Personal hygiene and physical training for women

by Anna M. Galbraith

FOOTNOTES:

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

CHAPTER V
THE RESPIRATORY AND CIRCULATORY SYSTEMS: THE KIDNEYS

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

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

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

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

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

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

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

Fig. 7.—The bony thorax, anterior view (Ingals).

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Fig. 10.—The diaphragm (after Kitchen).

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Sunshine increases the respiratory movements.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In reading, the distance of the book from the eyes should be twelve inches, and the book-rest should be inclined, sloping downward toward the reader, at about an angle of 85 degrees.

If the woman has any great amount of writing to do, she should learn to use a typewriter. In using this machine she not only writes very much more rapidly and easily, but the position of the body is much more erect than that assumed when using the pen, and it is not nearly so fatiguing to the muscles of the hands and arms.

All closely confining sedentary occupations, as writing, sewing, etc., should be frequently interrupted to move about for a few minutes, rest the eyes, and take a few deep breathing exercises before an open window; this is necessary for the eyes as well as for the ventilation of the lungs.

Ventilation of the Lungs and Breathing Exercises.—Forced respiration is essential to completely change the air in the lungs, to maintain the elasticity of the lung tissue, and to expand the chest in every direction. Only in this way can a thorough ventilation of the lungs take place; a full supply of oxygen is taken in, which stirs up, disinfects, and cools the stagnant residual air, and forced expiration expels the respiratory excretions. One of the frequent causes of foul breath is lack of ventilation of the lungs, so that the expired air becomes laden with impurities.

In normal breathing the current of air which passes in and out of the lungs travels through the nose, not the mouth. The ingoing air, by exposure to the vascular mucous membrane of the narrow and winding nasal passages, is warmed and moistened, and at the same time the mouth is protected from the desiccating effects of the continual inroad of comparatively dry air.

By means of respiratory exercises the mobility of the chest may be greatly augmented; there is an increased flexibility of the ribs and sternum, as well as loosening of the thoracic joints, which may have become stiff, and these exercises also lead to a development of the respiratory muscles.

In this manner only can the frame work of the chest become thoroughly inflated from within, and thus all parts of the lungs, which run the risk of becoming incapacitated from lack of use, be brought into play.

It is highly important that this thorough ventilation of the lungs should take place at least three times a day—the first thing in the morning, while making the toilet, again about the middle of the day, and at night just before retiring.

To obtain the greatest benefit from these exercises they must be taken without corsets, the clothing must be light and loose, and the body lightly clad. The air in the room must be fresh, and after they have been learned, they can, as a rule, be taken before an open window. In the morning they are best taken just after the cold bath, when, by removing the impurities and filling the lungs with fresh air, and at the same time starting up a good vigorous circulation, they cause one to begin the day with energy and zest.

The respiratory movements are diminished during sleep, and at the same time there is a large accumulation of blood in the splanchnic veins, so that, particularly when there is any tendency to difficulty with the breathing at night, the trouble is greatly lessened by filling the lungs with pure air just before retiring.

It is necessary, first of all, to learn the art of breathing, to be able to dissociate the clavicular, the costal, and the diaphragmatic. By clavicular breathing is meant the raising of the collar-bone and shoulders as high as possible by means of a slow but deep inspiration—this expands the apices of the lungs; costal breathing is the throwing out and expanding the chest to its utmost capacity, and so enlarging the chest in its transverse and anteroposterior diameters; diaphragmatic breathing is the depression of the diaphragm and the protrusion of the abdomen without raising the lower ribs. The last is the most readily learned in the supine position; the bed supports the weight of the body, so that the individual is able to concentrate her entire attention on fixing the bony thorax, depressing the diaphragm, and protruding the abdomen at every inspiration and retracting it to the utmost with every expiration. This, of course, develops and gives tone to the abdominal muscles.

When the woman has conquered these first principles of respiration, she is ready to put them into practice in the standing posture. They should be learned before a mirror, and after that taken before an open window. The hands should be placed on the hips; first elevating the collar-bones and the shoulders to the utmost, while still holding the breath, she expands the chest, always breathing in from above downward, and, lastly, the diaphragm is depressed. With the lungs thus expanded to their utmost capacity, the breath is held as long as possible, then the lungs are emptied by an abrupt and forced expiration.

These exercises should be repeated at first ten times, gradually increasing to thirty times. It is well to take one or two ordinary respirations between the forced ones.

It will be found that, as these exercises proceed and the lungs are filled with purer air, the breath can be held for a longer period of time, and that with practice the length of time that the breath can be held is greatly increased; it should be held for half a minute. Public speakers, singers, and divers are all skilful in this respect.

When these simple breathing exercises have been mastered, breathing exercises can be combined with other exercises, which have as their aim the development of the muscles of the chest.

Reading aloud, singing, talking, laughing, are all good exercises for developing the capacity of the lungs.

The Cure of Chronic Bronchitis by Deep-breathing Exercises.—The upper part of the body must be nude and the exercises taken before a mirror, so that the woman can watch the movements of the chest and abdomen, see that all the hollows of the chest are filled out during forced inspiration, and that the muscles of the abdomen are properly retracted. For the average woman this last will be the most difficult; in beginning these exercises she will find that it will require all her concentrated energy and will power to cause a retraction of these disused muscles.

Patients with chronic bronchitis do not have the ability to perform forced respiration properly. The respirations are too superficial, and the respiratory movements are not properly performed.

As respiration is ordinarily performed, the partial expansion of the upper part of the chest is accompanied by a contraction of the abdominal muscles, whereby the diaphragm is forced upward, with the result that the lower part of the lungs remains very slightly expanded, whereby the circulation as well as the removal of mucus is imperfectly performed. This lack of forced respiration is a frequent cause of acute bronchitis running into a chronic form.

In chronic bronchitis it is especially in the lower part of the lungs that stagnation of the secretions takes place, and they can only be dislodged from the mucous membrane by forced abdominal expiration and the ascent of the diaphragm. This causes a cough which expels the mucus, and forcible abdominal expiration and cough are the only means of drainage of the lower and deep-seated parts of the lungs. Further, in forced respiration the muscle tissue of the bronchial tubes contracts, which certainly does not take place in ordinary respiration, but, on the contrary, this tissue atrophies.

Other beneficial results from forced respiration are increased oxygenation, improved nutrition, changes of a mechanical nature, ventilation, and disinfection of the lungs, massage of the lungs and pleura, and drainage.

No other method of treatment is so successful in the cure of chronic bronchitis not dependent on disease of the nose and throat. In from two to six weeks of treatment, in which there is a profuse discharge of mucus, it will be found that the bronchial tubes have cleared up, provided that the patient is supplied with an abundant supply of fresh air day and night. Methodically practised, deep breathing is not only the surest cure, but also the safest stimulating expectorant.

Relation of Colds and Influenza to Pneumonia and Tuberculosis and their Prevention.—We have already seen that bacilli are not only the cause of acute infections, but also of chronic bronchitis, and that this was especially true of the bacillus of influenza and the pneumococcus of pneumonia.

It is well known that influenza is an infectious disease, which rapidly spreads through the family and the community, but it is not so well known that the so-called “common colds,” ordinary sore throat, and tonsillitis are also highly contagious. The infection is carried from one person to another by direct contagion; the air is being constantly sprayed with the germs of disease in talking, laughing, sneezing, and coughing. In coughing and sneezing it is not sufficient to hold the hand before the mouth—a handkerchief must be used for this purpose.

Colds are among the most frequent of the so-called minor ailments in this country. The causes are the overheating of the houses, the great dryness of the air, badly ventilated houses and public assembly rooms, which render people very susceptible to the great variations in temperature.

Prophylaxis, or the prevention of colds, combine all those measures which promote the general tone of the system, and may be said to embrace all the elements of personal hygiene. Good digestion and proper nourishment of the body with suitable food; the proper ventilation of houses, all public buildings and conveyances, for in these latter the public are brought into very close contact with their fellow-men.

Local prophylaxis would consist in the toilet of the nose and throat—the removing of adenoids and enlarged tonsils.

The individual must remember that she can reinfect herself; for this reason, an abundant supply of handkerchiefs must be used; they should be placed in a handkerchief bag and washed separately. Packs of cards should be thrown away before they become soiled. Sprays and atomizers must be individual property, and be kept thoroughly cleansed.

With the exception of deep-seated chest colds, in the early stages a cold may often be nipped in the bud by a few hours of hard sudorific work in the open air. In half a day the nasal ducts and respiratory system will throw off irritating matter that would take much longer time if the patient remained indoors and relied on the action of drugs alone.

Treatment.—Other methods of treatment are a hot tub-bath on retiring, an active but not too severe cathartic, as two grains of calomel, taken just before going to bed, and, if the individual is chilly, a hot lemonade should be taken at the same time. Both the cathartic and the free perspiration will aid in relieving the internal congestion and thus aid in its abortion. A cold sponge should be taken the following morning to tone up the system. Turkish baths are also useful in breaking up colds; again, the precaution must be taken to avoid chilling on leaving the bath.

The following tablet is a very simple and very efficacious remedy for breaking up a cold in the early stages: Take of powdered camphor ¼ gr.; of the sulphate of quinin ¼ gr.; and of the fluidextract of belladonna root ⅛ minim. This should be well mixed, and made up into one tablet or a capsule. One tablet is taken every half-hour, until four doses have been taken; after that one tablet every three hours, until the running of the nose has ceased, which generally occurs within twenty-four hours. If there is not marked improvement at the end of this time, or if there is any fever, a physician should be consulted at once.

Quinin, when given alone to abort colds, must be given in sufficiently large doses to produce cinchonism, the subjective symptom of which is a slight deafness or ringing of the ears. The natural tendency of cold is to cause inflammation of the middle ear, and since the use of quinin in large doses causes a congestion, and so predisposes to inflammation of the middle ear, its use should be avoided.

The great amount of illness and mortality from pneumonia during and following epidemics of influenza is too familiar to the public to need more than mentioning. The patient is so rapidly and extremely prostrated by the attack of influenza as to be susceptible to the ready action of the pneumococcus, which, as we have seen, is ever present, and the extension of the inflammation from the fine bronchial tubes to the air-cells of the lungs rapidly takes place. In the exhausted condition of the patient she is not able to resist this invasion, the heart is already weakened, and death frequently rapidly ensues as the immediate result of heart failure.

The Prevention of Tuberculosis.—The tubercle bacillus is practically ubiquitous, and the prevalence of tuberculosis is universal. Hence it is imperative to raise the resistance of the individual in every way possible, as well as to limit the spread of the infection. This means the employment of all the resources of public and personal hygiene, public and private sanitation, and the education of the public in how the disease is disseminated, and how its spread may be prevented; also the teaching of the individual, her duty to the family and society, as well as to herself, in order not to spread the contagion.

Tuberculosis attacks the crippled and poorly developed lung just as surely as it shuns the one which is fully expanded and in constant and active service. Numerous observations have established the existence of a constant ratio between tuberculosis of the lungs and deficient chest expansion.

Diet.—The doctrine has been growing among the laity that the child’s likes and dislikes should determine what food it should eat. Thus a finical taste is cultivated and a lack of proper nourishment follows, and it is this finical diet class of people which forms a large percentage of tuberculous invalids. It has long been recognized that a proper diet and the tolerance of it is of the utmost importance in the treatment of tuberculous patients, but from the foregoing it would appear that a proper diet throughout life is also of the utmost importance in the prevention of disease; a sufficiency, not only as to quantity, but also as regards variety.

It is the patient who can eat everything who stands a good chance of getting well. So, too, it is the individual whose diet for years has been perverse, who could not eat meat, to whom eggs were distasteful, who could not stand milk, who was infected with the vegetarian fad, or the two-meal-a-day fad, who stands a fair chance of falling a victim to tuberculosis, through a lowered tone of the system, because it offers but a feeble resistance to a powerful and insidious enemy. And the mode of the preparation of the food is an equally important factor. It has been shown that the poor cooking among the lower classes is a powerful predisposing cause to intemperance and tuberculosis.

Influenza is a frequent and important agent in bringing to light latent tuberculosis, and must be classed as an important exciting if not predisposing cause. Low, damp climates predispose to the infection by lowering the vitality. Tuberculosis is more prevalent in cities than in rural communities, due to the manner of housing and the character of the occupation.

Summary of the Present Views of Infection.—The doctrine of inherited and acquired susceptibility still holds sway; next, that all infants are susceptible, and that susceptibility lessens with increase in age; that adults are comparatively insusceptible when free from general and local lowered resistance and repeated and prolonged exposure.

As to the source of infection, the consensus of opinion and ascertained facts point to the sputum as of overwhelming importance; cow’s milk is an important factor; the food may be infected directly by coughing, or the dirt and dust from the floor and hands; the fingers and many other objects that find their way into the child’s mouth are sources of danger. To adults, both dust and moist droplets are more often the source of infection than infected food.

Expectoration.—Careless expectoration is the chief source of infection. Laws should be passed and enforced prohibiting the expectoration on pavements, stairways, in all public conveyances, and all public places.

The danger of infection from tuberculous house servants has not been sufficiently appreciated. A chronic cough in the case of a servant should be at once investigated by the family physician. Servants should be taught the necessity for washing the hands before touching the food or cooking utensils. The condition of their rooms, clothing, bathing, and other personal habits should be closely investigated, and personal cleanliness should be demanded as a sine qua non for obtaining or keeping a situation.

Since it is a well-known fact that tuberculosis can be acquired from the occupation of houses and rooms formerly occupied by tuberculosis patients, it has been suggested that a clean bill of health should be demanded of the owner of the house before renting it; that is, a certificate from the Board of Health, that no case of infection has existed in the house, or that it has been properly disinfected since that time. If such a movement became popular, landlords would be obliged to furnish these bills of health in self-defense. Since the Boards of Health demand the reporting of all cases of tuberculosis, this scheme is by no means impracticable or Utopian.

The tubercle bacillus is not destroyed by any degree of cold, but both light and sunlight are distinctly injurious to these bacteria. The lowest fatal temperature to the tubercle bacillus is 131° F. of moist heat, acting for a period of six hours. The thermal death-point of tubercle bacilli in milk is of great practical importance, and many experiments have been made which have determined that a temperature of from 140° to 167° F., was sufficient if continued for one hour. If it is desired to pasteurize the milk, it should be placed in a closed bottle or stirred and heated for at least twenty minutes at a temperature of 149° F.

Disinfection.—The use of formaldehyd gas has practically displaced the use of sulphur for the fumigation of rooms, as well as for the disinfection of furniture and clothing. For this purpose a moist vapor used in a sealed room is essential.

At least 8 ounces of the commercial 40 per cent. formalin should be used for each 1000 cubic feet of air content. The most efficient method is that used by Biggs, of New York, which is as follows: For an ordinary room, 1000 cubic feet, 1 pound of lime, 8 fluidounces of formalin, and from 2½ to 3 fluidounces of commercial sulphuric acid are required. All openings but the door are sealed. The formalin is poured into an empty water-pitcher, 4 ounces of water are added, and then the sulphuric acid is poured slowly in. The lime is placed in a china or earthenware wash-basin on the floor upon newspapers; all water is removed from the room. All drawers and cupboards opened; the mattresses stood on end; and the mixture poured quickly upon the lime, when the door is sealed. The sulphuric acid may be packed in a tin bucket containing the lime, and, with the formalin in a separate bottle, may be used by any person of ordinary intelligence. The room should remain closed from twelve to eighteen hours. It must not be lost sight of that after disinfection by means of formalin a thorough cleansing is imperative. A room which has been thoroughly cleaned and carbolized is safer than a room which has been disinfected with formalin and not properly cleaned.

