Community hygiene

Front matter

WOODS HUTCHINSON

Class Book.

Hji

Preface

One of the most significant and far-reaching movements of the day is the awakening of the health conscience of the community. No matter how alert, well informed, and prudent the individual may be, he is no longer able to protect his own health or that of his family from some of the most serious dangers which threaten it. Even the most wealthy and influential citizen is utterly powerless to insure the purity of his water-supply, the proper disposal of his sewage and garbage, the purity of the milk his children drink, or the wholesomeness of the food on his table, except by the aid of the strong arm of the law acting through public officers of health. In fact, health has become a community problem.

At first sight, the wisdom of giving children information about public health may seem open to question. They have no votes; and it will be several years before they are able either to influence public opinion or vote "yes" or "no" on questions of public sanitation. Furthermore, it may be argued that they are likely to have difficulty in understanding the engineering and chemical problems involved in public sanitary measures.

These theoretical doubts, however, have little substantial foundation. While it is true that children have no votes, they are far from being unable iv PREFACE

to influence public opinion. In fact, they are the most active and efficient teachers of their parents in particular and the community in general. "The wisdom of babes" has always had a high standing in history; and when children make up their innocent little minds that a certain line of hygienic conduct is right and proper, the community is bound to be strongly influenced in that direction.

Secondly, while some of the scientific principles involved are perhaps a little beyond their grasp, even when stated in the simplest way, the practical details of public health protection are a part of their everyday experiences, and are of direct interest to them.

Thirdly, the earlier that children can learn to cooperate with one another, with their parents and teachers, and with the community at large for the promotion of the public health, the better. The youngest child can do something in this direction and the older children almost as much as adults.

We are no longer satisfied merely to prevent disease. We want to build up and actively increase the vigor, wholesomeness, and happiness of the community. In this new and greater aim, it is even more important to have the cooperation of the children of the rising generation than that of the adult.

Acknowledgment is due to Dr. B. E. Roberts, formerly Assistant Surgeon, United States Public Health Service, for his valuable assistance in the preparation of the revised edition.

Contents

I. The Meaning of Health i

II. Causes of Health 9

III. Enemies to Health 17

Chapter I The Meaning Of Health

The naturalness of health. It is the most natural thing in the world to be healthy, and the easiest and pleasantest when you know how. In fact, one of the surest ways to be happy is to keep yourself and everybody around you healthy. To be healthy means simply to be clean, wholesome, and strong, able to do your share of the world's work cheerfully and well, and to lend a hand to others when you have a chance.

Not only will health go far toward making you happy, but it is also your duty to keep yourself in health — -the athletes call it "keeping fit" — fit for work, fit for play, fit for duty and helpfulness, so that you will always be able to carry your share and never be a burden to your family or to the community. It is really wrong to let yourself become sick or out of health when you can avoid it.

There is nothing mysterious or hard to understand about health. It means being in such good condition that you are ready to meet anything that happens and conquer it. If you are well, you will not only be able to do the ordinary, everyday, easy things well and promptly, but you will enjoy lighting and conquering cold weather, disease germs, and exposure of all sorts. The very things which make you uncomfortable and wretched if you are feeble or sickly, will invigorate you, warm your blood, and give you the joy of conquering them if you are strong and well.

The secret of health is to get the better of your surroundings and be master of your circumstances. The secret of ill health is to let them get the better of you. To be healthy, you must care for yourself as a good farmer does for his workhorses, or as a skillful engineer does for his engine. You must be well fed, well exercised, well rested, and well ventilated. It takes a great deal of work — either your own or your father's — to earn your food, house rent, and clothing, and to keep you strong and healthy; but when you learn to keep yourself well and take pride in doing so, it becomes one of the greatest pleasures in life.

If you are healthy and well fed and work under healthy conditions, work is not a punishment, but an enjoyment. At first it may seem too much trouble to keep yourself spotlessly clean; to keep your hands washed, your hair parted, your teeth brushed, and your nails trimmed. But you feel so much better after you have done these things, and you thus avoid so much illness and discomfort, that they soon become second nature. You feel positively

THE MEANING OF HEALTH 3

unhappy and uncomfortable if you have lost your toothbrush, or can't have clean water to wash in, or must go without your bath.

