 141–142.

Health foods and drinks, 3.

Heart, diseases of, due to focal infection, 82; common causes of troubles of, 90;

effect of alcohol on, 240–241;

effect of tobacco on, 250, 259–260, 263, 267;

death rates from diseases of, 284, 285.

Heat, enervating effect of, 11.

Heating systems, ventilation and, 10–11.

Hens, influence of mind on health illustrated by, 108–109.

Heredity, dependence of health of individual on, 164–165; eugenic improvement attainable through control of, 293;

discovery of laws of, resulting in science of eugenics, 293–294;

traits influenced by, 297–298;

distribution of traits, 298–300;

desirable and undesirable traits, 300–301;

illustrations of laws of, by Andalusian fowl and by guinea pigs, 307–316;

application of principles to human race, 316–322.

Hill-climbing, as exercise, 94; for overweight, 217.

Hodge, Clifton P., fly-trap invented by, 73–74.

Home exercise, 94.

Hookworm disease, preventive measures, 75.

Hot weather, diet in, 34.

Houses, disadvantages attached to invention of, 145–147.

Housing, hygiene of, 7–14; disadvantages of the poor regarding, 128–129.

Humidity of air, how to secure, 11–12.

Hurry, habit of, in modern life, 114; as a promoter of indigestion, 150;

excessive use of flesh foods due to, 151.

Hygiene, individual, ideals implied by, 1; medieval views contrasted with modern ideals, 1–2;

good, ventilation the first rule, of, 7;

mental, 105–118;

unity of, 121–126;

obstacles to, 126–135;

possibilities of, 135–143;

and civilization, 143–156;

public versus individual, 157–159;

necessity for cooperation between public and individual, 159–161;

race, 163–168;

of immediate concern to the present generation, while eugenics is important for future generations, 167–168.

Hypochondriacs, risk of becoming, 111.

Ice-cream, comparative food value of, 33.

Ideal food proportions, 173.

Ideals, of individual hygiene, 1; contrast afforded by medieval, 1–2;

present-day establishment of more wholesome, 2;

as to labor, 3–4;

still further improvement needed in American, 4–6.

Idleness, evils of, 91.

Impairments, unsuspected physical, 136–139.

Inactivity, necessity for periods of, 89; rest and sleep the two great forms of, 89.

Indians, bad effects of indoor living upon, 146–147.

Indigestible foods, digestibility of so-called, 49.

Individual hygiene, public hygiene versus, 157–159; practice of, a remedy for degenerative tendencies, 292.

Indoor living, unnatural character and evils of, 145–147.

Industrial workers, unsuspected impairments among, 137–138; calories of food consumed daily by different classes of, 195;

powers of, lessened by use of alcohol, 238, 244.

Infections of the body, by germs, 69–75; importance of cleanliness for avoiding, 75;

through the mouth, 78–83;

in colds, 272.

Infectious diseases, power of resistance to, weakened by alcohol, 68; results regarding, from teeth hygiene, 88.

Insect-borne diseases, 71.

Insomnia, remedial measures for, 102–103; often caused by excessive smoking, 264.

Instinctive eating, experiments with, 200–209.

Intestinal intoxication, distinguished from autointoxication, 81–82.

Intestinal poisoning, from insufficient mastication, 45.

Introspection, one of the curses of idleness, 91.

Iron, in vegetable foods, 40.

Italy, mortality statistics of, 286.

James, William, on enjoyment of life, 5; on religion of healthy-mindedness, 114.

Jews, effects of indoor living withstood by, 147.

Kidney, among the worst foods, 48.

Kidneys, death rates from diseases of, 284, 285.

Kipling, Rudyard, on concentrated foods, 41–42.

Labor, modern ideals concerning, 3–4; turned from drudgery into play by proper development of health ideals, 5–6;

division of, an evil of civilization, 152.

See Work.

Lamb, food value of, 29, 178.

Laxative drugs, avoidance of, 53.

Laxative foods, 52.

Leg-lifting exercise for faulty posture, 222.