After death or removal the entire place should be renovated. Besides disinfection and scrubbing the painted woodwork with a solution of hot soda water, the walls should be repainted or repapered, and the woodwork repainted.

Rugs, bedding, pillows, and clothing should be disinfected by hanging up in the room while it is undergoing disinfection. Books and all articles of small value should be burned. All soiled linen should be boiled.

The Kidneys and their Function.—The kidneys are the secretory organs of the urine; they are two in number, and are the largest tubular glands in the body. They are deeply seated in the lumbar region, lying one on each side of the vertebral column; the kidneys extend from the eleventh rib nearly to the crest of the pelvis. They are usually embedded in a considerable quantity of fat, which is the chief factor in holding them in position, aided to some extent by the large blood-vessels with which they are connected. The kidneys are oblong bodies and measure about 4 inches in length, 2½ inches in breadth, and over 1 inch in thickness. Their weight is about 4½ ounces.

As an excretory organ the kidney probably stands second to the alimentary canal; it surpasses in importance the skin, whose total excretion of water it equals. The abnormal substances appearing in the urine are often not the products of disease of the kidneys, but of some other organ or system.

The kidneys excrete and put the finishing touches upon the urinary fluid; they act at the end of the metabolic course, both as active and as passive agents. While to some extent the kidneys are mechanical contrivances, mere filters, so to speak, they are to a far greater degree active, specific glands. The renal epithelium has the power of synthesis, and builds up complex substances that are not apparent as such in the blood or lymph, as well as the power of analysis or breaking down of substances. These changes are due to the formation in the tubular cell of an enzyme, which we call histozyme. The kidney is the end link in the vascular chain, and the daily performance of healthy kidneys is no doubt a combination of the mechanical and the vital processes.

The Secretion of the Urine.—In a perfectly normal being the problems of waste and repair are balanced to a nicety. As we know, the tissues of the body are bathed in lymph containing in solution the compounds that are necessary for their nourishment—proteids, carbohydrates, fats, salts, and gases. Waste follows in direct proportion to the activity of the tissues. The worn-out, effete material first finds its way into the lymph, and from it into the blood-stream, to be later eliminated from the economy, else deleterious results will follow their retention in the body. It is by the selective action of the cells of the various glands of the body that these useless substances are removed from the blood, and converted into such forms as can be readily excreted. In the main, the products to be removed are urea and the allied nitrogenous bodies—carbon dioxid, salts, and water. These organs are of vital importance, since nearly all of the waste-products containing nitrogen are eliminated in the urine.

The most easily understood function of the kidneys is the excretion of the urinary water; this varies in amount with the rapidity of flow through the renal vessels and to some extent on the blood-pressure.

Fig. 11.—Relation of kidneys to heart and great blood-vessels: A, Heart; B, B, kidneys; C, bladder (after Quain).

The separation of the solid substances of the urine form the next function of the kidneys, and these substances fall into two groups—inherently useful materials, which are in excess or which have served their purpose, and substances which are inherently harmful. The latter class embrace many end-products of metabolism, which we are accustomed to consider as normal constituents of the urine.

The analytic study of the urine is of great value to the physician and surgeon, because of the knowledge which it gives concerning the processes of metabolism occurring within the body. The nature and amounts of the various end-products of metabolism are carefully investigated as they occur in the urine, whether they be normal or pathologic.

The Urine.—The normal human urine recently passed is a clear liquid, of a straw color, with an average specific gravity of 1020, the specific gravity indicating the amount of solids contained in the urine. It is acid in reaction. The quantity for twenty-four hours is 50 ounces, or about 3 pints, depending on the amount of water ingested. During sleep the amount secreted is less than at other times. The amount of urine is decreased after profuse sweating, diarrhea, thirst, diminution in the blood-pressure, and after severe hemorrhage. When the body temperature is considerably higher than normal, the amount of urine is again diminished in quantity.

Urea forms nearly one-half of the solids in normal urine and nearly one-half of the urea is nitrogen. It is the principal representative of the waste of the nitrogenous tissues. The chief source of urea is from the metabolism of the muscles; the ingestion of a large amount of proteid food stimulates metabolism. The quantity of urea passed in the twenty-four hours is about 500 grains.

The uric-acid constituent is very small, and in the human urine scarcely reaches 0.03 per cent. of the solids. Lack of exercise leads to an increased formation of uric acid by a lessening of the oxidation of the tissues. In gout the amount of uric acid excreted is abnormally small, because it accumulates in the blood and tissues. The brick-dust deposit sometimes seen in the urine is composed chiefly of the urate of sodium. The average daily amount of uric acid passed in the human urine is about 7 grains. The excretion of uric acid may be increased by drinking copious drafts of water.

Toxicity of the Urine.—After the removal of both kidneys the animal dies of uremia; that is, there is an accumulation of urinary products in the blood. The removal of one kidney is not necessarily fatal, and women have so lived very comfortably for many years. A human being excretes enough poisonous material by the kidneys in two days to cause death.

The Urinary Excretory Apparatus.—After the urine has been secreted by the kidneys it must be carried away from the body, so that the economy may not suffer from the resorption of the contained toxic principles. The excretory apparatus comprises the ureters, the bladder, and the urethra.

The ureters are two cylindric tubes of the diameter of a goose-quill and about 15 inches long. They make their exit from the inner border of the kidney, and pass downward and inward toward the median line, to empty into the base of the bladder by a slit-like orifice.

The bladder is the reservoir for the urine. It is a musculomembranous sac, situated in the pelvis, and in the female it is in front of the uterus and above the vagina. It normally contains one pint. It should be emptied four times a day. If it is allowed to go longer than this, it becomes overdistended, and is apt to displace the uterus backward, and the bladder-walls themselves become weakened.

The Physiology of the Female Generative Organs.—The internal and essential organs of generation are the uterus, ovaries, and the Fallopian tubes. These organs have to do with the process of ovulation, menstruation, and reproduction.

The Ovaries.—These are two small bodies of an almond shape, and lie one on either side of the uterus. The bulk of the organ consists of connective tissue, in which lie embedded the Graafian follicles, or ovisacs, in which the ova are contained.

During the child-bearing period, or from about the age of fifteen to forty-five years, the development of the Graafian follicles and the discharge of the ova are continually taking place. The liberation of the ova usually takes place at definite times, which, in general, coincide with the menstrual epochs, one or more ova being set free at each period, but this is by no means invariable.

The Uterus.—The virgin uterus is a small, hollow, muscular organ, somewhat pear shaped, whose cavity is about 1½ inches deep. The uterus is situated in the middle of the pelvic cavity, between the bladder and the lower bowel. It is held in position by broad elastic bands, which go to different sides of the pelvis; it is also in part supported by the structures below and above it; but so loosely is the uterus held that it is easily pushed about, as, for instance, by a full bladder or a packed bowel, and persistently allowing the bladder to become overful, and failure to have a daily evacuation of the bowels, are prolific sources of displacements of the womb.

Respiratory Movements of the Uterus.—When no constrictions are placed about the waist, the uterus moves freely up and down with every respiration. So distinctly, and with such regularity, do these movements occur that an operator, by watching the movements of the uterus, can tell the effect that the anesthetic is having on the patient’s breathing. These so-called respiratory movements play a very important rôle in the circulation of the uterus, and in the return of the venous blood to the heart.

Anything which interferes with these movements, as the wearing of corsets or of tight bands about the waist, prevents the free return of the venous blood. The uterus becomes congested, and through the constant abnormal weight of the organ itself, as well as by the pressing down upon it from above of the superincumbent organs, the uterus is pushed down below its normal position, the ligaments whose duty it is to hold it up become relaxed, and the unhappy woman suffers all the agonies that are attendant on the “falling of the womb.” For this reason the disorder is frequently met with in women who have never borne children as well as in those who have.

The Functions of the Uterus.—The function of the uterus is to provide a favorable place for the reception of the product of conception, where it may be protected and nourished during the period of its development. The purpose of menstruation is to keep the uterus in suitable condition for the reception of this product of conception at any time. It is now known that the menstrual flow is not the whole of menstruation, and that the changes going on in the uterus are almost as continuous as the process of digestion.

Average Duration of the Menstrual Flow.—The average duration of the menstrual flow is five days, although the variations are considerable in healthy women. A flow lasting any place from two to six days is perfectly consistent with health, but a flow continuing less than two days or more than six days generally indicates a local or general disease.

Character of the Menstrual Flow.—For the first few hours, or perhaps for the first day, the flow is usually slight in quantity and light in color; on the second and third day the flow reaches its height, and is profuse and dark in color, but it should never be clotted; after this it generally ceases. The amount of the flow varies from 5 to 10 ounces. If less than 5 or 6, or more than 18 napkins, are pretty well saturated through, the amount may be considered abnormal.

Premonitory Symptoms of the Flow.—The premonitory symptoms of the monthly flow should not be so marked as to cause the individual any discomfort. The first indication of the return of the period should be the flow. There is generally a feeling of abdominal fulness, with some lassitude and sometimes slight headache. The temperature is lower and the pulse is slower than at other times. This lowered tone of the system is an additional reason for increased care against exposure in wet or cold weather.

Hygiene of Menstruation.—During the menstrual period all cold baths must be strictly prohibited, whether tub-baths or cold sponges. The reason for this is that the application of cold to the surface causes a driving in of the blood from the exterior of the body to the internal organs, and, at the time of the menstrual periods, there is already a congested condition of the pelvic organs, and it must be remembered that congestion is the first stage of inflammation.

Hot or warm sponge baths may be taken throughout the period, and the vulva should be bathed with warm water twice a day throughout the entire period of the flow, as this not only removes the clotted blood before it decomposes and becomes the source of irritation, but also removes other irritating matters, and prevents the nervousness that is caused by local irritation.

Another question which is still sub judice is the necessity for and the frequency with which vaginal douches should be taken; all physicians are agreed that a vaginal douche, taken immediately after the menstrual period, is beneficial, as it removes all of the débris of the flow, which is sometimes very irritating.

Exercise.—A moderate amount of exercise should be taken every day; this is needed now quite as much as at any other time, and only good can result from it, and no harm comes of a woman going out in the rain or the cold weather. As has been shown, the menstrual process is going on for a large part of the time, and the flow is only the external appearance, but during the time of the flow the woman must be unusually careful not to get her feet wet or sit down with damp clothing on. Violent exercise of all kinds is to be prohibited at this time, as dancing, bicycling, gymnastics, and walks of over three miles. The reason for this is very obvious: the uterus has now reached the height of its turgescence, and is heavier than at any other time, hence the danger that displacements or a very profuse flow would be caused by any kind of violent exercise.

Treatment.—If the woman has been so unfortunate as to have been caught out in a heavy rain, so that her clothes have been wet through, or if in the cold weather she should come into the house thoroughly chilled, the best thing to do is to take off her wet things as quickly as possible; be well rubbed down with hot rough towels; drink a cup of hot tea, and go to bed at once, with a hot-water bag placed over the abdomen or under the small of the back. She should remain in bed until the next morning, to the end that the circulation may regain its equilibrium as quickly as possible by the immediate relief of the pelvic congestion.

If this exposure should have caused the sudden cessation of the flow, a hot mustard foot-bath should be taken. One tablespoonful of ground mustard is used to the gallon of water, as hot as it can be borne; the pail should be made as nearly full as possible, without running over, and a blanket wrapped about the pail and woman, so as to cause a profuse perspiration; this should be kept up for ten minutes; as the water cools off, hot water may be added.

Profuse menstruation, painful menstruation, and scanty, very slight, or irregular flow are all abnormal conditions that are due to some abnormal or pathologic causes, and a good gynecologist should be at once consulted, so that not only suffering may be prevented, but that serious consequences to the general health may be averted.

CHAPTER VI
THE NERVOUS SYSTEM AS THE BALANCE OF POWER IN THE BODY

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

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

Functional Nervous Disorders, Headache; Neurasthenia.

The Brain the Master Organ of the Body.—The brain is not only the most important organ in the body, but its essential organ, for the sake of which all the other organs and tissues exist, and it is the master of the whole. It not only receives help from every other organ, but it also largely controls the working of each. By its mental action alone it can hurry the heart’s beat or slow its pace; it can make the skin shrivel or flush; it can quicken or stop digestion; it can stop or change the character of all secretions; it can arrest or improve the general nutrition. Every organ and every vital process is represented in the structure of the brain, by special centers and groups of cells that have a direct relation with such organs and processes, and through which they are controlled.

The Functions of the Brain.—The brain may be said to have four chief functions; the first is that of motion; it presides over and stimulates all the voluntary muscular movements of the body, regulating their force, and coördinating in their working the different groups of muscles needed to perform them. Mind and muscular movement have the closest possible connection with each other. The second function of the brain is that of feeling and sensation; the third is that of nutrition; through this its own nourishment and that of the rest of the body is regulated. While mind is the fourth and highest form of nerve force, it is not created in the brain, but is absolutely conditioned by that organ.

Different groups of brain-cells have different work assigned them; some have motion, some have sensation, some have nutrition, and some have mind. For example, special tracts of brain govern inhibition. While every group does its own work, it is related to and combined with others, influencing them, and being influenced by them.

Every kind of mental activity uses up the brain energy of the cells. To think clearly, plenty of healthy blood must be supplied to the cells. In order to make healthy blood, there must be an abundance of fresh air supplied to the lungs, and a vigorous heart to pump it up to the brain. It has been demonstrated that, during intellectual work or emotional feeling, there is an increased supply of blood to the brain, which may become more or less congested, and that there is an actual rise of temperature; whereas during periods of relaxation, rest, or fatigue, the brain is pale and anemic.

The brain-cells generally, but particularly those cells involved in mental activity, are of such a nature and constitution that they cannot rest absolutely during the waking hours. They may act slowly or with great rapidity; different brains have different capacities for energizing, both in regard to speed and force; and, further, the brain may be pushed to work greatly in excess of its normal activity, just as an engine may be allowed to go at the rate of 50 or 60 miles an hour, or may be pushed to go at the rate of 100 miles an hour. In both cases the danger resulting from speeding are greatly in excess of going at the normal rate of speed.

In any case, the continuous brain action implies the necessity for continuous repair. The only complete physiologic rest which the brain enjoys is during sleep, when the process of repair goes on most rapidly; during this period the brain-cells absorb their nourishment from the blood in excess of their needs, and so lay up a store of energy for the waking hours.

Habit and Automatism.—It is one of the innate qualities of every tissue and of every organ in the body, that when any vital action is performed, any vital process gone through with, it is easier to do it the second time, and the continuous exercise of the action makes the performances more and more easy, until they become automatic.

The physiologic basis of habits consists of the plasticity of the nerve substance, and in the capacity of nerve substance to receive and retain impressions. There results the certainty that the nervous system will act again more easily in those ways in which it has already acted.

On the one hand, the automatic performance of work saves an enormous amount of brain energy; on the other hand, bad habits may be formed whose effects may be most pernicious, and which are gotten rid of only with the greatest difficulty. An example of the first is the young child learning to walk; at first he accomplishes the feat only by the fixed concentration of every power of the brain on the act; whereas the healthy adult walks automatically, without paying the least regard to the movements or the manner in which they are accomplished. Hysteria and ungovernable outbursts of passion furnish good examples of the bad habits that may be formed, owing to the lack of discipline and the powers of inhibition; every time that a woman gives way to one of these outbursts, so much the harder will it be for her to prevent or control another outbreak. Inhibition is the highest and most important function of the brain.

Habits woman must have, but it is for her to choose what they shall be, provided she chooses quickly; the time limit in habits is one of the strong evidences of the close connection of body and mind. It is a startling fact to face, that a woman’s habits are largely fixed before she is twenty; that the chief lines of her future growth and acquaintance before she is twenty-five; and her professional habits before she is thirty; yet to something like this James believes that physiologic psychology points. The woman becomes a bundle of habits, and her habits settle about her like a plaster cast.

