Chapter 10

HYGIENE IN GENERAL

Section I--The Fifteen Rules of Hygiene

The aids to health discussed in the preceding chapters may be summarized in specific formulas classified under the four heads, Air, Food, Poisons, and Activity, corresponding to the four chapters, and under fifteen sub-heads, corresponding to the fifteen sections.

I. AIR. 1. Ventilate every room you occupy. 2. Wear light, loose and porous clothes. 3. Seek out-of-door occupations and recreations. 4. Sleep out, if you can. 5. Breathe deeply.

II. FOOD. 6. Avoid overeating and overweight. 7. Eat sparingly of meats and eggs. 8. Eat some hard, some bulky, some raw foods. 9. Eat slowly.

III. POISONS. 10. Evacuate thoroughly, regularly and frequently. 11. Stand, sit and walk erect. 12. Do not allow poisons and infections to enter the body. 13. Keep the teeth, gums and tongue clean.

IV. ACTIVITY. 14. Work, play, rest and sleep in moderation. 15. Keep serene.

The application of these rules to one's daily life must be varied with each individual. The most practical method is for the individual to begin the improvement he would seek by constructing a typical day's program in which time is provided for, say, breathing and other exercises in bed, bath, toilet, walk to business, meals, amusement, etc., with special notes and memoranda as to the particular faults of omission and commission to be corrected. One might also, as Benjamin Franklin records in his autobiography, keep a daily record for a week as to how nearly the program is lived up to. By dint of such and other stimuli, the transition in habits can be made, after which the "rules" cease to be rules, as carrying any sense of restriction, and become automatic like putting on or taking off one's clothes.

Section II--The Unity of Hygiene

[Sidenote: The Rules Interrelated]

The above rules embody our preachment on individual hygiene. We have stated them as fifteen separate kinds of procedure. In actual life, however, our acts can not be so separated. The neglect or observance of one rule carries with it, to some extent, the neglect or observance of other rules. For instance, one can not take muscular exercise without, to some extent, taking breathing exercises. Swimming serves as a means of cleanliness, of skin gymnastics, of general exercise and of amusement. A game of tennis implies the practise, to some extent, of at least five of the fifteen rules.

The human body is a "harp of a thousand strings," which are intended to harmonize. If one of them is out of tune, it is likely to cause discord throughout, while to tune up one helps the harmony of all.

[Sidenote: Medical Specialists]

Any one ailment has a far-reaching effect throughout the system. It is because of this far-reaching effect that the "one idea" specialist in medicine has so often thought his particular specialty to be the one and only gateway to all therapeutics and hygiene. The oculist is liable to look at all ailments as related to the eyes; the dentist as related to the teeth; the mental hygienist as related to wrong attitudes of mind. If we examine their claims, we find that they are usually right in their affirmations, though wrong in their denials. It is their affirmations in which we are here interested. They find that the ailments within their own special province extend in unsuspected ways, and to a surprising degree into seemingly remote fields; and that to remedy the special defect which they can treat, will often go a long way toward remedying numerous other ailments.

[Sidenote: Remote Effects of Ailments]

It has already been noted that eye-strain leads to an astonishing number of serious nervous affections, and that corrective eyeglasses will often work wonders for remedying those ailments and improving the general health. There may be other unhygienic conditions equally responsible for these symptoms, and the correction of which may produce equally wonderful improvement. Vertigo may be due to eye-strain, or it may be due to wrong posture or to pressure of wax on the ear-drum. Diabetes may be aggravated by too much sugar, by infected tooth-sockets, or by too much worry. Tuberculosis may be due jointly to indoor-living, lack of exercise, wrong diet, wrong posture, sexual excess, alcohol, nerve-strain, and numerous other preconditions, besides infection with the tubercle bacillus. The social evil can be fought not only directly by attack on prostitution, and by appeals to self-control and moral ideals, but also indirectly by diminishing the consumption of alcohol and other drugs, for alcohol not only produces abnormal sexual desire but reduces the strength of will by which that desire is repressed. Forel asserts that the social evil can not be controlled until the use of alcohol as a beverage is abolished.

[Sidenote: Popular Delusions]

It is not uncommon for people to attribute their ailments to the less important rather than the more important cause, and so fail to get the best benefits of hygiene. Many people bemoan the fact that they sat in a draft and "therefore" caught cold, when what they most needed was not to keep out of drafts but to keep in such condition that drafts would do them good, not harm. Benjamin Franklin, a century ago, believed, what we now know to be true, "that people who live in the forest, in open barns, or with open windows, do not catch cold, and that the disease called 'a cold' is generally caused by impure air, lack of exercise, or overeating."

[Sidenote: So-called "Overwork"]

Most people who are "overworked" are, more properly speaking, simply the victims of bad air, bad diet, poisons, or worry. They believe that because they are tired it must be work which is hurting them. The man who breaks down in middle life commonly imagines that he has ruined his health by overwork. The college girl thinks she has ruined her health by study. All these "overworked" people prove their case by showing that they improve in health when given a vacation. This simply shows that a bad condition can often be remedied by improving the general health in any way whatever, even if the primary source of the difficulty is not reached. They are undoubtedly working beyond their working capacity; but their working capacity is only a fraction of what it would be if they took exercise, were not constipated, did not eat too much, abjured alcohol, or ceased to worry continually. If they lived hygienically in these respects, the work which was a drag might be an inspiration. A physician of wide experience says that every day men come to him broken down in health, invariably telling him that they have overworked; and yet upon questioning them he finds that none of them works as hard as he. Their breakdown was due to the terrible load of unphysiological habits which they had been carrying--a load so great that scarcely any work could be carried in addition.

[Sidenote: An All-round Regime]

Other examples might be given of ascribing ailments and disabilities to the less important instead of the more important causes. The error is almost always made of resting the blame on only one cause. In consequence most health-seekers make the mistake of making only one correction in their daily regime of life. One will cease alcohol drinking, another will give up tobacco smoking, another will give up coffee; a third will cease using all "red meats," another turns vegetarian, another adopts a raw food diet; another takes up outdoor sleeping; another adopts a daily game of golf; another embraces a mental healing cult; another takes up mastication. But great and permanent results require the adoption of an all-round, well-balanced regime.

Section III--The Obstacles to Hygiene

[Sidenote: Effort of the Will]

It is not enough that the individual should know how to live. Knowledge is of no avail without practise. Mr. Moody, the evangelist, once said of religious conversion, "Merely to know is not to be converted. I once boarded a train going in the wrong direction. Some one told me my mistake. I then had knowledge, but I did not have 'conversion' until I acted on that knowledge--seized my traveling-bag, got off that train, and boarded one going in the opposite direction." Many people are on the wrong train in hygiene, as in religion, and know it. They are traveling fast to that kind of perdition which in the end unhygienic living always brings. In fact, a great many people practise unhygienic habits more through indifference than through ignorance. Most people have acquired, by imitation of their neighbors, a great number of unhygienic habits and have continued in these habits for so many years, that they can not get rid of them, except through a great effort of will. This effort they are usually unable or unwilling to put forth unless very strong incentives are brought to bear. Often--in fact, if the truth were known, usually--they wait until ill health supplies the incentive. The man who is most receptive on the subject of health conservation, is, in the majority of cases, the man who has just had some ominous warning of coming ill health; although there is now a small but increasing number who do not wait so long, men who pride themselves on keeping "in the pink of condition." These are the men who are rewarded for their efforts by enjoying the highest reaches of working-power.

[Sidenote: Cost of Good Health]

The ordinary man, in ordinary good health, does not want or thinks he does not want to live hygienically. He sees all sorts of imaginary objections to adopting a hygienic life, and closes his eyes to its real and great advantages. One of the objections often trumped up is that the practise of hygiene costs too much--that it can only be a luxury of the rich. It is quite true that here, as elsewhere in human life, wealth confers great advantages. The death-rate among the rich is always less than that among the poor. And yet the rich have unhygienic temptations of their own, while the poor, on their part, are far from living up to their opportunities.

[Sidenote: Missionaries]

There are really only two material disadvantages from which the poor suffer in their opportunities to live a healthy life: One is unhygienic housing, both at home and at work; the other is unhygienic toil. It must be admitted that millions of unfortunates are unable individually to remedy these two disadvantages in their lot in life. Yet they can, even in these two respects, accomplish much if they take an intelligent interest in hygiene. The graduates of tuberculosis sanatoria are largely among the poor and they are doing much good missionary work in securing better ventilation, both in the home and in the workroom. They find this possible partly by insisting on more open windows in home and workshops, partly by changing their home to one better equipped with windows or situated in the suburbs instead of in the city, partly by changing their occupations, partly by getting the cooperation of their employer or simply by cooperating with him when he is ready to do his part. The workman can also accomplish something through the Trades Unions, especially in regard to hours of work. Employers will increasingly cooperate in this movement, as they come to realize that the securing of efficiency in their workmen is to their interest, and that monotony, long hours, and other unhygienic elements which are now, through sheer carelessness, often imposed on their workmen, bring back in the end big financial losses on themselves.

Except for the evils mentioned--those of housing and working conditions--there are few people so poor that they can not buy the means of living a healthy life. In fact, hygiene is one of the few precious gifts which can be had almost for the asking. Most people can sleep out-of-doors, if they will--if in no other way than by the so-called indoor window-tent--or can take deep-breathing exercises without cost. It costs nothing to stand, sit, and walk erect, to evacuate thoroughly, regularly, and frequently. It costs less than nothing to avoid overeating and overweight, and to be totally abstinent from alcohol and tobacco.

[Sidenote: Cost of Food]

Almost all can allow enough time for meals to eat slowly. Coarse and raw foods are always to be had and are usually cheaper than the conventional soft, concentrated cooked foods. In fact, meat, eggs, and like foods are among the most expensive and the least desirable. If we compare the cost of flour and of the other cheapest food materials, with the cost of oysters, one of the dearest, we find that the latter is fifty times as expensive as the former for the same food value. This takes no account, of course, of the expenses involved in cooking either of them. It has been proved by actual experience that one can live in the best of health on food costing as low as ten cents a day, exclusive of the labor of preparing, cooking and serving. Mrs. Richards, in her "Cost of Food," says that this is possible anywhere in America within fifty miles of a railroad. The only real objection to living on this minimum expense is the lack of variety. The following is a brief list of foods in ascending order of cost per 100 calories of food value, the cheapest being at the beginning and the dearest at the end: glucose, corn-meal, wheat-flour, oatmeal, cane-sugar, salt pork, rice, wheat bread, oleomargarine, beans, peas, potatoes, butter, milk, cheese, beef-stew, ham, mutton-chops, beef, eggs, and oysters. If the foods in this list be looked up in the table given in the SUPPLEMENTARY NOTES for their protein, fat, and carbohydrate contents, it will be seen that a well-balanced ration is possible without the use of expensive foods. In fact, among the cheap foods are some consisting mostly of protein, some consisting mostly of fat, and some consisting mostly of carbohydrate. For instance, cheap sources of protein are skim milk, beans, cheese, and peanuts. Cheap sources of fat are oleomargarine and cottonseed-oil. Cheap sources of carbohydrate, i.e., starch and sugar, are bread, bananas, potatoes, glucose, and even ordinary sugar. If a diet, selected for cheapness, is not at first well balanced, a judicious admixture of one or more of the foods just mentioned, will restore equilibrium. A cheap bulky food is cabbage.

[Sidenote: Repaid Cost]

Most of the rules of hygiene cost nothing to observe. But even when hygiene is costly at first, the cost is usually repaid in the end many times over. To ventilate a house in winter always costs a certain additional expenditure for coal, but it is better to pay the coal bill than the doctor's bills. To sleep out-of-doors costs some extra blankets, bedding, clothing, and roll curtains, but these not only save the cost of heating an indoor sleeping-room, but save also the cost of ill-health. There is no better economy than to keep one's working-power. To lose it means to lose its earnings and to have, in addition, the heavy expenses of medical attendance, medicines, and nursing, and often to lose life itself with its potential earnings of every sort. In short, an unhygienic life, for the sake of economy, is "penny-wise and pound-foolish."

[Sidenote: "I Have No Time"]

Many busy men object to hygiene because, they say, they have no time for it. They imagine that to devote an hour each day to exercise or relaxation is a waste of time and that they are really economizing their time by working that hour instead. We are here referring, not to those who can not control their working-time, but to those who deliberately choose to work when hygiene would require them to play. It is often those who fix their own working-hours, rather than those whose working-hours are fixed for them, who overwork the most. If these could know the suffering which sooner or later follows inevitably as the consequence of this mistaken policy, they would not pursue it for a single day. A slight loss of working-power comes immediately. A careful observer of mental workers found that an hour invested in exercise in the afternoon often pays for itself within a day, by rendering possible more rapid work. He also found an improvement in the quality of his work. The razor-edge of the mind needs daily honing through physical exercise. The same principle applies to all work. It is just as necessary to stop, at intervals, our physical and mental machinery for oiling and repairs, as to stop the machinery of a factory.

[Sidenote: "Too Much Trouble"]

Another objection is that the practise of hygiene is "too much trouble." It is undoubtedly true, that no one who has unhygienic habits can overcome them without a certain amount of "trouble." The people who get the best results are those who are never deterred by trouble so long as the trouble is worth while. For those who have not the necessary enthusiasm or self-control to break their unwholesome habits by sheer will power, the best advice is to so arrange their lives as to make the practise of hygiene inevitable. One physician in Chicago deliberately got rid of his automobile and other means of locomotion in order to force himself to walk to all his patients, and so secure enough physical exercise. Another man in New York City, with the same object in view, selected the location for his dwelling so that there was no rapid transportation available to take him to his office, making the walking back and forth a necessity from which he could not escape.

[Sidenote: Simplicity of Hygienic Living]

The only difficulty lies in overcoming the inertia of acquired habits. After one has changed his habits, it is just as easy to live rightly as to live wrongly. The rules of hygiene are not restrictive, but liberating. They may seem at first restrictive, for they prohibit many things which we have been in the habit of doing; but they are really liberating, for the things we were doing were unrealized restrictions on our own power to work, to be useful, or even to enjoy life. The "rules" of hygiene are thus simply the means of emancipating us from our real limitations. These so-called rules, when tried, will prove to be not artificial but natural, not difficult but easy, not complicated but simple. They are almost as simple as the direction to bathe in the river Jordan. It is, in fact, their very simplicity and availability to which is largely due their deplorable neglect and the failure to realize the wonderful benefits following their careful and continued observance.

[Sidenote: The Evil of Romancing]

Not only a healthy mental attitude toward life, but a healthy mental attitude toward one's own unhygienic habits is essential. It is a very common thing for a man to romance over his shortcomings, or his unhealthy physical conditions, to make humor of them to his friends. Very often the first step toward a better physical condition is a change in this mental attitude.

Section IV--The Possibilities of Hygiene

[Sidenote: The Preventability of Disease and Death]

Certain it is that more people would practise hygiene if they could be made to realize in some vivid way how much they needed it. Few persons, even when they read and accept the statistics on the subject, really have a picture of the imperative need of hygiene as an integral part of every human life. It is not brought home to them how widespread is illness, how numerous are preventable deaths, how many are the tendencies toward individual and racial deterioration.

The report of the Roosevelt Conservation Commission on National Vitality, indicates that annually there are in the United States over 600,000 deaths which might be prevented if existing knowledge of hygiene were properly applied; that at least half of the 3,000,000 and more sick-beds constantly kept filled in the United States are unnecessary; that the financial loss from earnings cut off by preventable disease and premature death amounts to over $1,500,000,000 annually; and that over 15 years are lost to the average life through the lack of application of knowledge which already exists but which simply has not yet been disseminated and applied.

[Sidenote: Impairments Unsuspected]

The health examinations of the Life Extension Institute have revealed unsuspected ailments in persons who considered themselves well, and to an extent which has astonished even those who have long been familiar with these subjects. Among large groups of clerks and employes of banks and commercial houses in New York City with an average age of 27 and all supposedly picked men and women, only 1 per cent. were found free of impairment or of habits of living inviting impairment. Of those with important physical impairments, 89 per cent. were, prior to the examination, unaware of impairment; 16 per cent. of the total number examined were affected with organic heart trouble, 42 per cent. with arterial changes, ranging from slight thickening to advanced arteriosclerosis, 26 per cent. with high or low blood pressure, 40 per cent. had sugar, casts, or albumin in the urine, 24 per cent. had a combination of urinary and other serious impairment, 47 per cent. had decayed teeth or infected gums, 31 per cent. had faulty vision uncorrected.

Among industrial groups, not exposed to any special occupational hazard or poisoning, the figures were as follows: With an average age of 33, none were found to be free of impairment or habits of living inviting impairment. Of those with important physical impairments, 89 per cent. were, prior to the examination, unaware of impairment; 3 per cent. of the total number examined were affected with organic heart trouble; 53 per cent. with arterial changes, ranging from slight thickening to advanced arteriosclerosis; 23 per cent. with high or low blood pressure; 45 per cent. had sugar, albumin or casts in their urine; 26 per cent. had a combination of urinary and other serious impairment; 69 per cent. had decayed teeth or infected gums; 41 per cent. had faulty vision uncorrected.

[Sidenote: Minor Ailments]

There are few persons in America to-day who reach the age of forty sound and normal in every part of the body, especially if we include among abnormalities the minor ailments. The extent to which minor ills are prevalent among those who pass for "well" people is not generally appreciated. Once we penetrate beneath conventional acquaintance we almost invariably learn of some functional trouble, such as impairment of heart, circulation, liver, kidneys, stomach; or gallstones, constipation, diarrhea; or insomnia, neurasthenia, neuritis, neuralgia, sick-headache; or tonsillitis, bronchitis, hay fever, catarrh, grippe, colds, sore throat; or rupture, enlarged glands, skin eruptions; or rheumatism, lumbago, gout, obesity; or decayed teeth, baldness, deafness, eye ailments, spinal curvature, flat foot, lameness; or sundry other "troubles."

These ailments, though regarded as "minor," should be recognized promptly and accepted as the signal that the person is moving in the wrong direction. There is no need for alarm provided this warning is heeded. Otherwise disaster is almost certain sooner or later to follow. The laws of physiology are just as inexorable as the laws of physics. There is no compromising with Nature. No man can disobey the laws of health to which he has been bred by Nature without paying for it--any more than a man can sign a check against his bank account without reducing the amount. He may not be immediately bankrupt, and until he exhausts his account he may not experience any inconvenience from his great extravagance, but Nature keeps her balances very accurately, and in the end all claims must be paid.

[Sidenote: The Personal Equation]

It is true, of course, that some persons have greater resistance than others. If we had a convenient barometer by which to measure daily the state of our vitality, we might register the effect of every unhygienic act. But it is so seldom that endurance is accurately measured that few people appreciate the enormous differences in people and the variations of the same person at different times. These differences and variations have a range of many hundred per cent. Some people can not walk upstairs or run across the street without being out of breath, while others will climb the Matterhorn without overstrain. The fact that certain people have lived to the century-mark in spite of unhygienic living is sometimes cited to prove that hygiene is ineffective. One might as well cite the fact that certain trees are not blown down in a gale or are not quickly destroyed by insect-pests to prove that gales have no tendency to blow down or insects to destroy trees.

[Sidenote: Over-confidence]

The truth is that a person who has so much vitality as to lead him to defy the laws of health and to boast that he pays no price no matter how he lives, is likely to be the very man to exhaust his account of health prematurely. There was, a few years ago, a famous American, possessed of prodigious bodily vigor. He ought to have lived a century. Unfortunately he had this "insolence of health." He was warned several times against overwork, lack of sleep, and abuse of his digestion. But he merely smiled and claimed that such warnings were for others, not for him. He met an untimely end, due as his physicians believed and as he himself acknowledged, when too late, to his abuse of the great powers with which Nature had endowed him and to the neglect of personal hygiene.

[Sidenote: Possible Health Attainment]

Conversely, an observance of the laws of hygiene affords wonderful results in producing vitality and endurance. Insurance companies are discovering that even weak and sick people, will, if they take good care of themselves, outlive those with robust constitutions who abuse them.

To those unfamiliar with the subject in its larger aspects, the possibilities seem almost beyond belief. As an example of the wonderful gains which can be secured by obeying the laws of hygiene may be cited the case of a young man who a few years ago was scarcely able to drag himself into the sun in Colorado, where he was endeavoring to rid himself of tuberculosis. He not only succeeded, but subsequently, by dint of following substantially all of the rules of hygiene here laid down, became an athlete and capable of running twenty-five miles for sheer love of sport and apparently without the overstrain experienced by "Marathon" runners. Kant and Humboldt are cases typical in different fields of achievement of many of the world's most vital men who have actually made over their constitutions from weakness to strength. Cornaro says that it was the neglect of hygienic laws which made him all but a dead man at thirty-seven, and that the thoroughgoing reform of his habits which he then effected made him a centenarian. His rules, drawn up four hundred years ago and described in his interesting work "The Temperate Life," are, so far as they are explained, almost identical with those given in this book. It is difficult to assign a limit to the good which can be accomplished by practising these rules and so minimizing the poisons which usually narrow and shorten our lives.

[Sidenote: Immortal Animal Cells]

So far as science can reveal, there seems to be no principle limiting life. There are many good and bad reasons why men die, but no underlying necessary reason why they must die. The brilliant Carrel has kept tissue cells of animals alive outside of the body for the past three years. These cells are multiplying and growing, apparently unchanged by time, to all appearances immortal so long as they are periodically washed of poison and nourished in a proper medium. If we could at intervals thoroughly wash man free of his poisons and nourish him, there seems to be no reason why he should not live indefinitely.

Section V--Hygiene and Civilization

In view of the vast extent of human misery from ill health, the question naturally arises, How does it happen that the world is burdened with so colossal a load? Is it no more than is biologically normal? Is it true that in other organisms, animals and plants, ill health is the rule rather than the exception? Are all races of men subject to the same heavy load?

[Sidenote: Natural Adjustments Upset]

These questions have not yet received sufficient attention. The answer seems to be that man is suffering from his own mistakes made unconsciously and in ignorance. He has upset the equilibrium which Nature had established among the various powers and activities of his body, and between himself and the outside world. Man has done mischief for his own body similar to what he has done for the natural resources on which he lives. In Professor Shaler's epoch-making little book, "Man and the Earth," he shows, for instance, that the little layer of soil on the surface of the earth from which plants and animals derive their nutriment was, before the advent of man, replenished quite as fast as it was washed away, but that after man had put his plow into it and had taken off the protective mat of vegetation, he unconsciously despoiled the accumulation of ages. "In a plowed field, an hour's torrential rain may wash off to the sea more than would pass off in a thousand years in the slow process of erosion which the natural state of the earth permits." He also shows that the constant croppings of the soil rob it of nitrogen, phosphorus, and other elements faster than Nature restores them. The problem of conservation is to reestablish the balance which has been lost through the depredations of man, for instance, to lessen soil-wash by terracing, and to restore to the soil the lost elements by supplying nitrates and phosphates and by other methods of scientific farming.

