The principles of hygiene; a practical manual for students, physicians, and health-officers

Front matter

J^eference %ihxavp

Medical Books

Boston.

Preface To The Sixth Edition

Since the previous edition has been issued the advancement of our knowledge of hygiene has continued, and it has been necessary to ampHfy the text in many particulars. This has been a period of general advancement, so that no particular phase of the subject has progressed to a greater extent than any other.

In order to maintain the relative size of the volume an effort has been made to eliminate any part of the text that appeared least essential to the uniform treatment of the entire subject.

As in the past, it has been a pleasure to accept the helpful suggestions of the reviewers.

It is hoped that this edition of the book may receive the same cordial approval that has been accorded to the other editions.

D. H. B.

January, 191S.

Preface

This book has been prepared to meet the needs of students of medicine in the acquirement of a knowledge of those principles on which modern hygienic practices are based ; to aid students in architecture in comprehending the sanitary requirements in ventilation, heating, water-supply, and sewage-disposal; and to aid physicians and health ofl&cers in familiarizing themselves with the advances made in hygienic practices in recent years.

The rapid strides made in our knowledge of the entire subject of hygiene has rendered such a book, based upon the more recent discoveries, almost a necessity to students of medicine.

No attempt has been made to treat the subject in an exhaustive manner, the object being merely to give the general principles upon which the health officer and the physician work in their respective capacities in dealing with conditions which are detrimental to health or which tend to improve health.

The entire range of subjects comprising the comprehensive field of hygiene has not been discussed, but all those subjects which appeared to the author to be most important for those for whom the book has been prepared have received the consideration which their relative importance demanded.

The metric system of weights and measures has been employed throughout the work except in quotations, lO PREFACE.

because this system is now in general use in all scientific laboratories in the United States, and because it is in every way preferable to the cumbersome and complicated system, with its various units, which is still in common use. The metric system was employed also because it is in common use on the Continent of Europe, and is also a legal system in the United States since 1866, when Congress passed an act making its use lawful in the construction of contracts and in all legal proceedings. It is rapidly coming into general use in medicine and pharmacy, and its general adoption has the hearty endorsement of numerous scientific societies. At the present time a bill is passing through Congress which, when enacted, will make its employment compulsory in all departments of the Government after January i, 1903. In the Appendix the relative values of the units of weights and measures of the metric system have been given in terms of the English system, and vice versa.

D. H. B.

PAGE

Causes of Disease, 17. — Sanitary Science, 28. — Hygiene, 28.

CHAPTER I. Air 32

Nature and Composition of the Atmosphere, 32. — Temperature of the Air, 34. — Pressure of the Atmosphere, 35. — Distribution of Atmospheric Pressure, 37. — Humidity of the Atmosphere, 38. — Hygrometry, 39. — Elastic Force of Vapor, 41. — Absolute Humidity, . 41. — Relative Humidity, 41. — The Influence of Humidity on Health, 42. — Movements of the Atmosphere, 42. — Clouds, 43. — Precipitation of Moisture, 43. — Climate, 44. — Ground-air, 52. — Sewer-air, 52. — The Impurities in the Air, 53 . — Examination of the Air by the Senses, 58. — Chemical Analysis of the Air, 59. — Diseases Produced by Impure Air, 62. — Effects of Vitiated Air Generally, 63.

Chapter II

Amount of Fresh Air Required, 67. — Cubic Space, 69. — General Rules for Ventilation, 71. — Natural Ventilation, 71. — Arrangements in Natural Ventilation, 73. — Artificial Ventilation, 81. — Removal of Dust, 86 — Humidifying the Air, 88.

CHAPTER III. Heating go

Loss of Heat from Buildings, 90. — Degree of Warmth, 90. — Heat Supplied by Radiating Surfaces, 91. — Systems of Heating, 93. — Direct Heating, 94. — Indirect Heating, 97.

Chapter IV

Physical Properties of Water, 100. — Chemical Composition, 100. — Rain-water, loi. — Spring-water, loi. — Well-water, 102. — River-water, 102. — Lake- water, 103. — Sea-water, 103. — Impurities in Water, 103. — Odors in Drinking-water, 107. — Effects of Impurities in Water, 108. — Dissolved Impurities, 109. — Approximate Composition

PAGE

of Drinking-water, 114. — ^Amount of Drinking-water Required Daily, 115. — Source of Water-supplies, 116. — Storage of Water, 121. — Purification of Water, 121. — Methods of Purification, 122. — Sterilization of Water by Means of Chemicals, 141. — Suitability of Water for Boiler Purposes, 143. — Standard Method of Water and Sewage Analysis, 145.