The Physiology of the Brain and Nervous System.—The brain, spinal cord, and spinal nerves constitute the so-called cerebrospinal nervous system. The brain is that portion of the nervous system which is contained within the cranial cavity and which it completely fills. The spinal cord is the continuation downward, from the brain through the spinal canal, of nerve substances, and from which the spinal nerves are given off. The nerves may be described as cords and threads of varying degrees of fineness, distributed to every tissue and organ in the body.

The nervous system has been likened to the electric telegraph, the brain being the central station, while, in addition to the special senses, the body is provided with numerous terminal substations in the skin and internal organs of the body, which keep the brain informed of what is going on in the world around it, as well as in the various parts of the body. The nerves simply act as conductors to transmit the messages. The body is supplied with two distinct sets of nerves or wires, one of which carries messages from the outside world and various organs to the brain, while the other set transmits orders from the brain.

The spinal cord is the center of reflex acts; that is, if the leg of a brainless frog is touched with acid, he will take the other leg to wipe it off with. There are, as we have seen, substations in the skin, hence the acid causes the sensation of a foreign body, word is telegraphed the spinal cord, where there is a large central station; from here word is sent out by another set of nerves, to move the leg away from the acid, but this being insufficient, word is telegraphed to the other leg to wipe off the offending substance. Did the same thing happen in the body, at the same time that the cord telegraphed word to the affected member to withdraw it, it would telegraph the brain, and the sensation of pain would be felt.

A message travels along a nerve at the rate of about thirty-six yards a second, or a mile a minute. This is about the time made by a lightning express train. The distance in the body being so short, the time taken is imperceptible, and we say that movement is instantaneous.

The paths traveled by nerve impulses are made passable by use; the oftener an impulse traverses a given route, the more adapted such a route becomes for future traffic.

But all of this has to do with the nerves which are under the control of the will. There is another set of telegraph wires in the body, called the sympathetic or vegetative system, so-called because it presides over the processes of nutrition and is beyond the control of the will.

The Hygiene of Work.—Since the motor centers are located in the brain, it is natural to expect that all definitely directed movements will directly affect the brain and the mental development, and so it is. Du Bois Réymond says that it is easy to demonstrate that such bodily exercises as gymnastics, fencing, swimming, riding, dancing, and skating are much more exercises of the central nervous system, of the brain, and spinal cord than of the muscles.

It is further urged that healthful energy of will is impossible without strong muscles, which are its organs, and that endurance, self-control, and great achievement all depend on muscle habits.

The philosophy of work consists in its necessity. The brain-cell in health cannot cease to be active, except to a partial extent during sleep. There must be some output of mind from the mind cell and of motor stimulus from the motor cell. The proper selection of work for that particular brain to do, and the physiologic regulations of the work done, is the basis of the hygiene of work. For health, for happiness, and for efficiency, right work rightly done is the most important matter in any man’s or any woman’s life.

The physiologic, as well as the moral necessity, has always been conceded for every man to have a life-work—a vocation; a work for which he should be fitted, and for which he was capable, sufficiently congenial not to sink into mere drudgery, and which would, at the same time, afford ample financial compensation to be remunerative and a stimulus to his power of endurance.

Important, from a physiologic point of view, as a vocation is for men, it is equally or even more important for women. It is highly probable that the unstable nervous system of women and their emotional extravagance and dissipations, whether of frivolity, wickedness, or grief, is largely due to lack of mental discipline and muscular development. It is a psychologic proposition that any woman who has a toothache suffers less if she keeps busy, and any one will testify that she suffers much less from the intense heat of summer if she is busily employed.

One of the great objects of a definite and fixed occupation is to turn the thoughts out from the ego. Work of some kind is indispensable to the health and happiness of every one, since it necessitates an objective instead of a subjective attitude of mind.

Experience teaches that the brain, like the muscles, is subject to training; occasional excessive efforts, with long intervals of repose, are rather injurious, while a many-sided activity, constantly repeated, interrupted by sufficient shorter rests and supported by sufficient nutrition, is strengthening. A healthy training of the brain should be as many sided as possible.

Symmetric development and training of every function of the brain is as essential for mental efficiency and sanity as the development of all the muscles of the body is for bodily vigor, and a one-sided training of the mental powers is as certain to produce eccentricities of habits of thought and actions as those occupations which call into play only the action of certain groups of muscles is to cause bodily deformities. Anything which will prove injurious to the delicate nerve substance must be avoided, as laziness, idleness, and, worst of all, any form of narcotics.

Many-sided life work, consistently carried through, not only strengthens the brain, but also its continued power of adaptation, and one’s whole life is a continuous struggle for adaptation. The more the brain works, the more capable it is of receiving new impressions and elaborating old ones, and it retains its elasticity longer.

Hurry generally implies lack of system in carrying out the routine of work, or the undertaking of more work than the individual can accomplish without injury to herself. Few things can more certainly muddle the brain and produce a sense of physical exhaustion than a sense of hurry. Without the sense of this insane driver with a lash in his hands standing over one, she can work more rapidly, with complete self-possession, and do more accurate and better work. The peculiar sense of being hurried has a direct benumbing physical effect, that can often be felt in the brain as distinctly confusing.

The Toxins of Fatigue.—By speeding the machinery to the utmost, a strain is placed on nerves and muscles, and they are kept keyed up to the greatest possible tension. There is a natural pace that one can keep up; force the pace, and weariness results. A man can go for hours at the rate of five miles an hour; he can run at the rate of six miles an hour for quite a long while; but if he tries to run eight miles an hour, he will drop out very soon. The powers of endurance must be gradually developed, but no machine should ever be run at its utmost speed.

By undue pressure, at any period of life, it is possible to use up energy that ought to have been spread out over long periods; and this is emphatically the case during adolescence; too heavy a drain is made on futurity, which means a serious breakdown, or, at least, premature old age.

It has long been assumed that during the activity of muscles substances were produced which exerted a poisonous influence upon the muscle tissues. Exactly what these substances were was not known, but it was supposed that they were definite products of metabolism or tissue waste. It is a well-known phenomenon, observed during the training of athletes and soldiers, that prolonged and disciplined exercise makes it possible for individuals to support easily an amount of work which would prove exhausting or even fatal to the untrained. Increased work, under any circumstances, means increased metabolism, and consequently a more rapid accumulation of its products.

A German investigator, Dr. Weichardt, has shown that if guinea-pigs were put upon a miniature treadmill and forced to run it until they dropped dead from exhaustion, a highly poisonous liquid could be pressed from their muscles, and that the injection of this liquid or extract into the veins of healthy guinea-pigs produced, when administered in small doses, rapid fatigue; whereas, larger doses caused death, accompanied by all the symptoms observed in the original animal during the process of mechanical tiring.

On the other hand, liquid taken from unworked guinea-pigs had no such effect. Further, that if these little animals were put upon a treadmill and worked to just short of exhaustion, and then were given time to recuperate, as we say, the liquid or extract from their muscles had no such effect: it was quite harmless.

From the results of these carefully carried out scientific investigations, Weichardt has come to the conclusion that fatigue is due to a definite toxin, analogous to that of diphtheria and tetanus, and he believes that the explanation of the phenomena of training lies in the fact that in the body of the athlete there must be a specific “antibody,” which neutralizes the “fatigue toxin” as soon as it is formed.

In the animals undergoing these experiments of extreme fatigue there was a fall of temperature. A practical use of this fact could be made for the individual, by noting the fact that a subnormal temperature was a grave danger-signal.

Other observers concede that fatigue is due to chemical substances, produced in the body as the result of brain and muscle activity, and find that these toxins produce a depressing effect, especially on the muscular system, and that the sensation of fatigue is in large part the manifestation of this depression. The action of toxins is not confined to the tissues in which they arise; excessive activity of one tissue can cause fatigue of others. The facts of acid intoxication are noticed as analogous to fatigue phenomena, so far as the latter are due to toxic substances. As antidotes, only rest and sleep can be relied upon.

Observations in the electric experiments on nerve-cells have shown a remarkable shrinking of the nerve-cells, and especially of their nuclei. After five hours’ continuous work, the cell nucleus was only half its normal size, and twenty-four hours of rest was necessary in order to restore it to its normal size, but half that amount of work does not require half that amount of time for its recovery.

The mental symptoms of normal fatigue are loss of memory; the sense of perception is less acute; the association centers act less spontaneously and therefore slower; the vocabulary diminishes; the emotional tone is lowered; the attention is unstable and flickering. All these are marked symptoms that the individual is far below her best. All kinds of perceptions are more acute in the morning.

Fatigue is not, therefore, merely physically uncomfortable; it is intellectually, physically, and morally dangerous.

Overwork.—A surplus nervous energy must be persistently aimed at—what Emerson calls “plus health.” It must be indelibly impressed on the intelligence of every one that no fatigued individual can be at her best; she is doomed to do inferior work, to be mentally depressed, and to be morally weakened. Hope and courage ooze away, and all sense of proportions and perspective are lost.

The amount of work that can be performed without fatigue is a matter of individuality, and the only safe gauge of overwork are the danger-signals sent out by nature—loss of appetite, insomnia, increasing exhaustion from day to day without increase in the amount of work done, mental depression, lack of interest and initiative. No one can afford to disregard these danger-signals.

Habitual overwork produces fag and a desire for stimulants to act as a spur to the overworked muscles during the day, and recourse to increased stimulants or sedatives to act as hypnotics at night. The inert nerve-centers have no reserve energy to give out, so it is worse than useless to stimulate them. On the other hand, the nerve-centers are at too low an ebb to react from the depressing effects of sedatives, which, to the individual, must be positively injurious. The aim must be to promote nutrition, and to give complete rest to the exhausted nerve-centers.

Brain work, to be beneficial, must be regulated with the greatest care. During the exercise of the brain there is always an increased blood-supply to it. If the exercise is continued too long, there is a tendency for the blood to remain in too great quantity, due to the exhaustion of the nerve-cells, which are no longer able to control the vessels.

During sleep the blood-supply to the brain is diminished and the cells recover themselves, but if this hyperemia be persistently kept up, sleep soon becomes impossible, the brain-cells have no opportunity to become repaired, and their activity is diminished.

Richardson says: “Making all allowances for differences, even in the prime of their mental and physical vigor, few individuals can exceed six, and for most persons prudence would direct not more than four or five hours of close mental application, without seriously endangering their health.”

No real advantage is gained by eight or ten hours of daily study, since the memory and reasoning powers become so exhausted that the assimilation of ideas becomes slower and more difficult. When in his prime, Walter Scott declared that six hours a day was all that he could profitably spend upon his literary compositions. In later years, because of his pecuniary embarrassment, he worked beyond this limit, and, as the result of excessive labor, his last years were spent in hopeless imbecility.

Signs of Overwork.—These show themselves in irritability, with a sense of exhaustion, the irritability being due to an exhaustion of the nerve-centers. Work becomes irksome. There are periods of depression and melancholia, which recur at shorter and shorter intervals and continue for a longer period of time. There is a slight loss of memory, together with inability to concentrate the mind upon any given subject for any considerable length of time, and the power of thought and judgment are impaired. There are sleepless nights, ringing in the ears, fatigue from the slightest exertion, an irregular action of the heart, with palpitation and a frequent desire to urinate. Various forms of pain and neuralgia occur.

There may be as yet no loss of flesh or impairment of the appetite, but this condition of cerebral anemia furnishes the possessor with a pair of blue spectacles through which the intelligence must look, and which throw their own color over everything. Distressing dreams and unrefreshing sleep allow the brain little opportunity for either rest or repair. The mind becomes as sensitive as the skin after a blister, and the calm, vigorous mental labor is superseded by feverish anxiety, wearing responsibility, and vexing chagrin.

When the brain is well supplied with a powerful circulation, and a rich blood-supply from a good digestion furnishes it with an abundance of pabulum, the cares of life are borne with equanimity and cheerfulness. One of the most unerring signs of failing health is the inability to withstand the pressure of these same daily cares. When the cares that formerly sat lightly on the shoulders become well-nigh an insupportable burden, a state has been reached where the mind reacts on the body.

Worry.—It is readily evident that worry is bred of exhaustion, and is one of the signs of overwork; but, if too often indulged in, it becomes a fixed habit, and the mind rapidly becomes settled in a state of gloom.

It is most important for overwrought business and professional women, but most especially for those women whose vocations in life combine three distinct occupations or callings—namely, wives who act in the capacity of housekeepers, ministers of finance to the household, and the bringing up of children—to realize the importance of not undertaking more than they can accomplish without fret and worry. The overconscientious woman may object that it is selfish to consider her own comfort when she has work to do for others, but to expend too freely of the nervous energy, even in a good cause, is like giving so much of our substance to charity that we ourselves are in turn obliged to lean on others for support. In properly conserving our own energies, we may ultimately be lightening the burden of others. There is a proper balance between the duty one owes to one’s self and to others.

Once bred, worry is an endless chain. Tell such a woman not to worry, and she worries for fear she may worry. She is afraid that she has decided wrongly, and regards decisions in regard to the most trivial affairs of life as though they were matters of vital importance.

The obsession “to arrive” is a fertile source of fret and worry. This habit of mind leads to frantic and incessant labor and blocks all pleasure at every point. The person who plays a game only to see who wins, loses half of the benefit of the recreation.

“The legs of the stork are long, the legs of the duck are short; you cannot make the legs of the stork short, neither can you make the legs of the duck long. Why worry?” (Chinese proverb.)

Insomnia.—This is another symptom of overwork. The mind, worried and harassed all day, retires at night to struggle in the darkness and solitude with worries, forebodings, doubts, and regrets, which now assume gigantic and fantastic shapes. In this case the insomnia is due to faulty habits of mind.

Another form of insomnia is caused by intellectual work being carried on at night until time for retiring; the mind is then so fully saturated with the subject that it is unable to throw it off on going to bed.

Whatever be the cause of the insomnia, it soon becomes a fixed habit, and, whether it is a case of laying awake a long time before sleep comes, or waking up at a regular hour toward morning,—and it is a curious fact that the habit of waking up recurs at almost precisely the same hour in the morning,—the longer this habit of insomnia is indulged in, the more difficult it is to break it up.

Nervousness.—This is a well-known sign of overwork, which shows itself in intense nervousness and irritability. Everything jars on the nerves. The woman gives way to her emotions, over which she loses control.

To keep placid when overworked to the limit of physical endurance requires a stolidity of soul and lack of nerves only known to the North American Indians, and perhaps the Japanese, and it matters not what the kind of overwork is, whether business, pleasure, or charity.

Nature’s Restoratives.—The proper division of the day is eight hours to be allotted to work, eight to sleep, and the remaining period of eight hours is to be divided among the various methods of refreshing body and mind—the toilet, eating, rest, and recreations.

Not only are rest, recreation, and sleep in proper proportions essential to the health of the body, but they are equally essential to the quantity and the quality of the output of work. From them result a feeling of physical well-being, an exuberance of animal spirits which go into the work. The perspective is more accurate, the judgment is clearer, and the creative power is greater. Work goes of itself with a swing. Happiness is an expansive quality, that makes itself felt throughout the entire body, but its effects are most manifest in the mental power.

The mother who so honestly works and plans for the good of her family as to give herself no time to rest after her physical efforts is in such an exhausted condition as only to be able to give them the tired and critical side of herself for daily association. There are few human achievements much finer than to make human beings happy, and this power woman is endowed with to a very large extent.