Lettuce, cellulose in, 41; vitamins supplied by, 42;

food value of, 175.

Lice, diseases carried by, 74–75.

Life, no principle which limits, 142–143; shortening of, by unhygienic modes of living, 155.

Life Extension Institute, purpose of, 1.

Lighting, electric preferable to gas, 13.

Lime, deficiency of flesh foods in, 39.

Linen, use of, in clothing, 17.

Literature, avoidance of morbid, 99.

Liver, excess of acids produced by eating, 39; among the worst foods, 48.

Liver diseases, death rate from, 285.

London, expectation of life in, 289.

Lusk, Graham, quoted on minimal cost of food, 190–194; experiments by, to ascertain basal metabolism of body, 196.

Malaria, not caused by night air, 22; carried by mosquitoes, 71.

Marriage, effect of health on opportunities for, 2; exercising wisdom of choice in, 165–166;

enactment of wise laws of, 167;

science of eugenics and, 293–323.

Mastication, required by hard foods, 41; value of thorough, and evils of insufficient, 44–47;

a desirable means of tooth and gum hygiene, 84;

and mental attitude, 110;

experiment to test effects of, on endurance and strength, 200–209.

Meat, decrease in amount eaten in middle life and in hot weather, 33–34; high-protein value of, 38;

too much, a common error of diet, 38–39;

excess of acids produced by, 39;

endurance tests to ascertain value of, in diet, 197–199;

sudden and complete exclusion from diet not desirable, 208;

indulgence of craving for, 209.

Meats, table of food values of cooked, 178.

Mechanical diet indicator, 202.

Medical examination, desirable for determining one's diet, 50.

Medical practise, modern radical revolution in, 2–3.

Medieval indifference to matters pertaining to human body, 1–2.

Melancholy, physical sources of, 57, 105–106.

Mendel, discovery of laws of heredity by, 295.

Menstrual period in women, mental effects of, 106.

Mental condition, relation of mode of breathing to, 26–27; effect on sleep, 104–105;

learning to avoid abnormal, 113.

Milk, food value of, 30, 181; protein value of human, 37;

vitamins supplied by raw, 42;

not cooked by pasteurization, 42–43;

among the best foods, 48;

pasteurizing, for avoiding typhoid germs, 73;

skim milk a cheap source of protein, 131.

Mind, exercise of the, 97; activity and rest needed by, 105;

serenity of, an important factor, 105;

interrelation of health and, 105–118.

Mind-cure, proper and improper employment of, 111–112.

Mineral oils, as intestinal lubricants, 53.

Mineral waters, not to be used habitually, 53.

Minor ailments, as warning signals, 138–139.

Moistening of air, methods for, 12.

Monotony and interruption, 92.

Moore, R. M., quoted on mortality among abstainers and non-abstainers, 229.

Mortality. See Death rate.

Mosquitoes, diseases communicated by, 22, 71; preventive measures against, 71–72.

Mouth, infection through the, 78–83; preventive measures against infection through, 83–88.

Moving pictures, eye-strain caused by, 93; hygienic value, in the way of recreation, 99.

Nasal congestion from overeating, 276.

Nasal douches, use of, 70, 276.

Nasal obstruction, a cause of colds, 272.

National Council of Safety, attitude toward alcohol, 244.

Nature, upsetting of equilibrium of, by civilized man, 143–156.

Neckwear, constriction from tight, 16.

Negroes, bad effects of indoor living upon, 146–147.

Nervous system, effect of alcohol on, 237–239.

Nervous troubles, outdoor treatment for, 21.

Neurasthenia, sometimes caused by a slouching posture, 57.

New York City, expectation of life in, compared with England and Wales, and London, 289.

New York State, death rate statistics of, 287, 288.

Nicotin, percentage of, in tobacco, 251–254; amount of, in tobacco smoke, 254–255, 260–261;

effects of, 255–256;

experiments with, on animals, 263.

Night air, mistaken ideas concerning, 22.

Nose, cleaning the, 70, 276–277.

