Short talks on personal and community health

Introduction

Since 1908 the Department of Public Health and Charities has issued health bulletins in the form of short talks addressed to the public through the press on subjects of vital interest dealing with the prevention of disease and the promotion of the public health. It has been my experience that such education, while profitable, is rather slow. The quickest and most valuable way of teaching the public is through the schools and colleges. Public health education makes its greatest impression upon the young. Their minds can be molded to think along the lines of health and sanitation.

The health talks in this book have received the hearty endorsement of the Department of Public Health and Charities of Philadelphia. They are written in such popular form as to be understood by every school pupil and college student. The subjects are so varied as to cover a very wide scope of public health work. A more intimate knowledge of these various principles of preventive medicine will be of greater material benefit than all legislation intended to regulate the habits and customs of the very busy American public.

WiLMER Krusen, M.D.,

Director, Department of Public Health and Charities, Philadelphia, 1916-1919.

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Preface

Public Health education is the foundation upon which rests the future progress of preventive medicine. The health officer cannot enforce his principles of sanitation and hygiene unless he can first make his community understand the importance of the various problems with which the public is confronted. The greatest drawback today in the programs of our health officials is ignorance of the public in matters dealing with the prevention of disease and the promotion of public health. Many have tried through the press, by lecture, by health literature, to convince the public of the importance of rightful living. But the people whom we most desire to reach can neither read nor write, or their foreign customs are such that they cannot or will not accept the new American ideas.

Our great housing problems, our infant welfare work, our effort to prevent occupational and infectious diseases, our campaigns to prevent accidents and our slogans to promote health depend entirely on the public's appreciation of the significance of these great factors. In order to bring our lesson home forcibly, we must vi Preface

educate and keep on educating the public. The manner in which this should be done so that it will include the rich and poor, the educated and the illiterate, is a problem.

One way of solving the problem, as suggested by the Assistant Commissioner of Health of Pennsylvania, Dr. John D. McLean, is by educating the children. They are the citizens of tomorrow. They are the books of information to illiterate parents. They are the foundation upon whom we rest the future progress of preventive medicine.

This book has been prepared primarily to accomplish the purpose just mentioned. It was designed to instruct the school pupil, the college student and the social worker in the elements of public health. The health talks are arranged in a short, concise manner, in popular form, free from technical terms, so as to be readily understood by the average person of school intelligence.

Large industrial plants, appreciating the value of keeping their employes in good health, are adopting facilities such as rest rooms, recreation fields and auditoriums for their benefit. The need for health education among these employes is becoming more apparent each day. The subject matter in this book is so arranged and selected as to fit the need of such education.

Preface vii

Health lectures are being conducted in most of the large cities by the health authorities in the schools, in child welfare stations and among civic and social organizations. As a guide for such lectures, the subjects mentioned in this volume should prove valuable.

It is not aimed to teach the public how to treat disease, but rather how to prevent it and avoid it.

Louis Lehrfeld, M.D.

