Personal hygiene

Front matter

ADA S.BALLIN

22101356180

BY

Preface

I have been asked by the publisher of the Sanitary Series to accomplish a rather difficult task, namely, to write a treatise on Personal Health, which shall be comprehensive and sufficiently technical to render it a useful handbook for students and medical men, while not too technical to be of service to the general public. I hope that in the endeavour to please both classes, I shall not fail to give satisfaction to either ; but as medical readers will not lose by perusing facts which are familiar to them, and it would be a distinct loss to general readers if those facts were omitted, I trust that I shall be excused if I have rather inclined towards making a simple, practical, and non-technical explanation of the laws of health. Wherever necessary to illustrate these laws, I have first dealt with the physiology of the subject. I trust, that the little work may do something towards promoting the study of that science, which is most calculated to improve the condition of the human race.

Ada S. Ballin.

London, W.

.

Contents

CHAP. PAGE

I. Introductory 1

II. In and about the Home ..... 7

CHAPTER II IN AND ABOUT THE HOME Where shall my House be 1

When we have to choose a house in which we hope to settle down for a number of years, perhaps for the term of our natural lives, the first question to decide is : “ Where shall it be?” Of course this question is very often practically answered by the necessities of business, or by wishing to live in the midst of friends ; but if the world lies all before us where to choose, and especially if there are little children to be brought up, a country home is preferable to one in any great town, for, other things equal, the death-rate in the country is far lower than that in towns, owing chiefly to the superior purity of the air. The chief points in choosing an abode are that the water-supply should be good and uncontaminated— as I shall indicate later when dealing with water-supply — that an approved system of drainage should be adopted, and that the house should not be in the immediate vicinity of ponds, sluggish water, or shrubberies, or have trees growing quite close to it, as all these things tend to render the air damp, impure, and liable to fogs. A dry, elevated site, sheltered from cold winds, is the best. All hollows or low-lying localities, where water is likely to lodge, and the neighbourhood of marshes, should especially be avoided. Rising ground, or the slope of a hill with trees near, but not so near as to prevent the free circulation of air round the house, should he chosen. The aspect for the house will doubtless be influenced greatly by the surrounding landscape, as people usually prefer to have the best view from their front windows ; but a south-east aspect is preferable, so that the front rooms may be brightened by the morning sun, and the back rooms by the evening sun. When the house faces directly south, the front rooms are overheated in summer, and the back rooms are dark, dismal, and unhealthy, for, as an Italian proverb well says, “ Where the sun does not go, the doctor does go.” In a country-house there is more choice of aspect than in town, for most of the streets in our towns, unfortunately, lie due north and south, or due east and west, so that for our living rooms we are generally forced to choose between a sunless aspect and one which during summer is excessively hot, since the sun falls on it for the greater part of the day. The habitual occupation of rooms looking due north is decidedly depressing, and great advantages would accrue from a diagonal arrangement of streets — north-east and south-west, north-west and south-east.

If business or pleasure necessitates a home within easy access to the interior of a town, the suburbs, especially those built on rising ground, are far preferable, from a health point of view, to a residence in the actual centre of the town • but if the latter is necessary, a dwelling should be chosen in a wide street — a square, terrace, or avenue, and always on the sunniest side of the way. A detached house is preferable to one semi-detached, as allowing free circulation of air, and a semi-detached house is, for the same reason, preferable to one in a street or row. Narrow streets and houses built closely back to back should be avoided as far as possible, and if a garden or open space can be obtained, behind or in front, so much the better.

In a closely-inhabited neighbourhood it is especially important to be as near the top of a slope or rising ground as possible, or, at any rate, not near the bottom, as persons living at the lower level are very apt to suffer from an accumulation of the sewage products from the upper houses, and soakage damp, which gravitate down to them.

In choosing a house or a site for building, its position as regards convenience of approach, or fashion of neighbourhood, ought to be a less consideration than its health aspect, especially with regard to its elevation and dryness of soil.

Soils

Moisture arising from the soil has a very injurious effect upon the health. The more moisture retained in a soil for evaporation, the less healthy is a house built upon that soil, so that the most healthy soil is that through which most moisture can percolate, leaving little for evaporation.