Nuts, vitamins supplied by, 42; among the best foods, 48;

digestibility of, when properly chewed, 49;

table of food values of, 183.

Oatmeal, food value of, 29, 180.

Obstacles, to hygiene, 126–135.

Oils, as laxative food, 52; as intestinal lubricants, 53.

Oleomargarine, a cheap source of fat, 131.

Olive oil, a concentrated food, 28–29.

Olives, food value of, 30, 182.

Onions, cellulose in, 41; food value of, 176.

Oranges, food value of, 30, 177.

Outdoor living, benefits, of, 18–20, 276.

Outdoor schools, 19.

Outdoor sleeping, 20–24, 104.

Overeating, causes of, 154; nasal congestion from, 276.

Overheating of rooms, 11.

Overnourishment, from too free use of sugar, 48.

Overstrain, results of, 90; prevention of, 91–92.

Overweight, influence of, on longevity, 30–31; life insurance estimates as to, 31–32, 213;

determination of, 31;

importance of checking tendency to, 32;

eating-habits that cause, 32–33;

diet for, 215–216;

fats to avoid, 216;

exercise for, 217;

main reliance to be placed on dietetic regulation rather than on exercise, 217;

avoidance of sudden reduction in weight, 217–218;

reduction of weight a simple matter, 218–219.

Overwork, popular delusions concerning, 124–125.

Pack, Fred. J., statistics by, on effects of tobacco, 256–259.

Paraffin oil, an intestinal lubricant, 53.

Parsnips, food value of, 41, 176.

Pasteurization, milk left uncooked by, 42–43.

Pastry, table of food values of, 179.

Patent medicines, habit-forming drugs in, 65.

Peanuts, food value of, 30, 183; digestibility of, 49;

a cheap source of protein, 131.

Peas, a high-protein food, 38; protein in, a possible objection, 39–40.

Pecans, food value of, 30, 183.

Pepper, to be used sparingly, 48.

Peroxide of hydrogen, for disinfecting raw foods, 43.

Personal equation, hygienic living and the, 139–140.

Perspiration, benefits of, 76.

Philosophy, help to be obtained from, in field of mental hygiene, 114; Oriental superior to Occidental in training in control of attention, 115–116.

Physical examinations, a remedy for degenerative tendencies, 292.

Physiological effects of alcohol, 236–244.

Pickles, table of food values of, 182.

Pie, food value of, 29, 179.

Pillows, use of, in sleeping, 104.

Plague, spread by fleas and lice, 74–75.

Play, the halfway stage between work and rest, 100–101. See Work and play.

Playgrounds, outdoor, 19.

Plays, hygienic value of, as recreation, 99.

Pneumonia, outdoor treatment for, 21; trend of death rate from, 285.

Poisons, from constipation, 51–56; relation of posture to, 57–64;

habit-forming drugs and patent medicines, 65;

substitution of milder for the more injurious, 65–66;

alcohol, 67–68, 227–249;

tobacco, 68–69, 250–271;

infections with germs, 69–78;

teeth and gums as a source of infection, 78–81;

focal infection and autointoxication, 81–83.

Poor, disadvantages of the, in opportunities to live a healthy life, 128.

Posture, physical value of an erect, 57; breathing exercises for correcting evils of, 58;

in standing and walking, 58–59;

of the feet, 59–60;

in sitting, 60–62;

pains due to faulty, 62;

effects of faulty, in children, 62;

teaching of correct, 63;

relation to character, 63–64;

corrective exercises for faulty, 221–223;

in cases of flat foot, 223.

Potatoes, food value of, 29, 176; valuable because of alkalinity, 43;

among the best foods, 48;

a cheap source of starch and sugar, 131;

for underweight, 220.

Preservatives, harmful, 65.

Preventability of disease and death, 135–136.

Preventive dental treatment, 86–87.

Preventive medicine, practise of, 2–3; application of methods by people themselves, 3.

Program, constructing a day's, 120; main features of a eugenic, 167.