PART I Preventable Diseases and How to Avoid Them „^^^

PAGE

Tuberculosis 5

Fresh Air Treatment of Tuberculosis 7

Facts about Tuberculosis, What is Tuberculosis 10

Don't Catch the Grippe or Epidemic Influenza 22

Sore Throat and its Significance 24

Are You Immune to (protected against) Diphtheria ? 30

Scarlet Fever ^ 34

Household Care of Scarlet Fever 36

Chicken Pox 39

How to Avoid Smallpox 41

Is Measles a Serious Disease ? 43

Whooping Cough 45

Mumps 47

High Lights on Infantile Paralysis 49

Cerebrospinal Meningitis 51

Colds, Coughs, and Pneumonia 53

Facts on Causes and Prevention of Pneumonia 55

Why You Should Not Spit 57

Hay Fever and Its Prevention 58

Mouth Infections as the Cause of General Diseases 60

High Cost of Preventable Disease 66

PART II Subjects for Spring and Summer

Spring Tonics 68

Malicious Medicine Habit 70

Misbranded Medicine Condemned IZ

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Contents

PAGE

Getting Rid of Household Pests 75

The Enemy at Home —The Fly 78

The Bedbug as a Carrier of Disease 87

Disease Associated with the Soil 93

First Aid to Heat Victims 97

Safety Hints for Bathers and Boating Parties 99

"Dog Days" 102

Summer Resorts and Public Health 104

PART HI

Subjects for the Holidays

Don'ts for the Fourth 110

Health Resolutions for the New Year 115

PART IV Miscellaneous Topics

Health Day and Its Significance 117

The Prevention of Physical Deformities 118

Health of Women Wage Earners 121

Recreation and Health 123

What Exercise and Recreation Mean to School Children 124

Exercise and Recreatio^i for the Busy Man or Woman 128

Vacant Lots and Gardens 130

Fresh Air — a Germicide 132

Ventilate the Garage 137

High Cost of Heating the Home 139

Coal Gas Detrimental to Health 142

Clean Streets Essential for a Clean Bill of Health 144

Eliminating the Dust Nuisance 146

Contents xi

PAGE

Occupation and Disease 151

Prevention of Industrial Accidents 153

Foot Strain and Its Relation to Health 155

Underweight and Its Significance 157

Proper Winter Clothing and its Health Aspects 165

Stop That Noise 168

Sanitation of Swimming Pools 173

Disinfectants 178

The Common Drinking Cup, Towel and Wash Rag 180

Preventive Inoculation 182

Clean Up Week— A Health Measure 185

Disease Transmitted by Domestic Animals 187

Regulating Rag Shops 191

Sewage Disposal 193

Refuse Disposal 195

PART V Foods and Water

Low Priced Foods with High Nutritive Value 196

Handling of Food and Its Relation to Public Health 199

Plea for Sanitary Restaurants 202

What the Public Should Know About Milk 207

Milk, A Perfect Food 210

Meat and Cattle Inspection 215

PART VI Talks About Infants and Children

Birth Registration an Important Subject 217

Preventing Blindness Among Babies 219

Care of the Baby During Hot Weather 221 xii Contents

PAGE

Care of the Baby During Cold Weather 223

Care of the Child During Pre-school Age 225

Preparing the Children for School 227

The Care of School Children 230

Trivial Complaints Among Children 251

Defective Vision Among School Children 253

Good Teeth Essential to Good Health 258

Tonsils and Adenoids 260

PART VH First Aid to the Injured 265

Index 269

Part I Preventable Diseases And How To Avoid Them

T^YPHOID FEVER is an infectious disease caused by a germ called the typhoid bacillus, which enters the body through the digestive tract. This germ invades the whole body through the blood but does its principal damage in the intestines. The improper disposal of the body discharges of a typhoid patient may give rise to other cases. Either the nurse may become infected if she does not wash her hands carefully after handling the patient, or other persons may contract the disease from drinking unfiltered water, by eating shell food obtained from impure waters, salads which are washed with contaminated water, milk which is not pasteurized or foods which are contaminated by handling or by flies. In country places where the outhouses are not properly screened, flies may convey the infection to the food.

TYPHOID CARRIERS.

Persons having had typhoid fever may after full recovery from the symptoms, continue to excrete from their bodies the germs of this disease. Such persons are called "carriers'' because they carry the germs in the body discharges. Their soiled hands coming in contact with food intended for others, spread the infection. There were many cases of typhoid fever in New York City which were traced to a servant who had the disease and carried it to the families where she was employed. She is well known among public health officials as "Typhoid Mary." Carriers of this kind are quarantined by the health department until they are no longer dangerous to the public or they are not permitted to engage in occupations which require the handling of foodstuffs.

HOW TO AVOID TYPHOID FEVER.

In the late summer and fall of each year there is an increase in the prevalence and mortality of typhoid fever. In Pennsylvania almost one-third of the cases are reported during the months of August and September. An analysis of the cases occurring during these months shows that 25 per cent, of them were contracted by persons while on their vacation. This disease has, therefore been properly termed "vacation typhoid," having been brought home by vacationists returning from country places, the seashore and mountains where proper sanitary measures had not been adopted to protect the public from infection. The water and milk supply are the chief sources of infection in summer resorts, while the less frequent sources of infection are foods contaminated by flies and by handling, raw vegetables washed in infected water or taken from fields fertilized with night soil, seafood taken from sewage polluted waters, and bathing in infected streams.