Health and happiness are first cousins. Many people think that it is a tiresome, melancholy, depressing thing to be thinking always about your health, to be afraid of catching diseases, refusing to eat this, forbidden to drink that, and living in constant fear that some disease may fasten itself upon you. So it may be, if you go about it in the wrong way. The fact is, however, that at least two thirds of the things you must do to keep yourself in health are things that you already like to do. You enjoy eating plenty of wholesome, nourishing, well-cooked food. You like plenty of play and exercise in the open air. You want to sleep ten hours every night in a warm, comfortable bed, in a pretty, well-lighted room with the windows wide open. You prefer to wear plain, light, comfortable clothing.

Almost the only things that seem really difficult are keeping your hands respectably clean, especially at meal times ; keeping everything out of your mouth except food, drink, and a toothbrush ; keeping away from dirty or unwholesome things like undrained marshes, street mud, and the mouths of sewers; and having the windows open at the top in cold weather.

If you keep doing vigorously and happily those things which make you well and strong, you won't need to worry much about the danger of becoming sick. Indeed, you won't have much time to spend in worry. It is a good thing to know enough about diseases to know how to avoid them ; but if you will keep yourself well fed, well exercised, well rested, perfectly clean, and do not touch or come in contact with people who are sick, — unless they actually need your help, — you will avoid most of the risks that can be avoided. Keep the germs away from you, and just what their special names are need not bother you. All germs are alike so long as they have not crept inside your skin, or so long as you are strong enough to kill them if they start a small colony in your body.

The money value of health. While we know that we cannot enjoy life or be of much use to others when we are out of health, we hardly realize what an exceedingly important and valuable thing health is to the whole community. We often speak of the great value of machinery, looms, mills, and factories. We marvel at the strength of engines — - the wonderful weights they can lift and loads they can haul. Yet we seldom stop to think that the most wonderful and valuable "steam power" of all is the strength and skill of human bodies and brains.

We boast of the wealth of our nation, of our rich and fertile farmlands, of our herds of cattle and flocks of sheep, of our splendid houses, factories, and shops, of our railroads with their thousands of engines and millions of cars and huge roundhouses and handsome stations, and the immense sums of money which all of these bring in every year. But

THE MEANING OF HEALTH 5

we forget that human labor earns more money for the nation every year than all these sources of wealth put together. The United States has more money invested in the health of men, women, and children — ■ will lose more by their sickness or weakness and gain more by their health and ' vigor — than in all of its other possessions put together. As a wise man expressed it years ago, "National health is national wealth."

When a factory is burned down, or the boiler of an engine explodes and tears it to pieces, or two locomotives crash together and are smashed into scrap iron, we can easily see that the owners, and through them the community, have lost a great deal of money. But until recently we did not see so readily that the community also suffers a heavy money loss if a man, woman, or child dies, ten or twenty years before the natural end of life, of some disease which might have been prevented. This does not include the grief and the suffering which falls upon the family and friends. One is just as serious and genuine a loss as the other. It has been carefully calculated that every human life has a money value to the community, beginning with a newborn baby at three hundred dollars, and rising to a full-grown man or woman at six thousand dollars. It is encouraging to see that the value of human life is rising steadily. Thirty years ago it was estimated at only two thousand dollars for a full-grown man.

The community is now taking up seriously the question of disease prevention and the increase of health and vigor. Already it feels justified in spending large sums of money to secure the conditions which produce health, working power, and happiness. Every year scores of new laws are passed by the different state legislatures and by Congress to secure pure and wholesome foods in shops and markets, to see that milk from our dairies is clean and wholesome, to bring an abundance of pure water to our cities and towns, sometimes from fifty or a hundred miles away in the mountains.

The State has recognized that it is not only our business and our duty to keep healthy ourselves, but it is also our business to see that all others in the community, particularly children and women, shall be given a fair chance to keep themselves healthy and vigorous and happy. To permit anything else would be to allow a waste and destruction of our most valuable natural resources, which are far more important than mines or forests or water power.