Rest, to be of value, must be systematically taken. Bearing in mind the shrinking in size of the nerve-cells after stimulation caused by work, and that they recovered their normal size in relatively less time if the shrinkage were less, it becomes obvious that, in order to accomplish the best work, whether purely mental, or of the more complex mental and physical work demanded of the mother who is at the same time the housewife, that a break in the day’s work will aid in securing the best results.

The exact time of the daily siesta must be adapted to the family régime, but a fixed hour should be set aside for this purpose, and this should be known as the mother’s hour, and nothing short of a catastrophe should be allowed to infringe on it.

The woman should retire to her bed-room, undress, and go to bed. The room should be darkened, and at the same time there must be an abundant supply of fresh air. One soon forms the habit of taking a short nap, of perhaps half an hour; one hour should be spent in bed. After this, she gets up, takes a shower or other bath, dresses, and is then ready to enjoy life and be a comfort to her family. In this way alone can absolute relaxation, rest of mind, and body be secured.

Avocation.—Second only to the physiologic necessity for a vocation in life, is the necessity for an avocation, and this must be in the nature of a recreation.

It is a well-known fact in farming that any one kind of crop will exhaust the very best soil, but few people recognize the necessity for a change of occupation and recreation in order to produce the best mental and physical results.

Joyless drudgery drains the springs of health. There is a mental starvation, due to the lack of recreation, as well as the physical, due to the lack of bread. The French aristocrats, noted for the gaiety of their pastimes, in spite of their dietetic and other sins, furnish a remarkable list of longevity. Persons of a cheerful disposition are generally long-lived, and anything tending to counteract the influence of worry and discontent directly contributes to the preservation of the health. Despair, which frequently results from years of overwork, can paralyze the energies of vital functions like a sudden poison, while hope fulfilled has cured many a disease.

The nature of the avocation chosen will necessarily depend upon the character of the vocation. For women whose vocations are intellectual and sedentary, as writers, teachers, stenographers, etc., some outdoor employment, which calls into activity the muscles of the body, rests the eyes and brain, and, at the same time, pleasantly occupies the mind, is the best, as walking, gardening, lawn-tennis, golf, rowing, etc.

For all women engaged in sedentary occupations, daily exercise in the open air is the first essential, and let them be assured that their feelings of fatigue and disinclination to exercise are no safe guide as to their ability to take exercise.

The first cause of the feeling of fatigue is due to the lack of oxygen in the lungs and the impure air of the room. On going out-of-doors, the woman will be surprised at how much stronger and better she feels after an hour’s brisk walk than she did on starting out.

“Fancy work” and lace-making, instead of being classed with recreations, must be classed with fine hand-sewing of the most taxing kind. It calls the same groups of muscles into play, and is productive of the same evils, with a greater tendency to produce eye-strain and a paralysis similar to writer’s cramp.

The proper avocation of the tired housewife, who has been on her feet all the time and whose vocation is manual labor, will be the diversion of the mind by reading a good book, while comfortably pillowed on a veranda chair, a drive, a visit to some congenial friend, a game of cards, or music.

Literary clubs for women should be more largely organized through the country and in country towns. In the cities women have found these clubs a great boon, not only to the health and happiness, but they are in the highest degree educational.

Further, women have found that these literary clubs were profitable, as a means of bringing their minds in contact with other educated minds, and thus they had not only the additional stimulus to study, but a broadening of their horizon, which the woman’s heretofore shut-in household life had precluded. Courses in domestic science would be a boon to the home.

The greater the number of interests which education and culture have created, the greater will be the diversity of the recreations open for the woman’s enjoyment.

Care must be taken that the avocation, which is at first an enjoyment and relaxation, is not turned into hard labor. The moment that any one strains every nerve, even to excel in a game, that moment it ceases to be a relaxation.

History shows that the laws of all nations have always provided a certain number of days of rest, or at least a change of occupation, and that these days were fixed at more or less regular intervals. This was partly from a religious and partly from a hygienic standpoint. The necessity for the interruption of the regular routine work has always been recognized, and one day out of every seven has been set aside for this purpose.

The custom that is so frequently adopted by city folk of going out of town over Sunday might very well be imitated by country folk by going into the town or city over Sunday. For not only is the too continuous application to one’s employment fraught with danger, but it has been conclusively shown that a monotonous routine of occupation, such as lived by the average farmer’s wife, is a severe tax on the sanity of the mind. Statistics show that the heaviest percentage of insanity falls on farmer’s wives, and the supposed cause of this is the monotony of their lives.

A horse cannot gallop as many hours as it can walk, and the daily task should be the sum-total of what man or beast can do compatibly with health. To combine a day of toil with a second of amusement in one twenty-four hours does not give the proper allowance for sleep, and cannot be done without injury to the individual.

Fun and laughter are the most efficacious remedies in the pharmacopeia, and tired humanity owes a debt of gratitude to the guild of humorists, be they writers, comedians, or musical composers.

The Physiologic Necessity for Laughter.—The attitude of the individual varies with age, temperament, and the perspective of life. Grave adults are apt to think of laughter and smiling as something occasional, a momentary lapse once in a while from the persistent attitude of seriousness. Healthy children, on the contrary, consider that a state of laughter is the normal condition of humanity, and that seriousness is a tiresome necessity, which must be tolerated from time to time. But very few people have any idea that there exists a well-defined physiologic necessity for laughter, and the greater the intellectual labor and the mental strain, the greater is this necessity.

The deep forcible chest movements increase the rapidity of the circulation, the force of the heart’s beat, and secures a more complete oxygenation of the blood.

It is not improbable that this accelerated circulation produces remote effects on the organism. One of the immediate effects of a good laugh is that it relieves the brain by the rapidity of the movements of the blood through the capillary circulation.

In addition to the immediate physiologic effects which result from laughter it is highly beneficial, by relieving the brain and nervous system from the intense strain and tension of the daily affairs and occupations of life, and gives relief to the severely congested capillaries, which otherwise involve considerable risk to the individual.

Physiologists hold that pleasurable feelings tend to further the whole group of organic functions, and that laughter produces a considerable increase of vital activity by the heightened nervous stimulation. There is a sense of increased energy, of a high tide of the fulness of the life current.

Vacations and Health.—The secret of success of the old Romans in conquering the world lay as much in their ability to maintain the health of their troops in their various campaigns as by the courage and organization of those troops; or, rather it may be said that courage is but the coefficient of a good physique and a general mental vigor.

A rest one day out of seven, with an occasional outing for the week-end, is good but not sufficient. If one would keep up to her highest standard of physical and mental efficiency, she must have at least one month of absolute change of environment and outdoor life in the year.

The kind of place one chooses for her vacation will depend on where her home is. To dwellers in cities, the mountains and seaside resorts are the most beneficial. August is our most trying month, and every one who can would do well to take her vacation at that time, always selecting some resort north of her own home, so that she may have the additional advantage of a more bracing climate.

Maine furnishes many of the most beneficial of our health resorts, combining as it does so many attractions—its bracing atmosphere of pine forests, its beautiful scenery with vast expanses of water, and the great variety of diversions which it affords.

It is always wise to send an advance scout to investigate the place in which you contemplate spending your vacation. Avoid low and swampy land; investigate the character of the water-supply and the nature of the plumbing, together with the sewerage system, for it is all too frequent that an attack of typhoid fever follows an outing in the country. Every good summer resort should furnish facilities for a variety of outdoor sports—golf, tennis, boating, swimming, etc.

During the vacation needless exposure to the direct rays of the sun must be avoided. There is probably nothing which lowers the vital resistance, and so prepares the way for disease as much as exhausting exposure to the hot rays of the sun.

Long hours of sleep should be indulged in. The morning air is the most beneficial; it is, therefore, a good habit to retire early and to rise early.

If the vacation is not properly spent, it may be the means of doing more harm than good. On the other hand, if properly spent, vacations prepare one as nothing else can to meet and resist the vicissitudes of the following winter. It is the people who go off on long vacations who have the least need of the doctor’s care.

Sleep.—During sleep all the bodily functions are in abeyance and the secretions are diminished; respiration is slow and confined to the chest, so that the amount of inspired air is only one-seventh of that during the waking hours; the temperature of the body falls; less blood circulates through the brain; and the sensibility of the nerves to external stimuli is diminished. Sleep is not only par excellence the time of repose and recuperation of the brain and nerve substance, but it is the only time when, by the diminution of waste caused by the incessant activity of the brain, that the organ can be properly nourished, the deficit in nerve force canceled, and the surplus of energy stored up.

Without this absolute remission of brain activity every twenty-four hours an actual destruction of substance would occur, which, if persisted in, would be so depressing to the nervous functions as to be inconsistent with life, and this is the case in the concluding stages of fatal diseases.

The sleepy feeling caused by fatigue is due to the circulation in the blood of toxins resulting from tissue waste, which benumb the brain-cells; while the feeling of freshness and bien-être with which one awakens in the morning is due to the elimination of the fatigue products from the blood during sleep. If the blood of a tired dog be transfused into the veins of a perfectly fresh animal, the latter will immediately show symptoms of somnolence and seek a dark corner for sleep.

The medical authorities of to-day are pretty well agreed that eight hours of sleep is the minimum required for the maintenance of health, and all concede that the brain-worker requires more sleep than the manual laborer. Every moment after the feeling of languor presents itself is a strain upon the nerves and muscles which will sooner or later invalidate for life, and finally bring the victim to a premature grave. Habitual deficiency of sleep will undermine the strongest constitution.

It is a matter of great importance to train one’s self in the habits of sleep, regularity in the hour of retiring, abstinence from active brain work for the hour immediately preceding going to bed, since, if active brain work is continued until one goes to her room for the night, the chances are that the brain will continue its activities after getting into bed, and sleep may be banished from the pillow for several hours.

A few minutes spent in breathing exercises, the vigorous use of the flesh brush or hair glove, a hot plunge or foot-bath are no mean hypnotics.

A sound sleep is dreamless. Dreams require a certain expenditure of nerve force and mental energy, so that dreamless sleep is the most restful. Disagreeable dreams and “night-mares” are generally associated with indigestion and biliousness, which also occasion a general restlessness. All this can be overcome by taking some medicine for the liver. Two grains of calomel taken just before retiring often works like a charm. The dose must not be repeated under a month. In case of tendency to insomnia, no coffee should be taken after breakfast.

Treatment of Insomnia.—The mechanical measures for the relief of insomnia have for their purpose the withdrawing of the blood from the brain to the surface of the skin. Hot foot-baths; general warm baths; cold douches to the spine, brisk exercise; light massage, and cold rooms. Mental work should be laid aside several hours before retiring; late suppers avoided; coffee, if taken at all, should only be taken for breakfast, and then only one cup. Reading or amusement should be selected that does not excite the nerves.

To woo sleep the woman should put herself in a position of rest, which of itself physiologically induces sleep. Avoid irritations, noises, bad air, cold feet, overloaded bowels, all of which tend to wakefulness and to prevent the proper physical rest. Then sleep usually comes of itself.

The Eyes: Eye-strain.—Of all the misfortunes that could befall a human being, the loss of sight is probably the greatest, and yet no organ of the body is so constantly abused as the eye.

The trouble is that the possessor of the normal eye does not take into consideration that in all near work, as in reading, writing, sewing, etc., the eye is actively engaged as well as the hands and brain, and that the eye only is at rest when looking into space or when closed.

Description of the Visual Apparatus.—The eyeball is contained and protected in a bony cavity, formed by the bones of the face and skull, and is supported by a cushion of fat and other tissues. It is held in place by its membranes and muscles, by which it is also moved. It is further protected by the eyelids, the eyebrows, and the eyelashes. The eyebrows protect the eyes from dust and perspiration and shade the eyes.

The eyelids are lined by a very delicate mucous membrane, called the conjunctiva. They are maintained in close apposition to the eyeball by atmospheric pressure. The tears are secreted by the lacrimal gland, which is at the upper and outer angle of the orbit. The lubrication by the tears and the mucus secreted by the conjunctiva cause them to move smoothly and without friction. An important function of the lids is to distribute the tears over the front of the eyeball, and by incessant winking to free the front of the eye from dust and to keep it moist.

The conjunctiva is continuous with the mucous membrane of the nose and mouth. Hence, in inflammation of the nasal mucous membrane, as in an ordinary cold in the head or influenza, the conjunctiva is liable to become very much congested or inflamed.

The eyeball is spherical in form, having the segment of a smaller and much more prominent sphere ingrafted on its anterior part. The segment of the larger sphere, which forms about five-sixths of the globe, is opaque, and forms the sclerotic coat, the so-called “white” of the eye. The smaller sphere, which forms the remaining sixth, is transparent, and is formed by the cornea.

The iris is a circular contracting membrane, suspended from the edges of the cornea, in front of the eye like a curtain. The iris gives color to the eye, and when we say that an eye is blue or brown, we mean that is the color of the iris. The iris is freely movable, and, according as to whether it dilates or contracts, there is an alteration in the size of the central aperture, called the pupil.

The chief function of the iris is to regulate the quantity of light admitted to the interior of the eye. In a very strong light the pupil quickly contracts, shutting out the excessive light, while in a subdued light the pupil dilates, thus allowing more light to enter. When looking at a distance or when looking languidly into space, the pupil dilates.

The Formation of the Image.—The eye is a camera, consisting of a series of lenses and media arranged in a dark chamber, the iris serving as a curtain. The object of the apparatus is to form on the retina a distinct image of external objects.

The Mechanism of Accommodation.—In the passive condition of the eye, when it is adjusted for far objects, the anterior surface of the lens is somewhat flattened. Accommodation for near objects consists in a contraction of the circular ciliary muscle and an increase in the convexity of the anterior surface of the crystalline lens.

The light enters the eyeball through the pupil, falls upon the retina, which has often been compared to the sensitive plate of a camera, is received and transmitted by the optic nerve to the visual centers of the brain. The eyeball does not see. It is only a sensitive end-organ, which receives and transmits the impressions to the higher centers of sight. The act of vision is performed in the brain.

The focusing power of the eye is the property of bending nearly parallel rays of light from distant and divergent rays or from close range so that they meet exactly on the sensitive retina; this is called refraction. In the normal eye these rays are focused exactly on the retina.

Optical Defects and their Correction.—In the normal eye the near limit of accommodation is from 4 to 5 inches, and the far limit may be put at an infinite distance.

Myopia or Near-sightedness.—This is one of the most common refractive defects of the eye. In this condition, because of the greater length of the eyeball or increased refractive changes of the media, rays of light from a distance are focused in front of the retina, producing an indistinct image.

The near-point is brought much nearer—from 2 to 2½ inches—and the far limit is at a very short distance.

In reading, the myope is obliged to hold her book very close to the eyes in order to see. In doing so, she strains her muscles of convergence, producing ocular congestion and compression of the eyeball.

The predisposing causes of myopia are heredity; it is said that half of myopics are descended from near-sighted parents; uncorrected astigmatism, and the effort to read very fine print or figures, entails severe strain on the eyes, which may result in myopia.

Myopia is corrected by a concave lens, which diverges the rays of light, prolonging the focal distance, so that the rays of light are focused exactly on the retina.

Not only are myopic eyes not injured by wearing suitable glasses, but, on the contrary, are often preserved from injurious pressure on the globe, due to the indulgence of the habit to nearly close the lids in order to see better, as is commonly done when glasses are not worn.

Hyperopia or Far-sightedness.—In this condition the eyeball is too short, and the rays of light from a distance are focused behind the retina. Instead of being distinct, the image is blurred. Hyperopia is corrected by a convex lens, which converges the rays of light, bringing them sooner to a focus. In the hyperopic eye the near-point of accommodation is at some distance, and a far limit of accommodation practically does not exist.

Presbyopia.—This is a loss of the power of accommodation, by which reading, writing, sewing, and other near work is accomplished. This power of accommodation is greatest in early life, and gradually diminishes until about the age of forty years, when reading at the ordinary distance becomes uncomfortable. At about seventy-five years of age the power of accommodation is practically lost.