The spring of the year is, therefore, the time to guard against avoidable infection with typhoid fever. One of the safest ways to secure almost certain immunity is by vaccination. This is attended with very little inconvenience, and comprises the hypodermic injection of dead bacteria at three different sittings, lo days apart. The dangers of such inoculation are practically nil, for no ill effects have been experienced in the Army and Navy where everyone is required to be vaccinated.

The value of inoculation has been proved beyond all doubt. During the Spanish-American War there were over 2700 cases of typhoid fever, resulting in 248 deaths, among 11,000 troops assembled at Jacksonville, Florida. Vaccination was not advocated at that time. During the occupation of Vera Cruz, however, in 19 14, by the United States Expeditionary forces there was only one case of typhoid, and this occurred in a civilian who had not been vaccinated. In the same year there were only 6 cases in the whole army; two of these occurred in unvaccinated men, while the other four were already infected before receiving their inoculations. In the recent World War, typhoid vaccination gave final proof of its value.

This preventive procedure should not be considered as a substitute for the usual sanitary measures, such as good water supplies, clean milk, fly suppression, cleanliness and personal hygiene, but as an important adjunct to them. Persons who intend to travel during the summer, especially in localities where typhoid may be prevalent, should protect themselves against infection by vaccination. While it has not been conclusively shown how long immunity from such inoculation lasts, it is claimed that at least three years can safely be relied upon. If the public should adopt this measure of protection, there will be less typhoid fever in this country and consequently a lower death rate. In 1919, many cities reported the lowest death rate from

Tuberculosis this disease in their history. By ehminating the vacation cases, however, there would be estab- Hshed a very low typhoid rate.

Get vaccinated now and avoid future trouble.

Tuberculosis

'T^HE widespread publicity which has been given to the campaign against the spread of tuberculosis has been greatly instrumental in reducing the incidence and the death rate of this disease throughout the country.

Tuberculosis is always contracted from an existing focus, either from the infected sputum of man or from the infected milk of cattle. The latter source has been practically eliminated, as 99 per cent, of the milk in the large cities is pasteurized. The fight against this disease, therefore, is limited chiefly to the proper disposal of the spittle of tuberculous patients. Warning has been frequently sounded against the indecent, foul and dangerous practice of spitting in public conveyances, railroad stations and on the open highways. This nuisance, nevertheless, still exists and tends to disseminate the disease to every individual who is susceptible. It is,

Tuberculosis therefore, the duty of every person who has tuberculosis of the lungs, to deposit his sputum in a suitable cup or paper handkerchief which should be carried at all times and which can be readily destroyed after use.

Progressive sanitary experts favor the establishment of detention wards in our hospitals for the restraint of persons with advanced tuberculosis who are dangerous to their fellowmen by reason of their physical condition or their careless personal habits. Public opinion has not yet sanctioned such radical supervision but it is only a question of time when the healthy citizen will demand municipal protection from his infected neighbor. Detention of this character will require a legal commitment backed by police surveillance. Such commitments must be either voluntary or by order of the court, and the method of procedure should follow the lines of commitment of insane patients. The eduQation of the public will accomplish this result in the near future. Meanwhile, it behooves all good citizens to urge the adoption of such a progressive sanitary standard. New York City has already taken this step forward.

Experience has shown that the chances for recovery from this disease are very great, provided the condition is diagnosed in its beginning

Fresh Air Treatment of Tuberculosis 7

and treatment is carried on faithfully and persistently. Fresh air, sunshine, good food and regular habits are the natural and best remedies and these are within reach of the rich and poor alike. On the other hand, poor housing, poor food and other limitations of poverty accentuated by the use of alcohol are important factors which obstruct the progress of this campaign against tuberculosis.