Prostitutes, disease among, 77.

Prostitution. See Social evil.

Protein, function of, as a constituent of food, 35–36; examples of, 36;

question of right proportion of, 36–37;

common error of diet in using too much, 38;

injuries from overabundance of, 38–39;

poisoning caused by decomposition of, in the colon, 56;

in cheap foods, 131;

list of foods high, moderate and deficient in, 171;

experiments to determine value of, in diet, 197–199.

Prunes, food value of, 30, 179; laxative quality of, 52.

Prussia, mortality statistics of, 286, 290–291.

Public hygiene, 157; what is included under, 157–158;

progress made in, 158;

various important measures of, 161–163.

Puddings, table of food values of, 179.

Pumpkins, cellulose in, 41.

Purins, in flesh food, leading to production of uric acid, 39; found in some vegetable foods, 40.

Pyorrhea, action of, 79–80; treatment for, 85–86.

Pyridin in tobacco smoke, 260–261.

Quack remedies, to be avoided in case of colds, 280.

Quacks and quack advertising, movement against, 162–163.

Quarantine, included in public hygiene, 158.

Quensel, Ulrik, on disagreement of work and alcohol, 244.

Quick lunches, an institution of civilization, 150; relative energy values and cost of different orders at, 184–190.

Quinine, use of, deleterious in case of colds, 280.

Race hygiene. See Eugenics.

Races, effects of indoor living on different, 146–147; varied conditions in different, with respect to resistance to disease, 323.

Raw foods, value of, 42.

Reading, choice of, for recreation, 99.

Reading on trains, eye-strain caused by, 93.

Ready-to-serve foods, analysis and cost of, 184–190.

Recreation, outdoor, 19; necessity for, 89, 98;

importance of enjoyment of, 98–99;

forms of, 99;

advantages possessed by games, 99;

reading, dancing and card-playing, 99–100;

suicidal amusements, 100.

Régime, demand for a well-balanced, 125–126.

Relatives, marriage of, 305–306.

Relaxation, cultivation of power of, 101; bathing a help to, 102.

Religion, as a help in field of mental hygiene, 114; of healthy-mindedness, 114–115.

Reproduction, rules of, under a eugenic program, 167.

Rest and sleep, the two great forms of inactivity, 89.

Rheumatism, traceable to focal infection, 82.

Rice, not a laxative food, 52; food value of, 180.

Richards, Mrs., on cost of food, 130.

Roosevelt Conservation Commission on National Vitality, report of, 136.

Rosenau, Dr., on sex instruction, 77.

Rowing-machine, home exercise on, 94.

Rubner, Prof., on injuries from overabundance of protein, 38–39.

Running, a beneficial exercise, 94.

Saccharin, harmful in foods, 65.

Salt, to be used sparingly, 48.

Salts, inorganic, in mixed diet, 43.

Sandals, benefits and risks in wearing, 17.

School, teaching correct posture in, 63.

Schools, outdoor, 19.

Segregation of defective classes, 321–322, 323.

Self-respect, relation between erect posture and, 63–64.

Serenity, to be practised as an art, 113.

Setting-up exercises, 221–224.

Sex hygiene, eugenics not limited to, 293–294.

Sex instruction, 77–78.

Shaler, N. S., "Man and the Earth," quoted, 143–144.

Shell-fish, a high-protein food, 38; special objections to too great an amount of, 39.

Shoes, care necessary in choosing proper, 16–17.

Shredded wheat biscuit, food value of, 29, 181.

Signal-station exercise, for faulty posture, 222.

Singing, as a hygienic practise, 26.

Sitting, correct posture in, 60–62.

Skim milk, a cheap source of protein, 131.

Skin training, establishing resistance to colds by, 273–274; means of, 274–275;

by wearing light, porous clothing, 275.

Sleep, one of the two great forms of inactivity, 89; means of inducing, 102–103;

importance of, to health, 103;

hours of, 103;

eating before, 103–104;

use of pillows, 104;

type of bed, 104;

effect of mental attitude on, 104–105.