I cannot insist too strongly upon the dangers of a damp locality, and I will here quote a few statistics which show the actual decrease in the death-rate by consumption, brought about by improved subsoil drainage. At Salisbury this decrease was 49 per cent ; at Ely, 47 ; at Rugby, 43 ; and at Banbury, 14, while a marked reduction was effected in the case of thirteen other towns. During the same period in Alnwick, Norwich, and Stafford, where no improvements had been effected in subsoil drainage, the death-rate from consumption remained stationary, although many other sanitary improvements had been made. Again, at Penzance, where the subsoil is naturally dry, the consumption death-rate was stationary, and no decrease was effected at Carlisle, because the attempts at subsoil drainage were frustrated by the low-lying condition of the district, where damp reigns supreme. Yet serious as is the consideration of the mortality from consumption in England, it must not be supposed that only this disease is affected by dampness of soil — for diseases of the throat and lungs, and rheumatism, with its attendant heart-disease, are also affected by it. Recent inquiries have shown, moreover, that it influences the fatality of acute specific diseases ; thus Dr. Blaxall has shown that in Swindon there was

IO twice the proportion of deaths from measles, whooping-cough, pneumonia, and bronchitis in that part of the town which is built on Kimmeridge clay, as there was in another part of the town which is situated 100 feet higher on oolitic limestone and Portland sand. Free intercourse took place between both parts of the town, and there seemed nothing to account for the difference in the death-rate but the dampness of the lower part, and the want of due precautions in order to prevent that dampness from rising into the houses.

There are many different soils, or, as the geologists call them, rocks, but as far as we are concerned they may be divided into two classes : —

1. Pervious Soils, that permit water to pass through

them, and which, arranged in their order according to the degree of perviousness, are gravel, sand, and some sandstones, chalk, by reason of its fissures, and loose rocks generally.

2. Impervious Soils, such as clay, many marls, hard

limestones, granite, and a variety of others.

On pervious soils typhoid fever and cholera may arise by wells becoming poisoned owing to soakage into them of drainage from cesspools or cattle-sheds ; but if such contamination is guarded against by a careful system of drainage, or if water is obtained from an unquestionable source, this danger is obviated; and a pervious soil is decidedly the best for sanitary reasons, for with a pervious soil the level of the subsoil water is generally low and can easily be lowered, whereas with an impervious soil, subsoil water is apt to collect in great quantities, and its removal is very difficult. Hence upon impervious soils rheumatic complaints, lung diseases, especially consumption and bronchitis, scrofulous diseases, and, in fact, all ailments which are encouraged by damp and putrefaction, flourish exceedingly.

The following illustration (Fig. 1) shows more clearly than words can do the relative value of a healthy and unhealthy soil. In high situations a clay soil is found not to be so

IN AND ABOUT THE HOME u

objectionable, as it is said to retain about tlie same percentage of moisture as chalk, and to possess great deodorising powers. In low situations clay soil should be drained by trenches with earthenware pipes laid at the bottom, filled in with pebbles to allow of percolation. As clay expands and contracts with varying conditions of moisture, it forms a very bad foundation for houses, and on all clay soils artificial foundations of concrete should be employed. The most healthy soil is a gravel or sand soil.

a. Gravel. Fig. 1. b. Clay.

Even when the natural soil of a neighbourhood is all that can be desired, it is necessary to be on one’s guard against the wiles of the jerry-builder, since that depraved individual has been known to remove the sand or gravel, which is a saleable commodity, and fill in the site with moist earth, road semirings, and the recent contents of dust-bins, amid which has been found decaying vegetable and animal matter. Another danger is that of a disused cesspool — a relic of some former building which may be buried beneath the site of the new house, and continue for years to give off poisonous gases, and cause mysterious complaints and diseases among its inhabitants.

A serious danger accrues from the building of houses over hidden wrater. Even in the most fashionable parts of London this is not unknown. In one case I was told by a medical friend, where illness in the family led to investigations in the basement, a stagnant and stinking pond was found beneath the pantry floor. It had been observed that each new servant who used the room suffered with his throat. In other still worse cases disused cesspools have been built over, and an instance occurred a year or two back in the house of a gentleman living not very far from Park Lane, who lost one of his children by typhoid fever. This led to an investigation of the drains, and at last a cesspool containing foetid matter was discovered just under the kitchen floor.

Old brick-barrelled drains beneath the house are another source of danger, for, as in the former cases, the foul air which they contain is apt to filter through the joints and brickwork into the house.

The neighbourhood of burial-grounds should be carefully avoided, especially in localities where the water is drawn from wells.