Every person over forty-five years, with normal or far-sighted eyes, should wear glasses to perform near work.

Astigmatism.—Astigmatism does not depend on the length of the eyeball, but on the curvature of the cornea, and rarely on that of the lens. Uncorrected astigmatism necessitates the expenditure of more muscular effort in the attempt to see distinctly than is necessary when refraction is normal. This is accompanied by early fatigue and more or less congestion of the vascular tunics of the eye. Astigmatism is corrected by a cylindric lens, which has a plane surface in one axis and a concave surface in the axis at right angles to it.

Fig. 12.—Astigmatic chart.

In simple astigmatism, on looking at the accompanying astigmatic chart with each eye separately, certain lines in the defective meridian seem very much blurred, while those at exact right angles appear clear and black. This furnishes a test for astigmatism, since to the normal eye the lines appear of equal distinctness and clearness. Astigmatism is a very common ocular defect.

The Mechanism of Eye-strain.—Comparatively few eyes are perfect. Far-sighted or astigmatic eyes can secure perfect vision by means of accommodation. By constant strain on the ciliary muscle, the crystalline lens is so increased in curvature as to exactly counterbalance the optical defect of the eyes.

Healthy eyes should do their work without the consciousness of the owner, and this is a safe test as to the kind and amount of work demanded of them.

Perfect rest for the eyes is impossible in the waking state—distant vision represents rest for the eyes and near vision exertion.

Near work is the chief cause of near-sightedness. Distant vision should alternate with near work, and in near work the object should not be brought nearer to the eyes than 12 inches.

The Local Symptoms of Eye-strain.—There may be a sense of fatigue in the eyes after reading for a short time, and this may be followed by a constant sense of discomfort in the eyes, which is increased on using them, and which may be accompanied by severe pain in the back of the head. There is a sensitiveness to light, and inflammation of the eyelids and conjunctiva. There may be twitching of the eyelids, and in extreme cases difficulty in keeping the eyes open on account of drowsiness. The eyes may smart, itch, or burn, and continually “water.”

As the trouble becomes more pronounced, reading for a short time may be followed by a blurring of the type, and finally the lines may run together. There is a constant sense of the eyes feeling for the lines, and, perhaps one of the first things to call attention to the condition of the eyes may be the losing of the lines in reading.

The general or reflex symptom of eye-strain is headache, which frequently takes the form of migraine. This is increased on reading, sewing, riding in the cars, etc. The headache is usually over the region of the temples or just above the eyes, but it may be on the top of the head or at the base of the skull.

Vision is so fundamentally related to all the brain functions that eye-strain, or anything which interferes with normal sight, may cause the most varied disturbances of bodily functions.

The Prevention of Eye-strain.—Persons whose work necessitates much ocular labor should vary their duties with intervals of rest. In continued reading or sewing it is well to desist at short intervals and fix the gaze on some distant object, and to frequently close the lids.

Lace work, very fine needle work, working on black goods, reading very fine print, or print on an inferior quality of paper, or attempting to read in a dim light, are all a severe tax on the eyes, and should be avoided, as they are certain to cause them permanent injury.

Defective vision is so common in school-children, it is so often present without being suspected, and so much harm is done to the eyes and the general health of the individual before it is discovered, that there should be a compulsory law requiring the examination of all school-children; and, again, before boys and girls enter the normal schools and colleges.

Clear vision gives clear judgment; defective vision in its various manifestations gives different warps and bents to the mind of their unfortunate possessors.

Veils.—The wearing of veils is responsible for not a little deterioration of vision, particularly when they are thick or dotted. Unless the meshes of the veil are very large, it holds a layer of impure air close to the face, so that the wearer is breathing vitiated air. It hinders clearness of vision, because the external world is viewed through a narrow lattice.

The best veil for the eyes is one with a single mesh, either without dots, or the dots so far apart that none shall come over the eyes.

Protection of the Eyes from the Glare of the Sun.—In very hot weather the eyes should always be so protected that the rays of the sun do not shine directly into them. This protection may be afforded by the brim of the hat or by a parasol. At the sea-shore, or on an ocean voyage, where the glare of the sun is constant and particularly trying, the eyes should be protected by wearing slightly tinted smoked glasses.

Artificial Lighting.—The main sources of artificial lighting are kerosene, gas, and electricity. The principal questions of importance are the quantity and quality of the light, its steadiness, the vitiation of the atmosphere by the products of combustion, and the expense; also the proper arrangement of the light.

Kerosene is the most extensively used means for artificial lighting. The principal objections are—the heat, the trouble of filling and keeping the lamps in order, and the danger of explosion and fire if upset; the odor and the great vitiation of the atmosphere.

The modern lamp gives a brilliant light, and if properly shaded by a slightly bluish chimney, so as to absorb the excess of yellow rays, it is very satisfactory.

Illuminating gas, as furnished in cities, has a great excess of yellow rays, which are very injurious to the eyes, and the vitiation of the atmosphere is very considerable. Gas-light is modified by the Argand and Bunsen burners. Of these, the Bunsen burner, a patented composition burner, heated to incandescence, is the best. It gives a white light, resembling daylight, and, under proper adjustment, a far greater volume than any other burner. It is not so hot, does not consume as much gas, and so there is less vitiation of the atmosphere. It is intensely brilliant, and must be shaded by ground glass or a proper shade.

Electricity gives the very best light, with a minimum amount of heat and vitiation of the atmosphere. For individual use 16-candle power is sufficient.

The lamp-shade should be opaque, of a dark-green color, and lined with a white, reflecting surface. Transparent lamp-shades, especially when patterned, are always bad, whatever their color; because of the different degree of illumination thrown upon the work, the light is irritating to the eyes.

Hygienic Precautions in Reading and Sewing.—There should be free access of open daylight. Near the window is obviously the best place for working, and the seat should be so selected that the window is to the left of the worker. This prevents the work from being shaded by the hand, and protects the eyes from being fatigued by the light falling directly into them.

Any room will have too much light into which the sun shines directly. Even if the worker’s face is not turned directly toward the sun, yet the light reflected from the book or other work will be so intense as to be dazzling. The softest and most pleasant light to work by is the diffused light from the northern sky. An excess of light may be easily regulated by a shade.

Reading.—Very fine type should always be avoided, it is a very unnecessary strain on the eyes, as are also books printed on a poor quality of paper with improper spacing. The paper should be unglazed.

Length of Line.—The length of the printed line should not be more than 4 inches, nor less than 2¾ inches; that is, not more than 10 or less than 7 centimeters. If the line is too long, the effort to find the succeeding line is too great. If, on the other hand, the line is too short, the lateral movements of the eye are so frequent that the muscles concerned in these movements soon become fatigued.

The position of the reader should be sitting upright, with the back toward the light, which should fall over the left shoulder, and the book held nearly on a level with the eyes. The book should be held at a distance of about 12 inches from the eyes. The light should be on a level with the head or slightly above it. In desk work, a shade should always be worn to protect the eyes.

Reading in the recumbent position is a pernicious habit, and is particularly bad when convalescing from an illness or when very tired.

Reading in carriages or cars is injurious to all eyes, but especially so to myopic eyes; because of the constant jolting, the distance between the type and the eyes is continually changing, necessitating the frequent and abrupt adjustments of accommodation; besides, the illumination is apt to be very poor. Reading in a dim light or the twilight is also very bad for the eyes.

Sewing and embroidery require the most trying ocular labor and the best conditions for illumination. Working on black goods by artificial light should be absolutely forbidden.

Injuries to the Eyes.—The most common injuries to the eyes are the entrance of small particles of dust, cinders, steel filings, etc., into the conjunctival sac, or into the substance of the cornea. Frequently, with the aid of a little winking, the tears wash away these foreign substances, but if the substance lodges in the lining membrane of the upper or lower lid, or is imbedded in the cornea, it may be necessary to resort to other means in order to remove them.

The lining membrane of the lower lid is brought into view by simple tension of the lower lid downward by one finger. If the offending particle is not seen, the upper lid should be averted. This may be easily effected by the fingers alone. The patient is told to look down, the edge of the upper lid and the lashes are seized by the thumb and forefinger of the right hand, and the lid is drawn at first forward and then downward away from the eye, then upward over the point of the thumb or forefinger of the left hand, which is held stationary on the lid and acts as a fulcrum. The foreign body should be removed with the handkerchief, but, if it is imbedded, it may be necessary for a competent physician to remove it.

The habit of opening the eyes when dipping the face into a basin of water, or when diving, produces congestion and inflammation of the conjunctiva.

Symptoms and Treatment of Conjunctivitis.—The eyes may be blood-shot and the lining membranes of the lids intensely red. There is a sense of irritation about the eyes and an intolerance of light, with a constant sense of discomfort. The sensation produced is that of having sand in the eyes. The eyes are heavy, and tire after using them for a short time.

The best treatment for acute conjunctivitis, which is so often caused by the penetration of dust or other foreign bodies into the conjunctival sac, is the application of cold water. A folded handkerchief is wrung out of ice-water and laid on the closed lids. It must be changed every few minutes, so that it shall not become warm; two cloths are necessary. When the acute symptoms have begun to abate, the patient will no longer find these applications grateful, and they must be discontinued.

For chronic conjunctivitis hot applications are the best. For these, one teaspoonful of fine table salt may be dissolved in a pint of hot water, or two teaspoonfuls of boric acid may be used instead; the last named is a mild antiseptic. The boric acid dissolves very slowly, so that it is well to prepare enough in the morning for the entire day. One tablespoonful of boric acid may be put into a quart bottle of hot water, and be well shaken from time to time, until there is a perfect solution.

When ready for use, half a pint may be heated, poured into a tumbler, which is then placed in a basin of hot water; this latter serves as a water-bath to keep the solution in the glass hot. The application should be made with a rather thick wad of absorbent cotton or a piece of fine cheese-cloth. The absorbent cotton should be picked up with all the water it will hold, and be placed over the closed eyes just as hot as can comfortably be borne, and held there until it begins to cool, when the procedure should be repeated. The two eyes can be treated simultaneously. These hot fomentations should be kept up for ten minutes, and be repeated four times a day.

Trachoma.—This malady, of which so much is heard now, is another name for granular conjunctivitis or granular lids. The affection is very contagious. It comes on slowly, and is frequently accompanied by redness and an appreciable degree of secretion in the early stages. Presence of secretion or of interference of the vision should always attract attention.

Strict precautions must be taken that the patient’s handkerchief, towel, and wash-basin are not used by other members of the family. Further, the other members of the family should bathe their eyes several times a day with a solution of boric acid.

Styes.—Styes are a very painful species of small boils that generally form on the edges of the eyelids. They are apt to appear in succession. Certain persons are liable to them if the system is run down from general causes. Like boils in other parts of the body, they give evidence of impaired nutrition.

Hot fomentations of boric acid solution will sometimes abort them if used early. If pus has formed, the stye must be opened by an incision parallel to the edge of the lid. This should not be attempted by any one except a physician.

Color-blindness.—As a rule, about 4 per cent. of males and about one-half of 1 per cent. of females are color-blind. The part of the color sense that is most often deficient is that for green and red.

Cataract.—This is a disease in which the crystalline lens or its capsule, or both, lose their transparency and become opaque. Eventually total blindness is the result. Senile cataracts appear after the forty-eighth year. The only remedy for the disease is the surgeon’s knife.

Functional Nervous Disorders.—Evidences of sound health are: first, individual adaptability or capacity of the individual to easily adapt herself to extremely opposite conditions of existence; second, endurance, or the capacity to do a considerable amount of mental work for a short time without suffering fatigue, or to be able to quickly recover from the fatigue; third, to be able to control the emotions; fourth, to be able to resist morbific influence; that is, the capacity on the part of sound organs of excretion to quickly eliminate all poisons from the system.

The signs of debility are just the reverse: first, deformity, obesity, or leanness; second, personal inadaptability, that is, when physical or mental discomfort is caused by such slight provocations as change of food, clothing, or climate; third, lack of endurance, so that a long rest is required to repair the fatigue incident to slight exertion; fourth, lack of control of the emotions; fifth, a proclivity to morbific influences, so that the individual succumbs to every contagion or miasm that she encounters.

Nervousness is a disease of civilization, coupled with overwork and indoor life. The more complex the environment in which the individual finds herself, and to which she must adjust herself, the greater the demands made on the nervous system.

The extreme dryness of our climate, together with the great variations of temperature between winter and summer and the rapid fluctuations of temperature, predisposes to nervous disorders.

Headache.—Headache is a symptom rather than a disease, but there is no symptom which requires more careful investigation of its cause than that of headache. It occurs at all ages, but is most common from ten to twenty-five years and from thirty-five to forty-five years. Women suffer from headache more than men, in the proportion of about three to one. Headaches are most common in the spring and fall of the year and in the temperate climates.

Causes of Headache.—These may be classified into those in which the blood is at fault; reflex causes; various nervous disorders; and organic diseases.

The blood may be impoverished, as in the case of anemia, where there is a deficiency in hemoglobin; but by far the most frequent cause of headache is where the blood is disordered, as in gout, rheumatism, kidney diseases, diabetes, and the infectious fevers and malaria.

Among the more common reflex causes are eye-strain, especially errors of refraction; disorders of digestion, particularly constipation; and pelvic disorders, as in inflammation of the pelvic viscera.

Functional diseases of the nervous system causing headache are overwork, neurasthenia, hysteria, epilepsy, and neuritis.

Among the most common of the organic diseases is arteriosclerosis; other diseases are meningitis and brain tumors.

Symptoms.—The pain is often dull in character and rendered worse by stooping; the location of the pain depends on the cause of the headache. The most common variety is over the forehead or eyes. In eye-strain the pain may either be in the front or back of the head. In indigestion, the pain is most frequently over the eyes, but it may also be on the top of the head. In anemia the pain may be either frontal or diffuse. In pelvic disorders the pain is generally at the base of the brain, though it is sometimes in the top of the head.

Neuralgic headaches are generally characterized by sharp paroxysmal attacks, located in the temporal regions, and associated with pain in other parts of the body. It is perhaps most frequently caused by anemia.

In hysteria the headaches are characterized by a circumscribed pain—it has been likened to the driving of a nail into the head.

In migraine the pain is paroxysmal and intensely severe; it is frequently caused by some poison in the blood, as in autointoxication, due to failure of proper regulation of the bowels, also by pelvic disorders.

Treatment.—The treatment is constitutional, and is based on the removal of the cause. First, there should be a regulation of the diet, a free evacuation of the bowels, and their proper regulation. In every case of headache there should be an examination of the urine. Often there is some congestion of the kidneys where it is least suspected. If the headache is persistently made worse by reading or sewing, the patient should be referred to a competent oculist. An inquiry should always be made into the condition of the menstrual function, backache, and leukorrhea. Any marked disorders here will necessitate a gynecologic examination.

For the immediate relief of migraine, the patient should go at once to bed and drink a glass of hot water; sometimes a cup of hot tea gives great relief. No food should be taken for from six to twelve hours, according to the severity of the case. The room must be kept dark and quiet and the head high.

A strip of prepared mustard leaf, 5 inches wide by 8 inches long, should be cut, and a piece of cheese-cloth, 6 or 8 layers thick, should be folded the same size. The cheese-cloth is then wrung out of hot water, and the mustard leaf is quickly dipped into the same. The cheese-cloth is placed on the back of the neck, between it and the mustard leaf. The clothes should be kept dry by a folded napkin. In this way the mustard may be kept on from six to eight minutes, until it begins to burn and the skin get red. If left on too long, the mustard may produce the most painful kind of a blister. When taken off the neck, the mustard may be put on over the stomach.