CHAPTER V. The Remov.^ axd Disposal of Sewage 151

The Removal of Sewage, 151. — Water-closets, 151. — ^Traps, 154. —Disposal of Sewage, 158. — Chemical Treatment of Sewage, 160. — ^Modern Methods of Sewage Purification, 162. — Sprinkling Filters, 168. — The Removal of Sewage by Liernur System, 170.— Commercial Value of Sewage, 171.

CHAPTER VI. Garbage Disposal 173

Collection and Removal of Garbage, 174. — Disposal of Garbage, ITS- CHAPTER VII.

Chemical Composition of the Body, 178. — Potential Energy in Food, 180. — ^Energy Derivable from Food, 182. — Nutritive Value and Cost of Food, 189. — Digestibility of Foods, 191. — Composition of Foods, 193. — Functions of the Alimentary Principles of Food, 194. — ^Water as Food, 195. — Different Varieties of Food, 196. — Animal Foods: Meat, 196. — Food-poisoning, 200. — Composition of Meat, 206. — Fish, 208. — Milk and ]\Iilk-products, 208. — Vegetable Foods, 221. — Bread, 222. — Preserved Meats, 224. — Preserved Vegetable Foods, 224. — Food-preservatives, 225. — Nuts and Their Uses as Food, 226. — Mineral Food, 226. — Beverages and Condiments, 227. — ^Adulterations of Food, 228. — Dietaries, 232. — Nutritional Diseases, 236.

Chapter VIII

Effect on the Lungs, 239. — Effect on the Circulation, 241. — Effect on the Muscles, 242. — Fatigue, 242. — Effect on the Nervous System, 243. — Effect on the Elimination of Nitrogen, 243. — Amount of Exercise that Should Be Taken, 244.

CHAPTER rX.

Clothing 247

Protection against Cold, 247. — Protection against Heat, 248. — Protection against Dampness, 248. — Protection against Injury, 249. — Injurious Effects of Clothing, 251. — Cleanliness in Relation to Clothing, 252. — Infected Clothes and Bedding, 253.

CHAPTER X. PAGE Personal Hygiene 254

Cleanliness, 255. — The Bowels, 255. — The Passions, 255. — The Mouth and Teeth, 255. — Habitation, 256. — Occupation, 256. — Mental Attitude, 257.

Chapter XI

The Effect of Anilin Dyes and Nitrobenzine and Its Compounds, 272. — Special Industrial Diseases, 274. — Influence of the Length of the Working-day on the Health of the Laborers, 276. — Lighting of Industrial Establishments, 278.

Chapter XII

Site, or Location, with Reference to Drainage Capacity of the Soil, 281. — Structure of the Walls, 282. — Cubic Space and Floor Space, 282. — Relation of Window Space to Cubic Space, 284. — Lighting, 285.— The Position of Blackboards, 286.— Corridors, Cloak-rooms, and Wardrobes, 286.— Ventilation, 287.— Heating, 288. — Water-supply and Sewage Disposal, 289. — Water-closets and Latrines, 290. — Desks and Seats, 290. — Defects in School-buildings, 292. — Medical Inspection of Schools, 295.

Chapter XIII

The Recruit, 302. — Training of the Recruit, 305. — Food of the Soldier, 306. — Clothing of the Soldier, 308. — Camps, 31 2. — Barracks, 315. — Marches, 317. — Camp Diseases, 318. — Antityphoid Vaccination, 320. — Foot Inspection, 322. — Body Inspection, 323.

Chapter XIV

Ventilation, 325. — Heating of the Vessel, 3 2 7. ^Lighting, 327. — Cleansing the Vessel, 327. — Water-supply, 327. — Food-supply, 328. — Clothing, 329. — Selection of Marines, 329. — Principal Diseases Among Mariners, 333.

CHAPTER XV. Soil 335

Ground-air, 335. — Ground-water, 336.— Pathogenic Bacteria in Soil, 338. — Improvement of a Damp Soil, 338. — Configuration of the Surface and Soil-covering, 338.

Chapter XVI

Position of the House, 340. — The Foundation and Walls, 341. — The Roof, 341. — The Interior Arrangement, 342. — The Size of the Rooms, 342. — The Sleeping-rooms, 343. — The Floors and Floor-

PAGE

coverings, 344. — The Wall-coverings, 344. — Ventilation and Heating, 345. — Cooling Devices, 346. — Plumbing and Drainage, 348. — Houses for the Poor, 348. — House-cleaning, 350. — Protection from Flies and Mosquitoes, 351.