For instance, laws have been passed to compel all factories and shops and work-places to be kept clean and wholesome and well lighted and well ventilated; to install guards over dangerous machinery ; to prevent workers — particularly women and children — from working for such long hours as to injure their health; to provide lunch-rooms, rest-rooms, and toilet-rooms; and even to have doctors

A LESSON IN MOTHERCRAFT and nurses in attendance to treat accidents and illnesses which occur. Funds are provided for workers who become ill, and, if they are killed, to support and educate their families and children.

This wonderful work is called Community Hygiene. Even now we are approaching the point where, by taking intelligent care of ourselves and doing what we can to help others, we are able to prevent at least half of the ordinary diseases and ill health. When we are properly organized, we shall probably prevent three fourths of the sickness and early deaths which now occur. Think what that will mean for the welfare and happiness of the community! As one probable result, we shall almost get rid of poverty. One of the ablest commissions that ever investigated the causes of poverty reported some years ago that in its judgment nearly two thirds of the poverty in the country was due to disease and ill health.

Then, let us keep ourselves healthy and do all that we can to help others to do the same. Let us get all the help and information we can which will teach us how to keep well and help others to keep well. By doing this, we shall make this world a comfortable and happy place in which to live.

Chapter II Causes Of Health

The prevalence of health. The causes of health are the causes of life — sunshine, food, air, and water. These are what the ancient Greeks called the four elements out of which the earth was made — fire, earth, air, and water. If we have plenty of fresh air and sunshine, plenty of good wholesome food, plenty of clean water to drink, and a fire to keep us warm in winter, we are more than likely to be healthy practically all of the time. Like the magicians of old, who claimed that they could call spirits from the vasty deep, the earth, and the clouds to aid them, we can call all the forces of nature — the sun, the wind, the rain, and the brown earth — to help us keep healthy. The science which tells us how to do this is called Hygiene.

In other words, health is a common thing, depending upon common things. The individual who is well fed, well exercised, well rested, and well warmed, is healthy. The city that is clean, sunny, and has plenty of open spaces for grass to grow and children to play, is healthy. The individual who lets himself be dirty, eats bad food, drinks impure water, breathes stale air, and works too hard without rest or play, becomes sick and makes others sick. The io COMMUNITY HYGIENE

city with dirty streets, bad water-supply, crowded houses, insanitary markets and bakeshops, and smoke-filled air that shuts out the sun, will have a high rate of sickness and death. Health is just a matter of common sense applied to the common things of everyday life.

We do not realize how common health is. So much disturbance is made about sickness, suffering, and death that we sometimes fancy disease is even more common than health. That is not true.

A hundred years ago — indeed, even fifty — there was some excuse for such a mistaken idea. Science had not then taken charge of human affairs. Dirt was not known to be dangerous ; and nobody thought it had any connection with disease. People in Europe and in this country did not know how to take care of their bodies, and did not know that many diseases could be prevented merely by keeping themselves, their food, water, and homes clean. Because they did not know, thousands of them died from diseases which we now know how to prevent, and the average length of life was only twenty years.

To-day we know better. Any modern community would be ashamed to have the number of cases of disease that was common in the best communities fifty or a hundred years ago. The broom and the scrubbing-brush, the meat and vegetable inspector, the city chemist who makes sure that the city water-supply is pure, the garbage-collector, and the street-

HOW OUR STREETS ARE KEPT CLEAN cleaner — these are some of the civic agencies which have made our communities wholesome places in which to live. To-day we live on an average nearly fifty-one years, chiefly because we know how to be clean. In India and China, where people have not learned how to take care of their bodies and homes, the average life is still about twenty years.

It has been found in schools and factories that the number of days lost from sickness 'by each of us is about fifteen in a year, which means that we are healthy over twenty days for each day on which we are sick. That is a fairly good average ; but some day we are going to do even better. We are learning more and more all the time about how to keep ourselves well.

How the Canal Zone was cleaned. What the community can do to make its citizens keep well was shown when the Panama Canal was built.

The Canal was cut through the deadliest fever swamp in the world. It was considered that Panama had the most unhealthy climate known, except perhaps some parts of Africa. Every tropical infection known — malaria, yellow fever, the Black Death, cholera, and smallpox — could be found in Panama. In 1 88 1 the French Panama Company attempted to dig the Canal, and lost more than one tenth of its working force every year, or half of its men in five years. Conditions were very bad indeed — so bad that some people thought the Canal could never be built at all.