Sleeping, out-of-door, 3, 20–24, 104; a preventive of colds, 9, 276;

for underweight, 220.

Sleeping porches, arrangement of, 22–23.

Sleeping tents, 23–24.

Social evil, remote causes of, 123; cooperation needed in movement against, 163.

Soups, food values of, 183.

Sour milk, among the best foods, 48; a means of reducing decomposition of protein in the colon, 56.

Specialists, medical, "one idea" doctrines of, 122.

Spinach, cellulose in, 41.

Spinal curvature, sometimes caused by faulty posture, 62.

Sponge-cake, food value of, 29, 179.

Squash, cellulose in, 41.

Standing, correct posture in, 58–59.

Starch, cheap sources of, 131.

Sterilization of defectives, 323.

Stevenson, R. L., on duty of being happy, 115.

Sugar, food value of, 30, 182; danger from overuse of, 48;

cheap sources of, 131;

taking of, for underweight, 220.

Sunlight, benefits of, to air, 14.

Sweden, American ideals of perfect manhood and womanhood inferior to those of, 4; attention to individual hygiene in, and decline in death rate, 159;

mortality statistics of, 286, 292.

Sweetbreads, excess of acids produced by, 39; among the worst foods, 48.

Sweets, table of food values of, 182; time for taking, 220.

Swimming, as exercise, 94; an example of healthful activity and relaxation, 101–102;

for overweight, 217.

Syphilis, destructive effect of, 78; resistance to, weakened by alcohol, 240.

Systemic injuries from mouth infection, 80–81.

Table, posture in sitting at a, 61.

Tea, degree of injury from, 66.

Teeth, benefits to, from hard foods, 41; evils of insufficient mastication, 44;

infection from decayed, 78–83;

danger from over-dentistried, 83;

method of cleansing, 84–85;

periodic examinations and cleanings, 86–87;

question of saving, at expense of other parts of body, 87;

correction of irregularities, 87–88;

care of temporary, 88;

results of teeth hygiene, 88;

malformation of, a cause of nasal obstruction and colds, 272.

Temperature of living-rooms and work-rooms, 11.

Tents for outdoor sleeping, 23–24.

Thinking, exercise in, 97.

Thoughts, effect of character of, on sleep, 104–105.

Ticks, diseases spread by, 74.

Time, taking of, for hygienic living, 132–133.

Tobacco, injury from poison in, 65; ill effects of, 68–69;

derivation of, 250–251;

composition of, 251–255;

effects on animals and on man, 255–265;

increase in use of, 267–268;

references concerning, 268–271.

Tobacco heart, risks accompanying, 263.

Tobacco smoke, air vitiation from, 13; amount of nicotin in, 254–255, 260–261.

Toeing out and toeing in, 60, 223.

Tomatoes, cellulose in, 41; vitamins supplied by, 42;

food value of, 176.

Tongue, cleansing, with tooth-brush, 85.

Tooth powders and pastes, use of, 85.

Tox?mia, autointoxication distinguished from, 81–82.

Traits, subdivisibility of each individual into, according to Mendelian discovery, 295; rules resulting from inheritability of, 296;

physical, known to act hereditarily, 297;

mental, 297–298;

moral, 298;

laws governing inheritance of, 293;

distribution of, 298–300;

socially noble and ignoble, 300–301;

mating of, in marriages, 304–305;

maturing of, at certain ages, 306;

dominant and recessive, 317–319;

need of education on inheritability of, 323.

Tree-swaying exercise for faulty posture, 222.

Tuberculosis, outdoor sleeping as a remedy for, 21; sometimes produced by the "consumptive stoop," 57;

infection from germs of, 71;

remote causes of, 123;

primarily a house disease, 146;

liability of different races to, 147;

public and individual hygiene invoked in fight against, 159;

resistance to, weakened by alcohol, 240;

trend of death rate from, 285;

application of science of eugenics to, 299.

Typhoid fever, death rate from, 285.

Typhoid germs, guarding against, 72–73.