Chapter XVII

Modes of Dissemination, 354.— Nature of Epidemics, 355.— Immunity and Susceptibility, 356. — Prevention of Infection by Inducing Active Immunity, 373. — The Haffkine Method of Protection, 374. — Value of Vaccination as a Protective against Small-pox, 379. — Precautions in Vaccination, 383.— Biologic Aids to Diagnosis, 384.— Personal Prophylaxis, 386. — Persistence of Pathogenic Bacteria in Dead Bodies, 390. — Transmission of Relapsing Fever, 391. — Prevention of MalaVia, 392. — Prevention of Yellow Fever, 395.^ Destruction of Vermin, 400. — Relation of Insects to the Spread of Disease, 402. — Remedies for Fleas, 408. — Animal Parasites, 411. — Prevention of Infection with Animal Parasites, 423. — Vegetable Parasites, 425.

Chapter XVIII

Disinfectants in Common Use, 430. — The Action of Sunlight on Bacteria, with Special Reference to Bacillus Tuberculosis, 430. — Disinfection on Large Scale, 431. — Formaldehyd, 432. — Generation of Formaldehyd Gas, 433. — Liquid Formaldehyd-spraying, 436. — Sulphur Dioxid, 436. — Hydrocyanic Acid, 437. — Corrosive Sublimate, 437. — Carbolic Acid, 438. — Trikresol, 438. — Creolin, 439. — Nitrate of Silver, 439. — Preparations of Lime, 439. — Washing Soda, 439. — Sulphate of Iron, 439. — Physical Agents, 440. — Disinfection of Infective Materials, 441. — Disinfection of Excreta, 441. — Disinfection of Sick-room, 442. — Disinfection of Habitations, 444. — Disinfection of Patient, 445. — Disinfection of Public Conveyances, 446. — Disinfection of Libraries, 448. — Barber-shops, 448.

Chapter XIX

Maritime Quarantine, 450. — Inland Quarantine, 451. — Isolation or House Quarantine, 452. — Value of Disinfection and Isolation, 452. — Period of Isolation, 456. — Period of Detention of Those Exposed to the Infectious Diseases, 456. — Maritime Quarantine, 457. — Quarantine Laws of the United States, 458. — Quarantine Regulations, 473. — Foreign and Insular Regulations, 477. — Interstate Quarantine, 507.— State Quarantine Regulations, 511. — House Quarantine, 513.

CHAPTER XX. Vital Statistics 517

The Census as a Basis for Calculation, 519. — Standards of Age-distribution, 519. — Calculation of the Birth-rate and the Death-rate,

PAGE

521. — Rate of Infant Mortality, 522. — Death-rate of Persons Engaged in Various Occupations, 522. — Mortality in Relation to Seasons, 523. — Mean Age at Death, 523. — Mean Duration of Life, 523. — ^Probable Duration of Life, 524. — Expectation of Life, 524. — Relation of Density of Population to the Death-rate, 525. — Necessity of System of Notification, 526. — Hospital for Infectious Diseases, 527.

Appendix 528

Rules for Interchange of Different Expressions of Results of Analysis, 528. — Rules for Conversion of Degrees of One Thermometer Scale into those of Another, 528. — Rules for Conversion of Kilogram-meters into Foot-pounds and Foot- tons, and vice versa, 529. — Values of Terms Employed in Connection with Fuel-value of Food, 529. — Comparison of Metric and English Weights and Measures, 529.

Index 531

THE

PRINCIPLES OF HYGIENE

Introduction

The comprehensive nature of the subject precludes the possibility of giving a short and precise definition. A late writer on hygiene has given the following definition : " Hygiene aims to make growth more perfect, life more vigorous, decay less rapid, death more remote," Hence hygiene treats of the laws of health ; of all those measures which tend to preserve the body in a healthy condition, as well as those which tend to improve the general health. It embraces a knowledge of the factors and conditions which bring about ill health and disease, as well as a knowledge of the methods of preventing disease, and of the measures which tend to fortify and improve the organism.

Health is that condition of the body in which all the various functions are performed normally, and without the manifestation of discomfort in any of its operations. Disease, on the other hand, implies the imperfect performance of one or more of the bodily functions because of the impaired structure of the corresponding organ or organs, and the consequent manifestation of discomfort, either in the part directly affected or in the body generally.

There are many factors which may operate in such a manner as to bring about disease. These factors are usually divided into the immediate and remote causes of disease.