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Finally the French Company broke down and gave up the task and the United States undertook it.

General Gorgas, head of the Panama Canal Health Commission, took hold of the health problem.

One of the first things he did was to ask the United States Government to buy large quantities of the best and purest food to be found anywhere in this country. Beef was bought by the ton, flour by the carload, sugar by the thousand pounds, potatoes and fresh vegetables by the shipload. All these foods were shipped down to Panama to feed the engineers and laborers. At first the Government built restaurants and hotels and boarding-houses, because the workers, thinking they were coming to the most unhealthful country in the world, had not brought their families with them. After a time, when they found their health was so carefully protected, they sent for their families. Then the Government provided markets and shops where good food was sold at cost, and nowhere in the civilized world could food of the best quality be found at so low a price as in the Panama Canal Zone during the five years of the construction. This settled the clean food question, and laid the foundation for the rest of the health work.

Putting in a pure water-supply. The next step that General Gorgas took was to stop the people from getting drinking-water from dirty or infected pools, sluggish streams, and stagnant swamps. He filled up all the shallow wells, because most of them were infected with typhoid fever. He supplied every construction camp and working village along the line of the Canal with pure filtered water, cooled with absolutely pure artificial ice.

This immediately stopped the typhoid fever, dysentery, and cholera which had caused thousands of deaths under the management of the French Company. At the same time he provided proper drains and sewers so that all the waste from the houses and shops was carried away and discharged into the rivers or the sea, where it could do no harm and could not infect the drinking-water. That was the second step in the health campaign. Those against malaria and yellow fever will be described in the next chapter.

What happened to the death-rate. None of these steps which General Gorgas took sound exciting or unusual. Pure food, pure water, proper drainage — everybody knows about these things. In fact, they are only the very same steps which every town, city, and village in the United States has known for the last twenty years that it ought to take if it is going to be a wholesome place in which to live.

What was the result? The death-rate in Panama in the old days before our Health Commission took charge had been from three to five times as great as that in the United States or Europe. The greater part of this frightful death-rate was caused by malaria, yellow fever, cholera, and typhoid, all of which diseases are especially bad in hot climates. The

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A WAY-STATION FOR GERMS The public drinking-cup is one of the busiest spreaders of disease germs known. If the big girl has a cold, what will happen to the baby if she drinks from the same cup? What if the big girl is coming down with scarlet fever?

most striking thing which General Gorgas did was practically to wipe out all these diseases, partly by installing the pure water-supply, and partly by methods which we shall describe in the next chapter. He not only brought the death-rate to the same level as that of the United States (about fifteen deaths to every one thousand persons), but in the last three years of the Canal construction he made the Canal Zone the healthiest place in the civilized world, with a death-rate of five to six per thousand,, or scarcely one third that of the United States. 1

1 It is only fair to say, however, that there was a much larger proportion of grown men and a smaller proportion of women and children

Contrast this with the conditions under the French Company, in 1881, when a death-rate of seventy-five to one hundred persons per thousand prevailed, and you will realize the result of keeping a community clean. It also shows how recent a thing is our knowledge of how to protect our health.

Why Panama is a lesson to our communities. If General Gorgas could do what he did in the unhealthiest climate in the world, in a community which contained a large percentage of uneducated laborers, and with no civic improvements or civic pride to help him, what cannot intelligent American towns and cities do if they will only use their own good common sense to wipe out those things which cause disease and to increase those things which cause health? Our climate is naturally healthful, our homes are good, our citizens are intelligent and public-spirited. We can get pure water at comparatively little cost, and good clean food without having to send it three thousand miles in refrigerator ships. We ought to be the healthiest nation in the world ; and if we will only do all that we know how to do and can do to keep ourselves well and help other people to do likewise, we can be much more healthy and happy than we are to-day.

in Panama than in the United States, which would mean a smaller number of deaths, because more deaths occur during the first ten years of life than during any other period.