Forty years ago Dr. Reid found that the air in the Houses of Parliament was contaminated by the neighbourhood of St. Margaret’s burial-ground, and a report of the French Academy of Medicine has stated that the emanations from Pere La Chaise, Montmartre, and Mont Parnasse have caused terrible diseases of the throat and lungs, to which numbers of people fall victims every year. Boards of Works, and authorities who have to do with the construction of houses, are lamentably to blame in their negligence with regard to burial-grounds, and until the consummation devoutly to be wished — universal cremation of the dead — is firmly established, thousands will fall victims every year to diseases propagated out of a false idea of what is due to the loved ones who have gone before us. For the present we can, as individuals, only take such steps as lie within our power to avoid danger from this source.

The Basement

The best means of avoiding or obviating dangers from the soil is to cover the whole site with a six-inch layer of concrete, which ought always to be laid, whatever the nature of the soil, although the Metropolitan Management Act of 1878 only enforces it with regard to sites not consisting of gravel, sand, or natural virgin soil. Good Portland cement concrete, with an aggregate of broken brick, burnt ballast, or wellwashed coarse sharp gravel, and a mixing of lime and gritty sand, not dust , is the best, and the concrete, instead of being thrown from a height, should be laid at the level and well rammed in to make it firm and even. In inspecting a house a board should be removed from one of the basement floors to see whether such a concrete foundation has been laid. It is best that the foundation of the house should be as little as possible below the level of the ground ; but if the foundation is sunk the basement should be used only for kitchens, offices, and cellars, and not in any way as living rooms. The widelyspread practice in small houses of making a “ breakfast-room ” on the basement — a room partially or wholly below the level of the soil, in which the mistress of the house sits nearly all day, is most injurious to health, depriving her of proper air and light, and often exposing her to damp exhalations, which come through the walls, even if there is a damp-proof foundation. Still worse is it to use such a room as a playroom for the children, or bedroom for the servants, and I have seen much ill-health in servants caused by sleeping in an underground room.

It is best, if possible, to have a cellarage under the lowest inhabited rooms of a house, as this conduces to dryness and health ; but the cellars should be easily accessible, so as to keep them clean, and should have impervious flooring.

Walls

Brick, stone, or concrete walls are all more or less pervious to damp, a great deal of which in moist situations, or when the walls are much exposed to driving rain, will pass through them in a vaporous form, induced by the heat of tlie rooms. During tlie night, when the rooms coo], the clamp becomes condensed, is again rendered vaporous by the heat next day, and saturates the air of the house. Thus many rooms are always damp during certain seasons of the year.

In walls partly or wholly beneath the ground, moisture from the earth soaks through at the side, and also rises in the wall by capillary attraction. The best surface to expose to the earth or to driving rain is a glazed brick surface jointed and pointed with cement. To prevent ground or side soakage from the soil into a wall, the best plan is to have what is called a dry area — that is to say, to have a space left between the main wall and a thin outer wall all round the house joining the two by stretched bricks. This should be drained, ventilated, so as to prevent dry rot, and covered in so that rain may not fall into it. When no such area can be made the wall should be thickly coated with asphalt. Such precautions from the outside are far better than any from the inside ; but in cases where they are unavailable, and damp is found to exude from and be reabsorbed into a wall, either of the following plans may be adopted for the inside : — Dissolve three-quarters of a pound of mottled soap in a gallon of water, and apply it hot to the surface with a large whitewaslier’s brush, being careful not to let it lather. When it is dry, next day, apply a solution of half a pound of alum in four gallons of water, all over the surface. One or two coats of boiled oil applied to the surface have been found effectual, or a more complicated plan is to prepare one pound of finely-powdered glass, and two pounds of slaked lime well dried in an iron pot, and passed through an iron sieve. Boil two ounces of grease with two quarts of tar for nearly twenty minutes, then add some of the lime to the tar and glass to form a thin paste, using at a time only sufficient to cover one square foot of the surface an eighth of an inch thick, and then adding lime again for the next piece of wall, and so on. This coating is more durable than the former, but all require occasional renewal ; they are more effectual than mere painting. Adamant cement is even better.

I have said that walls absorb a considerable amount of moisture when exposed to rain or damp, and this is especially true of brick walls, some bricks being so soft and porous that a single brick will absorb as much as a pound of water, acting just like a sponge. The thickness of Avails, of course, varies according to their height, but the importance of having substantial Avails is not merely to serve as a support for the weight above, but to maintain an even temperature during varying seasons, protecting the interior alike from heat and cold, by their action as non-conductors of heat, and also to keep out damp. Where walls are much exposed to driving rain various expedients have been resorted to, to prevent damp. Concrete walls, or brick Avails faced with concrete, are tolerably effective, but a glazed brick surface jointed and pointed with cement or coats of waterproof silicate composition as before described are more effective. Tiles or slates are sometimes used, but are not nearly so efficient ; if used, they should be fixed with zinc, copper, or galvanised iron nails, as the rusting of ordinary nails would cause them to fall away.