The immediate causes of disease may be again divided into three classes, physical, chemical, and vital. The

2 17 l8 INTRODUCTION.

physical causes of disease are such as are brought about by physical agencies. The diseases which are due to physical agencies are burns, cuts, bruises, fractures, and the like, and those diseases of the respiratory organs due to the inhalation of various forms of dust. The chemical causes of disease are corrosive and irritating drugs and chemicals which act directly through their corrosive action upon the part with which they are brought in contact, or indirectly through action upon the system after having been absorbed into the circulation. The vital causes of disease are the most important, because they are the most numerous and are frequently communicated from the sick to the well. They are also of great hygienic importance, because most of them are preventable. The vital causes of disease which are known to-day are the animal and vegetable parasites that are capable of lodging upon the surface of the body or penetrating into the blood and tissues, and thus give rise to disordered function either by producing obstruction, local irritation, absorbing large quantities of nourishment from the body, or by generating highly poisonous secretion and excretion products which produce disease through their local or general action. The principal animal parasites which produce disease are the various forms of intestinal worms, the trichinella spiralis, the filarise, the itch mite, the trypanosomata, and the malarial organisms. The principal vegetable parasites which produce disease are the different forms of pathogenic bacteria and the plants of somewhat higher order which produce tinea favosa and other skin diseases.

The remote causes of disease operate in such a manner as gradually to reduce the ph^'sical powers of the body, so as to make it possible for the vital causes to operate. The remote causes of disease may. be such factors as undue exposure to extremes of heat and cold, dampness or undue dryness of the atmosphere, imdue exposure to bright lights or strong currents of air may operate in this manner, prolonged absence of sunlight, deticient ventilation, the use of excessive amounts of

CAUSES OF DISEASE. x^

certain kinds of food and drink, the continued use of a diet which is deficient in one or more of the elements which enter into the composition of the body, maintaining the body in abnormal positions for a long time, undue physical or mental exertion, deprivation of food and sleep, and wearing of apparel which constricts certain portions of the body.

The causes of disease may also be divided into the predisposing and the exciting causes. The predisposing causes of disease are the various conditions which, by their influence upon the body, render it less resistant to the invasion of pathogenic bacteria, or otherwise predispose to disordered health. The conditions which have been classed as remote causes of disease also belong in this class, but besides these there are other important conditions which predispose to disease, such as the age and sex of a person, hereditary influences, race, conjugal condition, the hygienic condition of the environment, the density of the population, the nature of the occupation, and the climate of the locality. Dr. Farr found that the mortality increases with the density of the population, not in direct proportion to the density, but as its sixth root.

The exciting causes of disease are the specific elements which are the etiologic factors in the production of disease. These are synonymous with the immediate causes of disease in the first classification, the physical, chemical, and vital causes of disease.

Predisposing Causes of Disease. — i. Age. — The influence of age is a most important factor in the production of disease. The age groups in which the mortality is greatest are to be found in the periods of growth and decline, while the mortality is lowest during youth and the earlier periods of adult maturity. The highest mortality occurs among children imder one year of age, and then decreases rapidly until we reach the fifteenth year, after which it again gradually increases until we reach the period between sixt}' and seventy years, when

INTRODUCTION.

it again decreases. The following table, taken from the annual reports of the Bureau of Health of the city of Philadelphia, shows "the percentage of deaths to total mortahty during specified periods of life," for the years 1911 to 1915.

The Percentage of Deaths and Total Mortality at Different Periods OF Life in Philadelphia for the Years 191 i to 1915, Inclusive.

Years.

Per

Per

Per

Per

Per

Deaths.

Cent. •

Deaths.

Cent.

Deaths.

Cent.

Deaths.

Cent.

Deaths.

Cent.

0- 1. . . .

4,630

17-74

16.99

18.00

4,981

14.78

4,218

16.04

1. 139

4.36

3-37

3.77

1,021

3-79

3-56

2- 5

i,iS7

4-43

3.53

3.60

3-47

2.74

2.29

1.97

2.15

2.04

10- 15. . . .

i-iS i-iS

1.19

1. 11

1. 18

S8S

2.24

2.28

1.91

2.11

20- 30. . . .

1,749

7-iS

1,872

7.09

1,806

6.70

1,813

6.89

30- 40

2,580

9.96

2,276

9-31

2,388

9.11

2,301

8.54

2,343

8.91

40- 50

2,650

10.15

2,716

11.11

2,725

10.61

2,971

11.03

2,895

11.01

3.°72

11.77

3,082

12.60

3,170

12.35

3,339

12.40

3,430

13.04

60- 70. . . .

3.317

12.33

3,229

13.16

3,377

13.15

3,603

13.84

3,735

14.20

70- 80. . . .

2,737

10.48

2,798

11.44

2,827

11.20

3,076

11.42

3,208

12.20

80- 90. . . .

1,251

4.78

1,240

5.07

1,228

4.76

1,335

4-05

1,420

5-40

90-100. . . .

0.67

0.73

0.66

0.74

0.75

lOO-IIO. . . .

0.02

0.03

0.03

0.03