CHAPTER VII.
Personal Hygiene.
Activity and Rest — Food and Dietetics — The Caloric Value of Food — Elimination — Personal Hygiene of the Child — • Personal Hygiene of the Aged — Personal Hygiene of the Sick 241
11V(;IENE.
CHAPTER I.
INTKOnrCTION TO TIIK STIDV OF HYGIENE.
Hygiene is the oldest and the youngest of all sciences.
Hygiene is the oldest of all sciences because the preservation of life and health is an instinct born in the animal, and the coninion endeavor of human beings to preser'e their health and to prolong their lives is as old as human society and diitcs from the beginning of mankind.
Hygiene is the youngest of all sciences l)ecause it could oiil\ become a science when physiology, bac- teriolog'. and \ital statics had Ix-en firndy estab- li->hed ui)on a scientific basis.
Definitions. — Hygiene is the science and the art. the theory and the i)ractice of the preserxation and the promotion of hinnan health and life.
The aim and function of liy^ieiie arc ilic prexcntion of disease, the pn''entioii of premalurc dcatli. and the promotion of normal health in human beings.
Hygiene nuiy i)e personal or j)ublie. numicipal. State, and Federal. We also distinguish particular
18 INTRODUCTION TO THE STUDY OF HYGIENE
braiu'lies of hygiene, such as the hygiene of housing, of food, of school, of industry, etc.
Personal hygiene is the science and the art of the preservation and the promotion of individual health and life by +he prevention of constitutional diseases and by the increase of the vital force and resistance of the human body.
Public hygiene is the science and the art of the preservation and the promotion of public health by the prevention of environmental causes of disease, and by the improvement of conditions common to many persons and communities.
Sanitary science is the theoretical part of hygiene. It is based upon the investigations of the influence of envi- ronmental conditions, upon the health and life of human beings, and has for its aim the study of these condi- tions and of their effect upon the health and life of man.
Sanitation is the sum total of practical measures undertaken for the preservation of public health.
Sanitary art is the practice of public hygiene, the erection of public works for the improvement of public health.
Sanitary law or public health law or State medicine are terms applied to the rules, regulations, and laws prescribed by States or municipalities for the conduct of individuals and communities, with the aim to pre- serve and promote public health.
Foundations of Modern Hygiene. — Modern hygiene is based principally upon three sciences: sanitary science, bacteriology, and vital statistics.
Sanitary Science. — Men have known their depen- dence upon the soil upon which they dwell, the air
r Fix .\i>.\ii().\s or M()i)i:i!\ iiycikxe 19
which they l)r(';ith(\ tht> water which they ch'iiik. the fodil which they eat, the lioiises in which they Hve, and tlie many other external factors 1)>- wliich tlieir Wiv an«l well-l)einj,' are so ])r(>foiiii(lIy inihience(l. It is scarcely more tlian three score years, however, since sanitary science, the science of the environmental fac- tors, lias been firmly established and the direct causa- tive influence of the various external factors has been fully shown. Chadwick, Farr, PettenkofTer and others were the first to study the effects of soils, waters, foods, clothing, and the general environment of man. Only when the influence of these factors had been demonstrated could hygiene enter the rank of modern sciences.
Bacteriology. — The greatest impetus toward the establishment of modern hygiene has been given by bacteriology. Pasteur, Koch and a host of other investigators during the nineteenth century have dis- covered the hitherto hidden causes of many diseases which were destroying innumerable human beings. These discoveries of the germs causing disease have made possible the prevention of disease and the jiro- longation of the human life by the study and discovery of proper means of fighting the destructive agents of disease.
]'Hn} Statistics.— Wygwn^ is based on vital statistics. 'ital statistics may be termed "jjulilic health book- keej)ing." As in economic and financial undertakings it is impossible to determine the exact state of affairs and progress without a system of bo()kkee])ing, so it would be im])ossib|e w ithout such a system to determine the state of public health, its decline and fall, or rise
20 INTRODUCTION TO THE STUDY OF HYGIENE
and progress. By the means of vital statistics the num- ber of persons of various ages, sex, nationahty, etc., hving in a given period in a given place may be deter- mined, and the actual and natural increment of popu- lation, the birth-rate, marriage-rate, death-rate, etc., in a given year, period, or locality may be learned.
Vital statistics also show the general morbidity- rates, the rates of specific diseases, the probable duration and the expectation of life.
Since vital statistics have become an established science among civilized nations, the waste of human life from the various causes and the progress of sanitary endeavor by the efforts of personal, municipal, and public hygiene have become evident.
Conservation of Human Resoiirces. — The function of hygiene is the conser'ation of himian resources and the prevention of the waste of human life, of which there is still a lamentable and deplorable waste from preventable causes.
Upon examining the recorded causes of death in any given community, it is found that only a very small percentage of deaths (less than 2 per cent.) is due to old age. The other 98 per cent, of all deaths are caused by disease and pestilence, by violence and war, by sin and crime.