In the same way man has upset his pristine animal mode of living and needs to find scientific ways to restore the equilibrium. Most of the present-day problems of hygiene arise from introducing, uncompensated, the effects of certain devices of civilization. The inventions of civilization have done so much for man that he is apt to unduly glorify them and to overlook the injurious by-products. These by-products are often of prodigious significance to the race. The invention of houses introduced the problem of house hygiene; the invention of clothing, the problem of clothing hygiene; that of cooking, the problem of food hygiene; that of division of labor, the problem of industrial hygiene; and so on. To make these statements more concrete, we may consider some of them in more detail.

[Sidenote: Houses Artificial]

The invention of houses has made it possible for men to live in all climates, yet this indoor living is responsible for much disease. The houses give comfortable shelter and warmth and protect us from the elements and from wild animals. But the protection has been overdone. Like his cousin, the anthropoid ape, man is biologically an outdoor animal. His attempt at indoor living has worked him woe, but so gradually and subtly has it done so that only recently have we come to realize the fact. At first, dwellings were really outdoor affairs, caves, lean-tos, tents, huts with holes in the roof and the walls. These holes served to ventilate, though they were not intended for that purpose. The hole in the roof was to let out the smoke and the holes in the walls to let in the light. Gradually the roof-hole developed into a chimney with an open fireplace, which, in turn, gradually changed into a small flue for stoves whereupon it almost ceased to serve any ventilating function. The stove in turn has largely gone and is replaced in many cases by the hot-water or steam radiator, without any attempt at ventilation. The holes in the wall gave way, after the invention of glass, to windows which let in the light without letting in the air. Weather-strips, double windows, vestibule-doors, interior rooms, completed the process of depriving man of his outdoor air, shutting him into a cell in which he now lives--a sickened but complaisant prisoner--often twenty hours of the twenty-four. Tuberculosis, one of the worst scourges of mankind, is primarily a house disease. It is prevalent as indoor living is prevalent, and reaches its maximum in the tenement quarter of a great city.

[Sidenote: Effects on Different Races]

Only by generations of natural selection could we expect to make man immune to the evils of bad air. The robust Indian and the Negro, whose races, until the last generation or two, roamed in the open, fell easy prey to tuberculosis as soon as they adopted the white man's houses and clothes. The Anglo-Saxons who have withstood the influence of indoor living for several generations have, probably by the survival of the fittest, become a little better able to endure it, while the Jews, a race which has lived indoors longer than any other existing race, are now, probably by the same law of survival, the least liable to tuberculosis, except when exposed to especially unfavorable conditions of life.

[Sidenote: Compensation for Civilization]

But we, of this generation, can not afford to wait for natural selection to fit the race to an indoor environment; hence the supreme importance to us of air hygiene. We must compensate for the construction of our houses by insisting on open windows, or forced drafts, or electric fans, or open-air outings, or sleeping porches, or the practise of deep breathing, or all of these things.

[Sidenote: Clothing Artificial]

In the same way, clothing has protected our bodies from the cold but enervated or constricted them as well. The aboriginal tribes, even in cold climates, seldom used clothing. The Eskimo is an exception. The tribes toward the South Pole in similarly cold climates often have little more clothing than a blanket which they hang over their shoulders toward the wind. The weak, pale skin--to whose lack of adaptability we owe the chilling preceding a cold--the bald head, the distorted foot, the corns upon it, the cramped waist, are among the results of clothing ourselves wrongly. Hence we are discovering the need of restoring, as far as we can, the original conditions by making our clothes more light, more loose, and more porous, and, when possible, by taking the "barefoot cure," or the air bath.

[Sidenote: Cooking Artificial]

We come next to foods, and note that civilization has invented cooking and artificial foods. These inventions have greatly widened the variety of man's diet, but the foods of civilization are largely responsible for the decay of our teeth and the abuse of our digestive and eliminating organs.

[Sidenote: Soft Foods Artificial]

Judging from man's teeth and digestive apparatus as well as his general kinship to the anthropoid ape, it is reasonable to believe that, before fire was discovered, man was primarily a frugivorous animal, whose ordinary diet consisted of fruits, nuts, and tender shoots. While man still uses these fruits, nuts, and salads, his chief reliance is on prepared food, bread, butter, meat, and cooked vegetables. The diet of our progenitors must have been largely one requiring chewing, consisting, as it did, of hard fruits and stalks and perhaps also grains and flesh. Observation of manlike apes shows that they chew their food more thoroughly than man. Doubtless nuts constituted a considerable part of primitive food and required cracking by the teeth. The work we now do in flour-mills or the kitchen or with the knife and fork, was then done with the teeth. We even have our cook mash our potatoes and make puddings and pap of our food after it reaches the kitchen. Having already shirked most of the task of mastication by softening and cutting our food before it reaches our mouths, we shirk the rest of it by washing it down with water, or worse. An Italian dentist, who has had a wide range of observation, says that the knife and fork have committed "unpardonable crimes" by robbing the front teeth of their work of cutting. He sometimes prescribes for loose teeth the task of cutting a pound of bread daily. Whether any of it is swallowed or not is not important, but he insists that it must be cut by the teeth.

[Sidenote: Concentrated Food Artificial]

The deplorable lack of residue in modern food is one of the consequences of civilized life, for the bulky foods have been crowded out by concentrated foods, and, in many cases, the concentrated foods have been formed by getting rid of residue. Instead of chewing the sugar-cane, we use sugar, a concentrated extract which leaves no residue. We crush the juices from our fruits and throw away the pulp. We take the bran out of our grain and with it the vitamins essential to health. The bulky foods--fruits and fibrous vegetables--are often dropped from our menus.

[Sidenote: Hurry Artificial]

The hurry habit, another unfortunate by-product of civilized life, is one of the chief promoters of indigestion. In civilization we live by the clock. We schedule our trains and crowd our meal-time to catch them. We make engagements in neglect of the requirements of digestion. We have, in consequence, as one of the institutions of civilization, the "quick-lunch counter." At first we bolted a meal purposely and consciously. Later we formed the habit of food-bolting, and it now seems quite natural.

[Sidenote: Use of Flesh Food]

[Sidenote: Misled Appetites]

To the door of the hurry habit may also be laid the excessive use of flesh foods. Carnivorous animals bolt their food. Frugivorous animals, to which class the human race properly belongs, eat slowly. But when, through the perversions of civilized life, frugivorous man is forced to eat as fast as the carnivores, he instinctively adopts a similar diet. As someone has expressed it "when we eat as fast as a dog, we naturally crave the food of a dog." Our apelike progenitors had few, if any, flesh foods and only those which they could catch with the hand and eat raw. Our eliminating organs, the liver and the kidneys, have been framed to meet the demands of man's natural diet, but not adapted to handle the diet of civilized men in the excessive use of flesh foods and the use of alcohol. These organs are, fortunately or unfortunately, provided with a large factor of safety and can stand a great deal of abuse, but the cumulative effect of this abuse, especially when combined with an unhygienic life in general, sooner or later leads to disaster. Our tastes have also been perverted. The appetite is very likely to be innocently misled by the delicacies which civilization has invented, as well as by the tricks of cooking, seasoning, and preparing. For this reason, we can not trust, as thoroughly as we would like, the ordinary leadings of taste. The solution of this problem of nutrition, like the solution of the housing problem, must be sought by retaining the advantageous food customs which we now find about us and substituting scientific customs for the disadvantageous ones.

[Sidenote: Other Evils of Civilization]

It would be impossible to enumerate all the inventions of civilization which have brought us difficult problems of individual hygiene. We shall name only a few more. The invention of chairs, though adding to human convenience, has tended to produce wrong posture, from which spinal, nervous and digestive disturbances follow. The invention of the alphabet and of printing has made possible the accumulation of knowledge, but has promoted eye-strain with a great train of attendant evils. The device of division of labor has created much wealth, but destroyed the normal balance of mental and physical work, recreation and rest. From this follow occupational diseases of overstrain, bad posture, industrial poisons, and a craving for narcotics. A combination of conditions has lessened the opportunities for prompt discharge of the body waste, and so led to dulling of the reflex which promotes defecation. We are only just beginning to realize how serious are the consequences.

[Sidenote: "Remedies" that are Worse than the Evils]

We have described many of the unhygienic practises common to-day as direct results of upsetting Nature's equilibrium. Others are indirect results. These latter practises may be described as attempts to remedy the evils of the former, the "remedies," however, being often worse than the diseases. Much of our drugging, some of our wrong food habits and not a little of our immorality are simply crude and unscientific attempts to compensate for disturbances or deviations from a normal life. We wake ourselves up, as it were, with caffein, move our bowels with a cathartic, induce an appetite with a cocktail, seek rest from the day's fatigue and worries in nicotin, and put ourselves to sleep with an opiate. In these practises we are evidently trying in wrong ways to compensate respectively for insufficient sleep, insufficient peristalsis, indigestion, overfatigue, and insomnia--evils due, as previously explained, to upsetting Nature's balance, between work, play, rest and sleep.

So also our overeating is largely an unscientific effort to compensate for overconcentration of diet,--that is, an effort to get bulk. Again, too much protein is in large measure due to the need of compensating for rapid eating, for as has been remarked, protein is the one kind of food which can be eaten fast with impunity.

Again, a large part of our moral derelictions is due to an unbalanced life from which amusements are largely omitted. The "bad" boy in the city streets is usually following his instinct for amusement, of which the lack of playgrounds has deprived him. Dissipations of many kinds are explained in a similar way. It is largely because workmen are so often drudges and lack normal recreations that they seek amusement in the concentrated form they find in saloons, gambling places, dives and dance halls.

Finally those economic and social conditions of civilization which have resulted in deferring marriage beyond the best physiological age, lie behind prostitution and its terrible train of consequences including the venereal diseases.

The worst of it is that these wrong remedies, instead of helping, aggravate the disease. They become part of a vicious circle, which continues in an endless round.

[Sidenote: Shortened Human Life]

The combined effects of all the unhygienic modes of living are undoubtedly greatly to shorten human life. Most other mammals live about five times the growing period. In man, this would mean that the normal life-span should be about a century and a quarter, an age which is now reached only in one case out of millions.

[Sidenote: No Return to Nature]

Yet it would be foolish, even if it were possible, to attempt a complete "return to Nature" by abolishing all the ways and conventions of civilization. This would be throwing away our social inheritance and returning to barbarism. We must go forward, not backward. Just as the cure for the evils of Democracy is said to be more Democracy; so the cure for the evils of civilization must be more civilization. The equilibrium of Nature having been upset by civilization, science, one of the great products of civilization, must now work out the remedies. Just as the waste of the soil which civilization has brought is to be compensated by that great product of civilization, scientific agriculture, so the waste of vital resources is to be compensated by scientific hygiene. The saving of civilization depends on following not those who repudiate it, like Thoreau, but those who make use of it, like Pasteur. What the world needs is not to abolish houses, but to ventilate them; not to go naked, but to devise better clothes, which have all the advantages and none of the disadvantages of those we now wear; not to return to the diet of the anthropoid apes, but to remodel that which we have; not to give up chairs, but to improve the form of chairs; not to abandon reading, but to employ corrective eyeglasses and clear printing; not to abrogate division of labor, but to shorten the hours of labor and provide wholesome recreations and special compensating advantages when needed. When, in future centuries, these come to be reckoned among the great triumphs of civilization, we may expect human life to be longer and perhaps stronger than in any primitive state of Nature, just as where modern scientific forestry has been applied we find longer lived and better trees than ever grew in Nature's jungles.

Section VI--The Fields of Hygiene

[Sidenote: Public Versus Individual Hygiene]

The object of this book is primarily to instruct the individual as to what he can do to maintain his own individual health. But individual hygiene is only one particular branch of hygiene, and it is well for the individual, partly out of public spirit, partly in self-defense, to have some idea of the other important branches, namely, public hygiene, the hygiene practised by the health officer, semipublic hygiene, the hygiene of schools, institutions, and industrial establishments, and race hygiene or eugenics, the most important of all.

All these branches are so closely related that it is impossible to mark any exact dividing-line. But, in a general way, there is a broad distinction between eugenics, which is the hygiene of future generations, and the other two, which relate to the present generation, as also between these two themselves. Thus public hygiene is that which is practised by the government for its citizens, while individual hygiene is that which is practised by the citizens for themselves. Public hygiene consists chiefly in efforts by the government to maintain a wholesome environment in which to live, including good outdoor air--without smoke or foul odors--clean streets, pure water, good sewers, quarantine, and legal regulations concerning houses, schools, prisons, hospitals, and other public institutions, foods sold in markets, and conditions of employment. It is chiefly useful in preventing _acute_ or infectious diseases, such as typhoid fever, scarlet fever, measles, whooping-cough, small-pox, yellow fever, and diphtheria, and in preventing accidents and occupational diseases. Individual hygiene is chiefly useful in preventing the _chronic_ or degenerative diseases, that is, diseases of nutrition and of circulation, such as heart and kidney affections, nervous prostration, insanity.

Public hygiene has made much progress during recent years. In consequence, the number of deaths from the acute or infectious diseases has been greatly diminished. Health officers are beginning to demonstrate the truth of Pasteur's words, "It is within the power of man to rid himself of every parasitic disease."

It is this work which has reduced the general death-rate in civilized countries and sometimes cut it in two, as at Panama. The United States Public Health Service, on invitation of the Peruvian Government, recently cut the death-rate in two in one of Peru's disease-ridden cities.

Individual hygiene, on the other hand, has been greatly neglected, especially in the United States, and, doubtless largely as a consequence, the death-rates from the chronic or degenerative diseases are increasing rapidly. A further consequence is that, in the United States, while the death-rate in the early years of life (when infectious diseases do most of the killing) has been decreasing, the death-rate in later life (when the chronic diseases do most of the killing) is increasing. In Sweden, on the other hand, where individual hygiene is more generally applied, the death-rate is declining at all times of life. (See "Signs of Increase of the Degenerative Diseases," SUPPLEMENTARY NOTES.)

Both public and individual hygiene are being invoked in the fight against tuberculosis, a disease at once infectious and chronic, due to germs and to wrong methods of living.

[Sidenote: Cooperation Necessary]

No matter how thoroughly an individual attempts to care for his own health, he will find it almost impossible to avoid infections, at times, without the organized help of the community in which he lives. A man may do his best to keep his windows open, to breathe deeply, to eat hygienically, to hold his activities within the limits of overfatigue, to screen his house against flies and leave no tin cans about his kitchen door to breed mosquitoes; but if the city in which he lives has no good air for him to breathe, if his city's water supply is contaminated, if neighboring malarial swamps are not drained or covered with oil, if flies alight on the food before it comes to his own house, if the food contains disease germs or dangerous preservatives, or if his next-door neighbor visits him and leaves infection behind him, mere personal defenses will hardly be adequate.

Even in so private a matter as moving the bowels, sometimes the fault lies partly with circumstances beyond the control of the individual. Unfortunately in most of our cities and small towns "Comfort Stations" are rare or unknown, and when they are available they are often in such an insanitary condition as to be a source of danger through the spread of communicable disease. Constipation, as we have seen, is a far more serious matter than it is sometimes thought to be.

It is therefore incumbent on the individual to contribute his share to the hygienic work of society as a whole, in particular to take an active interest in health legislation and administration. A man can not live to the best advantage in a life isolated from all social obligations, any more than could Robinson Crusoe, who was unable to launch his canoe in the ocean, after he had been at great pains to construct it, because he had no one to help him. Each man should take part in the great social hygienic struggle, if he is to reap the highest rewards in his own personal hygienic struggle. And he can do a great deal if he will be patient and persistent. If, for instance, he would always insist on suitable air conditions in public buildings, electric cars, theaters, and churches, and encourage others to do so, it would not take long to make air reform general.

[Sidenote: The Consumer's Duty]

In fact, it is the common public, constituting the consumer, who has it in his power to bring about most of the necessary reforms in public hygiene. When the consumer really values hygienic environment, the producer will supply it. The great improvement in recent years in drinking water was brought about through the appreciation, by the consumer, of the danger from impure water. His complaints produced the change. Hotels found it profitable to provide and advertise pure water. So also the education of the public as to the dangers of a common public drinking cup led to the invention of bubbling fountains and cheap individual cups and to the introduction of these conveniences in railway stations and other public places.

We need to concern ourselves particularly with the character of our public water supply, air supply and food supply, the number of bacteria in milk, the fitness for human consumption of the meat, fowl, fish, and shell-fish sold in the public markets, and the use of adulterants and preservatives in canned and bottled goods.

[Sidenote: Quacks and Quackery]

Quacks and quackery should be vigorously fought by laymen as well as physicians. Quacks live by lying and misleading advertisements. Every one should cooperate to encourage the movement by which newspapers and magazines are giving up quack and immoral advertisements and the advertisements of alcoholic beverages. Especially should we refuse to patronize the quack advertiser. When no one is deceived by him, he will cease to advertise. A more immediate method is to change from the newspaper containing such advertising to one which does not. We should also appeal to the editors to reform their advertising, as many of them are now doing.

[Sidenote: Vaccination]

Vaccination is now a known preventive against smallpox, typhoid fever, and other germ maladies. Its use should be advocated and the ignorant prejudice against it should be overcome.

[Sidenote: Social Evil]

Last but not least, the individual should cooperate in the great movement against the social evil.

As soon as an individual becomes interested in caring for his own health and for the health of his family, his interest will not cease at individual hygiene; he will wish to improve the efficiency of the public health service by increased appropriations, improved equipment and personnel; and to cooperate with the health officer.

[Sidenote: Eugenics]

Race hygiene or eugenics, which has been mentioned as the third and most important branch of hygiene, aims to conserve the health of _future_ generations, through the action of those now living. Hygiene (individual and public) teaches us how to create for ourselves healthful conditions of living, but on every side we see evidences of the fact that we cannot entirely control conditions of health through hygiene only. Not all maladies by any means can be attributed to unnatural or unhygienic conditions of living. It is true that if followed out faithfully, the rules of hygiene will enable a man to live out his maximum natural life-span, with the maximum of well-being, and to run no risk of allowing any inherent weakness to be brought out. But some persons, even if they followed what is very nearly the normal code for the human being, would scarcely be able to avoid dire physical and mental fates. In short, we find that besides the hygienic factor in life which we may call environment, there is something else on which the health of the individual depends. This something else is heredity, or "the nature of the breed." Back of all the individual can do by hygiene lies his inheritance. To change this the individual can do nothing, but the parents of the individual can affect his inheritance, and we as parents can affect the inheritance of our offspring.

[Sidenote: Trustees of the Racial Germ-plasm]

First, we can carry through life uninjured the essential germ plasm which has been entrusted to our care. We should never forget that this germ plasm, which we receive and transmit, really belongs, not to us, but to the race; and that we have no right, through alcoholic or other unhygienic practises, to damage it; but that, on the contrary, we are under the most solemn obligation to keep it up to the highest level within our power. We are the trustees of the racial germ plasm that we carry.

[Sidenote: Wise Combinations of Germinal Traits]

Second, we can affect the life of our offspring by our choice in marriage. The basis of the development of desirable or undesirable tendencies or traits lies, of course, in the mating from which the individual springs. On the kind of combinations of germinal traits that are made by marriage depends whether or not undesirable traits shall reappear in the offspring. For instance, a man may inherit a defect from his father because his father married a certain type of woman. Had the father selected a different type, the children might not have inherited the father's defect. The importance of choice in marriage results from certain laws of inheritance, which make it clear that by proper combinations of individuals certain bad traits may be entirely "bred out."

[Sidenote: Choice in Marriage]

As soon as men and women acquire the knowledge that their choices in marriage largely determine whether or not their physical and mental faults and virtues will reappear in children, they feel a sacred responsibility in that act of choosing. A little conscious knowledge of what kind of combinations of traits bring about their reappearance in offspring can not help but modify a person's taste, and thus automatically direct the choice of a mate, which choice will still be, and rightfully, an instinctive one. Upon the wisdom with which choices in marriage are now made depends in large degree the health and efficiency of all the individuals who will constitute society in the coming generations. As the science of eugenics gathers a greater wealth of evidence and subjects it to vigorous analysis, its ability to guide the race to higher levels will become more positive and far-reaching. This can be done without surrendering the general principle of individual freedom. It will not reduce but increase the number of natural love-marriages. The errors of crude and superficial or overenthusiastic eugenists should not obscure the enormous possibilities of the science for the human race. Eugenic knowledge is, therefore, not only a personal advantage but a social necessity.

[Sidenote: Social Progress]

For society as a whole, a thoroughgoing eugenic program must include:

(1) The prevention of reproduction by the markedly unfit, such as the feeble-minded, by sterilization of the most unfit and by segregating the remainder in public institutions.

(2) The enactment of wise marriage laws.

(3) The development of an enlightened sentiment against improper marriages and the putting at the disposal of individuals contemplating marriage the data accumulated and principles worked out by eugenic students.

The Eugenics Record Office of Cold Spring Harbor, Long Island, N. Y., is now engaged in collecting such material.

For us of the present generation, hygiene is of immediate concern; but if we are to build for future generations, hygiene must give way to, or grow into, eugenics. The accomplishment of a true eugenic program will be the crowning work of the health movement and the grandest service of science to the human race. (For further comments on this subject see "Eugenics" in SUPPLEMENTARY NOTES.)

SUPPLEMENTARY NOTES ON SPECIAL SUBJECTS

SECTION I

NOTES ON FOOD

[Sidenote: Balancing the Diet]

It will help to balance the ration and to avoid an excess of protein and also to avoid a deficiency of either fat or carbohydrate, if we take a bird's-eye view of the various common foods in respect to the protein, fat and carbohydrate they contain. For this purpose the following table has been constructed.

[Sidenote: Common Foods Classified]

COMMON FOODS CLASSIFIED ---------------+-----------------+-------------+-------------- | Poor in | Rich in | Very rich in | Fat. | Fat. | Fat. ---------------+-----------------+-------------+-------------- Very high in | White of Eggs | | Protein | Cod Fish | | | Lean Beef | | | Chicken | | | Veal | | ---------------+-----------------+-------------+-------------- High in | Shell-fish | Most Fish | Protein | Skim Milk | Most Meats | | Lentils | Most Fowl | | Peas | Whole Egg | | Beans | Cheese | ---------------+-----------------+-------------+-------------- Moderate or | Most Vegetables | Peanuts | Fat Meats Deficient in | Bread | Milk | Yolk of Eggs Protein | Potatoes | Cream Soups | Most Nuts | Fruits | Most Pies | Cream | Sugar | Doughnuts | Butter ---------------+-----------------+-------------+--------------

The foods given in the uppermost compartment are those "very high" in protein (above 40 per cent. of their total calories, or food value, being protein). Those in the two compartments next below are merely "high" in protein (20 to 40 per cent.), while the lowest three compartments contain those "moderate or deficient" in protein (zero to 20 per cent.).

The compartment farthest to the right contains a list of those foods "very rich in fat." The two compartments next to the left contain those "rich in fat," and the three compartments to the extreme left contain those "poor in fat."

With reference to carbohydrates (starch or sugar), we can say that the foods in the lower left compartment are very rich in carbohydrate. Those in the two neighboring compartments (the one beginning "shell-fish" and the one beginning "peanuts") are moderate, and those in the remaining compartments are those poorest in carbohydrate.