The medicinal treatment must be directed by the physician, but a perfectly safe prescription, and one which may be kept on hand, is the following: Take of sodium bromid, 15 grains; of essence of peppermint, 10 drops; and of water a sufficient quantity to make 1 dram. Mix well. The dose may be repeated in three hours if necessary. This prescription should be put up by a good druggist, in a three-ounce quantity. Sometimes relief is afforded by 1 teaspoonful of the aromatic spirits of ammonia, taken in four tablespoonfuls of water, and this is about the right quantity of water to take any liquid medicine in. At night 2 grains of calomel should be taken, so that the patient shall not be disturbed through the night, and it is not so apt to cause nausea as when taken through the day.

Neurasthenia or Nervous Prostration.—This disease first saw light in the United States, and was christened by Beard as an American disease that was absent from no household in which the inhabitants used their brains. It is certainly much more prevalent in this than in any other country. Americans scarcely treat their bodies with more consideration than their automobiles; they put on high pressure and speed them to the utmost. Add to the high pressure under which we live that other fact of heredity, that many persons are born with unstable nerve-cells, and may be nervously bankrupt, and it is not difficult to understand that 50 per cent. of Americans are suffering in some degree from lowered nerve tone.

Causes of Neurasthenia.—All classes of men and women who use their brains severely, and who have seasons of excessive anxiety and responsibility, are subject to neurasthenia. We have seen that fatigue was caused by the accumulations of toxins in the body, due to muscular activity, but these toxins may also be caused by intellectual overwork or anxiety over domestic or business affairs.

Other causes are the intemperate amount of intellectual work which is forced on the brain, and the excessive indulgence of the emotions and the passions. Combined with the strenuousness of life is the large element of uncertainty, the intense anxiety, and the restless energy which is the price of success. Added to these may be lack of suitable and sufficient recreation and short hours of restless sleep; the restrictions of a narrow lot, loneliness, and isolation, the frequent repetitions of uninteresting tasks, added to the burdens of maternity, domestic cares, and worries.

In cities the ear-strain caused by the incessant noises of the street, the amount of work done by insufficient and improper lighting, the unsanitary mode of life, the improper diet, the monotonous and infertile work, the unhappiness and discontent bred of a life of idleness, or one given to society and gambling, whether bridge, whist or poker, the senseless bolstering of shattered nerves with alcoholic stimulants and beverages, patent medicines, and hypnotics, all add their quota to the breaking down of the nervous system.

A man can do a prodigious amount of work if he only varies it with play which really amuses him, or if he substitutes for mental occupation those which involve bodily exercises.

In so-called latent gout insomnia is a frequent symptom, or insomnia may develop as the result of bad nervous habits. Insomnia from whatever cause is followed by the impairment of nerve substance and an overloading of the body with toxins. This continued nerve exhaustion leads to oxaluria, uric acid, gout, anemia, gastric and intestinal dyspepsia, muscular insufficiency, and precordial distress.

Whatever enfeebles the body by overtaxing the nervous system the waste is in excess of the repair, in all overwork the destructive metamorphosis is greater than the reparative processes, and so there is an accumulation of toxic products and a more or less severe and permanent injury is done the nervous system.

Other causes of neurasthenia, not so generally recognized as overwork, are to be found in the pathologic conditions of the intestinal canal, which becomes a veritable culture tube, and absorption from this into the blood constantly takes place. And this condition of putrefaction has to be overcome before relief can be afforded, and in many cases this condition is associated with an insufficiency of the elimination of urine.

The large intestine is the seat of an enormous bacteriologic flora; they are not there by millions, but by billions. Some of them are harmless, but not all of them, and if these pathogenic bacteria are present in sufficient quantity, they, too, may produce symptoms of mild poisoning. So, too, may mere indigestion, or the malfunction of any other organ, torpidity of the liver, a deficiency of the excretion of bile, which is generally accompanied by constipation.

The Symptoms of Neurasthenia.—The symptoms are essentially those of chronic fatigue, which has become exaggerated and pathologic. They may be classified as sensory, motor, psychic, and somatic. The sensory symptoms first noticed are those of generalized fatigue, with such localized sensations as headache, backache, and limbache. The motor symptoms are muscular fatigue, muscular weakness, and muscular exhaustion on slight exertion. The psychic symptoms are manifested by a diminution in the capacity for sustained mental effort and the spontaneity of thought and exhaustion after slight mental effort. The somatic symptoms show themselves in atony of the digestive tract and the circulatory apparatus, with disturbances of the secretions.

Headache is one of the most common symptoms of localized fatigue, and, associated with this, may be a sense of constriction about the head, and there may be either a sense of lightness or fulness of the head.

A woman who is chronically tired loses all her personal vigor, force, aggressiveness, and, above all, will power. Associated with this lack of will power are hesitation, indecision, a marked irritability, and timidity. Neurasthenic patients are subject to spontaneous attacks of fear, causeless in origin, and generalized in character. These attacks may be accompanied by pallor of the face and palpitation of the heart, just as in normal fear. The tired woman is a cross woman. The irritability shows marked impairment of the power of inhibition.

The Rational Treatment of Neurasthenia.—First of all, there must be a removal of the cause which has produced it. There are two distinct classes of cases—the overworked and the idle. The first class, and the most important to the world, are the overworked. We may have to deal with the intellectually overworked, in which the mental overwork was combined with financial anxieties, domestic difficulties, or lack of success in their work, or the cause may have been the tremendous responsibilities of their positions, which involved the lives or fortunes of many people. Added to this great strain and overwork, has been a lack of proper intervals for rest, recreation, and sleep, and the body has become a storehouse for various toxins, and so is suffering from both acute and chronic poisoning.

This class of patients must have the most rigid rest treatment, such as was prescribed by Weir Mitchell years ago. It is most important that the patient should be removed from her old surroundings; if this is not possible, she should be isolated on the top floor of the house with a good nurse. The room selected must be bright and cheerful, with plenty of sunshine and fresh air; a window should be open practically all the time, for oxygen and sunshine are two of the best restoratives. The diet must be easily digested and very nutritious. The patient should be urged not to use her mind at all. Carefully selected short stories may be read aloud by the nurse; the reading should not be continued for more than half an hour at a time.

A great deal may be done to eliminate these toxins from the system by the proper use of electric-light baths, followed by the shampoo and the percussion douche; massage with salt water, salt rubs, and electricity.

In most cases a month of this absolute rest is as long as is beneficial to the patient. And for most of them the sea-shore is the best. There should be enough going on to be diverting without being overtaxing, and a climate should be selected which is warm enough for the patient to live out-of-doors. There should be short walks, drives, sails, etc., and this outdoor life, with a contemplation of nature, is the most powerful restorative. The grandeur of nature, whether it is the mighty forests, with their refreshing shade and quiet, or even stretched in a hammock watching the sky and trees, or the constant surging of the vast sea, bringing rest in its unceasing restlessness, with the ships sailing lazily along, until the whole fades away in the distant horizon. In the vastness of the universe, the ego becomes contemptibly unimportant and insignificant.

After several months spent in this way the body has gotten rid of its toxins, nerves and muscles are rested, and through the soothing influence of nature the neurasthenic is gradually trained back to a healthier habit of thought and a more rational frame of mind. There is substituted for the morbid emotional complex a feeling of pleasure and energy. Reason and judgment reassert their sway; outdoor life quickens the perceptions, and forms tranquilizing memory pictures on the brain that return later to solace and refresh the individual.

There is another, and a very large class, of cases among women of leisure who have suffered all their lives from a lack of a vocation; they have nothing to think of except themselves. They do not know what it is to be quite well; they travel from one part of the country to another, and from one country to another, but they never rise above a certain level of invalidism. They are self centered, and what they need is the work cure. In the majority of cases, before these patients can be restored to health, powerful habits must be eradicated, new interests in others must be supplied to supplant the most intense egotism, new paths must be hewn out in the brain, the will must be recreated, and character can only be imparted by those who possess it.

CHAPTER VII
THE HYGIENE OF THE MIND AND ITS RELATION TO THE PHYSICAL HEALTH

Heredity; Temperament; Social Instincts; Fear.

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

The Environment; the Choice of Friends; Literature.

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

The solidarity of brain and mind is an axiom of modern medicine, and it is a fundamental principle that must be kept constantly in view in all physical and mental training. Hitherto unsoundness, inefficiency, and weakness of mind have only been lightly touched upon in preventive medicine, but the importance of the mind as the chief factor in health and disease is so paramount that it can no longer be ignored.

The problems that present themselves to the mother and the educator to-day are practically the same, and the mother is one of the most potent educators that we have—how the mind can best be strengthened, broadened, and be made the most efficient working instrument possible through the application of modern scientific and physiologic knowledge. These are questions of vital importance to the human race.

Heredity.—Holmes says: “Each one of us is only the footing up of a double column of figures that goes back to the first pair. Every unit tells, and some of them are plus and some of them are minus. We are mainly nothing but the answer to a long sum in addition and subtraction. Slight obliquities are what we most have to do with in education.”

There are certain hereditary predispositions that will develop under certain conditions; some of them are good, some are evil; that is, with the natural development of the mind, certain peculiarities of the ancestors will be reproduced. The problems suggested are how the mind can best be developed, educated, and trained, so that hereditary weaknesses may be counteracted or held in abeyance, and that latent hereditary talents may be discovered and developed.

The first proposition that we have to face is that like produces like. There are modes of education, of conduct in life, and of occupation that should be avoided where a boy or girl is handicapped by a bad heredity. There are special precautions and attention to physiologic laws which would save the minds of many young men and women with a bad heredity from passing into a state of inefficiency and actual disease. Heredity implies only potentiality toward good or evil, and the latter may be averted by knowledge and the proper practice.

Temperament.—This comprises the general make up of the individual, the shape of the head, the appearance of the eyes, the mobility of the features, the texture of the hair and skin, and the kind of movement. The recognition of the kind of temperament, and a suitable training for its best development, is of the greatest importance in attaining good health and success in life.

There are four general types of temperaments—the nervous, the phlegmatic, the arthritic, and the scrofulous or lymphatic.

The nervous temperament has certain marked characteristics, as the small, wiry figure, the well-shaped head, the bright, restless eye, nervous bearing, highly strung and sensitive nerves, feeling pain keenly and bearing it badly. This woman is imaginative, sensitive, fond of intellectual work, often artistic and ambitious. In her the brain and mind are dominant above all else. When run down, this woman will be difficult to bring up again to the normal level. She will grow thin, dyspeptic, irritable, and often neuralgic. She will be peculiarly liable to nervous disorders.

This temperament has its special temptations—alcohol and sedative drugs are two of them. Alcohol is not taken steadily or for social reasons, but for the effect of alcohol on the brain, and there is the greatest danger of becoming addicted to alcoholic habits, and finally of becoming an uncontrollable dipsomaniac.

The phlegmatic or bilious temperament relates more to the training of the body, since in this class of cases the mind is not exposed to the same dangers, but the oversanguine temperament has its own dangers, which may lead to lack of effort, speculation, and financial ruin.

The arthritic have a predisposition to both rheumatism and gouty disorders, to which they are distinctly more liable than others, and the fact that there is this latent tendency should be taken into consideration during childhood and youth.

Social Instincts.—Social instincts lie at the foundation on which the family and community is based. It may be said that any individual who is destitute of them is in an abnormal condition, hence a right training of the social instincts is, beyond doubt, one of the most important means of securing happiness to the individual and order to society. The child’s or youth’s relation to others, her affection for others, and her altruistic practices, all go for the making of society, good citizenship, and patriotism in the race.

At the school age the social instincts are one of the strongest elements in life, and one of the most powerful adjuncts in developing mind and body. The cravings of young women for social amenities are stronger, and her deprivation of them more hurtful, than in the case of young men. There are few girls in whom it does not require some regulation. The strain of too much social life is injurious; social dissipation cannot be combined with school life without wrecking the health of the young woman; nervousness, anemia, and mental depression follow.

That individual cannot be said to be healthy mentally whose social instincts are poor and perverted. Commonly one of the first symptoms of a disordered mind is the diminution of the social instinct. The insane are notoriously asocial.

Fear.—This is one of the most elemental and primitive of the emotions. Biologists assure us that fear and surprise were the first of the emotions to be developed, and that the feeling of the ludicrous was the last. Darwin says that the earthworm knows fear, and darts into its burrow like a rabbit when alarmed. So we see that fear is common to all forms of animal existence, even to the lowest. This universality of fear has come about through the working of the laws of natural selection, which prescribe that only those creatures shall survive that can best adjust themselves to their environment. Within limits, fear as a primary instinct has been and is eminently useful. It is the cry of alarm raised by the senses which act as guardians of the body, and, at a signal, in virtue of the nervous automatism, the organism is put in a position of defense. On the other hand, fear may serve to paralyze, as has been observed in the case of birds, many of which, though scarcely wounded by the small shot, fall to the ground as if struck by lightning, panting with wide-open eyes. In human life, while fear incites to activity, it may also paralyze that activity.

Mosso says that the fear that young children have of cats and dogs, before they have learned why they are to be feared, is a consequence of heredity. We are born to a heritage of fear. If we fear ghosts and demons less, we fear microbes and bacteria more. The professional or business man fears failure, but fear should be a guardian, not a jailer. A healthy fear of indigence will lead to thrift, industry, and such measures as will secure one’s personal independence. Up to a certain point, fear is a protection, but beyond that it paralyzes.

Mental Development.—We note that at birth the brain is mindless, and that the brain-cells, which are the vehicle of the mind, undergo their greatest development during childhood from stimuli coming from without the body. The brain-cells possess infinite possibilities and potentialities. They are developed from the stimuli from without through the eyes, ears, touch, taste, and smell. There is another series of constant impressions which are received from within the body, and these come from the muscles.

These impressions, conveyed to the brain-cells from the body, and from the outer world beyond the body, leave a fixed registration, the writing on the brain-cells has begun, and this constitutes memory; and the imprint on these cells is similar to that which type leaves of letters and words on the page of the printed book. These printed impressions on the cells can be revived and seen and heard by the mental consciousness, just as a printed book can be opened and seen and read by its owner.

The natural qualities of the mind are imitation, acquisitiveness, emotionalism, and imagination.

The force of example in the home, at school, and in the book world is among the most potent influences in molding character. The young girl instinctively imitates her mother, her friends in real life, and in her book world, and the woman will be the composite production, combining traits of all of these, which will be ingrafted on the ancestral traits which have been inherited.

In young children it is difficult to decide where the imagination leaves off and the spirit of untruthfulness begins. In any case, the tendency to exaggeration and untruthfulness are so prevalent in childhood that it must be checked at the earliest signs of its appearance. The vice becomes so deep rooted that it affects the mind in all its workings and the entire life as well. It follows men and women into their business careers, their scientific life, and their professions.

Professor Swift, in a very interesting study of the development of the mind, invokes the aid of biology to show that all children are but little animals, having no inborn notions of right and wrong, inheriting no sense of justice; savage, by nature, and predatory by instinct.

He finds a psychic justification for fighting among boys. “Fighting in some form,” he says, “is one of the first means by which the mind becomes accustomed to intense action. To fight well, a boy must be capable of severe concentration of attention.”

And he has found the age at which boys come to think that laws and the recognized rules of right conduct should be voluntarily respected varies from fifteen to seventeen years and older. These figures are approximately correct for girls.

Absolute truthfulness, square dealing, honesty, honor, and an esprit de corps should be demanded. Hitherto these principles have not been sufficiently inculcated in girls as the fundamental principles on which life must be met. The discipline has been too lax in the home and in the school; it is that of implicit and prompt obedience on the word of command; the proper subjection to and respect for those placed in authority; the kind of discipline given in business life, the hospital, and the army, and the lack of which has cost so much happiness and so many thousands of lives.