Chapter III

Rocks in the life-stream. Much of our health knowledge is very old. We did not need, for instance, to wait for the discovery of the microscope or the invention of the steam engine to know that if people did not have enough food to eat, or ate spoiled food, they would become sick. In fact, we usually know by instinct what to do to keep well. We eat when we are hungry, drink when we are thirsty, and dislike muddy water in our glasses or dirty food on our plates. We dislike the taste of most poisonous things, without needing to be told that they are bad for us. We dislike the hot, burning taste of alcohol, for instance, when we first try it. People who use it must teach themselves to like it, or even to swallow the wretched stuff without gasping and making a face.

Dangers which we do not know. Although we know by instinct a great many of the things which are bad for our health, there are other kinds of danger which we cannot understand unless we are told about them. These dangers have been discovered only in the last thirty or forty years, since the microscope came into use. They are the great diseases which run through a country, an army, or a town ; and which are now called infections because they are " catching" and spread from one person to another "by touch." Sometimes they are called contagions from two Latin words which mean by touch, or spread by touch. Both these words mean that you catch the disease because something from the body or breath of a sick person has come in contact with your body.

Most of these infections are fevers. When we have caught a fever infection, our bodies become hot, our faces turn red, our heads ache, and we say we feel " as if we were burning up." When a fever thermometer is slipped under our tongues, we find that our body heat, or temperature, has gone up from 98.6 to 100, 102, or even 105 degrees. It is no wonder we feel as if we were burning up, for we know that when the thermometer rises to 102 degrees in the shade we think it is a very hot day.

Although these fevers or infections are troublesome, and some of them are extremely dangerous, they usually " run their course " and come to an end of their own accord. They may make us feel very sick while they last, but we know that almost always the fever will " break " in a few days, the headache and backache disappear, we will feel much better, and will soon be well.

For a long time people were greatly puzzled over the reason why these fevers behaved in this curious way. All of them, except the very worst, broke and began to improve sooner or later. Stranger still, each particular fever or infection took a certain length of time to run its course, varying from three or four days for a common cold to three weeks for typhoid fever.

Some fevers were even more peculiar; for while they ran for several weeks, or even months, they kept the patient sick only about half or a third of the time. These were the malarial fevers or agues — ■ or, as they were sometimes called, ' ' chills-and-fever, ' ' or " fever-and-ague." In some of these the patient one day was exceedingly ill and wretched, with a very high temperature and shaking until his teeth chattered. The next day he was practically well and able to go to work. The following day he came down with another chill and fever. This succession of fever and normal condition continued for weeks. The patient could tell with absolute certainty that on, say, Tuesday and Thursday and Saturday of next week, or the week after next, he would be very ill, and on Monday and Wednesday and Friday practically well. Some other kinds of malaria have a three-step instead of a two-step gait, making a patient sick one day, well two days, then sick again, then two days well. Still another has the habit of making the patient sick only two or three days out of the week, but gives him no idea in advance what days they will be.

How we discovered the germ. This singular way the infections had of following their own peculiar course gave rise many centuries ago to the notion that they were due to some kind of tiny plant or insect or worm which had made its way into the human body and was living its own life there. About fifty or sixty years ago we succeeded for the first time in making microscopes powerful enough to make such tiny objects visible. As soon as a drop of blood or saliva or other fluids from the body of a patient sick with these curious " living fevers " was placed under the microscope, we found that it was swarming with thousands of these tiny creatures. At first it was supposed that they were very small animals, but it was soon found that most of them were tiny plants, more like moulds and the fine, dusty powder in puff-balls than anything else. As these plants had never been seen before, they had no name; and they were christened germs, from a Latin word meaning seeds or sprouts.

As one disease after another was studied, it was found that each of these infectious fevers was due to a special kind of germ ; that the length of time it took for the fever to get to its height was simply due to the length of time its germ needed to grow to its full size and numbers in the human body; and that the breaking and fall of the fever was due to the weakening and death of the germs under the attack of the cells and fluids of the body.

The same microscope which enabled us to see the germs also showed us that every part of our bodies was made up of an enormous number of tiny cells. In fact, our body cells and the germs which attack them are much alike, only our body cells are from twenty to fifty times as big as the germs, and are animals, while most of the germs, as we have seen, are vegetables or plants. Another difference is that our body cells are tied together and packed closely side by side, like bricks in a house, or popcorn in a ball, while the germs are all separate and distinct from one another. Like fish in the sea, they swim about freely in all directions, in the blood or other fluids of the body.