The old Romans were evidently quite familiar with the upward and downward soakage in brick walls, for it is a characteristic of all Roman walls that at regular intervals in the brickAvork flat red slates are introduced, evidently with the object of interrupting the soakage by capillary attraction. A further development of this idea is the damp-proof course, which should be introduced into all outer walls at a level of about a foot above the surface of the ground. Such a course may be made of asphalt, stoneware, or slate laid in cement, a double course of plain tiles laid in cement, Avhich are less liable to break than slates, or sheet lead. Portland cement is often used, but this is liable to crack.

To exclude damp from houses by building double walls is i6 an old expedient which was tried, but not found very successful, in the Temple of the Vestal Virgins at Rome, which was built against a hill, so that damp filtered through the outer walls and caused a high mortality and large sick-list among the holy maidens, who, unfortunately for the romance which shrouds them, suffered much from colds in the head and rheumatism.

But as we do not now build houses right against the sides of hills, a hollow wall serves effectually to exclude damp, the main wall being best protected by an outer shell of glazed brick or stone work, five or six inches thick, fixed at a distance of about two inches by galvanised iron clamps. In fact, it would be a good plan to build all the outer walls of a new house hollow, with binding bricks, having glazed surfaces, so as not to conduct moisture, at regular intervals, in order to give the double walls the strength and stability of a substantial single one. Owing to the air contained between such walls, they act far better as non-conductors of heat than any single wall could do. Ventilating bricks should be inserted here and there, and the necessity for ventilation is greater in proportion as the outer walls are less pervious, for it must be remembered that air passes through bricks and other pervious materials, and is necessary to the health of the inhabitants. Impervious outer walls not only prevent the entrance of moisture into the house, but also hinder the exit of such moisture as always collects in the inner portions of walls, from the breath of the inhabitants, the steam of cooking, etc. They prevent evaporation by arresting the exchange of inside and outer air. Hence the best walls are the double ones just described, as, being porous, they are more readily cleared of moisture. Walls below the level of the damp-proof course, described above, should always be rendered impervious ; but except in very damp districts there is no necessity for the upper walls to be so. Those on the inside should not be thickly painted or varnished over, — ordinary plastering does not make them impermeable, but where they are coated with an impervious material on the inside there is increased need of proper ventilation.

Old Houses

In building a new house, it is of course possible to pay attention to all sanitary details ; but in redecorating an old one it is also possible to do a great deal, as, for example, the drainage may be remodelled and a damp-proof course inserted. If one cannot build for oneself and wait for the house to thoroughly dry, it is best to rent one that has already been occupied, as new houses are generally damp, and it is said to take three years to dry a house thoroughly. Never choose a house in a hurry ; it should be carefully and most minutely inspected and tested. I have known some women decide upon taking a lease of a house in less time than others would take to choose a new dress, but such things done in haste are generally repented of at leisure.

If people would only, in choosing a house, pay more attention to its real value and construction from the point of view of health, and less to its mere outward show and appearance, the actual saving in life and in health would be vastly increased. As it is, the jerry-builder knows that as long as he puts a good face upon matters, giving an imposing frontage and effective internal decoration, his houses are sure to let, — never mind if they are based on a soil made from road sweepings and dust and refuse of all kinds, if the chimneys smoke, the roof leaks, and the bath in the smart-looking bathroom communicates directly with the main drain, and is a perfect contrivance for admitting typhoid fever and diphtheria into the house.

Going over the New House

If possible, a competent surveyor, specially skilled in sanitary science, should be engaged to go over the house ;

C i8 but the tenant himself should accompany him on his rounds, and should keep his eyes open to detect any faults or flaws.

Beginning with the roof, the pointing of all the brickwork in stacks and parapets should first be examined, a little stick being used to poke at it, in order to see that it will not crumble away. Then the bedding and jointing of the copings, and the condition of the lead flashings and gutters, should be tested, as well as the tiles and roof covering, so as to discover whether there is sufficient protection against rain, snow, wind, and changes of temperature ; whether proper rain-pipes and arrangements for carrying off water are provided, and whether the skylights are water-tight. It is also as well to see that there is proper means of escape by the roof in case of fire ; that the chimney-pots are in good working order ; and, if there is a drain ventilating-pipe running up the side of the house, that it is carried sufficiently far up so that the foul air from it may not enter the upper bedrooms and skylights. The position of the rain-pipes should be noted, as, if they open anywhere near the windows or air inlets of the house, it is most necessary to ascertain on coming to the ground that they are properly disconnected from the drains. The spaces beneath the roof should be well ventilated, as impure air, which, when heated, rises, is very apt to collect in them.