Self-control.—The perfect capacity for self-control in all directions and at all times is the ideal state at which we aim. It is the standard aimed at by developing the power of the will and the strength of inhibition. The great difficulties, the magnitude of the task, may be conceived of from the saying of the wisest of all men: “He who conquers his own spirit is greater than he who taketh a city.” The reason is plainly evident—all the hardest battles of life must be fought out alone, there is a feeling of isolation, as if one were struggling alone against the combined forces of the universe, and, at the same time, there is going on the struggle for the mastery between the two conflicting natures, “When I would do good, evil is present with me.” Whereas, in concerted action there is a feeling of sympathy, of reinforcement from outside help, and the pleasant stimulation of competition.

If youth were taught that certain enemies were going to present themselves on the field, that they come for the most part in the first instance single handed, and if grappled with one at a time, and the contest between right, and perhaps inclination, be then and there fought to a finish, each successive time the conflict would be easier and the victory more certain; that in losing such a battle there must always be a certain loss of self-respect, a feeling of moral weakness, it may be even so slight a fault as the exaggeration of facts; while, on the other hand, a victory always gives something of the same feeling of exultation that one has in any fairly won contest or game. A feeling of pleasurable superiority, of having one’s self well in hand. In the moral habits every gain on the wrong side undoes the effects of many conquests on the right. The training of the will becomes the most vital of all problems. Nothing that is learned in youth is really so valuable as the power and habit of self-restraint, of self-sacrifice, of energetic, continuous, and concentrated effort.

The Moral Sense.—From fifteen to twenty-five years of age is the most crucial period of life in regard to the hygiene of the mind. It is during this period that the brain first exhibits some of its strongest hereditary tendencies. While such mental factors in human life as conduct and character are being consolidated, as they now are, hereditary predispositions manifest themselves, telling for good or evil, for success or failure.

The acquisitions then made are critical in the extreme and often final. The real love of right, hatred of wrong, duty, conscience, religion, become solid and effective in forming character.

The emotional nature instinctively shows a leaning toward the opposite sex; love between the sexes toward the close of adolescence is the most intense and most unreasoning of human passions. The sense of right, wrong, and duty become active principles, dominating the character. There are yearnings after the ideal, an intense scorn of and hatred of evil. The purposes in life are then shaped. The impressions and resolutions then formed affect the whole tenor of the woman’s life, as a rule, more than at any other time.

The capacity to feel pleasure reaches its greatest intensity. The sex relations are built up on safe and natural lines, regulated by family life, social feelings, and the carrying of the thoughts and the emotions into other channels, controlled by certain instinctive natural tendencies, by morality and religion. To think and feel properly should mean to act rightly as a physiologic corollary.

Music, literature, and art, imaginative works of all sorts, mix themselves up with the sex feeling, so that the two help to form the emotional nature. Far-away glimpses of poetic feeling, pleasurable altruism, citizenship, and patriotism show themselves in the earlier stages and give direction to life in the later. The whole period is one of immense importance for the health and happiness of the remainder of life, and the risks to the body and mind are then very great. A fact which is of great importance, and which is especially true of adolescence, is that it is possible by undue pressure to use up stores of energy that should have been spread out over very long periods. Through such overexertion in study or in games too heavy a drain is made on futurity, and mental disorders at this time are by no means infrequent, mental depression being generally the first to appear. This is more especially true in the descendants of neurotic families. The subjects are troubled with neuralgias, insomnias, and there is a pessimistic view taken of life.

The Religious Instincts.—Möbius says, “We reckon the downfall of religion as one of the causes of mental and nervous diseases. Religion is essentially a comforter. It builds for the man, who stands amid the evil and misery of the world, another and fairer world. Besides his daily careful life, it lets him lead a second and purer life. The consciousness of being within the hand of Providence, and the confident hope of a future redemption, is a support to the believer in his work and care, for which unbelief has no compensation. Meditation calms and refreshes him like a healing bath. Worship breaks in upon the daily drudgery of his days with rest and meeting.” The morality of a nation suffers most severely through the downfall of its religion, as experience has always and everywhere proved.

The religious instinct has a very close relation to the emotions, morals, esthetic feelings, to social instinct, and to sex. The feelings of reverence and awe, and the consciousness of the infinite in man are vague, but are the most powerful parts of his nature.

Religion furnishes the only pure ideals that half of the world has access to. It has proved an intellectual stimulus, and roused a metaphysical frame of mind in some of the most vigorous nations, such as the German and Scotch. It leads more toward refinement of life than any other agency. It stimulates the benevolent and altruistic feelings, and leads to their practical demonstrations; it fights vice and immorality; it seizes on the best that is in man and transforms the character.

The Advantages of College Life.—College life is of the greatest possible advantage to girls in many ways: it is broadening to the mind; discipline is maintained, and, at the same time, the girl is thrown on her own resources; adequate means are provided for developing both mind and body to their greatest capacity.

Whether the girl comes from the country, a country town or city, her social group is comparatively limited; her world is very little and the ego is very large. The discipline that any large body of students bring to bear on the conduct and behavior of the individual is one of the important advantages of a college training. The insignificance of the ego, who is only a unit in this large community, is quickly impressed on the gray matter of the brain, and the rough and unpleasant angles are soon smoothed off. This, in addition to the discipline afforded by the college officers, and the total lack of discipline is the weakest point in the average girl’s education. To be brought into intimate relation with the members of a large and educated community is in itself a liberal education. To learn to respect the rights and the opinions of others, to perceive that any given subject has a great number of points of view, is attaining toward a healthy mental balance that will make the woman broader minded, more sympathetic, more companionable, and more charitable in her views of life.

In addition to the regular college curriculum are the opportunities afforded, not only to special students, but to the entire body of students, for a liberal education in music and art, and so a broad foundation for general culture is laid that will greatly increase the opportunities for pleasure all through life.

So that, in addition to the actual knowledge acquired by a college education, there are also the advantages of the discipline of and development of mind and body; the knowledge of how and what is worth while to study; the power to study and solve life’s greatest problems for herself and those dependent on her; the firm muscles, the clear brain, the steady nerves, the power of judgment, the control of the will, and the formation of character—on all of which the ultimate happiness and success in life depend.

Dr. Beard gives to brain workers a value of life of fourteen years above the average. The brain-working classes are less apt to worry, less apprehensive of indefinite evils, and less disposed to magnify minute trials than those who live by the labor of their hands.

Spinoza says that every advance toward perfection gives us happiness, and it is safe to say that the buoyancy which characterizes contemporary thought, the hopeful outlook amidst the dangers which threaten us, the sense of the added cubit to the man’s stature, are due largely to the recognition of the power for good within his soul of which he was not formerly aware.

Balance of the Mental Faculties.—There must exist a certain balance between the various faculties of the brain in order to insure sanity. A high order of intelligence without much will, or keen emotions without a corresponding power of inhibition, and overmastering will and slight moral sense, vivid imagination without common sense, intense social instinct without much conscience, fervid religious instinct without much sense of duty or altruism, must invariably produce one-sided and unbalanced individuals, and the results would be bad for society; and too many of these one-sided or unbalanced people would impair if not endanger the safety of the State.

Excessive ambition, misdirected energy, longing for the unattainable, regret for the unalterable, anticipation of future unhappiness, lack of a sense of perspective, fretting over non-essentials, indecision, reopening of troublesome questions already settled, avarice, selfishness, excessive emotions, uncontrolled passions, and the actual cultivation of the melancholic state are some of the causes of mental anguish and subsequent physical suffering.

Well-balanced mental faculties give a philosophic view of life; guard the mental and hold the emotional in check; grasp the true relationships in life, and view it in the proper perspective.

The Effect of the Higher Education of Women.—Nothing is so convincing as actual experience and statistics;[5] and nothing is so broadening to the mind as the study of history.

Never before in the history of the human race has any such large body of young women been given the educational advantages for the development of body and mind which they enjoy to-day. From antiquity there have been exceptional women, who were highly educated and cultured, as in Alexandria, Athens, and in the old European universities, but up to the present day any tendency toward the education of the masses of women has been looked at askance, and in this respect the position of the people of the United States was long peculiarly provincial.

To two men belong the great credit and honor of conceiving the idea of a liberal college education, and a medical college training, for women in this country.

In 1865 Mathew Vassar, “having recognized in woman the same intellectual constitution as in man,” founded a college for women only, and thus gave women the opportunity for the same education that young men enjoyed at their colleges.

In 1850 the Woman’s Medical College of Pennsylvania was incorporated. The idea of establishing a college for the medical education of women originated with Dr. Bartholomew Fussel, of Chester County. The query arose in his mind, “Why should women not have the same opportunities in life as men?”

Just how strong the public sentiment was against these movements, and the leaders of the opposition comprised the most prominent educators and physicians of the day, and what impediments they placed in the way, it is now difficult to realize.

The opponents of the higher education of women urged three final objections: First, women were mentally incapable of receiving the same kind of intellectual education as was given to young men at college. Second, they lacked the physical endurance to bear the strain of mental work. And, third, such an education would render the young woman masculine—she would no longer be willing to look after the ways of her house, her natural affections and power to love would vanish, she would become unwilling to marry and bear children.

Ex-President Eliot, of Harvard University, who has so long been the great educational leader in this country, in his paper on “The Higher Education of Women,” says: “During the past thirty-five years three distinct apprehensions concerning the effect of the higher education of women seem to me to have been removed. In the first place, there was a perfectly sincere doubt (because there was little experience to go upon) whether young women were so capable as young men of receiving what was then called the higher education; or, in other words, whether the young woman had the capacity to master by study the traditional subjects of the higher education. That doubt has been completely removed.

“Secondly, it was feared that if the young women studied in the colleges three or four years, beginning at about eighteen years of age, that such study would have serious effect on their health and on their fitness for their natural functions in after-life. This apprehension was felt by many physicians and was warmly expressed. For a whole generation we have been trying the experiment, and the result is perfectly clear. These apprehensions have not been justified. It is apparent that young women can do much mental work for three or four years between the age of eighteen and twenty-two, not only without impairing their physical vigor, but all the time improving it, if they live wisely and under right conditions.

“And thirdly, there was the strong apprehension felt by many excellent people, lest in the process of the higher education young women would be denatured. They admitted that young men were not denatured in any way by the higher education at college, but they thought that there was a serious chance that young women would be altered in their feminine nature by the process of education. It has turned out that a young woman who studies in college, from the age of eighteen to twenty-two, is no more altered in her nature than a young man is who goes through a similar process. It takes a great deal more than that to alter the nature of a woman.

“I suppose that this apprehension was based on the fact that women seem, to men at least, more tender, fragile, and delicate than men, and, therefore, more liable to be bruised or coarsened than men; it was feared that the kind of public life, so to speak, in large groups would have some tendency to deprive them of their natural delicacy, refinement, and tenderness. It has not turned out so, and everybody recognizes that it has not turned out so.”

When higher education, the professions, and industrial pursuits are all unquestioningly thrown open to women, then it can be reasonably supposed that they will come to possess those traits of mind—judicial, logical, creative, etc., now generally considered as masculine traits, and they will not only be more attractive and companionable for their husbands, but will be far more competent teachers for their children, their enlarged range of thought and vision inspiring greater confidence in their sons, and stimulating higher ideals in both sons and daughters.

The Environment.—As we have seen, the brain registers every impression from within and from without; if the impressions are those of discomfort, gloom, darkness, ugliness, those things, being inharmonious to the constitutional working of the brain, do harm and tend to set up bad habits. First, the body must be healthy, and the environment good in order to insure a healthy, vigorous mentality. Too much thought and care cannot be given to the environment of the child, youth, and adult.

Careful attention must be given to the toilet. The quality and condition of the underlinen, the cut and fit of the clothes, all tell on the mind. It has been said that a man tries to live up to his clothes; hence, the uniform of the soldier and the cassock of the priest. Clothes are not only an index of the character, but they help to make it. The clothing that comes into intimate contact with our bodies has a soothing or irritating effect upon the mind. It has also been said that for a woman to know that she was properly dressed had a soothing influence on the mind, second only to that of religion itself.

In the evening, laying aside the business suit of the day with all the anxieties and dust of toil, and replacing it by a tasteful house-gown, brings a sense of freshness that brightens the mind and stimulates the appetite. The clothing should always be suitable to the employment, to the purse, and to the surroundings, or good taste is violated, and, again there is an unhealthy reaction on the mind.

To live in a gloomy house, with a dull ugly wall-papers, and no sunshine entering the room, may produce in their inhabitants want of appetite, interfere with nutrition, make them gloomy, unhappy, and hard to live with. While esthetic surroundings render life happier, brighter, and higher.

If one cannot afford expensive paintings to hang on her walls, she can select photographs of the old masters, neatly framed, which, placed in harmonious surroundings, elevate the mind, cause a love of the beautiful, develop the taste, and lay the foundation for a broad culture that will increase the enjoyment of nature as well as of art.

The Choice of Friends.—We have seen that the impressions conveyed to the brain-cells leave a fixed registration and are indelibly stamped there. These may be called the sensitive plates of the mind, and it is because of this writing on the brain that the selection of our friends and associates is a matter of such vital importance.

The subconscious mind, of which we hear so much to-day, does not originate thought; it can only elaborate and develop it, and the most important fact which has as yet been discovered in regard to the subconscious mind is that it is suggestible; that is, it is subject to moral influence and direction. A few words of commendation and praise brighten the whole day; if we can forget our pain for a little while, it is apt to cease.

All our greatest intellectual leaders, from time immemorial, have been unanimous in their teachings that one of the most important elements in the molding of the mind and character was the nature of our friendships. Tennyson says, “I am a part of all that I have met.” “A man’s friendships shape his life more than aught else, or more than all else.” The immortal bard puts it, “It is certain that either wise bearing or ignorant carriage is caught, as men take disease of one another; therefore, let men take heed of their company.” And again, “’Tis meet that noble minds keep ever with their like, for who so firm that cannot be seduced?”

Certain requirements and standards should be met, and the girl or woman should be sure that the individual, whether man or woman, comes up to the standards of her own clan.

A friend should be congenial, with similar tastes, opportunities, and training; frank in criticism, yet sympathetic in spirit; loyal and staunch in adversity, and one who disseminates an atmosphere which is broadening, elevating, and uplifting. Such a friend is to be desired and to be sought after.

Literature.—Not one of the least of the great molding influences on the mind and the social life of to-day is its literature, and the form of this which reaches the greatest masses of the people are the daily press, the literary magazines, and the modern novel. It is scarcely possible for the young to conceive the great impression which is made on the mind and character by the kind of books which they read. Carlyle said, “We cannot look however imperfectly upon a great man without gaining something from him.” And to this statement might well be added, it is impossible for the mind to be brought into intimate contact with the lives of dissolute men and women, so vividly portrayed in many of the novels of the day, without being smirched by it. It is no more safe to read such a class of books, hoping to escape contamination, than it would be to live in the malarial districts of Africa, and hope to escape contracting that insidious disease.

However limited the geniuses may be in our immediate circle of friends, each of us may have for her most intimate friends the greatest geniuses the world has ever known, and have them at their best.

Two axioms should always be kept in mind—a real love for books is formed in early life or not at all, and to have books for friends one must own them, have them on her own shelves, to take down and put up at will, to mark, to compare, and study. So whatever else one lacks, she should always have her own library, even if it is a limited one.

Next in importance to the recognition of good reading must necessarily be a recognition of the limitations of one’s reading. Whether in the capacity of student, housewife, mother, or business woman, the time that can be devoted to general literature is very limited.