Thus, practically, the nearer the name of any food is to the upper corner of this triangular table, the more protein that food contains; the nearer it is to the right hand corner, the more fat; and the nearer to the remaining corner (lower left), the more carbohydrate (starch and sugar).

[Sidenote: Ideal Food Proportions]

An ideal proportion of the three food elements is to be had only in the middle compartment of the lowest row. But it is by no means necessary or advisable to confine one's diet to the few foods which happen to fall in that compartment, provided foods chosen from other compartments _balance_ each other. Thus, fruit and nuts balance each other, the one being at the left and the other at the right of the ideal compartment. In the same way, potatoes and cream balance each other, as do bread and butter. Instinctively these combinations have been chosen, especially bread and butter. This combination is, however, slightly too low in protein, and a better balance is obtained by adding a little from the compartment vertically above the ideal. In this way we obtain the familiar meat-, egg-, or cheese-sandwich, constituting of itself a fairly well-balanced meal.

In short, in order to maintain a diet correct as to protein, it is only necessary to make our main choices from the lowest row and, in case the foods so chosen are near the bottom, to supplement these by a moderate use from the row above and a still more sparing use of those in the top compartment.

The following more detailed and specific table of food values will prove helpful to those who desire intelligently to balance their diet or to provide balanced menus for their families. A very little attention to this subject will enable one to acquire sufficient knowledge of dietetic needs to successfully govern the diet in a general way without weighing or measuring the food. In the following table the number of calories available in ordinary food portions is stated. Such a table should not, of course, be memorized, but an occasional reference to it will enable one soon to acquire a working knowledge of the food values of the main articles in the dietary.

TABLE OF FOOD VALUES

THE WEIGHT (IN GRAMS, OUNCES AND ROUGH MEASURE) OF A PORTION CONTAINING 100 CALORIES OF EACH FOOD AND THE NUMBER OF CALORIES IN THE 100 IN THE FORM OF PROTEIN, FAT AND CARBOHYDRATE.[A] -----------------------------+----------------+-----+-----+------------------ | "Portion" |Wgt. of 100| Percent of Name of Food | Containing | Calories | | 100 Calories +-----+-----+-----+----+------- | Roughly | | |Pro- |Fat |Carbo- | Described |Gram |Ounce|tein | |hydrate ----------------------------------------------------------------------------- VEGETABLES -----------------------------+----------------+-----+-----+-----+----+------- *Artichokes, as purchased, | | | | | | average, canned | |430 |15. | 14 | 0 | 86 *Asparagus, as purchased, | | | | | | average, canned | |540 |19. | 33 | 5 | 62 *Asparagus, as purchased, | | | | | | average, cooked | |206 | 7.19| 18 |63 | 19 *Beans, baked, canned |Small side dish | 75 | 2.66| 21 |18 | 61 *Beans, Lima, canned |Large side dish |126 | 4.44| 21 | 4 | 75 *Beans, string, cooked |Five servings |480 |16.66| 15 |48 | 37 *Beets, edible portion, | | | | | | cooked |Three servings |245 | 8.7 | 2 |23 | 75 *Cabbage, edible portion | |310 |17. | 20 | 8 | 72 *Carrots, edible portion, | | | | | | average, fresh | |215 | 7.6 | 10 | 8 | 82 Carrots, cooked |Two servings |164 | 5.81| 10 |34 | 56 *Cauliflower, as purchased, | | | | | | average | |312 |11. | 23 |15 | 62 *Celery, edible portion, | | | | | | average | |540 |19. | 24 | 5 | 71 Corn, sweet, cooked |One side dish | 99 | 3.5 | 13 |10 | 77 *Cucumbers, edible portion, | | | | | | average | |565 |20. | 18 |10 | 72 *Egg plant, edible portion, | | | | | | average | |350 |12. | 17 |10 | 73 Lentils, cooked | | 89 | 3.15| 27 | 1 | 72 *Lettuce, edible portion, | | | | | | average | |505 |18. | 25 |14 | 61 *Mushrooms, as purchased, | | | | | | average | |215 | 7.6 | 31 | 8 | 61 *Onions, fresh, edible | | | | | | portion, average | |200 | 7.1 | 13 | 5 | 82 *Onions, cooked |Two large | | | | | | servings | 240 | 8.4 | 12 |40 | 48 *Parsnips, edible portion, |One and a half | | | | | average | servings | 152 | 5.3 | 10 | 7 | 83 Parsnips, cooked | | 163 | 5.74| 10 |34 | 56 *Peas, green, canned |Two servings | 178 | 6.3 | 25 | 3 | 72 *Peas, green, cooked |One serving | 85 | 3. | 23 |27 | 50 Potatoes, baked |One good sized | 86 | 3.05| 11 | 1 | 88 *Potatoes, boiled |One large sized | 102 | 3.62| 11 | 1 | 88 *Potatoes, mashed (creamed) |One serving | 89 | 3.14| 10 |25 | 65 *Potatoes, steamed |One serving | 101 | 3.57| 11 | 1 | 88 *Potatoes, chips |One-half serving| 17 | .6 | 4 |63 | 33 *Potatoes, sweet, cooked |Half of average | | | | | | potato | 49 | 1.7 | 6 | 9 | 85 *Pumpkins, edible portion, | | | | | | average | | 380 |13. | 15 | 4 | 81 Radishes, as purchased | | 480 |17. | 18 | 3 | 79 Rhubarb, edible portion, | | | | | | average | | 430 |15. | 10 |27 | 63 *Spinach, cooked, as |Two ordinary | | | | | purchased | servings | 174 | 6.1 | 15 |66 | 19 *Squash, edible portion, | | | | | | average | | 210 | 7.4 | 12 |10 | 78 *Succotash, canned, as |Ordinary serving| | | | | purchased, average | | 100 | 3.5 | 15 | 9 | 76 *Tomatoes, fresh, as |Four average | | | | | purchased, average | tomatoes | 430 |15. | 15 |16 | 69 *Tomatoes, canned | | 431 |15.2 | 21 | 7 | 72 *Turnips, edible portion, |Two large | | | | | average | servings | 246 | 8.7 | 13 | 4 | 83 Vegetable oysters | | 273 | 9.62| 10 |51 | 39 ----------------------------------------------------------------------------- FRUITS (FRESH OR COOKED) -----------------------------+----------------+-----+-----+-----+----+------- *Apples, as purchased |Two apples |206 | 7.3 | 3 | 7 | 90 Apples, baked | | 94 | 3.3 | 2 | 5 | 93 Apples, sauce |Ordinary serving|111 | 3.9 | 2 | 5 | 93 *Apricots, edible portion, | | | | | | average | |168 | 5.92| 8 | 0 | 92 Apricots, cooked |Large serving |131 | 4.61| 6 | 0 | 94 *Bananas, yellow, edible | | | | | | portion, average |One large |100 | 3.5 | 5 | 5 | 90 *Blackberries, as purchased, | | | | | | average | |170 | 5.9 | 9 |16 | 75 Blueberries | |128 | 4.6 | 3 | 8 | 89 *Blueberries, canned, as | | | | | | purchased | |165 | 5.8 | 4 | 9 | 87 Cantaloupe |Half ordinary | | | | | |serving |243 | 8.6 | 6 | 0 | 94 *Cherries, edible portion, | | | | | | average | |124 | 4.4 | 5 |10 | 85 *Cranberries, as purchased, | | | | | | average | |210 | 7.5 | 3 |12 | 85 *Grapes, as purchased, | | | | | | average | |136 | 4.8 | 5 |15 | 80 Grape fruit | |215 | 7.57| 7 | 4 | 89 Grape juice |Small glass |120 | 4.2 | 0 | 0 | 100 Gooseberries | |261 | 9.2 | 5 | 0 | 95 *Lemons | |215 | 7.57| 9 |14 | 77 Lemon juice | |246 | 8.77| 0 | 0 | 100 Nectarines | |147 | 5.18| 4 | 0 | 96 Olives, ripe |About seven | | | | | | olives |37 | 1.31| 2 |91 | 7 *Oranges, as purchased, | | | | | | average |One very large |270 | 9.4 | 6 | 3 | 91 Oranges, juice |Large glass |188 | 6.62| 0 | 0 | 100 *Peaches, as purchased, | | | | | | average |Three ordinary |290 |10. | 7 | 2 | 91 Peaches, sauce |Ordinary serving|136 | 4.78| 4 | 2 | 94 Peaches, juice |Ordinary glass |136 | 4.80| 0 | 0 | 100 *Pears |One large pear |173 | 5.40| 4 | 7 | 89 Pears, sauce | |113 | 3.98| 3 | 4 | 93 *Pineapples, edible portion, | | | | | | average | |226 | 8. | 4 | 6 | 90 Raspberries, black | |146 | 5.18| 10 |14 | 76 Raspberries, red | |178 | 6.29| 8 | 0 | 92 *Strawberries, as purchased, | | | | | | average |Two servings |260 | 9.1 | 10 |15 | 75 *Watermelon, as purchased, | | | | | | average | |760 |27. | 6 | 6 | 88 ----------------------------------------------------------------------------- COOKED MEATS -----------------------------+----------------+-----+-----+-----+----+------- +Beef, round, boiled (fat), | | | | | | 1099++ |Small serving | 36 | 1.3 | 40 |60 | 00 +Beef, round, boiled (lean), | | | | | | 1206++ |Large serving | 62 | 2.2 | 90 |10 | 00 +Beef, round, boiled (med.), | | | | | | 1188++ |Small serving | 44 | 1.6 | 60 |40 | 00 +Beef, 5th right rib, | | | | | | roasted, 1538++ |Half serving | 18.5| .65| 12 |88 | 00 +Beef, 5th right rib, | | | | | | roasted, 1616++ |Small serving | 32 | 1.2 | 25 |75 | 00 +Beef, 5th right rib, |Very small | | | | | roasted, 1615++ | serving | 25 | .88| 18 |82 | 00 +Beef, ribs, boiled, 1169++ |Small serving | 30 | 1.1 | 27 |73 | 00 +Beef, ribs, boiled, 1170++ |Very small | | | | | | serving | 25 | .87| 21 |79 | 00 *Calves foot jelly, as | | | | | | purchased | |112 | 4. | 19 |00 | 81 *Chicken, as purchased, | | | | | | canned |One thin slice | 27 | .96| 23 |77 | 00 *Lamb chops, boiled, edible | | | | | | portion, average |One small chop | 27 | .96| 24 |76 | 00 *Lamb, leg, roast |Ordinary serving| 50 | 1.8 | 40 |60 | 00 +Mutton, leg, boiled, 1184++ |Large serving | 34 | 1.2 | 35 |65 | 00 +Pork, ham, boiled (fat), | | | | | | 1174++ |Small serving | 20.5| .73| 14 |86 | 00 +Pork, ham, boiled, 1192++ |Ordinary serving| 32.5| 1.1 | 28 |72 | 00 +Pork, ham, roasted (fat), | | | | | | 1484++ |Small serving | 27 | .96| 19 |81 | 00 +Pork, ham, roasted (lean), | | | | | | 1511++ |Small serving | 34 | 1.2 | 33 |67 | 00 *Turkey, as purchased, | | | | | | canned |Small serving | 28 | .99| 23 |77 | 00 +Veal, leg, boiled, 1182++ |Large serving | 67.5| 2.4 | 73 |27 | 00 ----------------------------------------------------------------------------- CAKES, PASTRY, PUDDING AND DESSERTS -----------------------------+----------------+-----+-----+-----+----+------- *Cake, chocolate layer, as |Half ordinary | | | | | purchased | square piece | 28 | .98| 7 |22 | 71 *Cake, gingerbread, as |Half ordinary | | | | | purchased | square piece | 27 | .96| 6 |23 | 71 *Cake, sponge, as purchased |Small piece | 25 | .89| 7 |25 | 68 Custard, caramel | | 71 | 2.51| 19 |10 | 71 Custard, milk |Ordinary cup |122 | 4.29| 26 |56 | 18 Custard, tapioca |Two-thirds | | | | | | ordinary | 69.5| 2.45| 9 |12 | 79 *Doughnuts, as purchased |Half a doughnut | 23 | .8 | 6 |45 | 49 *Lady fingers, as purchased | | 27 | .95| 10 |12 | 78 *Macaroons, as purchased | | 23 | .82| 6 |33 | 61 Pie, apple, as purchased |One-third | | | | | | ordinary piece | 38 | 1.3 | 5 |32 | 63 *Pie, cream, as purchased |One-fourth | | | | | | ordinary piece | 30 | 1.1 | 5 |32 | 63 *Pie, custard, as purchased |One-third | | | | | | ordinary piece | 55 | 1.9 | 9 |32 | 59 *Pie, lemon, as purchased |One-third | | | | | | ordinary piece | 38 | 1.35| 6 |36 | 58 *Pie, mince, as purchased |One-fourth | | | | | | ordinary piece | 35 | 1.2 | 8 |38 | 54 *Pie, squash, as purchased |One-third | | | | | | ordinary piece | 55 | 1.9 | 10 |42 | 48 Pudding, apple sago | | 81 | 3.02| 6 | 3 | 91 Pudding, brown betty |Half ordinary | | | | | | serving | 56.6| 2. | 7 |12 | 81 Pudding, cream rice |Very small | | | | | | serving | 75 | 2.65| 8 |13 | 79 Pudding, Indian meal |Half ordinary | | | | | | serving | 56.6| 2. | 12 |25 | 63 Pudding, apple tapioca |Small serving | 79 | 2.8 | 1 | 1 | 98 Tapioca, cooked |Ordinary serving|108 | 3.85| 1 | 1 | 98 ----------------------------------------------------------------------------- FRUITS (DRIED) -----------------------------+----------------+-----+-----+-----+----+------- *Apples, as purchased, | | | | | | average | | 34 | 1.2 | 3 | 7 | 90 Apricots, as purchased, | | | | | | average | | 35 | 1.24| 7 | 3 | 90 *Dates, edible portion, | | | | | | average |Three large | 28 | .99| 2 | 7 | 91 *Dates, as purchased | | 31 | 1.1 | 2 | 7 | 91 *Figs, edible portion, | | | | | | average |One large | 31 | 1.1 | 5 | 0 | 95 *Prunes, edible portion, | | | | | | average |Three large | 32 | 1.14| 3 | 0 | 97 *Prunes, as purchased | | 38 | 1.35| 3 | 0 | 97 *Raisins, edible portion, | | | | | | average | | 28 | 1. | 3 | 9 | 88 *Raisins, as purchased | | 31 | 1.1 | 3 | 9 | 88 ----------------------------------------------------------------------------- CEREALS -----------------------------+----------------+-----+-----+-----+----+------- *Bread, brown, as purchased, |Ordinary thick | | | | | average | slice | 43 | 1.5 | 9 | 7 | 84 *Bread, corn (johnnycake) | | | | | | as purchased, average |Small square | 38 | 1.3 | 12 |10 | 72 *Bread, white, home made, as |Ordinary thick | | | | | purchased | slice | 38 | 1.3 | 13 | 6 | 81 Corn flakes, toasted |Ordinary cereal | | | | | | dishful | 27 | .97| 11 | 1 | 88 *Corn meal, granular, | | | | | | average | | 27 | .96| 10 | 5 | 85 *Corn meal, unbolted, | | | | | | edible portion, average | | 26 | .92| 9 |11 | 80 *Crackers, graham, as | | | | | | purchased |Two crackers | 23 | .82| 9 |20 | 71 *Crackers, oatmeal, as | | | | | | purchased |Two crackers | 23 | .81| 11 |24 | 65 *Hominy, cooked |Large serving |120 | 4.2 | 11 | 2 | 87 *Macaroni, average | | 27 | .96| 16 | 2 | 83 *Macaroni, average, cooked |Ordinary | | | | | | serving |110 | 3.85| 14 |15 | 71 *Oatmeal, average, boiled |One and a half | | | | | | serving |159 | 5.6 | 18 | 7 | 75 *Popcorn, average | | 24 | .86| 11 |11 | 78 *Rice, uncooked | | 28 | .98| 9 | 1 | 90 *Rice, boiled, average |Ordinary cereal | | | | | | dish | 87 | 3.1 | 10 | 1 | 89 *Rice, flakes |Ordinary cereal | | | | | | dish | 27 | .94| 8 | 1 | 91 *Rolls, Vienna, as | | | | | | purchased, average |One large roll | 35 | 1.2 | 12 | 7 | 81 *Shredded wheat |One biscuit | 27 | .94| 13 | 4.5| 82.5 *Spaghetti, average | | 28 | .97| 12 | 1 | 87 *Wheat flour, entire wheat | | | | | | average | | 27 | .96| 15 | 5 | 80 *Wheat flour, graham, | | | | | | average | | 27 | .96| 15 | 5 | 80 *Wheat flour, patent roller | | | | | | process, family and | | | | | | straight grade spring | | | | | | wheat, average | | 27 | .97| 12 | 3 | 85 *Zwieback |Size of thick | | | | | | slice bread | 23 | .81| 9 |21 | 70 ----------------------------------------------------------------------------- DAIRY PRODUCTS -----------------------------+----------------+-----+-----+-----+----+------- *Butter, as purchased |Ordinary pat or | | | | | | ball | 12.5| .44| .5|99.5| 00 *Buttermilk, as purchased |One and a half | | | | | | glass |275 | 9.7 | 34 |12 | 54 *Cheese, American, pale, as |One and a half | | | | | purchased | cubic in | 22 | .77| 25 |73 | 2 *Cheese, cottage, as | | | | | | purchased |Four cubic in | 89 | 3.12| 76 | 8 | 16 *Cheese, full cream, as |One and a half | | | | | purchased | cubic in. | 23 | .82| 25 |73 | 2 *Cheese, Neufchatel, as |One and a half | | | | | purchased | cubic in. | 29.5| 1.05| 22 |76 | 2 *Cheese, Swiss, as |One and a half | | | | | purchased | cubic in. | 23 | .8 | 25 |74 | 1 *Cheese, pineapple, as |One and a half | | | | | purchased | cubic in. | 20 | .72| 25 |73 | 2 *Cream |One quarter | | | | | | ordinary glass | 49 | 1.7 | 5 |86 | 9 Kumyss | |188 | 6.7 | 21 |37 | 42 *Milk, condensed, sweetened, | | | | | | as purch. | | 30 | 1.06| 10 |23 | 67 *Milk, condensed, | | | | | | unsweetened (evap. cream) | | | | | | as purchased | | 59 | 2.05| 24 |50 | 26 *Milk, skimmed, as |One and a half | | | | | purchased | glasses |255 | 9.4 | 37 | 7 | 56 *Milk, whole, as purchased |Small glass |140 | 4.9 | 19 |52 | 29 Whey, as purchased |Two glasses |360 |13 | 15 |10 | 75 ----------------------------------------------------------------------------- SWEETS AND PICKLES -----------------------------+----------------+-----+-----+-----+----+------- *Catsup, tomato, as | | | | | | purchased, average | |170 | 6. | 10 | 3 | 87 *Honey, as purchased |4 teaspoonfuls | 30 | 1.05| 1 | 0 | 99 *Marmalade (orange peel) | | 28.3| 1. | .5| 2.5| 97 *Molasses, cane | | 35 | 1.2 | .5| 0 | 99.5 *Olives, green, edible | | | | | | portion |Seven olives | 32 | 1.1 | 1 |84 | 15 *Olives, ripe, edible | | | | | | portion |Seven olives | 38 | 1.3 | 2 |91 | 7 *Pickles, mixed, as | | | | | | purchased | |415 |14.6 | 18 |15 | 67 *Sugar, granulated |3 teaspoonfuls | | | | | |or one and a | | | | | |half lumps | 24 | .86| 0 | 0 | 100 *Sugar, maple |4 teaspoonfuls | 29 | 1.03| 0 | 0 | 100 *Sirup, maple |4 teaspoonfuls | 35 | 1.2 | 0 | 0 | 100 ----------------------------------------------------------------------------- NUTS -----------------------------+----------------+-----+-----+-----+----+------- *Almonds, edible portion, | | | | | | average |About eight | 15 | .53| 13 |77 | 10 *Beechnuts | | 14.8| .52| 13 |79 | 8 *Brazil nuts, edible |Three ordinary | | | | | portion | size | 14 | .49| 10 |86 | 4 *Butternuts | | 14 | .50| 16 |82 | 2 *Cocoanuts | | 16 | .57| 4 |77 | 19 *Chestnuts, fresh, edible | | | | | | portion, average | | 40 | 1.4 | 10 |20 | 70 *Filberts, edible portion, | | | | | | average |Ten nuts | 14 | .48| 9 |84 | 7 *Hickory nuts | | 13 | .47| 9 |85 | 6 *Peanuts, edible portion, | | | | | | average |Thirteen double | 18 | .62| 20 |63 | 17 *Pecans, polished, edible | | | | | | portion |About eight | 13 | .46| 6 |87 | 7 *Pine nuts (pignolias), | | | | | | edible portion |About eighty | 16 | .56| 22 |74 | 4 *Walnuts, California, | | | | | | edible portion |About six | 14 | .48 | 10 |83 | 7 ----------------------------------------------------------------------------- MISCELLANEOUS -----------------------------+----------------+-----+-----+-----+----+------- *Eggs, hen's, boiled |One large egg | 59 | 2.1 | 32 |68 | 00 *Eggs, hen's whites | |181 | 6.4 |100 | 0 | 00 *Eggs, hen's, yolks |Two yolks | 27 | .94| 17 |83 | 00 *Omelet | | 94 | 3.3 | 34 |60 | 6 *Soup, beef, as purchased, | | | | | | average | |380 |13. | 69 |14 | 17 *Soup, bean, as purchased, | | | | | | average |Very large plate|150 | 5.4 | 20 |20 | 60 *Soup, cream of celery, as | | | | | | purch., average |Two plates |180 | 6.3 | 16 |47 | 37 *Consomme, as purchased | |830 |29. | 85 |00 | 15 *Clam chowder, as purchased |Two plates |230 | 8.25| 17 |18 | 65 -----------------------------+----------------+-----+-----+-----+----+-------

[A] Abstracted from A Graphic Method of Practical Dietetics, Irving Fisher, Journal of A. M. A., Vol. xlviii, pp. 1316-1324.

[*] Chemical Composition of American Food Materials. Atwater and Bryant. U. S. Department of Agriculture Bulletin, No. 28.

[+] Experiments on Losses in Cooking Meats. (1900103, Grindley, U. S. Department of Agriculture Bulletin, No. 141.)

[++] Laboratory number of specimen, as per Experiments on Losses in Cooking Meat.

[Sidenote: Cost of Ready to Serve Foods]

The following table, adapted from one compiled by Gephart and Lusk ("Analysis and Cost of Ready to Serve Foods"), shows in convenient form the relative energy values and cost of the more commonly used articles of food.

A brief glance at this table will show how easily one might slowly starve on very expensive food, and yet how easily the energy food needed can be secured at a very low cost.

It would, of course, be a great mistake to regulate the diet solely with regard to fuel value. Digestibility, as well as protein, mineral and vitamin requirements, must also be considered. Nevertheless, the main requirement is for fuel, and this, as the table shows, can be secured at a surprizingly low cost.