Coming down into the house, we should note whether the plaster of the ceilings and walls is free from cracks, and whether the walls have been newly stripped and repapered or coloured, for sometimes it will be found that as many as four or five layers of paper have been left on the walls, each of which may exhale poisonous matters and impurities absorbed during the tenancy of past occupiers- — nay, even the germs of diphtheria and scarlet fever. Next, notice whether the setting of the fire-grates is free from cracks, and by lighting some brown paper or a little fire in each grate, make sure that you will not have to endure the curse of a smoky chimney. The hanging of the window-sashes and doors, and the condition of the woodwork and joiners’ work generally, should next be examined ; and it is wise to be very much on one’s guard in new houses against the use of unseasoned wood, which may be made to look very well, but which soon warps, with the result that windows and doors will not open, and “ stick,” requiring constant attention, and becoming provocative of a tendency to profanity. The locks of the doors should be tried, and all defects of whatever kind should be jotted down systematically as one goes from room to room, in a new note-book, specifications made from which can, if the house proves sufficiently satisfactory, be placed in the landlord’s hands, so that he may put everything in proper order before the tenancy is entered upon. The arrangements for ventilation, warming, and drainage, of course, need special attention ; but of these I must speak more in detail later on.

Coming to the lower part of the house, it is well to enter the rooms after they have been shut up for some hours, in order to detect whether there is stuffiness, mustiness, or any other unpleasant smell, the origin of which, if it exists, must of course be inquired into. Against damp, as I have shown, we must be especially on our guard j and this cannot always be detected at first sight. Walls covered with battening and canvas should arouse suspicion, as they may conceal the presence of damp without in the least protecting from it. Fires should be lighted in the lower rooms and allowed to burn for an hour or so, with all windows and doors shut ; very often beads of damp may then be seen to stand out upon the walls ; but it is generally best to take a little handmirror with you, and wipe it carefully with a handkerchief in each room after the fires have drawn ; it quickly becomes misty if the room is damp.

Staircases should always be well lighted and ventilated, sash-windows being the most suitable for them. A well-staircase, carried the whole height of the house, with a skylight and ventilator at the top, affords the best means of lighting cind ventilating side corridors and lobbies. Ordinary staircases should be built against an external wall, so that there can be a window at every half-pace landing. In inspecting the basement and outer walls due attention must be paid to the points I have noted above.

CHAPTER III The Lungs

Before considering the question, wliat we breathe, it is best to gain some idea of the mechanism of breathing. The organs concerned in breathing are the nose, mouth, larynx or organ of voice, the trachea or windpipe, and the bronchi or tubes by which air is conveyed into a number of tiny sacs which are called vesicles, each of which is surrounded by a network of fine blood-vessels called capillaries, the endings of the minute subdivisions of the pulmonary artery, which brings the blood from the heart.

The windpipe consists of from sixteen to twenty half-lioops of cartilage, which may be felt in the front of the throat. They are united by a tough fibrous tissue, which is elastic, and the back of the trachea is formed of similar tissue. The object of the half-hoops is to keep the tube constantly open, while the softness of the back part of the tube prevents injurious pressure on the oesophagus or gullet, which is placed immediately behind the windpipe. The windpipe extends till just below the top of the breast bone, where it divides into two smaller pipes or bronchi, the structure of which is similar to its own. These are about two inches and a half long, and then di /ide into two tubes nearly equal in size. From these the division of tubes goes on in pairs, and the smaller tubes extend like the branches of some trees, and never reunite. The smallest branches, or, as they are called, terminal bronchi, have no cartilaginous hoops, but are more richly supplied with involuntary muscular fibres. These open into wider tubular passages, called alveolar passages, around which the air-cells are formed in clusters. Each air-cell is somewhat rounded in shape, and consists of a fine membrane surrounded by fibres of elastic tissue. A dense network of capillary blood-vessels is contained in the wall of each cell, only one layer of which lies between two of the tubular passages, so that the blood in the capillaries is exposed on two sides to the influence of the air, what intervenes between it and the air being the structureless walls of the capillary and air-cell.