Of particular interest is the fact that tuberculosis among colored people is on the increase while among whites it is steadily decreasing. This indicates the need of more persistent efforts to inform the poor and uneducated about matters of public health. Instruction in the public schools should aid materially in accomplishing this purpose.

The Fresh Air Treatment of Tuberculosis

TN the past there has been a general exodus of tuberculosis patients to the Western States in the attempt to secure climatic living conditions which may effect a permanent cure, or at least arrest the further progress of the

8 Fresh Air Treatment of Tuberculosis

disease. This popular idea has brought many a hardship upon famihes of meager means who have spent their fortunes in the hope that dear ones afflicted with this disease might obtain the benefit of travel and favorable climate. Places known for their dry atmosphere, and located at a relatively high altitude were Meccas of refuge. Very often those who were on their way to recovery were overtaxed by the burden of travel, change of scene from home, and the mental depression resulting from the absence of friends and relatives, and, instead of improving, their condition became worse.

Of late, there has been a gradual but decided change in the trend of opinion regarding the travel of tuberculous individuals to places distant from home where climatic conditions are said to be ideal. Many of our infected population cannot afford to make such expensive trips which often prove of no avail. The medical profession has been inclined toward recommending places near home, but just far enough away to insure atmosphere free from the dust and dirt of the city in overcrowded and overheated living quarters where infection breeds and spreads, and also just near enough so that the patient may, at frequent intervals, be in contact with those near and dear to him.

Fresh Air Treatment of Tuberculosis 9

There are a number of places in the suburbs of every large city and state close to home where tubercular patients may receive the fresh air cure.

In fact the outdoor life in that part of the country where the temperature varies, has a stimulating effect upon the body, promotes more active resisting powers, and does not have the disadvantages which accompany an unaccustomed climate at a distance from home. The beneficial effects of high altitude have probably been overestimated. The advantage of the fresh air in localities to which the patient has already become acclimated overbalances those in places of low atmospheric pressure. A low pressure causes extra work upon the heart muscles of the patient already physically depressed by reason of his chronic disease.

The number of persons who are permanently cured of tuberculosis is increasing rapidly each year. This is proved by the actual number of discharges from sanatoriums and by the findings at autopsies which show healed lesions in the lungs of persons who have died from other causes. Furthermore, during the last thirty-five years the death rate from tuberculosis has been reduced one-half as a direct result of education of the public on methods of prevention and on the simple measures of treatment. A still greater reduction in the mortality from this disease and an increase in the number of cures can be secured by the adoption of open air treatment in the vicinity of the patient's home.

Facts About Tuberculosis. What is Tuberculosis?

T^UBERCULOSIS is a disease of the lungs, or, less commonly, of the bones and glands caused by a germ called the tubercle bacillus. This germ produces and throws off poisons which kill the structures around it. This germ grows and produces more germs, invading the whole body until finally it kills the person in whom it grows. In recent years it has been shown that the germ frequently gets into the body in childhood, but, since it does not grow easily in the human body, many of these germs are killed at once by juices in the body. Others are inactive for a long time in the glands of the chest or abdomen and do not develop until by some chance the resisting power of the body is lowered

Note : Many extracts in this section are from "What You Should Know About Tuberculosis," by the National Association for the Study and Prevention of Tuberculosis.

sufficiently for the germ to grow, the thoroughly healthy body not being a favorable growing place. Overwork, dissipation, dark dirty homes or work-places, bad or scanty food, late hours, drunkenness, and certain diseases, such as grippe, measles, whooping cough, pneumonia and typhoid fever weaken the body, give the germ the opportunity it needs and enable it to develop. In bodies thus weakened, the germ can flourish, and, if they are not strengthened in time by proper living, the disease will progress. This advance is usually slow and gradual, so that the patient may live from two to ten years, but in the more rare form its advance is rapid, so that the patient dies in from six weeks to a year.

NATURAL RESISTING POWERS.