=========================================================================== | No. of | Cost of One Name of Food. | Calories in | Order "Quick | One Order.[B]| Lunch" | | Restaurant. -------------------------------------------+---------------+--------------- Napoleon | 418.6 | $0.05 Crullers | 416.6 | .05 Cabinet pudding and vanilla sauce | 416.6 | .05 Cocoanut pie | 357 | .05 CD--Roast beef sandwich with roll | 357 | .05 Bath buns | 357 | .05 Bread custard pudding | 357 | .05 Pineapple pie | 357 | .05 Corn muffins | 357 | .05 Apple pie | 357 | .05 New England pudding with vanilla sauce | 312.5 | .05 Chocolate spiced cakes. | 312.5 | .05 Walnut layer cake with marshmallow | | icing | 312.5 | .05 Milk crackers | 312.5 | .05 Bread pudding with vanilla sauce | 312.5 | .05 Pumpkin pie | 312.5 | .05 D--Lamb croquettes and mashed potatoes | 833.3 | .15 Coffee cake | 277.7 | .05 Rhubarb pie | 277.7 | .05 D--German meat cakes and French fried | | potatoes | 833.3 | .15 Old-fashioned molasses cake | 277.7 | .05 Lemon pie | 277.7 | .05 CD--Vienna roast with French fried potatoes| 833.3 | .15 Butter cakes | 277.7 | .05 Minced ham sandwich | 277.7 | .05 Pork and Boston beans | 833.3 | .15 Cornmeal cakes with maple cane sirup | 500 | .10 D--Ham croquettes | 500 | .10 Cold rice pudding | 277.7 | .05 Ham sandwich with roll | 250 | .05 Banana layer cake | 250 | .05 CD--Creamed chipped beef on toast | 833.3 | .15 Cocoa | 250 | .05 CD--Roast beef cutlet with tomato sauce | 833.3 | .15 CD--German meat cakes with lyonnaise | | potatoes | 833.3 | .15 CD--Swiss cheese sandwich | 250 | .05 C --Boston baked beans | 500 | .10 D--Vienna roast, spaghetti and potatoes | 625 | .15 Chocolate cornstarch with cream | 227.2 | .05 Wheat cakes with maple cane sirup | 500 | .10 Milk crackers and milk | 500 | .10 CD--American cheese sandwich | 227.2 | .05 C --New York baked beans | 500 | .10 Hot corn bread | 416.6 | .10 CD--Country sausage | 227.2 | .05 Indian pudding with maple sauce | 227.2 | .05 CD--Minced tongue sandwich with tea | | biscuits | 227.2 | .05 Cream roll | 227.2 | .05 D--Beef cakes with brown gravy and | | macaroni | 625 | .15 C --New York beans, on the side | 227.2 | .05 Graham crackers | 227.2 | .05 D--Broiled ham | 833.3 | .20 D--Roast beef hash, browned | 625 | .15 Oyster pie | 625 | .15 CD--Minced chicken sandwich | 227.2 | .05 Apple tapioca pudding | 227.2 | .05 Potato salad | 416.6 | .10 Chocolate layer cake | 208.3 | .05 CD--Breaded veal cutlet and tomato sauce | 833.3 | .20 Egg plant fried in butter | 625 | .15 Buckwheat cakes with maple cane sirup | 417.6 | .10 D--Roast beef croquettes with macaroni | 625 | .15 D--Fried bacon with French fried potatoes | 833.3 | .20 D--Sardine sandwich | 208.3 | .05 CD--Minced ham sandwich with olives | 208.3 | .05 CD--Ham and New York Beans | 625 | .15 Vanilla cornstarch with cream | 208.3 | .05 CD--Roast beef cutlet and mashed potatoes | 625 | .15 D--Lamb cutlet and mashed potatoes | 625 | .15 Cocoanut cake | 208.3 | .05 Cream cheese walnut sandwich | 208.3 | .05 C --New York baked beans with tomato sauce | 416.6 | .10 D--Ham and Boston beans | 625 | .15 D--Liver and onions with French fried | | potatoes | 833.3 | .20 CD--Beef stew | 625 | .15 CD--Pork and New York beans | 625 | .15 CD--Ham sandwich | 192.3 | .05 Rice croquette with bacon | 625 | .15 Baked apple with cream | 416.6 | .10 D--Frankfurters and potato salad | 625 | .15 Baked beans with macaroni | 625 | .15 Cup of coffee (containing cream and | | sugar) | 192.3 | .05 D--Mince pie | 417.6 | .10 CD--Lamb stew | 625 | .15 CD--Broiled salt mackerel with mashed | | potatoes | 833.3 | .20 Cherry pie | 357 | .10 Pound cake | 357 | .10 D--Chicken cutlet and mashed potatoes | 625 | .20 CD--Shredded wheat and milk | 357 | .10 Cream tapioca pudding | 192.3 | .05 Soda crackers and milk | 357 | .10 Strawberry pie | 357 | .10 Chocolate eclair | 192.3 | .05 CD--Baked lamb pie (individual) | 625 | .15 CD--Corned beef sandwich | 192.3 | .05 D--Broiled bacon | 833.3 | .20 Rice cakes with maple cane sirup | 625 | .15 D--Cold ham | 500 | .15 D--Roast beef croquettes and spaghetti | 500 | .15 CD--Chipped beef and scrambled egg | 833.3 | .20 D--Minced ham with scrambled eggs | 833.3 | .20 Peach pie | 357 | .10 D--Baked macaroni and cheese | 357 | .10 Huckleberry pie | 357 | .10 French toast with maple cane sirup. | 625 | .15 CD--Corned beef and New York beans | 500 | .15 Blackberry pie | 357 | .10 CD--Veal pot pie with dumplings | 500 | .15 CD--Creamed codfish on toast | 500 | .15 D--Vienna roast with stewed tomatoes | 500 | .15 CD--Tomato omelet | 625 | .20 D--Small oyster fry | 625 | .20 Hot rice with cream | 500 | .15 D--Plain oyster fry with bacon | 625 | .20 CD--Hamburger steak | 625 | .20 D--Corned beef hash, browned in pan | 500 | .15 D--Corned beef hash, steamed | 500 | .15 Cream | 500 | .15 CD--Chicken wings on toast | 625 | .20 D--Country sausage and French fried | | potatoes | 500 | .15 CD--Corned beef and Boston beans | 500 | .15 CD--Two fried eggs | 500 | .15 CA--Ham omelet | 625 | .20 CD--Plain omelet | 500 | .15 CA--Fried liver and mashed potatoes | 500 | .15 CD--Creamed chipped beef | 500 | .15 D--Large oyster fry | 833.3 | .25 Apple fritters with fruit sauce | 312.5 | .10 D--Fish cakes with tomato sauce | 500 | .15 French fried potatoes, extra order | 312.5 | .10 Chocolate cornstarch with whipped cream| 156.25 | .05 Shredded wheat and cream | 416.6 | .15 D--Chicken croquette and French fried | | potatoes | 500 | .15 CD--Corned beef hash with poached egg | 625 | .20 CD--Ham and eggs | 833.3 | .25 D--Ham and potato salad | 625 | .20 CD--Baked shad and dressing | 625 | .20 CD--Hamburger steak with Spanish sauce | 625 | .20 Charlotte russe | 156.25 | .05 CD--Creamed eggs on toast | 625 | .20 D--Bacon and eggs | 833.3 | .25 Strawberry fruit jelly with whipped | | cream | 156.25 | .05 CD--Buckwheat cakes with country sausage | 625 | .20 D--Oyster sandwich | 312.5 | .10 C --Chicken giblets on toast | 625 | .20 Hot rice with butter | 312.5 | .10 Pimento olive cheese sandwich | 156.25 | .05 CD--Liver and bacon with lyonnaise potatoes| 833.3 | .25 CD--Corned beef hash, browned, with two | | poached eggs | 833.3 | .25 Buttered toast | 312.5 | .10 CD--Liver and bacon | 833.3 | .25 CD--Chicken hash | 416.6 | .15 D--Two scrambled eggs | 416.6 | .15 CD--Milk | 277.7 | .10 Apple sauce with whipped cream | 147.05 | .05 Hot rice with poached egg | 416.6 | .15 CD--Corned beef with potato salad | 416.6 | .15 Fish cakes with poached egg | 625 | .20 CD--Cold roast beef | 416.6 | .15 D--Hot rice with milk | 277.7 | .10 CD--Small steak | 833.3 | .30 Baked apple | 138.8 | .05 Baked apple with ice cream | 277.7 | .10 D--Two lamb chops | 833.3 | .30 D--Chicken salad sandwich | 277.7 | .10 CD--Corned beef hash, steamed, with | | poached egg | 500 | .20 C --Boston beans on side | 131.57 | .05 Tomato sandwich | 131.57 | .05 D--Lamb chops, breaded, with mashed | | potatoes | 500 | .20 CD--Maple flakes with milk | 277.7 | .10 CD--Corned beef | 416.6 | .15 CD--Bulgarzoon | 131.57 | .05 D--Spanish omelet with French fried | | potatoes | 625 | .25 Baked apple custard with whipped cream | 250 | .10 Boiled rice, side order | 131.57 | .05 CD--Fried egg sandwich | 250 | .10 CD--Onion omelet | 500 | .20 CD--Baked weak fish with dressing | 500 | .20 CD--Sirloin steak | 1250 | .50 Fresh cooked oatmeal with cream | 416.6 | .15 CD--Fish cakes with macaroni | 500 | .20 Sliced bananas with cream | 250 | .10 C --Macaroni, side order | 125 | .05 CD--Roast sirloin of beef and mashed | | potatoes | 500 | .20 D--Tomato omelet with potatoes | 625 | .25 CD--Two boiled eggs | 357 | .15 CD--Fish cakes with spaghetti | 500 | .20 CD--Macaroni omelet and tomato sauce | 625 | .25 CD--Small steak with onions | 833.3 | .35 CD--Fish cake sandwich | 227.2 | .10 CD--Egg salad | 500 | .20 CD--Parsley omelet | 500 | .20 Green split pea soup | 227.2 | .10 Vanilla ice cream | 227.2 | .10 CD--Tenderloin steak with onions | 1250 | .55 CD--Cornflakes and milk | 227.2 | .10 Strawberry tart | 227.2 | .10 CD--Tuna fish salad | 500 | .25 CD--Sirloin steak with onions | 1250 | .55 Pineapple fruit jelly with whipped | | cream | 108.69 | .05 CD--Cup custard | 227.2 | .10 CD--Roast beef with potato salad | 500 | .25 CD--Tenderloin steak | 1250 | .60 D--Milk toast | 312.5 | .15 Strawberry cornstarch with whipped | | cream | 104.16 | .05 Strawberry ice cream | 208.3 | .10 CD--Clam chowder | 416.6 | .20 C --Chicken soup | 312.5 | .15 CD--Crab meat salad | 416.6 | .20 Vegetable soup | 192.3 | .10 Stewed rhubarb | 92.59 | .05 CD--Creamed chicken on toast | 357 | .20 Strawberries with cream | 277.7 | .15 Strawberry short cake | 277.7 | .15 CD--Chicken omelet | 416.6 | .20 CD--Deviled crab | 277.7 | .20 Sliced bananas | 89.28 | .05 CD--Spaghetti and cheese | 178.57 | .10 CD--Fried ham | 416.6 | .25 D--Minced chicken sandwich with lettuce | 166.66 | .10 C --Bean soup with croutons | 166.66 | .10 CD--Hot roast beef sandwich | 250 | .15 CD--Club sandwich | 416.6 | .25 CD--Sliced chicken sandwich | 156.25 | .10 CD--Poached eggs on toast | 500 | .20 Strawberries with ice cream | 192.3 | .15 C --Cream of wheat | 125 | .10 Blackberries and cream | 113.63 | .10 Stewed corn | 52.08 | .05 C --Creamed asparagus on toast | 192.3 | .20 Watermelon | 125 | .15 C --Tomato soup with rice | 73.52 | .10 Sliced pineapple | 35.21 | .05 Grape Fruit | 78.12 | .15 CD--Raw oysters | 55.55 | .15 Sliced tomatoes with lettuce | 50 | .15 C --Sliced tomatoes | 30.48 | .10 Tomatoes and lettuce with dressing | 53.19 | .20 Cantaloupe | 36.23 | .15 Champagne[E] | 357 | 1.00 ---------------------------------------------------------------------------

[B] These values cover the whole portion as served, including bread and butter.

[C] Contains 15 per cent. or over of heat in protein.

[D] Contains the protein of meat, milk, eggs or cheese.

[E] Not purchased in the restaurant.

[Sidenote: The Minimal Cost of Food]

Professor Graham Lusk has very kindly contributed the following comments and additional table, derived from this material:

"The above are analyses of 350 different samples of foods purchased over the counters of a company which maintains a chain of restaurants in New York City, and obtained without knowledge on the part of these restaurants that the analyses were contemplated.

"One may reliably assume that for the man of ordinary size, who lives without doing any special muscular exercise, the fuel requirement of the body each day amounts to 2,500 calories of heat. Translated into common terms, this is the quantity of heat which would be required to raise about 25 quarts of water from the freezing to the boiling point. Miss Cauble, a special investigator of the Association for the Improvement of the Condition of the Poor, kindly estimated the cost at wholesale prices of the ingredients of different portions sold in the restaurants. These are given in Table 9 beginning on page 64 of the pamphlet from which the above table was derived. The data enable one to construct a new table which gives the estimated wholesale cost of 2,500 calories in the various familiar forms of food sold in the restaurant. This represents the minimum cost of fuel for the support of an adult during twenty-four hours without taking into consideration labor, fuel or rent which, in the case of the restaurant, must be included in the cost of the foods when they are eaten. It represents the minimal cost of food in the home.

"It appears from the table given below that the cost of 2,500 calories in the wholesale market varies from $.04 in the case of boiled rice to $.61 for shad. About half of the dishes can be obtained at wholesale at a price less than $.25 for 2,500 calories, or less than a cent per hundred calories, a cost which is the standard striven for in school lunches. The table is given on the next page.

ESTIMATED WHOLESALE COST OF THE UNCOOKED INGREDIENTS OF 2500 CALORIES CONTAINED IN STANDARD FOODS ARRANGED ACCORDING TO THEIR INCREASING COST. Apple tapioca pudding $.04 Rice, boiled (side order) .04 Bath buns .06 Pie, apple .07 Pie, rhubarb .08 Apple, baked .09 Pie, strawberry .09 Cocoa .09 Crullers .10 *Fish cakes with tomato sauce .13 Muffins, corn .13 *Lamb croquette and mashed potatoes .14 *Beans, Boston baked .15 *Beef, corned .15 Pie, lemon .15 Chicken wings on toast .16 Napoleon .16 *Salad, potato .16 Toast, buttered .16 Cream roll .17 *Beef, creamed, chipped, on toast .18 Cakes, butter .19 *Roast, Vienna, and spaghetti and potatoes .19 Pudding, tapioca, creamed .20 Sandwich, oyster .20 *Veal cutlet, breaded and tomato sauce .20 *Beef, corned, hash browned in pan .21 *Liver and bacon .21 *Roast, Vienna, with French fried potatoes .21 *Stew, lamb .21 *Beans, New York, baked .22 Cakes, buckwheat, with maple cane sirup .22 Coffee, cup of (contained cream and sugar) .22 Pudding, bread, with vanilla sauce .24 *Beef, corned, hashed, steamed .25 Oatmeal, fresh cooked, with cream .25 *Stew, beef .25 Pie, oyster .26 Potatoes, French fried, extra order .26 *Sandwich, ham .26 *Beef, creamed, chipped .27 *Sandwich, corned beef .27 *Beef, corned, hashed, steamed, with poached egg .28 *Mackerel, broiled salt, with mashed potatoes .28 Milk .29 Pudding, rice, cold .29 *Rice, hot, with poached egg .29 Soup, bean, with croutons .29 *Sandwich, minced chicken .30 Cornstarch, chocolate, with cream .31 Ice cream, strawberry .31 *Omelet, ham .32 Sandwich, cream cheese walnut .32 *Omelet, plain .33 Cornstarch, vanilla, with cream .34 *Omelet, onion .34 *Oyster fry, small .34 *Eggs, fried (2) .35 *Sandwich, fried egg .35 Sausage, country .35 *Chicken croquette and French fried potatoes .36 *Eggs, creamed, on toast .36 *Omelet, parsley .37 *Omelet, Spanish, with French fried potatoes .37 *Sandwich, tomato .39 *Eggs, scrambled (2) .40 *Lamb chops (2) .40 Sandwich, club .40 *Salad, tuna fish .41 Custard .43 *Sandwich, chicken, sliced .43 *Steak, tenderloin .43 *Ham, fried .44 *Sandwich, roast beef, hot .44 Strawberries with cream .44 Toast, milk .45 *Eggs, boiled (2) .47 *Omelet, chicken .47 *Sandwich, minced chicken with lettuce .49 *Eggs, poached on toast (2) .59 *Shad, baked, and dressing .61

[*] These orders contained bread and butter, which are figured in the food values. Of the orders containing bread the fractional part of the nutritional energy of the order from this source averaged 43.7 per cent. of the total.

"Contemplation of these results may be made after the housekeeper has carefully gone through the monthly hills for food, divided the cost of the total food by the number of days in the month and then divided this figure by the number of people in the family, counting children between five and fifteen years of age at two-thirds of an adult.

"It would be interesting to know whether the cost of food for the adult as determined in this fashion was $.25, $.50 or $1.00 per day. Wherever the higher values are reached it is certain that extravagant profits are paid to middlemen or great waste exists in the kitchen.

"The theme might still further be elaborated, but the essential data for those interested in food economics can be obtained from the table itself. Wholesale prices are used for the reason that retail prices are subject to great variation. The fluctuation of retail prices does not make it feasible to give their equivalents for the wholesale list, but the relationship can be judged by noting the equivalents for the extremes. In this table, for example, the retail price of 2500 calories of rice would be about 13 cents as against 4 cents wholesale, and for shad about $1.50, retail as against 61 cents wholesale."

CALORIES OF FOOD CONSUMED DAILY[F]

[F] _Skandinavisches Archiv fuer Physiologie_ XXXI. Band. 1., 2 u. 3. Heft, Leipzig, Verlag Von Veit & Comp., 1914.

The following table is derived from data produced by Becker and Hamalainen of the University of Helsingfors, Finland, from actual experiment with individuals alternately resting and working at their respective trades while in the "respiration calorimeter."

--------------+----+---------+-----+-----------------+--------+--------- | | | | During | During | Total | | | | Rest | Work | Calories | | | +-----------------+--------+ per Day Occupation | Age| Height | Wgt.|Calories|Calories|Calories| (8 Hrs. | | Ft.-Ins.| Lbs.|per Hour|per Hour|per Hour| Work. | | | | |per Lb. | | 16 Hrs. | | | | |of Body | | Rest) | | | | |Weight | | --------------+----+---------+-----+--------+--------+--------+--------- MEN --------------+----+---------+-----+--------+--------+--------+--------- Shoemaker | 56 | 5-0 | 145 | 73 | .50 | 172 | 2544 Shoemaker | 30 | 5-8 | 143 | 87 | .60 | 171 | 2760 Tailor | 39 | 5-5 | 141 | 72 | .50 | 124 | 2144 Tailor | 46 | 5-101/2 | 161 | 102 | .63 | 135 | 2712 Bookbinder | 19 | 6-0 | 150 | 87 | .58 | 164 | 2704 Bookbinder | 23 | 5-41/2 | 143 | 85 | .59 | 163 | 2664 Metalworker | 34 | 5-4 | 139 | 81 | .58 | 216 | 3024 Metalworker | 27 | 5-5 | 130 | 99 | .76 | 219 | 3336 Painter | 25 | 5-11 | 154 | 104 | .67 | 231 | 3512 Painter | 27 | 5-8 | 147 | 111 | .79 | 230 | 3616 Joiner | 42 | 5-7 | 154 | 81 | .50 | 204 | 2928 Joiner | 24 | 5-51/2 | 141 | 85 | .60 | 244 | 3312 Stone-worker | 27 | 5-11 | 156 | 90 | .57 | 408 | 4704 Stone-worker | 22 | 5-8 | 141 | 85 | .60 | 366 | 4288 Sawyer | 42 | 5-5 | 167 | 86 | .50 | 501 | 5384 Sawyer | 43 | 5-5 | 143 | 84 | .59 | 451 | 4952 --------------+----+---------+-----+--------+--------+--------+--------- WOMEN --------------+----+---------+-----+--------+--------+--------+--------- Hand-sewer | 53 | 5-3 | 139 | 75 | .54 | 83 | 1864 Hand-sewer | 35 | 5-6 | 143 | 64 | .45 | 88 | 1728 Machine-sewer | 53 | 5-3 | 139 | 75 | .54 | 103 | 2024 Machine-sewer | 19 | 5-3 | 110 | 64 | .58 | 119 | 1976 Wash-woman | 43 | 5-3 | 125 | 75 | .60 | 285 | 3480 Wash-woman | 19 | 5-3 | 110 | 64 | .58 | 186 | 2512 Waitress | 43 | 5-3 | 125 | 75 | .60 | 228 | 3024 Waitress | 19 | 5-3 | 110 | 64 | .58 | 143 | 2168 Bookbinder | 22 | 5-4 | 105 | 70 | .65 | 98 | 1904 Bookbinder | 22 | 5-3 | 112 | 61 | .54 | 127 | 1992 --------------+----+---------+-----+--------+--------+--------+---------

For example, for sawyers (an active occupation), the heat production and consequent requirement in calories worked out as follows:

During rest 84 calories x 16 h. 1344 During work 451 calories x 8 h. 3608 ---- Total calories 4952

The tailor (sedentary occupation) showed the following heat production and calorific requirement:

72 calories x 16 h. 1152 124 calories x 8 h. 992 ---- Total calories 2144

These figures show the wide variation in food requirements according to age, weight and occupation.

[Sidenote: Basal Metabolism]

Francis G. Benedict and his co-workers at the Nutrition Laboratory of the Carnegie Institution of Washington, and Prof. Graham Lusk of Cornell University, have also made a large number of experiments to ascertain what is termed the basal metabolism or heat production of the body at perfect rest, and also that under varying degrees of activity. The results are closely in agreement with the above.

Benedict has lately produced evidence to show that the basal metabolism, or heat production, at rest is not governed entirely by such factors as body weight and body surface, but by the amount and activity of the active protoplasmic cells of the body--the cells that compose the organs and muscles and blood. The condition of these cells when the measurements are taken (which may be influenced by age, sleep, previous muscular exercise and diet) materially affects the amount of heat production and the requirements in energy food. Such experiments show why a man must literally burn up his own body, if he takes in no fuel in the form of food. Benedict's views also account for the higher energy requirement of men as compared to women, who, as a rule, have more fat and less muscular tissue than men.

[Sidenote: Diet and Endurance]

We have quoted Rubner (_vide_ page 38) as condemning the very old popular idea that meat is very "strengthening." Actual experiments on this point have shown exactly the opposite to be the case. Meat eating and a high-protein diet instead of increasing one's endurance, have been shown, like alcohol, to actually reduce it.