Typhus, carried by lice, 75.

Ulcer of the stomach, sometimes caused by focal infection, 82.

Underclothes, benefits of loose, porous, 14; suitable material for, 17.

Underweight, relation of, to longevity, 30–32; determination of, 31;

remedy for, 33;

life insurance statistics as to, 219;

diet for, 219–220;

exercise for, 220.

United Kingdom, consumption of alcohol in, 235, 236.

United States, consumption of alcohol in, 235, 236; trend of death rate in, 281–285;

comparison of death rate with those of other countries, 286.

Unity of hygiene, 121–126.

Uric acid, caused by purins in diet, 39.

Urinary system, death rates from diseases of, 284, 285.

Vaccination, overcoming prejudice against, 163.

Vacuum cleaners, advantages of, 13.

Variety, need of, in work, 92.

Vegetables, bulky foods, 29; suitable diet for middle life, 33–34;

objection to some, on account of richness in protein, 39–40;

cellulose supplied by, 41;

vitamins supplied by, 42;

acids supplied by, 43;

among the best foods, 48;

laxative food, 52;

table of food values of, 175–176.

Venereal diseases, infections from, 77–78; resistance to, weakened by alcohol, 240.

Ventilation, importance of, 7; motion, coolness, humidity, and freshness, of air chief features of, 7;

overemphasis of danger from drafts, 8–9;

by means of windows, 9;

use of window-boards, 9–10;

air-fans as a help in, 10;

heating systems and, 10–11;

importance of cool air and enervating effect of hot, 10–11;

dryness and humidity of air, 11–12;

relation of clothing to, 14–18;

necessitated by conditions of civilization, 147;

as a preventive of colds, 275.

Vermin, diseases spread by, 74–75.

Vertigo, causes of, 123.

Vital resistance, increased by outdoor sleeping, 21–22.

Vital surplus, conservation of, 5.

Vitamins in foods, 42; importance of well-being of body, 42.

Walking, correct posture in, 58–59; as exercise, 94;

pleasures of, as recreation, 99;

for overweight, 217.

Water, drinking, with meals, 48; varying effects of habits of drinking, on constipation, 52;

freeing from typhoid germs, 72;

importance of pure supply of, 162.

Water closets, height of seats of, 54.

Weak feet, causes of, 60; disturbances of health due to, 224;

means of detecting, 224–225.

Weight, relation of, to longevity, 30–32; the correct average, 213–214;

standards for, at various ages and heights, 214;

avoidance of sudden reduction in, 217–218.

See Overweight and Underweight.

Wheat-bran, a preventive of constipation, 52.

Whisky, not to be taken for colds, 280. See Alcohol.

Wholesale costs of uncooked ingredients of standard foods, 192–193.

Will, exercise of the, 97–98; effort of, necessary to hygienic living, 126–127.

Window-boards, use of, 9–10.

Windows, best ventilation to be had through, 9.

Wood fires as ventilators, 10.

Woody fiber necessary in diet, 41.

Wool, use of, in clothing, 17.

Work, normal, one of the great blessings of life, 91; arrangement of hours for, 92;

need of variety of, 92.

See Labor.

Work and play, the two great forms of activity, 89; adjusting the proportion of, 90.

Working conditions, disadvantages of the poor regarding, 128–129.

Worry, physical sources of, 105–106; physical effects of, 112;

practising art of serenity as an offset to, 113;

ailments aggravated by, 123.

Writer's cramp, cause of, 62.

Yard-arm exercise for faulty posture, 221–222.

Yellow fever, carried by mosquitoes, 71.

Zhebrovski, E. A., experiments of, with cigaret-smoking rabbits, 255.

Transcriber's note: Three typographical errors have been corrected, which are marked in the text by underlining and mouse hovers. The same has been done with missing footnote or reference marks. The inconsistent hyphenation of the words borderline, cooperation, coordination, cornstarch, healthymindedness, makeup and smallpox, and the inconsistent accenting of Beitr?ge, employes and regimé has been left as in the original.