Fortunately for us the germ of tuberculosis does not grow easily in the human body. All animals have a certain degree of resistance to the germ. In some this resisting power is very low; in some very high. The guinea pig, for example, has almost no resistance to this disease, while the goat has so high a resistance that it is very hard to infect it at all. Among human beings the Indian and probably the Negro show a very low resisting power, and when infected, are apt to have the rapid and dangerous form of the trouble. The average white man on the contrary has considerable resisting power, and it takes repeated, prolonged exposure and unfavorable conditions of working and living, to infect him, except in early childhood, when, it should never be forgotten, infection is very easy.

HOW THE GERM DEVELOPS.

The first manifestation of the activity of the germ in the body is the formation, usually in the lungs, of a small gray lump, which we call a tubercle. This is about the size of the head of a pin, and when examined under a microscope, it is seen to consist of a cheesy mass of dead tissue with germs lying in it. The formation of this dead tissue by the poisons of the germ is called ''Caseation." Surrounding the cheesy center is a double layer of cells thrown out by the body to protect itself from the invading germ. If the poisons of the germ are sufficiently strong, or if the cells surrounding the germ are sufficiently weak, they too will be destroyed, and by degrees successive layers of tissue will be killed, the trouble thus spreading at the outer border through larger and larger areas of tissue until finally the whole lung is involved. When the mass of dead tissue reaches an air tube it is coughed up and leaves a small cavity behind. When this cavity becomes bigger, other sorts of germs from the outside air may get into it and help the tubercle germ to spread destruction, thus finally producing what we call "Consumption."

If, however, the body is put under favorable conditions of feeding, of fresh air and of wise living, its cells will be so strengthened that it will be able to kill the poison of the germs.

The disease can be compared to a battle between the germs which have gotten into the body and the cells which make it up. If these cells are well nourished and cared for they will win, and will shut in and finally kill the germ; if not, the germs will, by degrees, kill them and cause the patient's death.

TUBERCULOSIS MAY BE CURED.

Once the disease has attacked the body, it always leaves scars behind, as a careful examination of dead bodies will show. Since, however, with careful living, these scars will remain firm and strong, enclosing the trouble, in which by degrees the germ may die out, patients may justifiably be considered "cured"; but it must never be forgotten that as a result of dissipation, poor housing conditions, neglect of personal hygiene and cleanliness, overwork or sickness, the disease may break out again.

Tuberculosis is not like typhoid fever or smallpox, or measles, or scarlet fever, which diseases are easily and quickly taken if you come in contact with those who have them, and which develop in from one to two weeks. It is caught much less easily, takes a long time to develop after it is caught, and can be prevented from developing very often by clean living, or can be cured or arrested in a large number of cases if it has not gone too far. Therefore, it is not necessary to despair and give up hope if you, or some one you love, has caught this disease, but it does demand an immediate improvement of your ways of life and of your surroundings, so as to strengthen your body to the utmost in order that it may be able to shut in, wall up and conquer the trouble. In tuberculosis, scars are always left and germs for a long time may be found in these scars, and improper living can enable them to break out again, but, as ample experience has shown, it may be so successfully walled in that all symptoms of its presence will be lost, and the patient can resume a normal and useful life if only he is willing to live wisely and prudently. However, a relapse is always possible after an arrest, even after many years.

INFECTION FREQUENTLY TAKES PLACE IN CHILDHOOD.

Infection very frequently takes place in early childhood through the alimentary tract. The germs enter the lymphatic glands and lie quiet here for many years. It seems probable that many of those who develop the disease in adult life have carried the hidden infection since childhood and have not received a new infection when symptoms of the disease appear.

A BAD AIR DISEASE.