An experiment was made by one of the authors to determine this question. The experiment consisted of endurance tests made on 49 persons representing the two types of dietetic habits. The persons experimented upon constituted three classes: first, athletes accustomed to high-protein and full-flesh dietary; second, athletes accustomed to a low-protein and non-flesh dietary; third, sedentary persons accustomed to a low-protein and non-flesh dietary. The subjects consisted of Yale students and instructors, a Connecticut physician, and several other physicians and nurses. All of the low-protein and non-flesh subjects except one had abstained from flesh foods for periods of 4 to 20 years, and 5 of them had never eaten such foods.

The experiments furnished a severe test of the claims of the flesh-abstainers. Two comparisons were planned, one between flesh-eating athletes and flesh-abstaining athletes, and the other between flesh-eating athletes and flesh-abstaining sedentary workers. The results would indicate that the users of low-protein and the non-flesh dietaries have far greater endurance than those who are accustomed to the ordinary American diet.

In the absence of any exact mechanical method of measuring endurance, simple endurance tests were employed, such as holding the arms horizontally as long as possible and deep knee bending. The tests were made before witnesses.

The comparison for arm holding shows a great superiority on the side of the flesh-abstainers. Only 2 of the 15 flesh-eaters succeeded in holding their arms out over a quarter of an hour, whereas 22 of the 32 abstainers surpassed that limit. None of the flesh-eaters reached half an hour, but 15 of the 32 abstainers exceeded that limit. Of these 9 exceeded an hour, 4 exceeded 2 hours and 1 exceeded 3 hours.

In respect to deep knee bending, if we take the number 325 for reference, we find that, of the 9 flesh-eaters only 3 surpassed this figure, while of the 21 abstainers, 17 surpassed it. Only 1 of the 9 flesh-eaters reached 1,000 as against 6 of the 21 abstainers. None of the former surpassed 2,000 as against 2 of the latter.

Similar results have been found in other investigations. It is probable that the inferiority of meat-eaters in staying power is due primarily to high protein, not to meat _per se_.

In 1906, nine Yale students under the direction of one of the authors experimented with Mr. Horace Fletcher's method of thorough mastication and instinctive eating. The experiment began with an endurance test on January 14, and consisted mainly of two parts, each of which lasted about ten weeks.

The object of the first half of the experiment was to test the claims which have been made as to the effects upon endurance of thorough mastication combined with implicit obedience to appetite. Our conclusion in brief is that these claims, so far as they relate to endurance, are justified.

The method may be briefly expressed in two rules.

1. _Mastication._--Thorough mastication of all food up to the point of involuntary swallowing, with the attention directed, however, not on the mechanical act of chewing, but on the tasting and enjoyment of the food; liquid foods to be sipped and tasted, not drunk down like water. There should be no artificial holding of food in the mouth beyond the time of natural swallowing, even if, as is to be expected at the start, that swallowing is premature. It is not intended to "count the chews," or to hold the food forcibly in the front of the mouth, or to allow the tongue muscles to become fatigued by any unnatural effort or position, or in any other way to make eating a bore. On the contrary, every such effort distracts one from the natural enjoyment of food. Pavlov has shown that without such attention and enjoyment of the taste of food, the secretion of gastric juice is lessened. The point of involuntary swallowing is thus a variable point, gradually coming later and later as the practise of thorough mastication proceeds, until the result is reached that the food remains in the mouth without effort and becomes practically tasteless. Thus the food, so to speak, swallows itself, and the person eats without thought either of swallowing or of not swallowing it; swallowing is put into the same category of physiological functions as breathing, which ordinarily is involuntary.

2. _Following instinct._--Never to eat when not hungry, even if a meal (or more than one, for that matter) is skipped. And when a meal is taken, not to be guided by the quantity of food offered, or by past habit, or by any theories as to the amount of food needed. The natural taste or appetite is alone consulted, and the subject selects, from the food available, only those kinds and amounts which are actually craved by the appetite. After practise, the appetite gradually becomes more definite and discriminating in its indications.

During the second half of the experiment the two rules above mentioned were continued in force, but a third rule was added, namely, when the appetite was in doubt, to give the benefit of that doubt to low-protein and non-flesh foods. In other words, the influence of suggestion was invoked to hasten the change which had been inaugurated by arousing the natural appetite. Suggestion was introduced merely because the experiment was limited in time. In no case was it allowed to override the dictates of appetite.

Careful records of the amount of food taken and the constituents in (1) protein, (2) fats and (3) starches and sugars, were kept for each man for each day. In order to avoid weighing the food at the table and the annoyance which such a procedure involves, the food was all weighed in the kitchen and served in definite portions of known food value. From the records thus supplied, it was easy, by means of a "mechanical diet indicator" devised for the purpose, to find the proportions of food elements. The first result of the experiment was a reduction in the amount of protein consumed.

During the first four weeks, the men consumed an average of from 2,760 to 3,030 calories per day, of which 120 to 240 were in the flesh foods, such as meats, poultry, fish and shell-fish, and that 2.4 to 2.7 calories of protein were ingested for each pound of body-weight. Translating Professor Chittenden's figures for the physiological requirement of ingested protein, we find it to be from 1.3 to 1.7 calories per pound of body-weight. Thus the men were at this time consuming nearly double the Chittenden allowance. During the last four weeks of the experiment all these magnitudes were lower. The per capita calories ranged from 2,220 to 2,620, of which only 40 were in flesh foods, and the protein had fallen to 1.4 to 1.9 calories per pound of body-weight, which corresponds closely to the Chittenden standard.

Gymnasium tests were made at the beginning, middle and end of the experiment. These tests were of two kinds--tests of strength and tests of endurance.

During the first period there was a slight increase in strength (from an average "total" strength of 1,076 to 1,118), and during the second period a slight fall to 995, which is about 12 per cent. from the mid-year's 1,118, and about 8 per cent. from the original 1,076. Thus the strength of the men remained nearly stationary throughout the experiment.

It is fortunate that the strength of the men remained so nearly stationary; for it demonstrates the more clearly that the increase in endurance which will be shown below was an increase in endurance _per se_, and not in any degree due to an increase in strength. Strength and endurance are entirely distinct and should be separately measured. The strength of a muscle is measured by the utmost force which it can exert _once_; its endurance by the number of times it can repeat a given exertion _well within its strength_.

After much consideration and consultation it was decided not to place reliance on the ordinary ergographs as a means of measuring endurance. Instead, seven simple gymnastic tests of physical endurance were employed, and one of mental endurance. The seven physical tests were:

(1) Rising on the toes as many times as possible.

(2) Deep knee bending, or squatting as far as possible and rising to the standing posture, repeating as often as possible.

(3) While lying on the back, raising the legs from the floor to a vertical position and lowering them again, repeating to the point of physical exhaustion.

(4) Raising a 5-lb. dumb-bell (with the triceps) in each hand from the shoulder up to the highest point above the head, repeating to the point of physical exhaustion.

(5) Holding the arms from the sides horizontally for as long a time as possible.

(6) Raising a dumb-bell (with the biceps) in one hand from a position in which the arm hangs down, up to the shoulder and lowering it again, repeating the motion to the point of physical exhaustion. This test was taken with four successive dumb-bells of decreasing weight, viz., 50, 25, 10 and 5 lbs. respectively.

(7) Running on the gymnasium track at a speed to suit the subject, to as great a distance as possible.

The mental test consisted of adding specified columns of figures as rapidly as possible, the object being to find out whether the rapidity of performing such work tended to improve during the experiment.

PERCENTAGE OF IMPROVEMENT IN ENDURANCE (EXACT OR UNDERSTATED) OF EIGHT MEN.

AVERAGE. B Lq. Lw. M P R T W Jan.-Mar. 33+ 36 50 -- 26 18+ 66+ 33 Jan.-June 84+ 84+ 181 29 56+ 89+ 80+ 107+

The figures of this table show an undoubted increase in endurance, both for the first half and more especially for the whole period of the experiment.

Three methods of estimating the increase of endurance between January and June were used. These may be put together in the following table:

PERCENTAGE OF INCREASE OF ENDURANCE, JANUARY TO JUNE, BY THREE METHODS.

AVERAGE SIX TESTS. B E Lq. Lw. M P R T W 85 13 194 95 212 56+ 73 66 109

OMITTING DOUBTFUL CASES "+" 84+ ... 84+ 181 29+ 56+ 89+ 80+ 107+

"PURE" ENDURANCE OF BICEPS. ... ... 62 ... 50 ... 170 200 100+

The first line of this table tells us the average of the recorded improvement in endurance shown for each man. The average of these averages is 101 per cent. for the entire club, and is probably within the truth; for most of the individual figures which go to make up this result are understatements, not overstatements.

The second line shows the average improvement in tests in which there is no doubt that the figure is at least not too high, though it may be too low. The average of these is 89 per cent., and is therefore certainly too low an estimate of the average improvement for the eight men who improved at all.

The third line shows the increase of _pure_ endurance (that is, endurance considered apart from strength) for the five men for whom the figures were available. The average of these is 116 per cent.

We are quite safe in saying, therefore, that the average improvement of the eight men who improved was 90 per cent.

The phenomena observed during the experiment may be summarized as a slight reduction of total food consumed, a large reduction of the protein element, especially of flesh foods, a lessened excretion of nitrogen, a reduction in the odor, putrefaction, fermentation and quantity of the feces, a slight loss of weight, a slight loss of strength, an enormous increase of physical endurance, a slight increase in mental quickness. These phenomena varied somewhat with different individuals, the variations corresponding in general to the varying degree in which the men adhered to the rules of the experiment.

That we are correct in ascribing the results, especially in endurance, to dietetic causes alone, cannot reasonably be doubted when it is considered that no other factors of known significance were allowed to aid in this result.

While the results of the present experiment lean toward "vegetarianism," they are only incidentally related to its propaganda. Meat was by no means excluded; on the contrary, the subjects were urged to eat it if their appetite distinctly preferred it to other foods.

The sudden and complete exclusion of meat is not always desirable, unless more skill and knowledge in food matters are employed than most persons possess. On the contrary, disaster has repeatedly overtaken many who have made this attempt. Pavlov has shown that meat is one of the most and perhaps the most "peptogenic" of foods. Whether the stimulus it gives to the stomach is natural, or in the nature of an improper goad or whip, certain it is that some stomachs which are accustomed to this daily whip have failed, for a time at least, to act when it was withdrawn.

Nor is it necessary that meat should be permanently abjured, even when it ceases to become a daily necessity. The safer course, at least, is to indulge the craving whenever one is "meat hungry," even if, as in many cases, this be not oftener than once in several months. The rule of selection employed in the experiment was merely to _give the benefit of the doubt_ to the non-flesh food; but even a _slight_ preference for flesh foods was to be followed.

_REFERENCES_

Adami, J. G.: _Autointoxication and Sub-Infection_, British Medical Journal, January 24, 1914, p. 177; Jour. A. M. A., XII, No. 9, p. 701.

Benedict, F. G., and Carpenter, Thorne M.: _The Metabolism and Energy Transformation of Healthy Man During Rest_, Carnegie Institution of Washington, D. C., 1910.

Benedict, F. G.: _The Nutritive Requirements of the Body_, Amer. Jour. of Physiology, 1906, XVI, pp. 409-437.

Benedict, F. G.: _The Factors Affecting Normal Basal Metabolism_, Proc. Nat. Acad. Sc., 1915, I, p. 105.

Benedict, F. G., and Smith, H. M.: _The Influences of Athletic Training upon Basal Metabolism_, Proc. Nat. Acad. Sc., 1915, I, p. 102.

Benedict, F. G., and Emmes, L. E.: _A Comparison of the Basal Metabolism of Normal Men and Women_, Proc. Nat. Acad. Sc., 1915, I, p. 104.

Benedict, F. G., and Cathcart, Edward P.: _Muscular Work_, Carnegie Institution of Washington, D. C., 1913.

Bryce, Alexander: _Modern Theories of Diet_, New York, Longmans, Green & Company, 1912; London, Edward Arnold, 1912.

Cannon, Walter B.: _Bodily Changes in Pain, Hunger, Fear and Rage_, D. Appleton & Company, New York and London, 1915.

Chittenden, Russell H.: _Physiological Economy in Nutrition_, Frederick A. Stokes & Company, New York, 1904.

Chittenden, Russell H.: _The Nutrition of Man_, Frederick A. Stokes & Company, New York, 1907.

Editorial: _Newer Aspects of Metabolism_, Jour. A. M. A., 1915, LXIV, p. 1327.

Fisher, Irving: _A Graphic Method in Practical Dietetics_, Jour. A. M. A., 1907, XLVIII, pp. 1316-1324.

Fisher, Irving: _The Effect of Diet on Endurance_, Transactions of the Connecticut Academy of Arts and Sciences, 1907, XIII, pp. 1-46.

Fisk, Eugene Lyman: _A Sensible Diet for the Average Man and Woman_, New York Medical Journal, July 4, 1914.

Gephart, F. C., and Lusk, Graham: _Analysis and Cost of Ready-to-Serve Foods_, Press of the American Medical Association, Chicago, 1915.

Gouraud, F. X.: _What Shall I Eat?_ Rebman Company, New York, 1911.

Hall, Winfield S.: _Nutrition and Dietetics_, D. Appleton & Company, New York and London, 1910.

Higgins, Robert: _Is Man Poltophagic or Psomophagic?_ The Lancet, London, 1905, I, pp. 1334-1337.

Hindhede, M.: _What to Eat and Why_, Ewart, Seymour & Company, Ltd., London, 1914.

Hutchison, Robert: _Food and the Principles of Dietetics_, William Wood & Company, New York, 1911, third edition.

Kinne, Helen, and Cooley, Anna M.: _Foods and Household Management_, The Macmillan Company, New York, 1914.

Lusk, Graham: _The Elements of the Science of Nutrition_, W. B. Saunders & Company, Philadelphia and London, 1909, second edition.

Mendel, Lafayette B.: _The Relation of Foodstuffs to Alimentary Functions_, Amer. Jour. of Med. Sciences, 1909, CXXXVIII, pp. 522-526.

Pavlov, I. P.: _The Work of the Digestive Glands_, Charles Griffin & Company, Ltd., London, 1910, second English edition, translated by W. H. Thompson.

Rose, Mary Swartz: _A Laboratory Hand-Book for Dietetics_, Macmillan & Company, New York and London, 1914.

Sherman, H. C.: _Chemistry of Food and Nutrition_, The Macmillan Company, New York, 1913.

Sherman, H. C.: _Food Products_, The Macmillan Company, New York, 1914.

Stiles, Percy Goldthwaite: _Nutritional Physiology_, N. B. Saunders Company, Philadelphia and London, 1912.

Tigerstedt, Robert: _A Text-Book of Human Physiology_, D. Appleton & Company, New York and London, 1906, third German edition, translated by John N. Murlin.

Taylor, Alonzo Englebert: _Digestion and Metabolism_, Lea & Febiger, Philadelphia and New York, 1912.

Von Noorden, Carl: _Metabolism and Practical Medicine_, William Heinemann, London, 1907.

SECTION II

NOTES ON OVERWEIGHT AND UNDERWEIGHT

How many people after age 35 have a conformation of body that is in accord with proper ideals of health and symmetry? The average individual, as age progresses, gains weight until he reaches old age, when the weight usually decreases.

This movement of weight is so universal that it has been accepted as normal, or physiological, whereas it is not normal, and is the result of disease-producing and life-shortening influences.

The standards for weight at the various ages and heights have been established by life insurance experience, but these standards, which show an increase in weight as age advances, by no means reflect the standards of health and efficiency. They merely indicate the average condition of people accepted for life insurance, whose death rate--while covered by life insurance premiums--is yet far above that obtaining among people of the best physical type, who live a thoroughly hygienic life.

MEN--OVER AVERAGE WEIGHTS Experience of 43 American Companies--1885-1908.[G] Number of Policyholders 186,579 -------+---------------+---------------+---------------+--------------- Ages | Overweight | Overweight | Overweight | Overweight at | 5 to 10 lbs. | 15 to 20 lbs. | 25 to 45 lbs. | 50 to 80 lbs. Entry | | | | -------+---------------+---------------+---------------+--------------- | Death | Death | Death | Death | Death | Death | Death | Death | Rate | Rate | Rate | Rate | Rate | Rate | Rate | Rate | Below | Above | Below | Above | Below | Above | Below | Above |Std.[H]| Std. | Std. | Std. | Std. | Std. | Std. | Std. -------+-------+-------+-------+-------+-------+-------+-------+------- 20-24 | 4% | ... | 4% | ... | ... | 1% | ... | 3% 25-29 | 7 | ... | 10 | ... | ... | 12 | ... | 17 30-34 | 1 | ... | 14 | ... | ... | 19 | ... | 34 35-39 | 0 | ... | ... | 1% | ... | 31 | ... | 55 40-44 | 6 | ... | ... | 10 | ... | 40 | ... | 75 45-49 | ... | 3% | ... | 9 | ... | 31 | ... | 51 50-56 | ... | 2 | ... | 21 | ... | 24 | ... | 49 57-62 | ... | 2 | ... | 25 | ... | 12 | ... | 38 -------+-------+-------+-------+-------+-------+-------+-------+-------

The heaviest mortality (75 per cent. above the standard), is found among those aged 40 to 44 who are 50 to 80 pounds overweight.

[G] _Medico-Actuarial Mortality Investigation_, Volume II, page 13, compiled and published by The Association of Life Insurance Medical Directors and The Actuarial Society of America.

[H] The standard death rate is that experienced by average insurance risks of the same age, according to the Medico-Actuarial Committee.

It seems reasonable to deduce from these figures that the usual gain in weight with advancing years is not an advantage but a handicap. We should endeavor to keep our weight at approximately the average weight for age 30, the period of full maturity, as experience shows that those so proportioned exhibit the most favorable mortality. This weight, for the various heights, is shown in the following table:

AGE 30--MEN ------------------------------------------------------------------------ Height. | Pounds. || Height. | Pounds. || Height. | Pounds. -----------|----------||-----------|----------||------------|----------- Ft. In. | || Ft. In. | || Ft. In. | 5 | 126 || 5 7 | 148 || 6 1 | 178 5 1 | 128 || 5 8 | 152 || 6 2 | 184 5 2 | 130 || 5 9 | 156 || 6 3 | 190 5 3 | 133 || 5 10 | 161 || 6 4 | 196 5 4 | 136 || 5 11 | 166 || 6 5 | 201 5 5 | 140 || 6 | 172 || .......... | ......... 5 6 | 144 || ....... | ...... || .......... | ......... ------------------------------------------------------------------------

AGE 30--WOMEN ------------------------------------------------------------------------ Height. | Pounds. || Height. | Pounds. || Height. | Pounds. -----------|----------||-----------|----------||------------|----------- Ft. In. | || Ft. In. | || Ft. In. | 4 8 | 112 || 5 2 | 124 || 5 8 | 146 4 9 | 114 || 5 4 | 127 || 5 9 | 150 4 10 | 116 || 5 4 | 131 || 5 10 | 154 4 11 | 118 || 5 5 | 134 || 5 11 | 157 5 | 120 || 5 6 | 138 || 6 | 161 5 1 | 122 || 5 7 | 142 || .......... | ......... ------------------------------------------------------------------------

In fat people, the number of working cells is relatively less in proportion to the weight than in thin people, as fat cells do not work. Also, there is less body surface exposed in proportion to the body weight, and consequently less heat loss. Likewise, fat people are less active, and their little cell-engines do not call for so much fuel; but in most cases the fuel is furnished right along in the ordinary diet, and what is not burned up is stored up.

[Sidenote: Diet for Overweight]

For extreme overweight, diet should be prescribed accurately by the physician to suit the needs of each individual case. Certain general principles may be stated, however, as applicable to the average case.

Meals should be light and frequent, rather than hearty and infrequent. A little fruit may be taken on rising and a glass of hot water.

A light breakfast is advisable; one or two poached eggs, no sugar, bread and butter in small quantity.

For dinner, choice may be made of chicken, game, lean meat, fish not cooked in fat, in moderate portions, and of such vegetables as celery, spinach, sea-kale, lettuce, string beans, cucumbers, carrots, tomatoes, cabbage, Brussels sprouts, turnips, bulky vegetables of low food value. Tapioca or similar pudding may be used for desserts, and melon, and other cooked unsweetened fruits.

A glass of hot water on retiring is advisable.

It is surprising what an enormous fuel value certain foods have which are eaten very carelessly, and what a very low fuel value others have which are quite satisfying to hunger. For example: One would have to eat $9.00 worth of lettuce and tomato salad to furnish 2,500 calories, the amount of fuel for the day's requirements (Lusk), while about 30 cents' worth of butter, or 10 cents' worth of sugar would furnish the same amount of energy. No one would think of feeding exclusively on any one of these foods, but it is easy to see how the elimination of butter and sugar and the introduction of such foods as lettuce, tomatoes, celery, carrots, spinach and fruits, all of which have a low fuel value, would enormously reduce the available energy and therefore the fat-forming elements in the diet, yet fill the stomach and satisfy the hunger-craving. Hunger is largely dependent upon the contractions of the empty stomach and not upon a general bodily craving for food.

[Sidenote: Fat Forming Foods That Should, as a Rule, be Avoided by Overweights]

Foods to avoid, in cases of overweight, are sugar, fats, milk as a beverage, salmon, lobster, crabs, sardines, herring, mackerel, pork and goose, fat meats, nuts, butter, cream, olive oil, pastry and sweets, water at meals. Alcohol, which is not a food, although often so called, should be avoided, as it is a fuel. It is good to burn in a stove, but not in the human body.

[Sidenote: Exercise for Overweight]

Walking, swimming, golf, billiards, hill-climbing, are all beneficial forms of exercise for the middle-aged and elderly, who are chiefly affected by overweight.

Irksome and monotonous forms of exercise, while difficult to follow regularly, are usually of more benefit, as they are less likely to create an appetite. Simple exercises, if repeated from twenty to forty times, night and morning, will accomplish much. No apparatus is required, and any movements that bring into play the entire muscular system, and especially the muscles of the trunk, with deep breathing, are sufficient. (See "Setting-up" exercises described in the "Notes on Posture," page 221.) The main reliance should be upon dietetic regulation rather than upon exercise. A very moderate increase of exercise and a persistent adherence to a proper diet will work wonders in weight reduction.

[Sidenote: Avoidance of Sudden Reduction]

It is unwise to attempt a sudden reduction in weight. Profound nervous depression may be caused by too rapid reduction in people of nervous temperament, especially if they have long been overweight. By gradually modifying the diet and moderately increasing the exercise, the results can be obtained with mathematical precision and without undue hardship. It may be necessary to forego certain pet dietetic indulgences, but such indulgences, are, after all, a mere matter of habit and a liking for new forms of food can usually be acquired. One can not have the cake and penny too. One can not safely reduce one's weight by any mysterious method that will leave one at liberty to continue the indulgences, whether of sloth or of appetite, that are responsible for its accumulation.

[Sidenote: Summary]

The reduction of weight is really a very simple matter. No mysterious or elaborate "systems" or drugs are needed.

If a reduction in the amount of energy food and an increase in the amount of exercise is made, no power on earth can prevent a reduction in weight.