Hundreds of thousands of innocent infants and children are still killed, crippled, and maimed by infectious diseases. The lives of thousands of adults are still being destroyed by typhoid, tuberculosis, and many other diseases of adult life. Pneumonia, nepliritis, and other constitutional diseases are still the causes of innumerable deaths. Many, if not all, of
C().\si-:Rv.'n().\ or m max h'EsorucKs 21
these are l;irj;ely i)revental)le. (ireat as is the \v;istc of luiniau life at present, it i-^ iiicoiuparaMy less tliaii in the i)ast. (Ireat sanitary ])n»«jress lias been made (Inrini: tiie last and i)resent centuries. The average length of life has heen considerably len<;thened, the mortality-rates have decreased, and many diseases which were among the worst enemies of mankind Iimvc either entirely disappeared or their ravages have been materially lessened.
The length of life has increased over 100 )CT cent, during the last few centuries, the jjrogress having been greatest during the nineteenth century. During the sixteenth century the average length of life was from eighteen to twenty years, during the eighteenth centur> it was a little over thirty years, while at the end of the nineteenth centur' it reached thirty-eight to forty years. The general mortality-rate in London per 1000 inhabitants in the year IGSO was oO; in 17S0, 40; in 190'), l.").l. In Berlin the rate from ITol to 17S() was 39.34 i)er 1000 inhabitants; from 1S41 to 1870, 28.7S; from ls71 to 1900, 20.22. In urban America (white) this rate fmrn ls()4 to 1S25 was 24.(>; from l.S2() to 1S,"')0. 20.7; from ls(»4 to ls7.'). 2r).4; from 1S7() to ISSS, 22.9; and from lss9 to 1901. 21. In New ^"ork the rate was 2.").<)<t in issC, 1C...")2 in 190S, and less than 12 in liMO.
There has been a great reduction in the mortality from certain diseases like smallpox, yellow fe\er, diphtheria, cholera, txplutid fever, and malaria. l)in-- ing the eighteenth century oO.OOO.OOO i)eoj)le died of smallpox in Europe; in 1900 there were but :'..")00 deaths from it in the United States.
Since 1793 the I'nited States has had .')00,(M)0 cases
22 INTRODUCTION TO THE STUDY OF HYGIENE
of yellow fever, resulting, it is estimated, in about 100,000 deaths. Since the discovery of the species of mosquito which transmits the causative factor, and the practical preventive measures to which this has led, the cases of yellow fever have been greatly reduced. In Havana there were 4420 deaths from this cause in the eight years from 1891 to 1S9S, while in the eight years from 1899 to 1906 they numbered but 465.1
The reduction of the mortality-rate from typhoid fever has also been great but not yet as marked as that of yellow fever, cholera, and smallpox.
The Main Causes of Disease. — A preliminary announce- ment with reference to mortality in 1915, issued by the Bureau of Census, indicates that nearly one-third of the 909,155 deaths reported for that year in the "Registra- tion Area" which contained approximately 67 per cent, of the population were due to three causes — heart diseases, tuberculosis and pneumonia; and nearly two-thirds were due to twelve causes — viz., cardiac diseases, tuberculosis, pneumonia, nephritis, cancer, apoplexy, intestinal diseases, arterial diseases, diabetes, influenza, diphtheria and typhoid fever.
Further Possible Prevention of Disease. — Though much has already been accomplished in the prevention of disease and in conservation of human life, a great deal more may be done by proper sanitary measures and hygienic control.
According to the calculations of Professor Fisher, "the length of life could easily be increased from forty-five to sixty years, a prolongation of fifteen years. This would result in a permanent reduction in the
1 Report on National Vitality.
liOl.K or THE MUSK IS I'Uol'll YLA X IS 2:1
death-rate of about 2.") jut ((Mit. The i)rnKij)al rtuhie- tions would conic from the ])revcntion of infantile diarrhea and enteritis (over (iO jxt cent.), broncho- I)neunionia (50 per cent.), meningitis (70 per cent.), ty{)hoi(l fever (S.") per cent.), tuberculosis (7') per cent.), deaths by violence (35 per cent.), pneumonia (45 per cent.), so that the estimate of fifteen years' prolongation of life is a safe minimum without taking into account possible future discoveries in medicine or the cumulative influence of hygiene."
The Role of the Nurse in Prophylaxis. — Among those combating disease and death there are few whose work is so far-reaching and whose endeavors are so valuable, or whose work is as important in ])rophyl- axis as that of the nurse. Since Florence Nightingale had demonstrated the need and value of the nurse in war, an even more emphatic demonstration has been made of the nurse's value in peace. Not only as an aid to the physician, but also by her own work in prophylaxis, has she become one of the most impor- tant conservators of human life, and her role in the prevention of disease and premature death cannot be overestimated.
Within a comparatively short time the lunnbcr of nurses in the I'liited States has been increased to many thousands. At present the nurse is found not only at the sick-bed in the individual home, but also in the tnbrr(ulo>i> clinics, in factories and workshops, in department stores, in tenement-house de])artments, health departments, and in a great man" i)rivate as well as public institutions. There is no doubt that her field of work and usefulness will be still further expanded until it will embrace all human activities.