As has been said, this disease is probably caught in most cases in childhood and lies inactive in the body for a longer or shorter time until the conditions are favorable for it to develop, but it can be acquired at any time or age. Since the germ can, and often does, lie quiet in the bod}^ for many years before it develops and is discovered, it is usually difficult or impossible to say just when or under what circumstances the person became infected. It should always be remembered that it is almost always a house or indoor infection, and that it is rarely if ever caught outdoors where the sunlight, which is our best disinfectant, quickly kills the germ. Thus the great and real danger is from living with careless, dirty consumptives, and especially in dark, damp, dirty or ill-ventilated houses, sleeping and living rooms, workshops, factories or stores, which have become infected with the germ by the sick people's careless spitting habits. The germ, which is a microscopic rod, invisible to the unaided human eye, is found in millions in their spit from very early in the disease, and it is through this spit almost alone that it reaches others. If we could collect and destroy all the spit of such patients and make them cover their mouths when they cough, we could almost wipe out the disease. Fortunately, when people spit outdoors the danger is not quite so great, since, sooner or later, the sunlight will destroy the germ; but when they spit indoors, as many do, where the sun cannot get at the germ and kill it, it may remain alive and active for a long time. Hence people who spit in this way are a terrible danger to all who live with them, or to those who stay in the places where they live or work. Many people do not know that they have tuberculosis, but think that they have only a ''bad cough," when they already have the disease and are bringing up the germs in their spit. Every one, therefore, who spits or has a cough should be just as careful about his spitting as if he knew that he had tuberculosis. If those with germs in their sputum spit on floors or sidewalks, the sputum will be ground under foot, blown around as dust in the air, and inhaled by other people, and will finally reach the lungs.

INFECTION FROM CARELESS PERSONS IN THE HOME.

In the home the chief danger, as has been said, is to children, although adults may also become infected. The two chief sources of infection for children are, first, consumptive relatives or fellow lodgers, and secondly, infected rooms, dwellings or dishes. Children are apt to be kissed and fondled, and in this way the germs may be carried directly to them. Again, they play around on the floors, too often infected with spit, and thus acquire the trouble. Therefore, the kissing or fondling of little children by sick relatives or friends should be prohibited, as well as the bad habit of feeding them from the spoons and plates of such people. Indeed, as far as possible, children should be kept away from their sick relatives as long as the latter cough and spit.

THE DANGER OF INFECTED ROOMS.

No one should move into a previously occupied home until all the rooms are thoroughly cleaned and aired. In the dark corridors of many houses the germ may Hve for a long time and unfortunately many people who would not spit on the floor of a bedroom, will do so on the floor of a corridor. If every one should see to it that his home is kept strictly clean, that as much sunlight as possible is admitted to it, and that no one is allowed to spit on the floor, it would do much to lessen his family's danger of catching this disease.

Dry sweeping of rooms should never be allowed, as it raises clouds of dust, which may contain the germs, which are thus breathed directly into the lungs. Therefore, all broom sweeping should be preceded by strewing the floor with damp sawdust, old tea leaves or bits of wet paper and if it is at all possible, vacuum sweeping or cleaning should be used.

HOW WORKING MEN INFECT ONE ANOTHER.

Outside of the home, there is much danger in insanitary shops, workshops, factories and mills. Experience shows that both clerks and w^orkmen too often spit carelessly on the floors of their w^ork places, and since some of them, often without knowing it, have the disease, they infect their fellow workmen. Every year thousands of American laborers are made sick in this way.

What is Tuberculosis? 19

INFECTION FROM A COUGHING PATIENT. "droplet INFECTION."

Infection is also carried by coughing and sneezing by which acts fine sprays of mucus are thrown into the air carrying with the droplets, the germs of tuberculosis. This could be entirely avoided, if every one formed a habit of covering his mouth with a handkerchief at such times. This danger is so real that public opinion should enforce such a custom.

INFECTION THROUGH MILK.

The germ may also be taken into the body in uncooked cow's milk. Cows frequently have tuberculosis and the germ may get into the milk, sometimes in large numbers. While in grown people this is not a common source of infection, it is a frequent source in little children who drink much uncooked or unpasteurized cow's milk. The germs are carried by the milk into the bowels, pass through their walls and enter the system through the lymphatics, lodging usually in the glands around the roots of the lung, or in those attached to the intestines. Therefore, unless one is certain that the cow which supplies the milk is free from tuberculosis (which can be told by a test that a good veterinary doctor can easily make), the only safe thing is to pasteurize or boil all milk which is used by the children of the household.