A careful study of history and biography should always precede fiction. It is a fundamental part of a liberal education to know something of the world’s history, and the history of the English nation, as well as the biographies of the men and women who were such important factors in making its various epochs.

This should be followed by a study of the classics, and that education has not been liberal which has not included a study of the modern classics. German literature opens up a new and delightful world. A study of the classics forms the taste, elevates the mind, broadens the vision and the power of judgment, and it is a profound help in the formation of character. After such reading as this, who would be willing to spend her time on the cheap and trashy novels of the day.

Good modern fiction should be taken up as a recreation by the woman whose life is laborious, its questions perplexing, and its complications tiresome; in other words, after the woman has left the high-school or college and has entered on her life’s vocation. For young girls, not only is too much time apt to be given to fiction which should be devoted to other and more important matters, but it is apt to do much harm by giving them a wrong impression of life.

The Power of the Will or Inhibition.—The conduct of mankind is chiefly governed by the emotions, instincts, and impulses. Spencer traces all human action to the desire for pleasure in the large and philosophic sense of the term. If this be so, then the education and hygiene of the emotions and impulses must be of the very highest importance in the life of each individual and in the social world. The question arises, and it is all important, can those inhibitory centers be so developed in youth, and so cultivated in life, that they can act as antagonists to what is morbid? Can they be used as direct preventive and curative agencies against tendencies and impulses which are foolish and hurtful? And the answer of educators, as the result of large experience and observation, is emphatically, yes.

But the training, to be efficient, has to be systematic, persistent, and along well-defined lines. The first step in this training must be the strict avoidance of all that has a tendency to lower the standards of morality, whether this is in the line of companions, literature, the stage, music, or art. To do otherwise is not brave, but as foolhardy as it would be for a weak army to advance against a powerful foe; it means annihilation or to be taken prisoners of war.

To overcome obsessions and delusional beliefs by volitional effort, the effort should be made to direct the mind to other subjects which have nothing whatever to do with the obsession, rather than to make a direct stand of the will against it, since the will may put forth its utmost strength in the way of direct repression of the temptation to any immoral action, and may entirely fail, while, by directing the same amount of force in changing the direction of thought, complete success may be attained.

The influence of the will upon the emotions is a matter of the highest importance in regard to the direction of the current of thought and the determination of actions. Control your passions; govern your temper. We can no more avoid feeling mentally hurt than we can feeling physical hurt, but we have exactly the same power of the withdrawal of the attention from the mental hurt as from the bodily pain, by determinately fixing it upon some other object.

“I am, I ought, I can, I will,” are, as has been well said, the only firm foundation-stones upon which we can base our attempts to climb into a higher sphere of existence. The first implies a faculty of introspection, the second a moral judgment, the third a consciousness of freedom to act, the fourth a determination to exercise that power.

The influence of the will on the conduct is first automatic, through previously acquired habits; second, through the emotional state, and third, by our notions of right and wrong. In the fundamental principles of living must be included a genuine consideration of the right of others. The memory is an automatic reproduction of ideas, the mechanism of recording processes.

The education of the will, the power of breasting the current of the desires, and doing for long periods of time what is distasteful and painful, all tend to increase the power of inhibition and strength of the will. Nothing that is learned in youth is really so valuable as the power and habit of self-restraint, of self-sacrifice, of energetic, continuous, and concentrated effort.

Seneca claims that difficulties strengthen the mind as labor does the body. Plato said, that “self-conquest is the greatest of all the victories.”

Character lies preëminently in the sphere of the will, and anything which weakens the will saps the worth of life at all points. The strength of will bears not only on character, but on happiness and influence as well. The leader must show reserved power, and make it plain that she has herself well in hand, to secure confidence. “Will makes men giants.”

The Effect of Mental Attitude on the Physical Health.—The ordinary operations of the mind have little effect on the physical condition, but such emotions as fear, worry, anxiety, grief, despair, anger, hatred, and the like depressing emotions act directly upon the muscular and nervous mechanisms, profoundly affecting the secretions and the excretions, and stamp themselves upon the very tissues of the organism.

Of all the mental attributes the emotions are the most exhausting. A woman can spend more of her strength in five minutes of unnatural excitement than in a day of calm, steady brain work.

A perfect temper is not only a prime requisite for a club president, but for every man and woman in this hard workaday world, with its fierce competitions, its petty jealousies, and the stiletto practices of the cowardly, and it is one of the greatest preventives of indigestion, insomnia, and nervous prostration.

Forget your grievances. Every time that one repeats them to herself or to a friend she lives them over again, and the original trouble was but the merest moiety of suffering compared to a wound torn open afresh every day. To cherish a vindictive spirit does a vast amount of injury to the possessor of that spirit. In view of the facts of the beneficial effects of fighting upon small boys, and that the combative propensities of the Irish peasant commonly evaporates with his shillelagh, it would seem commendable to introduce boxing matches among women as a way to settle their differences.

From the standpoint of health, the intense excitement attendant on playing for high stakes, the loss of sleep, the unnatural life, the loss of money that one can ill afford to lose, must eventually lead to a serious if not to a fatal breakdown.

It is not the natural and reasonable intellectual work that injures the brain, but the various emotions—ambition, anxiety, disappointment, the hopes and fears, the loves and hatreds of our lives—that wear out the nervous system and endanger the balance of the brain.

Powerful emotion is like concentration attended with dissociation, it occupies the mind to the exclusion of all else, even to the dictates of self-preservation and reason. The will is more or less suspended and held in abeyance during the emotional states.

The too great concentration of the attention on one’s business or occupation is a self-indulgence that often ignores the importance of the lighter side of life and the legitimate claims of family and friends.

Less ambition and more philosophy would greatly lessen the number of cases of nervous prostration and allied neuroses. All of one’s fortune is not staked on one throw of the dice; if the woman fails in one direction, there are other resources left.

Concentration of the mind on the physical suffering leads to the so-called habits in disease; there may have, in the first place, been a real physical cause. For example, in case of injury to a limb followed by severe pain in that member it has happened that after amputation of the limb the consciousness of pain persisted in the brain. In the functional neuroses, the first cause may have been a real physical one, but the individual becomes so self-centered, it is with difficulty that the mind can be withdrawn from the ego, and a cure can only be effected by supplanting the intense egotism by new interests.

Medical literature contains numerous observations of ailment caused by fright, and even of death itself so caused. It is not uncommon for medical students to contract the disease about which they are studying. In the old small-pox epidemics it was a very generally observed fact that those who feared contracting the disease were the most apt to get it. The reason is very easily explained—fear so suppressed the functional activities of circulation and nutrition, as to predispose the individual to take any disease to which she was exposed.

Autosuggestion is the predominant element in the concentration of the thought on one particular subject, and of the narrowing of the perspective to a single point of view.

Prolonged anxiety or grief will cause an emaciation, second only to that of tuberculosis itself, by the depression of the heart’s action and the circulation, the loss of appetite, the interference with nutrition, and the loss of sleep.

Worry is, as we have seen, in the first instance most frequently bred of exhaustion, but, if indulged in, it readily becomes a fixed habit, and the mind rapidly settles into a state of fixed gloom.

Worry is a type of fear. It is a futile regret over past mistakes and the miserable forecasting of the future. It has been called the great shortener of life under civilization—of all forms the financial one is the most frequent and, for ordinary minds, the most distressing.

Anxiety and the anxious frame of mind is in readiness to take fright in connection with our most vulnerable points on all occasions of apprehension or uncertainty. As no one’s future can be clear throughout, there is never wanting the matter of anxiety to a mind susceptible of this state.

It is a significant fact that our asylums are recruited from the classes who spend their lives amid narrow monotonous surroundings; hence the large proportion of women, especially of farmers’ wives, whose lives are probably the most narrow and the most monotonous. From this result the fixed ideas, the obsessions, and all the absorbing egotism of insanity.

With a variety of valuable and permanent interests, the mind is well safeguarded against attacks of worry. The overworked woman should increase her recreations, leave home for short intervals, travel, and have entire rest and change of scene. With increased vigor of body will come increased power of the will and the capacity to abolish worry.

Anger floods the brain with blood, and if the arteries are brittle, as they are in old age, and the individual is just as old as her arteries, the rise in arterial tension may result in the rupture of a blood-vessel, and the subsequent hemorrhage into the brain may cause an attack of apoplexy, paralysis, or even death. Attacks of anger hasten the deterioration of the arteries; in this way anger has been known to cause death.

Every violent physical sensation will react on the lungs; every powerful normal emotion, whatever its cause, will also make its influence felt on the respiratory functions. An exercise which is performed with tranquil breathing if the mind is free from care, quickly produces respiratory disturbances if the mind is brooding and preoccupied. Those who have acted as seconds in a duel to men accustomed to the use of the sword know that they become breathless in the duel much more quickly than they do in the fencing school.

Depressing emotions make themselves felt in the respirations of animals as well as of man. A sensitive horse, which is badly used at its work, or even roughly spoken to, rapidly becomes breathless.

The dog is incomparably less swift than the hare, but is able to catch it; the fright of the hunted animal disturbs its breathing and robs it of much of its strength.

In fright the disorder of the respiratory movements destroys the regularity of the interchange of gases which takes place in the lungs, between the venous blood and the atmospheric air, and thus profoundly hinders the function of the aëration of the blood.

The more impressionable the subject, the more easily do the emotions influence his respiratory actions. Hence, the superiority in certain bodily exercises of men whose minds are calm and masters of themselves.

Emotional causes, such as worry, anxiety, and grief, as well as the more tangible physical factors, cause softening and disease of the tissues, which frequently accounts for the arteriosclerosis and premature senility. Alienists have long found abundant evidence that abnormal physical conditions are capable of producing mental diseases, but the reverse is quite as true.

And not only the imagination, but the intellect, the emotions, and the will have or may have a powerful influence over the sensations and organic functions.

It is not only profoundly true that mental attitude has much to do with bodily function, capable of producing changes in its nutrition and secretion, but we may go further and say that healthful and hopeful habits of thought do much to put the body on the defensive against the assaults of disease.

Mental attitude refers not to the will or the emotions, but to the mind in its entirety. The trend of a woman’s thoughts, the use she makes of her intellect, the strength of the volition, the sense of responsibility, and the objects of her life are all questions that have a distinct bearing upon the bodily functions and the health of the individual.

A Definite Occupation a Physical Necessity.—It is now generally conceded by the leading sociologists of the day that women who are not engaged in the duties of maternity need the same intellectual and industrial activities as men. Many go further, and it is their opinion that there is no reason for excluding women, who are fulfilling the duties of maternity, from exercising full intellectual and physical activities in other directions. And the proof that this is not a mere theoretic assumption is to be found in the fact that many women have not only given birth to a family of children, but have successfully reared them, and, in addition, have been eminent in other pursuits and callings. Well-known illustrations of this fact are to be found among the most noted sovereigns that Europe has ever had—Catherine de Medici, Maria Theresa, Catherine II of Russia, and Queen Victoria.

Pleasure seeking, as the end and object of life, leads to ennui, disgust, and physical and mental deterioration, while the slavery of housework, the childish vanities, and petty cares and vexations are most injurious to the nervous system, so that for the life of the housewife the education preceding it should be broad; and the more highly educated the woman is, so much the more effectually can she free herself from attaching too much importance to every little detail, and so neglecting what is higher and more important, and it will be a great preventive of irritability of temper, quarrelsomeness, and even melancholia and mental derangement, from which so many of these women suffer in consequence of the monotony of their lives.

Every girl when she leaves school, which she should consider the very alphabet of her education, should prepare herself for some definite occupation, just as her brother does.

Clouston, in answer to the question as to how the powers of the mind can best be developed, conserved, and made the best use of for life’s work, says: “It is a most fortunate thing, if, during the later period of adolescence, an occupation in life has been selected which really suits the capacity of the individual and goes with his innate tendencies. The seriousness and the settledness of the life of the period, with the bracing of every nerve and sinew to do the work, to gain a reasonable position in society, and to enjoy a fair amount of happiness, is in itself a tonic of no mean value, while overtaxing of body and mind is always a risk, as well as an ambition which overreaches itself. The repressions of woman’s life in civilized society constitute one of her serious strains and dangers. The life and conditions of a working woman who has six or seven children in a few years, who has small means, and but little help, is in my judgment the very hardest of any human being in our modern social system.”

Thomas[6] thus sums up his views as to the evils resulting from the non-occupation of women of the better classes. “Human nature was made for action; and perhaps the most distressing and disconcerting situation which confronts it is to be played on by the stimulations without the ability to functionate. The mere superinducing of passivity, as in the extreme case of solitary confinement, is sufficient to produce insanity, and the emotion of dread or of passive fear is said to be the most painful of the emotions, because there is no possibility of relief by action.

“The American woman of the better class has superior rights and no duties, yet she is worrying herself to death; not over specific troubles, but because she has lost her connection with realities. Many women, more energetic and more intelligent than their husbands or brothers, have no more serious occupation than to play the house cat, with or without ornament. It is a wonder that more of them do not lose their minds; that more of them do not break with the system entirely, is due solely to the inhibitive effect of early habits and suggestions.

“The remedy for the irregularity, pettiness, ill health, and unserviceableness of modern women seems, therefore, to lie along educational lines. Not in general and cultural lines alone, but in a special and occupational interest and practice for women, married or unmarried. This should preferably be gainful, though not onerous or incessant. Normal life without normal stimulation is impossible, and the stimulation best suited to the nervous system is some form of interesting work.”

The Psychology of Success.—Success has been defined as the accomplishment, the realization of what has been willed or wanted, the ripe fruition of the well-tended tree. The achievement of fame or fortune is what the world generally regards as success.

Before entering on an enterprise, all the premises in the case must be had in order to form correct judgments, otherwise incomplete and imperfect knowledge of the case will lead to error in judgment, in which there could be said to be “no chance of failure, it was a certainty.”

An element that always makes for success is to be able to supply a want of the public; it is partly a question of demand and supply. It is sometimes possible to create a demand. But, as a rule, success is the fruition of patience and well-directed energy.

There is nothing which tends so much to the success of volitional effort as the confident expectation of its success, while nothing is so likely to induce failure as the apprehension of it. Since the tendency of the cheerful and joyful emotions is to suggest and keep alive the favorable anticipations, while that of the depressing emotions is to bring before the view all the chances of failure, the former will increase the power of volitional effort and the latter will diminish it.

The mental condition also exerts a direct influence upon the physical powers, through the organs of the circulation and of the respiration, the heart’s impulse being more vigorous and regular, the aëration of the blood being more efficiently performed, in the former of these conditions than in the latter.

Success too easily won, or won early in life, may really be a cause of failure, because, having been once achieved, the individual may be content with what she has and not proceed to higher development. And so a very inferior success may be the tomb of energy and the satisfied goal of ambition, instead of a stimulus to higher things.

Lack of success may also be caused by indulgence or lack of courage, the individual preferring to sail along the chartered course of mediocrity rather than to strike out a new path for herself, involving risk, anxiety, and endless work.

And perhaps jealousy in the rank and file of the lazy, indifferent, and mediocre far more often impedes effectually the road to success than is dreamed of, so that a greater degree of secretiveness, warding off the scent, of the intentions, the aspirations, and the methods of work, until the object shall have finally been achieved.

Another and most important secret of success is to recognize failure as only a stepping-stone to higher things. Eggleston says, “Persistent people begin their success where others end—in failure.”

The people who succeed in this world are the people who get up and look around for the circumstances they want; if they cannot find them, make them. “Circumstances,” said Napoleon, “I make circumstances.”

There are four mental requisites necessary to the achievement of success, namely: a clear view of the end; a judicious indifference to the sentiment around by the sweeping away of obstacles; an indomitable energy; and the power to resist the temptation to rest on the soporific plane of mediocrity.