Even a sedentary worker uses up about 2,500 calories a day. By reducing the food to 1,200 calories (this can be done without decreasing its bulk) and increasing the exercise to the point of burning up 3,000 calories, the tissues are drawn upon for the difference, and a reduction in weight must be experienced just as surely as a reduction in a bank account is made by drawing checks on it.

MEN--UNDER AVERAGE WEIGHT

Experience of 43 American Companies Duration of Experience, 1885-1908 Number of Policyholders, 530,108[I]

--------+------------------------------------------------------------- | Underweight, || Underweight, || Underweight, | 5 to 10 lbs. || 15 to 20 lbs. || 25 to 45 lbs. Ages |-------------------||---------+---------||---------+--------- at | Death | Death || Death | Death || Death | Death Entry. | Rate | Rate || Rate | Rate || Rate | Rate | Below | Above || Below | Above || Below | Above | Std.[J]| Std. || Std. | Std. || Std. | Std. --------+---------+---------||---------+---------||---------+--------- 20-24 | ... | 7% || ... | 15% || ... | 34% 25-29 | 1% | ... || ... | 8 || ... | 16 30-34 | ... | 4 || ... | 0 || ... | 8 35-39 | 9 | ... || ... | 3 || ... | 2 40-44 | 15 | ... || 13% | ... || 3% | ... 45-49 | 3 | ... || 1 | ... || 11 | ... 50-56 | 10 | ... || 8 | ... || 9 | ... 57-62 | 7 | ... || 18 | ... || 19 | ... --------+---------+--------------------+--------------------+---------

[I] Medico-Actuarial Mortality Investigation, Volume 11, page 10.

[J] The standard death rate is that experienced by average insurance risks of the same age, according to the Medico-Actuarial Committee.

The most favorable mortality (19 per cent. below the average) is found among those aged 57 to 62 who are extremely light in weight, compared with the average weight for those ages. The next lowest mortality in any other age group (15 per cent. below the average) is among those aged 40 to 44 who are 5 to 10 pounds under the average weight.

[Sidenote: Diet for Underweight]

Thin people lose heat more readily than stout people, as they have a larger percentage of active tissue and expose more skin surface in proportion to the body weight. They require, therefore, an abundant supply of energy food, or fuel foods, fats, starch and sugar. Butter and olive oil are better than other fats and less likely to disturb the digestion. Sugar is a valuable fuel food, but should not be taken in concentrated form into an empty stomach. Sweets are best taken at the end of a meal, but in such cases the teeth should be well cleansed. Fruit at the end of a meal tends to prevent any injury to the teeth from sugar and starches.

Potatoes, cereals, bread and all starchy vegetables are fattening, but should be well chewed and tasted before swallowing. Thin, anemic people derive much benefit from egg lemonade or egg-nogs (without alcohol) made from the yolks, which contain fat, iron and other valuable elements.

[Sidenote: Exercise for Underweight]

Overfatigue and exhausting physical exertion should be avoided.

Moderate systematic exercises, with deep breathing, and sleeping out of doors, or approaching as near to it as one can, are advisable. At middle life and after, underweight, unless extreme or accompanied by evidence of impaired health, should not give any concern. Other things being equal, the old motto "A lean horse for a long race," holds good.

SECTION III

NOTES ON POSTURE

[Sidenote: Corrective Exercises for Faulty Posture]

Among simple exercises recommended for strengthening the abdominal muscles and restoring the organs to normal position are the following:

Lie flat on the back and rise to a sitting posture; squat until the thighs rest upon the calves of the legs. Lie flat on the back, head downward on an inclined plane (an ironing board, uptilted, will do) and make a bridge at intervals by arching the abdomen and resting on shoulders and heels.

From the fundamental standing posture described in this section, a number of exercises can be developed.

1. _Yard-arm._--While deeply inhaling (through the nose) slowly raise the arms to horizontal position, straight out from the sides; let the arms fall slowly to the sides while exhaling. The chest should be well arched forward, hips drawn backward and arms hung back of thighs while performing this exercise.

These movements should be performed at the rate of about 10 per minute.

3. _Tree-swaying._--While in the standing position, thrust the arms straight above the head, then sway from side to side, moving from the hips upward, the arms loosely waving like the branches of a tree. (Sargent.)

4. _Leg-lifting._--Assume the standing position, but with hands resting on the hips. Raise the right thigh until at right angles with the body, leg at right angles with thigh, thrust the leg straightforward to a horizontal position, then sweep the leg back to standing posture. Repeat with the left leg. (Sargent.)

5. _Signal Station._--Assume the standing posture with hands on hips. Thrust the right arm straight upward, while lifting the left leg outward and upward and rigidly extended. Lower the limbs and repeat on other side. (Sargent.)

6. _Crawling Position._--Rest on hands and knees, thighs and arms at right angles to the body, spine straight. Reach forward with arm and follow with thigh and leg of same side; repeat on other side. Knee protectors can be worn during this exercise.

[Sidenote: Corrective Exercises for Flat Foot]

Draw two parallel chalk lines about three-fourths the length of one foot apart and practise walking on them until the habit of toeing straight is acquired.

When standing, do not keep the heels together and toes out, as in the ordinary attitude prescribed by athletic manuals, and the military attitude of "attention." Correct posture is more like the military attitude "at rest"--namely, heels apart, toes straight forward, the sides of the feet forming two sides of a square. This attitude gives stability and poise and insures a proper distribution of the weight of the body upon the structures of the feet.

This straightforward direction of the feet with heels apart is also noted in Spartan sculpture.

Those who stand a great deal should avoid distorted positions, such as resting the weight on the sides of the feet, or on one foot with the body sagging to one side. The body weight should be kept evenly supported on both feet.

[Sidenote: Consult Specialist]

When the condition of flat foot is found, the advice of an Orthopedic surgeon (specialist on bone deformities, etc.) should be sought, as often a plaster cast of the foot is required in order that a proper brace be adjusted to assist in the cure. In some cases, operative treatment may be needed.

The condition is one which should be treated by a physician or surgeon, and not by a shoemaker. The ordinary arch supports supplied by shoemakers do not cure flat foot. Shoes for such feet should be made to order, and have a straight internal edge.

All such measures must be supplemented by proper exercises, and the correction of faulty position of the feet while walking.

Unless "toeing out" is corrected by exercise and a proper shoe, an arch brace will do more harm than good.

The disturbances of health due to weak feet are manifold, just as are those due to eye-strain. Pain in the feet, legs and back, often mistaken for rheumatism, and improperly treated with drugs and liniment, chronic general fatigue and nervous depression are often due to this rather common affection.

[Sidenote: Detecting Weak Feet]

To detect weak feet, note whether there is a tendency to toe out when walking, and a bending inward of the ankles when standing or walking, or a disposition to walk on the inner side of the feet, as shown by the uneven wearing of the shoe. This condition may be present with a high instep, and no evidence of flat foot. As flat foot develops the inward bend of the ankle is easily apparent. The inner hollow of the foot disappears and the entire sole rests flat upon the ground when the shoes are removed.

The earlier in life this condition of weak feet is detected, the better for the individual. After middle life, a cure, especially in extremely heavy people, may be difficult or impossible, if the arches are completely broken down. Much relief, however, can be afforded by proper braces, fitted scientifically, by means of a plaster cast.

In young people, a cure can almost invariably be effected, and after a time braces and supports are not needed.

It is a very grave mistake to suppose that in such cases so-called arch supports will either cure flat foot or that people with weak feet are necessarily condemned to wear such supports throughout life.

The cure is sometimes effected in a short time, but it may take a year or two, and with proper management it can usually be accomplished, unless there is some unusual complication.

The prevention of flat foot consists largely in affording due exercise of the leg and foot muscles and tendons by plenty of walking and running, especially in childhood, and especially on rough ground. Flat pavements are, indirectly, one cause of flat foot.

SECTION IV

NOTES ON ALCOHOL

The influence of alcohol on longevity can be most satisfactorily determined by the records of life insurance companies wherein the death-rates among those abstaining from alcohol have been computed as compared to those of the general class of insured lives. In considering such figures it is well to bear in mind that the general or non-abstaining class comprises only those who were accepted as standard healthy risks and so far as could be determined were moderate in their use of alcohol. Such experiences have been carefully compiled by the following companies:

United Kingdom Temperance and General Provident Institution of London;[1][K] The Sceptre Life;[2] The Scottish Temperance Life of Glasgow;[3] The Abstainers and General Life of London;[4] The Manufacturers' Life of Canada;[5] Security Mutual Life of Binghamton, N. Y.[6]

[K] The notes ("[1]" etc.) refer to the publications listed at the close of the section.

[Sidenote: Comparative Mortality Among Abstainers and Non-Abstainers]

The comparative mortality among abstainers and non-abstainers in several of these companies is shown in the charts exhibited in this section.

It is probable that the heavier mortality among non-abstainers as compared to abstainers is not wholly due to the chemical effect of alcohol on the tissues, but in some degree to collateral excesses (especially those resulting in infection from the diseases of vice) and a more careless general manner of living engendered by alcoholic indulgence; that, furthermore, those who indulge in so-called moderation are open to greater temptation to increased indulgence and final excess than those who abstain altogether.

It has often been alleged, however, that the lower mortality among abstainers was due solely to a more conservative habit of living, and that this class is largely composed of people in favorable or preferred occupations, such as clergymen and teachers.

The experience of the Security Mutual of Binghamton, N. Y., does not support such a postulate. During a twelve years' experience the mortality among the abstainers was one-third that of the tabular expectation, and their occupations were classified as follows:

Clergymen 4 per cent. Farmers 19 " " Clerks 15 " " Miscellaneous (earning $15 to $25 per week) 62 " "

Mr. Roderick McKenzie Moore, Actuary of the United Kingdom Temperance and General Provident Institution,[7] has this to say regarding the abstainers' class in that company:

The total abstainer class was not "nursed" or favored to produce a low mortality. So far as could be determined (and many of the risks came in personal contact with the officers) they were of the same general class as the non-abstainers. They were written by the same group of agents, for the same kind of policies, for the same average amounts, _and were in the same general walks of life_, and of the same general financial condition. They were almost equal in numbers to the general class and did not form a small high grade section of the policyholding body. On the contrary, greater care was exercised in the selection of the non-abstainers because of the less favorable experience anticipated on them, and many borderline risks were accepted in the abstaining class because of a feeling that their abstinence would neutralize some unfavorable factor.

UNITED KINGDOM TEMPERANCE AND GENERAL PROVIDENT INSTITUTION OF LONDON HEALTHY MALES--WHOLE LIFE POLICIES 1866-1910

EXPECTED MORTALITY________________________________________100%

NON-ABSTAINERS, RATIO ACTUAL TO EXPECTED MORTALITY........ 91%

[L]ABSTAINERS, RATIO ACTUAL TO EXPECTED MORTALITY--.--.--. 66%

MORTALITY AMONG NON-ABSTAINERS--STANDARD RISKS--37.7% HIGHER THAN AMONG ABSTAINERS

[L] THAT IS, WHERE--ACCORDING TO THE MORTALITY TABLES UPON WHICH PREMIUMS ARE BASED--100 WERE EXPECTED TO DIE, ONLY 66 ACTUALLY DIED.

* * * * *

SCEPTRE LIFE ASSOCIATION OF LONDON WHOLE LIFE POLICIES 1884-1911

EXPECTED MORTALITY________________________________________100%

NON ABSTAINERS, RATIO ACTUAL TO EXPECTED MORTALITY........ 80%

ABSTAINERS, RATIO ACTUAL TO EXPECTED MORTALITY--.--.--.--. 52%

MORTALITY AMONG NON-ABSTAINERS--STANDARD RISKS--51.8% HIGHER THAN AMONG ABSTAINERS

THE LIFE EXTENSION INSTITUTE, INC.

* * * * *

THE SCOTTISH TEMPERANCE LIFE ASSURANCE CO. OF GLASGOW HEALTHY MALES--WHOLE LIFE POLICIES 1883-1912

EXPECTED MORTALITY________________________________________100%

NON-ABSTAINERS, RATIO ACTUAL TO EXPECTED MORTALITY........ 66%

ABSTAINERS, RATIO ACTUAL TO EXPECTED MORTALITY--.--.--.--. 48%

MORTALITY AMONG NON-ABSTAINERS--STANDARD RISKS--43.5% HIGHER THAN AMONG ABSTAINERS

* * * * *

COMPARATIVE MORTALITY AMONG USES OF ALCOHOL 43 AMERICAN LIFE INSURANCE COMPANIES 1885-1908

DEATH RATE AMONG INSURED LIVES GENERALLY--MEDICO ACTUARIAL TABLE 100 |||||||||||||||||||||||||

DEATH RATE AMONG POLICYHOLDERS USING 2 GLASSES OF BEER OR 1 GLASS OF WHISKEY DAILY 118 ||||||||||||||||||||||||||||||

DEATH RATE AMONG POLICYHOLDERS GIVING HISTORY OF PAST INTEMPERANCE, BUT APPARENTLY CURED 150 ||||||||||||||||||||||||||||||||||||||

DEATH RATE AMONG POLICYHOLDERS USING MORE THAN 2 GLASSES OF BEER OR 1 GLASS OF WHISKEY DAILY, BUT, REGARDED AS TEMPERATE & STANDARD RISKS 186 |||||||||||||||||||||||||||||||||||||||||||||||

* * * * *

Now that accurate laboratory evidence is available regarding the physiological effect of alcohol in so-called moderate doses the insurance experience seems consistent, and the higher mortality among so-called moderate drinkers is only what we would naturally expect to find in the light of the most recent knowledge regarding its effects upon the human organism, not only in the direct causation of disease, but in lowering the defense to disease and increasing the liability to accident, and the tendency to careless living.

[Sidenote: Medico-Actuarial Mortality Investigation]

In the recent medico-actuarial investigation[8], including forty-three American life insurance companies, the combined experience on users of alcohol has been compiled, with very interesting results. It may be subdivided as follows:

First: Those who were accepted as standard risks but who gave a history of occasional alcoholic excess in the past. The mortality in this group was 50 per cent. in excess of the mortality of insured lives in general, equivalent to a reduction of over four years in the average lifetime of the group.

Second: Individuals who took two glasses of beer, or a glass of whisky, or their alcoholic equivalent, each day. In this group the mortality was 18 per cent. in excess of the average.

Third: Men who indulge more freely than the preceding group, but who were considered acceptable as standard insurance risks. In this group the mortality was _86 per cent._ in excess of the average. In short, we find the following increase of mortality over the average death rate among insured risks generally:

Steady moderate drinkers but accepted as standard risks 86 per cent. Having past excesses 50 " " Very moderate drinkers 18 " "

This means that steady drinkers who exceed two glasses of beer or one glass of whisky daily are not, on the evidence, entitled to standard insurance, but should be charged a heavy extra premium.

In these groups, the death rates from Bright's disease, pneumonia and suicide were higher than the normal.

[Sidenote: Consumption of Alcohol]

The per capita consumption of alcohol has greatly increased in the United States in recent years, while in the United Kingdom it has materially decreased, as shown in the following table. This factor must be considered in assigning a cause for the increasing mortality from degenerative diseases in this country as compared to a decreasing mortality from these maladies in Great Britain.

ANNUAL PER CAPITA CONSUMPTION (IMPERIAL GALS.) OF ALCOHOL IN VARIOUS COUNTRIES[9] 1896-1912

--------+------------------------------+-------------------------------- | 1896-1900. | 1908-1912. +------+------+--------+-------+------+------+--------+--------- | Beer.| Wine.|Spirits.| Total.| Beer.| Wine.|Spirits.| Total. --------+------+------+--------+-------+------+------+--------+--------- Germany | 25.4 | 1.37| 1.66 | 28.43 | 22.4 | 1.09| 1.29 | 24.78 U. K. | 31.6 | .39| 1.05 | 33.04 | 26.65| .26| .71 | 27.62 France | 5.5 | 19.9 | 1.7 | 27.1 | 8.6 | 24.7 | 1.42 | 34.72 U. S. | 13.01| .30 | .81 | 14.12 | 16.62| .52| 1.02 | 18.16 --------+------+------+--------+-------+------+------+--------+---------

#Laboratory and Clinical Evidence Relating to the Physiological Effects of Alcohol#

To interpret correctly the mortality statistics relating to moderate drinkers and total abstainers, one must have some knowledge of the physiological effects of alcohol in so-called moderate doses, a knowledge which is often lacking in those who assume to interpret such statistics.

For example: If it could be shown that small doses of alcohol produce no ascertainable ill effects upon the human organism, the higher mortality among the moderate drinkers as compared to total abstainers might have to be explained as due to some as yet unrecognized cause or causes other than alcohol. But if laboratory and clinical evidence shows that alcohol in so-called moderate quantities (social moderation) produces definite ill effects, such as lowering the resistance to disease, increasing the liability to accident and interfering with the efficiency of mind and body and thus lessening the chances for success in life, to say nothing of any toxic degenerative effect upon liver, kidneys, brain and other organs, the excess mortality that unquestionably obtains among moderate drinkers as compared to total abstainers must be ascribed chiefly to alcohol.

It is not possible here to give all the evidence, but the following items will serve to clarify these questions.

[Sidenote: Effect on Brain and Nervous System]

Kraepelin[10] and his pupils have contributed most extensively to our knowledge on this subject. According to such authorities, a half to a whole liter of beer is sufficient to lower intellectual power, to impair memory, and to retard simple mental processes, such as the addition of simple figures. Habitual association of ideas, and free association of ideas are interfered with.

As far back as 1895, Smith demonstrated the influence of small doses of alcohol in impairing memory, and these results have been confirmed by Kraepelin and quite recently by Vogt[11] in experiments on his own person--15 cc. (about 4 teaspoonfuls) of whisky on an empty stomach, or 25 cc. with food, being sufficient to distinctly impair the power to memorize.

Careful and exact experiments have shown the influence of moderate doses of alcohol in lessening the amount of work performed by printing compositors. There has also been shown a disturbance in the sequence of ideas. The time that elapses between an irritation and the beginning of a responsive movement can be measured within one one-thousandth of a second. According to Aschaffenburg,[12] under the influence of even very small doses of alcohol this reaction period is disturbed and shortened. It is below the normal, the acceleration being attained at the expense of precision and reliability. Indeed, the reaction is often premature, and constitutes a false reaction--"the judgment of the reason comes limping along after the hasty action."

It is now conceded that alcohol is not a real brain stimulant, but acts by narrowing the field of consciousness. By gradually overcoming the higher brain elements the activities of the lower ones are released, hence the so-called stimulation and the lack of judgment and common sense often shown by those even slightly under the influence of alcohol. The man who wakes up under alcohol is really going to sleep, as far as his judgment and reason are concerned. Complete abolition of consciousness is brought about by sufficient doses as when ether or chloroform is taken.

Under moderate doses, muscular efficiency is at first increased a little and then lowered, the total effect being a loss in working power, as shown by the experiments of Dubois, Schnyder,[13] Hellsten,[14] and others.

[Sidenote: Influence on Bodily Resistance to Disease]

Muller, Wirgin and others[15] have shown that alcohol restricts the formation of antibodies (the function of which is to resist infection in the blood) in rabbits, and Laitinen[16] has shown that the prolonged administration of small doses in men (15 cc.) is sufficient to lower vital resistance, especially to typhoid fever.

Rubin[17] has demonstrated that alcohol, ether and chloroform, injected under the skin, render rabbits more vulnerable to streptococcus (blood poison) and pneumnococcus infection (pneumonia); Stewart,[18] that small amounts lower the resistance to tuberculosis and streptococcus infection; Craig and Nichols,[19] that moderate doses of whisky were sufficient to cause a negative Wassermann reaction in syphilitic subjects; Fillinger[20] found the resistance of red blood cells much reduced after the administration of champagne to healthy human subjects. Similar results were found in dogs and rabbits.

Weinburg[21] confirmed these results by the same methods, showing that 20 per cent. of the red cells lose their resistance after the administration of 450 cc. of champagne.

Parkinson,[22] in a series of careful tests, failed to establish any influence on phagocytosis (capacity of the white blood cells to destroy bacteria), except when large doses or continuous moderate doses were taken.

[Sidenote: Effect on Circulation]

On the heart and circulation, alcohol acts as a depressant, increasing the rate, but not the force, of the pulse. It causes depression of the nerve center controlling the blood vessels and thus lowers blood pressure. Large doses cause paralysis of these nerves and of the heart.

Miller and Brooks[23] found from small doses (6 to 12 cc. absolute alcohol) an increase in blood pressure in conscious (unanesthetized) animals, contrary to the findings of Crile,[24] Cabot,[25] Dennig,[26] Hindelang and Gruenbaum, Alexandroff[27] and others, _in man_; but the amounts were small and variable, according to individual susceptibility, _thus showing the drug to be, even on such evidence, uncertain and unserviceable as a heart stimulant_.

[Sidenote: Food Value]

Atwater and Benedict,[28] and Beebe[29] and Mendel,[30] have shown that alcohol is a "protein sparer," and can, to some extent, take the place of fats and carbohydrates. This is what is meant by calling alcohol a "food." Always, however, it fails to pass some test by which true foods are measured. Apart from its effect on the nervous system, among which must be figured its action on the blood vessels which causes a _loss of body heat_, Mendel has shown that in moderate doses (96 cc. daily) it increases the output of uric acid and allied (purin) bodies derived from the tissues, a fact which distinguishes it from all other foods. These poisonous or drug effects must always be considered, together with any alleged nourishing effects. Alcohol is still used by some as a rapidly available fuel-food in fevers, and when ordinary foods cannot be readily digested and made available. But this is done to a much less degree than formerly, now that its narcotic and poisonous effects are more fully understood. Sugar and water often serve quite as useful a purpose.

It seems reasonable, on the evidence herein presented, to class alcohol among the narcotic or "deadening" drugs, such as ether or chloroform. Indeed, Aschaffenburg[31] has recently called attention to the growth of the ether habit in eastern Germany, where this drug is used as a so-called stimulant, while in reality the effects are well known to be narcotic, or deadening.

The laboratory and the life insurance records simply give exact expression to what has long been a matter of common knowledge to the employer of labor and to leaders and commanders of men; to wit, that the influence of alcohol on any large group of men, whether they be artisans or soldiers, is harmful and lowers the efficiency of the group. Individual susceptibility varies, but the man who thinks he is an exception and can indulge with safety may find that he is mistaken only after serious damage to the body has been done and perhaps a definite loss sustained in happiness and achievement.

[Sidenote: Effect on Offspring]

Stockard,[32] in his experiments on animals, has demonstrated conclusively that the germ cells of males can be so injured by allowing the subjects to inhale the fumes of alcohol that they give rise to defective offspring, although mated with vigorous untreated females. The offspring of those so treated when reaching maturity are usually nervous and slightly undersize. These effects are apparently conveyed through the descendants for at least three generations. Such evidence establishes at least the probability of the transmission of serious ill effects to human offspring through alcoholic indulgence of the male parent.

Much of the statistical evidence that has been produced on both sides of this question of the transmissibility of the effect of alcohol is misleading unless very critically analyzed, but the results of exact laboratory experiments can hardly be gainsaid.

Those who trifle with alcohol should at least take the precaution to be periodically examined in order to detect the earliest signs of ill-effect. One's own feelings are not safe guides, and may fail to warn of danger until serious damage has been done.

In 1914, at the annual meeting of the National Council of Safety, at which there were present representatives from several hundred large industries, the members unanimously voted to abolish liquor from their plants. It has been well stated by Quensel[33] that "work and alcohol do not belong together, especially when the work demands wideawakeness, attention, exactness and endurance."

The restrictive and prohibitive measures of the French and Russian governments, the well known opposition of the Kaiser to alcohol and the warnings uttered by Lord Kitchener and leading British statesmen, are sufficient evidence that the condemnation of alcohol represents the deliberate judgment of the world's strong men.

_REFERENCES_

[1] United Kingdom Temperance and General Provident Institution of London, Annual Report, 1910.

[2] Sceptre Life Association, Annual Report, 1912.

[3] Scottish Temperance Life Assurance Company, Annual Report, 1912.

[4] The Abstainers and General Insurance Company, Ltd., Annual Report, 1912.

[5] McMahon, T. F.: _The Use of Alcohol and the Life Insurance Risk._ Proceedings of the Association of the Life Insurance Medical Directors of America, 1911, Twenty-second Annual Meeting, p. 473; Medical Record, LXXX, p. 1121.

[6] Lounsberry, R. L.: Proceedings of the Life Assurance Medical Directors. October, 1913.

[7] Moore, Roderick McKenzie: _On the Comparative Mortality Among Assured Lives of Abstainers and Non-Abstainers from Alcoholic Beverages._ Transactions of the Institute of Actuaries, 1913, XXXVIII, pp. 248-272.

[8] Report of Medico-Actuarial Mortality Investigation, IV, pp. 11-13.

[9] Statistical Abstract for the United Kingdom, Sixty-first Number, 1809-1913 (Wyman & Sons), London, 1914, p. 173; Statistical Abstract for the Principal and Other Foreign Countries, 1901-1912, Thirty-ninth Number, pp. 505, 506, 507; Statistical Abstract of the United States, Thirty-sixth Number, 1913, p. 516.

[10] Kraepelin, Emil: _Ueber die Beeinflussung einfacher psychischer Vorgaenge durch einige Arzneimittel_, Verlag von Gustav Fisher, Jena, 1892; Aschaffenburg, Gustav: _Praktische Arbeit unter Alkoholwirkung, Psychologische Arbeiten_, 1896, I, pp. 608-626; Kurz, Ernest, and Kraepelin, Emil: _Ueber die Beeinflussung psychischer Vorgaenge durch regelmaessigen Alkoholgenuss, Psychologische Arbeiten_, 1901, III, pp. 417-457; Mayer, Martin: _Ueber die Beeinflussung der Schrift durch den Alkohol, Psychologische Arbeiten_, 1901, III, pp. 535-586; Rudin, Ernst: _Ueber die Dauer der psychischen Alkoholwirkung, Psychologische Arbeiten_, IV, pp. 1-44.

[11] Vogt, R.: _Om virkningen af 15-50 cm3 koncentrert spiritus paa erindringsevnen_, Norsk. Mag. f. Laegevidensh., 1910, LXXI, pp. 605-626; The Lancet (London), 1910, II, p. 1040.

[12] Aschaffenburg, Gustav: _Crime and Its Repression_, Little, Brown & Company, Boston, 1913, p. 84.

[13] Schnyder, L.: _Alkohol und Muskelkraft_, Archiv fuer Physiologie, 1902-3, XCIII, p. 451.

[14] Hellsten, A. F.: _Ueber den Einfluss von Alkohol, Zucker und Thee auf die Leistungsfaehigkeit des Muskels_, Munchen Med. Wchnschr., 1914, LI, pp. 18-94.

[15] Bastedo, Walter A.: _Materia Medica Pharmacology and Therapeutics_, W. B. Saunders Company, Philadelphia and London, 1913, p. 333.

[16] Laitinen, T.: The Norman Kerr Lecture on _The Influence of Alcohol on Immunity_, Med. Rec., LXXVI, 1909, pp. 445-446. Read before the Twelfth International Anti-Alcoholic Congress, held in London, July, 1909; _Uber die Einwirkung der kleinsten Alkoholengen auf die Widerstandsfaehigkeit des tierischen Organismus mit besonderer Beruecksichtigung der Nachkommenschaft_, _Ztschr. f. Hyg. u. Infections-krankheiten_, LVIII, 1907-8, p. 139.

[17] Rubin, George: _The Influence of Alcohol, Ether, and Chloroform on Natural Immunity in its Relation to Leucocytosis and Phagocytosis_, Jour. Infct. Dis., 1904, I, pp. 425-444.

[18] Stewart, Chas. E.: _The Influence of Alcohol on the Opsonic Power of the Blood_, Mod. Med., 1907, XVI, pp. 241-246. Read before the American Society for the Study of Alcohol and Drug Neuroses, Atlantic City, June 4, 1907, and published in the Jour. of Inebriety.

[19] Craig, Chas. F., and Nichols, Henry J.: _The Effect of the Ingestion of Alcohol on the Result of the Complement Fixation Test in Syphilis_, Jour. A. M. A., 1911, LVII, pp. 474-76.

[20] Fillinger, F. V.: _Weitere Mitteilungen ueber Resistenzverminderung der Erythrozyten nach Alkoholgenuss_, Deutsch. Med. Wchnschr., 1912, XXXVIII, p. 999.

[21] Weinburg, W. W.: _The Lowering of Stability of Erythrocytes in Alcoholic Intoxication_, Russky Vratch, 1912, II, p. 1324; New York Med. Jour., 1912, XCVI, p. 1040.

[22] Parkinson, P. R.: _The Relation of Alcohol to Immunity_, The Lancet (London), 1909, VII, pp. 1580-82.

[23] Brooks, Clyde: _The Action of Alcohol on the Normal Intact Unanesthetized Animal_, Jour. A. M. A., 1910, LV, pp. 372-73. Read in the Section on Pathology and Physiology of the A. M. A. at the Sixty-first Session, St. Louis, June, 1910.

[24] Crile, George W.: _Blood Pressure in Surgery_, J. B. Lippincott Company, Philadelphia, 1903. Cartwright Prize of the Alumni Ass'n of the College of Physicians and Surgeons, New York City.

[25] Cabot, Richard C.: _Studies of the Action of Alcohol in Disease, Especially upon the Circulation_, Med. News, LXXXIII, 1903, pp. 145-153. Read before the Association of American Physicians, May 13, 1903.

[26] Dennig, Hindelang und Gruenbaum: _Uber den Einfluss des Alkohols auf den Blutdruck und die Herzarbeit in pathologischen Zustaenden_, Namentlich beim Fieber, Deutsch. Arch. f. klin. Med., 1909, XCVI, pp. 153-162.

[27] Alexandroff, Emilie: _Ueber die analeptische Wirkung des Alkohols bei pathologischen Zustaenden_, Cor. Bl. f. schweiz. Aerzte., 1910, XL, pp. 465-475; Action of Alcohol During Febrile and other Pathologic Conditions, Jour. A. M. A., 1910, LV, p. 174.

[28] Atwater, W. A., and Benedict, F. G.: _An Experimental Inquiry Regarding the Nutritive Value of Alcohol_, National Academy of Science, 1902, Sixth Memoir.

[29] Beebe, L. B.: _The Effect of Alcohol and Alcoholic Fluids Upon the Excretion of Uric Acid in Man_, Amer. Jour. Physiol., 1904, XII, pp. 13-37.

[30] Mendel, L. B., and Hilditch, Warren W.: _The Influence of Alcohol Upon Nitrogenous Metabolism in Men and Animals_, Amer. Jour. Physiol., 1910, XXVII, pp. 1-23.

[31] Aschaffenburg, _Ibid._

[32] Stockard, C. R.: _A Study of Further Generations of Mammals from Ancestors Treated with Alcohol_, Proc. Soc. Exper. Biol. and Med., 1914, XI, p. 136.

[33] Quensel, Ulrik: _The Alcohol Question from a Medical Viewpoint--Studies in the Pathology of Alcoholism_, Year Book, United States Brewers' Association, 1914, p. 168.

* * * * *

Bastedo, Walter A.: _Materiel Medico, Pharmacology and Therapeutics_, W. B. Saunders Company, Philadelphia and London, 1913, p. 318.

Bertillon, Jacques: _On Mortality and the Causes of Death According to Occupations_, Proceedings of the Fifteenth International Congress on Hygiene and Demography, Washington, 1912, I, p. 345.

Boos, William F.: _The Relation of Alcohol to Industrial Accidents and to Occupational Diseases_, Proceedings of the Fifteenth International Congress on Hygiene and Demography, Washington, 1912, I, p. 829.

Cabot, Richard C.: _The Consumption of Alcohol and of Other Medicines at the Massachusetts General Hospital_, Boston Med. Jour., CLX, 1909, pp. 480-81.

Dixon, W. E.: _Alcohol in Relation to Life_, The Nineteenth Century, 1910, LXVII, pp. 516, 523.

"Ethyl Alcohol," _The Dispensatory of the United States of America_, J. B. Lippincott & Company, Philadelphia, 19th edition, p. 102.

Ewald: _Alcohol in Relation to Infectious Diseases_, Med. Rec., 1913, LXXXIV, p. 75. Read before the Fourth National Congress on Physiotherapy, Berlin, March 26, 1913.

Horsley, Sir Victor: _Discussion on Alcohol in Therapeutics_, Med. Rec., 1912, LXXI, p. 951. Read before the Hunterian Society.

Hunter, Arthur: _Can Insurance Experience be Applied to Lengthen Life?_ Proceedings of the Association of Life Insurance Presidents, Eighth Annual Meeting, 1914, pp. 27-37.

Kelynak, T. M.: _The Drink Problem_, London, Methuen & Company, 1907.

Landau, Anastazy: _Beitrage zur hehre vom Purinstoffwechsel und zur Frage ueber den Alkoholeinfluss auf die Harnsaureausscheidung_, Deutsch. Arch. f. klin. Med., XCV, 1908-9, pp. 280-328.

Miller, Joseph L.: _The Physiologic Action, Uses and Abuses of Alcohol in the Circulatory Disturbance of the Acute Infection_, Jour. A. M. A., 1910, LV, pp. 2034-2037. Read in the joint session of the Sections of Practice of Medicine and Pharmacology and Therapeutics of the A. M. A., Sixty-first Annual Session, held at St. Louis, June, 1910.

Neff, Irwin H.: _The Problem of Drunkenness_, Proceedings of the Fifteenth International Congress on Hygiene and Demography, Washington, 1912, IV, p. 510.

Phelps, Edward Bunnell: _The Mortality from Alcohol in the United States_, Proceedings of the Fifteenth International Congress on Hygiene and Demography, Washington, 1912, Vol. I, p. 813.

Proceedings: Association of Life Insurance Medical Directors, October, 1911.

Report of the Committee of Fifty on: Physiological Aspects of the Liquor Problem, Houghton, Mifflin & Company, two volumes, 1903.

Togel, O., Brezina, E., and Durig, A.: _Ueber die kohlenhydratsparende Wirkung des Alkohols_, Biochem. Ztschr., 1913, I, 296; Editorial, Jour. A. M. A., 1913, LXI, p. 967.

Williams, Henry Smith: _Alcohol, How it Affects the Individual, the Community and the Race_, The Century Company, New York, 1909.

Woods, Robert A.: _The Prevention of Inebriety: Community Action_, Proceedings of the Fifteenth International Congress on Hygiene and Demography, Washington, 1912, IV, p. 517.

#Additional Notes on Alcohol#

[Sidenote: Nutrition Laboratory Experiments]

There has lately been undertaken at the Nutrition Laboratory of the Carnegie Institution at Washington a very broad and comprehensive study of the effect of moderate doses of alcohol on the healthy and normal human body. The immense scope of the investigation planned may be judged by the fact that under the physiological division of the research, as laid out by Professors Raymond Dodge and E. C. Benedict, there are seven main sections and one hundred and sixty subdivisions. The program has been arranged after conferences, either in person or by letter, with the leading physiologists of the world, and may take ten years to complete.

[Sidenote: Psychological Effects]

The psychological program, carried out with the co-operation of Dr. F. Lyman Wells, has already been completed and the results recently published.[34] These results must be accepted as the testimony of pure science, free from all bias or even remote suggestion of propaganda. They were based upon experiments with moderate doses of alcohol (30 cubic centimeters, or about 8 teaspoonfuls, and 45 cubic centimeters) upon ten normal subjects, very moderate users of alcohol, and may be summarized as follows:

[Sidenote: Lower Levels Spinal Cord]

A very simple reflex act, the "knee-jerk," a nervous mechanism controlled by a center at the lower level of the spinal cord, was markedly depressed, the time of response being increased 10 per cent. and the thickening of the muscles concerned in the act decreased 45 per cent. In some subjects the larger dose, 45 cubic centimeters, practically abolished the knee-jerk.

The eye-lid reflex, elicited by a sudden noise, showed the next largest effect, the time of response being increased 7 per cent. and the degree of movement decreased 19 per cent.

[Sidenote: Higher Levels]

Other nervous mechanisms, or reflex arcs, at the higher levels of the cord, were next investigated: (1) eye-reaction to suddenly appearing stimulus, and (2) speech reaction to visual word stimuli. Dose A (30 cubic centimeters), accelerated the eye-reaction, while dose B (45 cubic centimeters) positively depressed it, agreeing with the simple reaction experiments of Kraepelin. This was the only instance of acceleration of movement of the voluntary muscles through alcohol, all the other tests showing it to be a consistent depressant. The speech reaction showed a positive depressant effect of 3 per cent.

[Sidenote: Memory]

Free association of ideas and memory tests were also made, and showed practically no effect from alcohol, but, unfortunately, the smaller dose only was used in these tests.

The sensitiveness to electrical stimulation was decreased 14 per cent.

Motor co-ordination, as evidenced by eye-movements in fixating seen objects, was next investigated. The velocity of these movements was decreased 11 per cent. Finger-movements, measured in an exceedingly delicate way, were reduced in speed 9 per cent.

[Sidenote: Heart and Pulse]

The effect on the pulse while these tests were made was observed, and electrocardiograms taken. The pulse was found to be accelerated, but not increased in force, that is, the "brake" was taken off the heart, but no driving force supplied by alcohol. The condition of the circulation was impaired by the narcotic effect of alcohol on the cardio-inhibitory center which holds the heart action in check.

[Sidenote: Decreases Organic Efficiency]

According to the investigators, the effect is to "decrease organic efficiency." This should shut off such little debate as still persists with respect to alcohol having any value as a heart stimulant.

[Sidenote: Always a Depressant]

While these investigations only confirm in part the contention of the Kraepelin school that alcohol first acts by depressing the higher centers, and tend to show that its first and most profound effect is on the lower levels of the spinal cord and the simpler nervous mechanisms, it confirms the view of these and other investigators, that the total effect of alcohol is that of a narcotic, depressing drug, even in the smallest doses usually taken as a beverage.

[Sidenote: Resistance of Higher Brain Function]

The possible reactions are more complex than those supposed by Kraepelin, and there is evident in the higher centers (the effect on highest brain functions, were not measured by Dodge and Benedict) a power of "autogenic reinforcement," which is well exemplified by the ability of a half-intoxicated person to sober up under some shock or strong incentive. When social conditions do not stimulate this reinforcement, but, on the contrary, dull and retard it, as in convivial company, there is reinforcement of the lower, more animal mechanisms of the nervous system, and we have exhibited revolting and foolish reactions to alcohol, which are consistent with these findings.

[Sidenote: Explanation of Memory Effects]

The slight effect on memory and free association is explained partly by the methods used in the laboratory (difference in time of recognizing words suddenly exposed a second time), which are more in the nature of "short cuts" and perhaps not so accurate a reproduction of normal memorizing as those employed by Kraepelin and Vogt (memorizing numbers and verse), and partly by the power of "autogenic reinforcement," which it is difficult to eliminate in a laboratory test.

This, the latest contribution of science to the study of alcohol, gives added proof that the higher mortality among so-called moderate users of alcohol is largely due to the unfavorable effect on the protective mechanism of the body.

[Sidenote: Lower Resistance]

This has been further emphasized by the studies of Reich[35] at the University of Munich, who found that the resistance of blood cells to salt solution and to typhoid bacilli was less among alcohol users than among total abstainers.

Konradi[36] has found that comparatively few antibodies against cholera germs develop in persons who consume alcohol daily in fairly large quantities and who had been inoculated against cholera. Pampoukis[37] has observed that alcoholics are not favorable subjects for inoculation against rabies. The Pasteur Institute in Budapest has made similar observations, based on twenty-five years' experience.

#Additional References#

[34] Benedict, E. C.: _The Psychological Effects of Alcohol_, The Carnegie Institution, Washington, D. C., 1916.

Benedict, E. C.: _The Psychologic Effect of Alcohol on Man_, The Journal A. M. A., 1916, lxvi, p. 1424.

[35] Reich, H. W.: _Ueber den Einfluss des Alkoholgenusses auf Bakterizidie, Phagozytose und Resistenz der Erythrocyten, beim Menschen_, Arch. f. Hyg., 1916, lxxxiv, 337.

[36] Konradi: _Ueber den Wert der Choleraschutzimpfungen_, Centralbl. f. Bakteriol., I. O., 1916, lxxvii, 339.

[37] Alcohol and Immunity, Jour. A. M. A., 1916, lxvi, p. 962, p. 1122.

SECTION V

NOTES ON TOBACCO

It is the purpose of this section to present as fairly as possible the evidence relating to the effects of tobacco on the human body, so that those who smoke may correctly measure the probable physical cost of the indulgence. The extremes of opinion on this subject are well expressed in the following verses:

"Hail! Social Pipe--Thou foe to care, Companion of my elbow chair; As forth thy curling fumes arise, They seem an evening sacrifice-- An offering to my Maker's praise For all His benefits and grace." DR. GARTH.

"A custom loathsome to the eye, hateful to the nose, harmful to the brain, dangerous to the lungs, and the black stinking fume thereof nearest resembling the horrible Stygian smoke of the pit that is bottomless." JAMES I.

[Sidenote: What it Is]

Tobacco is a plant, Nicotiana Tabacum of the order Solanaceae, which includes Atropa Belladonna, or "Deadly Nightshade," Hyoscyamus, or "Henbane," Solanum Dulcamara, or "Bitter Sweet," all powerful poisons, and likewise the common potato and tomato, which are wholesome foods. The cured leaves are used for smoking and chewing, or when powdered, as snuff.

[Sidenote: History]

Prior to the middle of the 16th Century, the use of tobacco was confined to the American Indians. In 1560 the Spaniards began to cultivate tobacco as an ornamental plant, and Jean Nicot, the French Ambassador at Lisbon, introduced it at the court of Catherine de Medici in the form of snuff. Smoking subsequently became a custom which spread rapidly throughout the world, although often vigorously opposed by Governments. In the 17th Century, smoker's noses were cut off in Russia.

[Sidenote: Composition]

Tobacco contains a powerful narcotic poison, nicotin, which resembles prussic acid in the rapidity of its action, when a fatal dose is taken.

The percentage of nicotin present varies according to the brand and the conditions under which it is cultured.

The following figures have been given by the various authorities.

London Lancet[38] .64 to 5.3 per cent. French Dept. of Agriculture[39] .22 to 10.5 " " Connecticut Agricultural Experiment Station[40] 2.89 " " (Home grown--after fermentation.) U. S. Dept. of Agriculture[40] .94 to 5. " " (Domestic.)

Aside from nicotin it also contains small quantities of related substances--nicotellin, nicotein, a camphoraceous substance termed nicotianin, said to give tobacco its characteristic flavor, and likewise a volatile oil developed during the process preparation. On heating, pyridin (a substance often used to denature alcohol), picolin, collidin, and other bases are formed, as well as carbolic acid, ammonia, marsh gas, cyanogen and hydrocyanic acid, carbon monoxide (coal gas) and furfural. Furfural is a constituent of fusel oil, which is so much dreaded in poor whisky. The smoke of a single cigaret may contain as much furfural as two ounces of whisky.

The complex constitution of tobacco and the smoke from its combustion has caused much debate as to the substances that are responsible for its charm and its ill effects, which are to be described. No one can doubt the serious injurious effects from such a powerful poison as nicotin if taken in any but the most minute quantities (one to three milligrams have produced profound poisoning in man).

It has been maintained by some that nicotin is practically destroyed in the process of smoking, and that the effects of tobacco are limited to the decomposition products resulting from the burning tobacco, especially pyridin. But pyridin is also formed in the burning of cabbage leaves, and cabbage leaves do not possess any attractions for smokers, neither do they produce the well-known effects that smoking and chewing tobacco produce. No doubt pyridin and furfural are factors in the drug effects of tobacco, but recent painstaking experiments by high authorities have shown the presence of nicotin in tobacco smoke, and when we reflect that there is sometimes sufficient nicotin in an ordinary cigar to kill two men, it is not strange that enough of it may be absorbed from the smoke passing over the mucous membranes of the nose, throat and lungs to produce a distinct physiological effect.

Investigators who claim to show by experiments the absence of nicotin from tobacco smoke must explain why the palpable effects of smoking, in those who have not established a "tolerance," are those of nicotin poisoning, and why the symptoms produced by chewing tobacco are identical with those following the smoking of tobacco, which are: mild collapse, pallor of the skin, nausea, sweating, and perhaps vomiting, diarrhea, muscular weakness, faintness, dizziness, and rise in blood pressure followed by lowered blood pressure.

Nicotin is undoubtedly decomposed by burning, but it may become volatilized by heat and a certain amount absorbed before decomposition takes place.

Lehmann,[41] in 1908, found in tobacco smoke the following percentages of the nicotin contained in the tobacco:

Cigaret smoke 82 per cent. Cigar smoke 85 to 97 " "

The London Lancet[42] (1912) gives the following figures:

Cigaret smoke 3.75 to 84 per cent. Pipe mixture smoke, smoked as cigarets 79 " " Pipe smoke 77 to 92 " " Cigar smoke 31 to 63 " "

The United States Department of Agriculture[43] found in tobacco smoke about 30 per cent. of the nicotin originally present in the tobacco.

Contrary to general opinion, Havana cigars contain less nicotin than the cheaper brands, which augurs ill for the large class of people who cannot afford to smoke higher priced brands. Many of the cheaper grades do, however, show a low percentage of nicotin.

[Sidenote: Effects on Animals and Man]

By means of an ingenious apparatus, Zhebrovski,[44] a Russian investigator, compelled rabbits to smoke cigaret tobacco for a period of 6 to 8 hours daily. Some died within a month, and showed changes in the nerve-ganglia of the heart. Others established a tolerance similar to that exhibited by habitual smokers, but upon being killed at the end of five months, degenerative changes similar to those produced by the injection of nicotin were found, viz., hardening of the blood vessels. There is, indeed, no difficulty in producing the characteristic effects of nicotin by administering tobacco smoke, either in man or in animals.[45]

Nicotin causes brief stimulation of brain and spinal cord, followed by depression. There is an increased flow of saliva, followed by a decrease (large doses diminish it at once) and often nausea, vomiting and diarrhea. The heart action is at first slowed and the blood pressure increased. Subsequently there is a depression of the circulation, with rapid heart action and lowered blood pressure. In habitual smokers, this preliminary stimulation may not occur. The stimulating effect on the brain is so brief that tobacco can not properly be termed a stimulant. Its effect is narcotic or deadening. Those who fancy that their thoughts flow more readily under the use of tobacco are in the same case with any other habitue whose thoughts can not flow serenely except under his accustomed indulgence. That a sound healthy man, who has never been accustomed to the use of tobacco, can do better mental or physical work with tobacco than without it has never been shown. Indeed, such experiments as have been made on students and others show to the contrary.[46]

The statistics presented by Prof. Fred. J. Pack are of interest in this connection.

In six educational institutions the students competing for places on the football team were grouped as follows:

------------------------+-----------+-----------+------------ | Number | Number | Per Cent. Institution. | Competing |Successful.|Successful. |for Places.| | ------------------------+-----------+-----------+------------ _Institution A._ | | | Smokers | 11 | 2 | 18.2 Non-smokers | 19 | 11 | 57.9 _Institution B._ | | | Smokers | 10 | 4 | 40 Non-smokers | 25 | 17 | 68 _Institution C._ | | | Smokers | 28 | 7 | 25 Non-Smokers | 17 | 14 | 82 _Institution D._ | | | Smokers | 28 | 11 | 39.3 Non-smokers | 15 | 10 | 66.6 _Institution E._ | | | Smokers | 10 | 7 | 70 Non-smokers | 15 | 12 | 80 _Institution F._ | | | Smokers | 6 | 0 | 0 Non-smokers | 26 | 15 | 57.7 ------------------------+-----------+-----------+------------

SCHOLASTIC STANDING

---------+-------+-------++--------+-------+-------- Institu-|Smoker.| Non- ||Institu-|Smoker.| Non- tion. | |smoker.|| tion. | |smoker. ---------+-------+-------||--------+-------+-------- A | 65.2 | 69.8 || G | 74.0 | 75.0 B | 64.7 | 74.6 || H | 75.2 | 79.4 C | 78.8 | 81.1 || I | 81.6 | 88.4 D | 75.8 | 77.6 || J | 78.5 | 81.3 E | 84.6 | 84.8 || K | 74.0 | 84.6 F | 69.6 | 71.3 || L | 77.3 | 77.6 ---------+-------+-------++--------+-------+--------

The following table shows the relative scholastic standing of smokers and non-smokers:

------------+--------------+-----------+------------- | Number | Total | Average | of Men. | Mark. | Mark. ------------+--------------+-----------+------------- Smokers | 81 | 6,034 | 74.5 Non-smokers| 101 | 8,021 | 79.4 ------------+--------------+-----------+-------------

Twelve institutions reporting:

------------+--------------+-----------+------------- | Number | Highest | Lowest | of Men. | Marks. | Marks. ------------+--------------+-----------+------------- Smokers | 81 | 4 | 12 Non-smokers| 101 | 11 | 6 ------------+--------------+-----------+-------------

---------------------------+-----------+------------- Number of | Highest | Lowest Men. | Marks. | Marks. ---------------------------+-----------+------------- 101 non-smokers furnish | 11 | 6 101 smokers would furnish | 5 | 15 ---------------------------+-----------+-------------

------------+------------+----------------+---------- | Number | Total | | of Men. | Conditions | Average. | | and Failures. | ------------+------------+----------------+---------- Smokers | 82 | 70 | .853 Non-smokers| 98 | 48 | .439 ------------+------------+----------------+----------

[Sidenote: Tobacco Smoking Athletes]

Prof. Pack's conclusions were as follows:

1. Only half as many smokers as non-smokers are successful in the "try outs" for football squads.

2. In the case of able-bodied men smoking is associated with loss of lung capacity amounting to practically 10 per cent.

3. Smoking is invariably associated with low scholarship.

There have of course been many notable instances of high scholarship and prodigious mental achievement by heavy smokers. Such exceptions, however, do not affect conclusions derived from the study of average groups.

Hitherto figures on smoking and athletics have been open to question because comparisons were made between groups that are not of necessity of the same physical and mental type, having no important difference except in the use of tobacco. But Prof. Pack has sought to avoid this objection. As he points out, the football squad is probably as nearly a homogeneous group as it is possible to find. It seems reasonable to account for the inferior physical and mental work of these particular groups of smokers on the theory that in the main the well known toxic effects of tobacco are sufficient to create this difference.

Dr. George J. Fisher,[47] in a series of careful tests found:

1. Cigaret smoking caused an increase in the heart rate.

2. Cigaret smoking maintained a blood pressure which, under the circumstances of the experiment, would otherwise have dropped.

3. Cigar smoking caused a considerable increase in heart rate and blood pressure.

4. In a number of instances, in the cigar test, the heart was unable to maintain, with a vertical position, the increased blood pressure found in the horizontal position, showing a disturbance of the control of the blood vessels. This latter effect was more pronounced in tests taken on non-smokers.

5. It was also noted that smoking was not conducive to concentration upon the reading, which the men attempted during the tests.

Bush,[48] in a series of tests on each of 15 men in several different psychic fields found the following conditions among smoking students immediately after the period of smoking was completed:

1. A 101/2 per cent. decrease in mental efficiency.

2. The greatest actual loss was in the field of imagery, 22 per cent.

3. The three greatest losses were in the fields of imagery, perception and association.

4. The greatest loss, in these experiments, occurred with cigarets.

Bush ascribed these effects to pyridin, claiming that his experiments failed to reveal nicotin in the tobacco smoke, except in a very small proportion in that of cigarets.

Tests for nicotin in smoke are beset with many difficulties and possible fallacies which have in the past misled investigators into apparently determining that tobacco smoke contained no nicotin, but simply decomposition products.

Pyridin is unquestionably present in tobacco smoke, and is a poisonous substance, although less so than nicotin. It is not found, however, in chewing tobacco, and as the clinical effects of chewing tobacco are apparently identical with those of smoking tobacco, very strong and universally accepted chemical proof of the absence of nicotin from tobacco smoke must be awaited before accepting such a conclusion. (See([41]), ([42]), ([43]) in bibliography.)

Cigaret smoking is a time waster; that is, it breaks up the power of attention, as few smokers are satisfied with one cigaret and the mere physical act of lighting a fresh cigaret disturbs the continuity of thought and work. Dr. W. J. Mayo[49] calls attention to the fact that according to his observations research scholars who smoke cigarets have not done well.

[Sidenote: Insurance Experience on Tobacco Smokers]

Only one insurance company, the New England Mutual,[50] has published any experience on tobacco users. This covered a period of 60 years and a body of 180,000 policyholders, as follows:

RATIO OF ACTUAL TO EXPECTED MORTALITY.[M]

------------------------------------------------------- ABSTAINERS. | RARELY USE. | TEMPERATE. | MODERATE. --------------|-------------|------------|------------- Tobacco, 59% | 71% | 84% | 93% Alcohol, 57% | 72% | 84% | 125% -------------------------------------------------------

[M] The standard here used is the American Experience Table, which is largely an artificial table upon which premiums are based, but which provides for a much higher mortality than the average companies sustain. For example, the actual mortality of the New England Mutual in 1913 was 57 per cent. of the expected.

[Sidenote: Interpretation]

Fifty-nine per cent. of the expected mortality means that where, according to the premium tables, 100 were expected to die, only 59 actually died.

The general class of risks in this company were of excellent quality, as the figures show. Nevertheless, the abstainers exhibited a far lower mortality than that experienced by the general class.

Dr. Edwin Wells Dwight, who presented the figures, urged caution in their interpretation, suggesting that the low mortality among abstainers, both from alcohol and tobacco, might well be due to a more conservative habit of living. Furthermore, as the abstainers from alcohol were not separated from the abstainers from tobacco in this analysis a perfect comparison can not be made; but our knowledge of the toxic effects of both these narcotics and the preceding statistics of Doctor Pack justify us in assigning to tobacco a positively unfavorable effect.

[Sidenote: Poisonous Effects]

Experiments on animals with nicotin extracts from tobacco and inhalation of tobacco smoke have produced hardening of the large arteries. Clinical observation by some of the world's best authorities indicates that the same conditions are brought about in man by heavy smoking.[51]

Disturbance of the blood pressure, rapid heart action, shortness of breath, palpitation of the heart, pain in the region of the heart, are important effects. Tobacco heart is often lightly spoken of because the abandonment of the habit will often restore the heart to its normal condition, but tobacco heart sometimes causes death, especially under severe physical strain or in the course of acute disease, such as typhoid or pneumonia. Surgeons[52] have noted failure to rally after operation in tobacco users, who are, of course, deprived of their accustomed indulgence immediately before and after operation. It is probable that many such cases pass unrecognized, although the alcoholic is usually supplied the narcotic his system demands.

Cannon, Aub, and Binger[53] have also shown that nicotin stimulates the adrenal glands, small organs adjacent to the kidneys, which secrete a substance that in excess powerfully affects the blood vessels, constricting them and temporarily increasing the blood pressure. This influence may be partly responsible for the change in the blood vessels noted in heavy smokers.

Excessive smoking is often an important factor in causing insomnia.

Blindness or tobacco amblyopia, a form of neuritis, is not an uncommon affection among smokers. There is also often an irritant effect on the mucous membranes of eyes from the direct effect of the smoke.

Catarrhal conditions of the nose, throat and ear have also been noted.

Acid dyspepsia is a common affection among smokers.

Few people realize that so many ingredients in tobacco and tobacco smoke are deadly poisons. Few people know that one drop of nicotin on the unbroken skin of a rabbit will produce death.[54] Two drops on the tongue of a dog or cat will prove fatal; moreover, fatal poisonings have occurred in man from swallowing tobacco and even from external application of strong solutions. A case was recently reported from New Haven of fatal poisoning in a baby,[55] who had been fed from a milk bottle and milk-mixture in which some tobacco had been accidentally spilled.

SUMMARY

From the mass of evidence and opinion with which medical literature is loaded, a few salient facts stand out:

First: Tobacco and its smoke contain powerful narcotic poisons.

Second: It has never been shown to exert any beneficial influence on the human body in health, and it is not even included in the United States Pharmacopoeia as a remedy for disease, notwithstanding the claims that are made for its sedative effects and its value as a solace to mankind. If these benefits are real and dependable, they should be made available in exact dosage and applied therapeutically. If they are not real and dependable in a medical sense, they are not real and safe as a mere drug indulgence.

Third: The symptoms following tobacco-smoking are identical with the effects of tobacco-chewing among those not accustomed to its use; hence, any collateral psychic effect, such as the sight of smoke, the surrounding, etc., are of minor importance in establishing the habit. The main charm to the smoker is the drug effect, as in any other similar indulgence. Nicotinless tobacco is not popular, notwithstanding the efforts of the French and Austrian Governments to make it so.

Fourth: Fortunately, the sedative drug effect is so slight, as compared to that of other narcotics--opium, alcohol, cocaine, etc.--that the tobacco habit is less seductive and may be broken with comparative ease and is therefore less harmful morally. Men who have smoked or chewed steadily for 40 years have been known to give up the habit without experiencing much physical discomfort. Like any other habit, however, there is a tendency to increasing indulgence, and this is a risk that the smoker takes, just as does the alcohol user or the opium habitue who begins with so-called moderate indulgence.

Fifth: The well-known effects of tobacco on the heart and circulation should lead one to pause and consider the possible cost of this indulgence, especially as--

Sixth: It is difficult to determine, years in advance, whether or not one is endowed with sufficient resistance to render so-called moderate smoking comparatively harmless.

Seventh: The vital statistics show that diseases of the heart and circulation are rapidly increasing in this country in which--

Eighth: The per capita consumption has rapidly increased in recent years, while--

Ninth: In the United Kingdom, where these diseases are decreasing, there has been no material increase in the use of tobacco, and the per capita consumption is less than one-third that of the United States.

[Sidenote: Increase of Smoking]

In 1880 the annual per capita consumption of tobacco in the United States was about 5 lbs., while in 1914 it had risen to more than 7 lbs. In the United Kingdom the per capita consumption is about 2 lbs., and there has been no material increase in recent years.

The cigaret bill, in particular, has grown enormously, having more than doubled in the past five years, while there has been a slight increase in the consumption of cigars, smoking tobacco, chewing tobacco and snuff, as shown in the following table:[56]

------------------------------------------------------------------------ Fiscal | | | Tobacco, | Year | Cigars | Cigarets | Chewing and | Snuff | | | Smoking | --------+----------------+----------------+---------------+------------- 1910 | 8,213,356,504 | 7,884,748,515 | 436,608,898 | 31,969,111 1911 | 8,474,962,786 | 9,254,351,722 | 380,794,673 | 28,146,833 1912 | 8,350,119,103 | 11,239,536,803 | 393,785,146 | 30,079,482 1913 | 8,732,815,703 | 14,294,895,471 | 404,362,620 | 33,209,468 1914 | 8,707,625,230 | 16,427,086,016 | 412,505,213 | 32,766,741 |----------------+----------------+---------------+------------- Total | 42,478,879,326 | 59,100,618,527 | 2,028,056,550 | 156,171,635 ------------------------------------------------------------------------

Tenth: The poetic effusions of the lovers of the weed are no safer guide than the exaggerated and intemperate denouncements of people who have idiosyncrasies against tobacco and simply hate it.

Eleventh: Those who now smoke should have a thorough physical examination to determine the condition of the heart and blood vessels. This examination should be repeated at least annually, in order to detect any adverse influence on the circulation.

_REFERENCES_

[38] _The Toxic Factor in Tobacco_, The Lancet (London), 1912, I, p. 944.

[39] French Department of Agriculture, Compt. Rend. Acad. de Science, CLI, p. 23.

[40] Garner, W. W.: _The Relation of Nicotin to the Burning Quality of Tobacco_, U. S. Department of Agriculture, Bureau of Plant Industry, Bulletin No. 141, Sept. 30, 1909, p. 15; _A New Method for the Determination of Nicotin in Tobacco_, U. S. Department of Agriculture, Bureau of Plant Industry, Bulletin No. 102, July 6, 1907, p. 12.

[41] Lehmann, K. B.: _Untersuchungen ueber das Tabakrauchen_, Munchen, med. Wchnschr., 1908, LV, pp. 723-25; _The Physiological Action of Tobacco Smoke_, Med. Rec., 1908, LXXIII, pp. 738, 739.

[42] _The Toxic Factor in Tobacco_, The Lancet (London), 1912, II, pp. 944-947.

[43] Garner, W. W.: _The Relation of Nicotin to the Burning Quality of Tobacco_, U. S. Department of Agriculture, Bureau of Plant Industry, Bulletin No. 141, Sept. 30, 1909, p. 15.

[44] Zhebrovsky, E. A.: _The Effect of Tobacco Smoke upon the Blood Vessels of Animals_, Russky Vratch, 1907, VI, p. 189; 1908, VII, pp. 429-431; Med. Rec, 1908, LXXXIV, pp. 408, 409.

[45] John, H.: Editorial, Jour. A. M. A., 1914, LXII, pp. 461-2; _Ueber die Beeinflussung des systolischen und diastolischen Blutdrucks durch Tabakrauchen_, Ztschr. f. exper. Path. u. Therap., 1913, XIV, pp. 352-365; Pawinski, J.: _Ueber den Einfluss unmassigen Rauchens (des Nikotins) auf die Gefaesse und das Herz_, Ztsch. f. klin. Med., Berl., 1914, LXXX, pp. 284-305.

[46] Pack, Frederick J.: _Smoking and Football Men_, Popular Science Monthly, 1912, LXXXI, p. 336.

[47] Fisher, George J. [Monograph not yet published.]

[48] Bush, Arthur D.: _Tobacco Smoking and Mental Efficiency_, N. Y. Med. Jour., 1914, XCIX, pp. 519, 529.

[49] Mayo, Wm. J.: Personal communication.

[50] Dwight, Edwin Wells: Proc. Assoc. Life Ins. Med. Dir., Oct., 1911, II, p. 474.

[51] Favarger, Heinrich: _Experimentelle und klinische Beitraege zur chronischen Tabakvergiftung_, Wien. klin. Wchnschr., 1914, XXVII, pp. 497-501; _Experimental and Clinical Study of Chronic Tobacco Poisoning_, Jour. A. M. A., 1914, LXII, p. 1764; Pekanovits. _Effects of Tobacco Smoking_, Jour. A. M. A., 1914, LXXII, p. 1907.

[52] Bangs, L. Bolton: _Some Observations on the Effects of Tobacco in Surgical Practice_, Medical Record, LXXIII, March 4, 1908, pp. 421-23-51.

[53] Cannon, Aub. Binger: _Effect of Nicotin Injection on Adrenal Secretion_, Jour. Pharm. and Exper. Therap., 1912, p. 381; Editorial, _Nicotin and Adrenals_, Jour. A. M. A., 1912, LXIII, p. 1287.

[54] Hare, Hobart Amory: Fiske Prize Dissertation, No. 34, p. 1884. Dixon, A. S.: Proceedings of the Academy of Natural Sciences, Philadelphia, Nov. 11, 1884.

[55] Reynolds, H. S.: Jour. A. M. A., May 30, 1914, LXII, p. 1723.

[56] Annual Report of the Commissioner of Internal Revenue, 1914, p. 34, Government Printing Office, Washington, D. C.

* * * * *

Bamberger, J.: _Hygiene of Cigar Smoking_, Abstr. Jour. A. M. A., 1904, XLIII, p. 706; Zur Hygienie des Rauchens, Munchen. med. Wchnschr., 1904, LI, pp. 1344-1345.

Current Comment: _Some New Evidence on the Tobacco Question_, Jour. A. M. A., 1912, LIX, p. 1798.

Editorial: _The Pharmacology of Tobacco Smoke_, Jour. A. M. A.. 1909, LII, p. 386.

Editorial: _The Use of Tobacco_, Jour. A. M. A., 1910, LX, p. 32.

Editorial: _Tobacco-Smoking and Circulation_, Jour. A. M. A., 1914, XLII, p. 461.

Hochwart, L. Von Frankl: _Die Nervoesen, Erkrankungen der Tabakraucher_, Deutsch. med. Wchnschr., 1911, XXXVII, pp. 2273, 2321.

Index Catalogue of the Library of the Surgeon-General's Office, second series, XVIII, pp. 297-306.

Larrabee, R. C.: _Tobacco and the Heart_, Abstr. Jour. A. M. A., 1903, XLI, p. 50. Read before the Massachusetts Medical Society, June, 1903.

Pel: _Un cas de psychose tabagique_, Ann. med. Chir., 1911, XIX, p. 171.

SECTION VI

AVOIDING COLDS

[Sidenote: Infection]

Bacteria play a part in most colds. In some cases there is a general infection, with local symptoms, as in grippe; in others there is a local infection, with mixed classes of bacteria. It is probable that these various forms of bacteria are constantly present in the nasal secretions, but do not cause trouble until the local resistance or the general resistance is in some way lowered.

[Sidenote: Nasal Obstruction]

In many, the susceptibility to colds is due to abnormalities in the nose or throat. Nasal obstruction is a very common condition. The nose, like the eye, is usually an imperfect organ. These obstructions are often the result of adenoids in childhood, which interfere with the proper development of the internal nasal structures. Malformation of the teeth and dental arches in childhood are frequent and often neglected causes of nasal obstruction. Such malformations are caused by the arresting of the growth of the upper jaw and nasal structures. Correction of the deformity of the arches often renders nasal surgery unnecessary. Such conditions not only predispose to colds, but increase their severity and the danger of complicating infection of the bony cavities in the skull that communicate with the nose. They also increase the liability to involvement of the middle ear and of the mastoid cells which are located in the skull just behind the ear. The importance, therefore, of having the nose and throat carefully examined, and of having any diseased condition of the mucous membrane or any obstruction corrected must be apparent. All who suffer from recurrent colds should take this precaution before winter sets in.

[Sidenote: General Resistance]

If the nasal passages are put in a healthy condition, strict obedience to the rules of individual hygiene will almost wholly prevent colds. In fact, except where actual nasal defects exist, the frequency of colds is usually a fair indication of how hygienically a person is living. The following points need especial emphasis, though they repeat in some cases what has already been said in the text.

[Sidenote: Skin Training]

It is a familiar fact that exposure and chilling will often produce a cold. This is usually due to the fact that the nerve centers controlling the circulation of the skin are over-sensitive, and exhibit a sort of hair-trigger reaction to exposure, causing a disturbance of the circulation, and of the heat-regulating machinery of the body of which the spongy shelf-like turbinated bones in the nose are an important part. Skin training, then, appears to be the first hygienic steps toward establishing a resistance to colds.

Such training for the skin may be secured by various means. One should first accustom himself to a gentle draft.

Cool bathing, to a point that produces a healthy reaction, is another important feature of skin training.

Cold bathing, by those affected with kidney trouble, is not advisable, but delicate individuals, who cannot react well to the cold bath, can greatly increase their resistance by graduated cool bathing performed as follows: Standing in about a foot of hot water, one may rub the body briskly with a wash cloth wrung out of water at about 80 degrees F. and reduced day by day until it is down to 50 degrees F. Following this the cold douche or affusion may be taken (water quickly dashed from a pitcher) beginning at 90 degrees F. and daily reducing until 50 degrees F. is reached, or just before the point where an agreeable reaction ceases to follow.

[Sidenote: Light Clothing]

The wearing of loose, porous clothing, and the air bath--exercise in a cool room without clothing--are also valuable measures in skin training. Very heavy wraps and fur coats should be worn only during unusual exposure, as in driving or motoring. Outer clothing should be adapted to the changes in the weather, and medium-weight underclothing worn throughout the winter season. Office-workers and others employed indoors are, during the greater part of the day, living in a summer temperature. The wearing of heavy underclothing under such conditions is debilitating to the skin and impairs the resisting power.

Overheated rooms should also be avoided for the same reason. In rooms where people are moving about, the temperature should not be allowed to rise above 65 degrees. In ordinary offices or dwelling rooms, the temperature should not be allowed to rise above 68 degrees and adequate ventilation should be provided.

[Sidenote: Fresh Air]

Living out of doors, especially sleeping out, gives the skin exercise, and further keeps fresh air in the lungs. It is one of the foremost methods of prevention against colds. Army men remark that so long as they are out of doors, even if exposed to bad weather, they almost never catch cold, but do so often as soon as they resume living in houses.

Long breaths taken slowly and rhythmically, say ten at a time and ten times a day are helpful.

[Sidenote: Constipation]

Constipation predisposes to colds, and should be vigorously combated by proper diet and exercise, and regular habits of attention to the bowel function.

[Sidenote: Overeating]

Overeating frequently leads to nasal congestion. Eat lightly, using little meat or other high protein foods such as white of eggs, and thoroughly masticate the food.

[Sidenote: Fatigue]

Avoiding undue fatigue will help greatly in preventing colds.

[Sidenote: Nasal Toilet]

The regular use of nasal douches is not advisable. The mucous membrane of the nose is intolerant of watery solutions, and a chronic congested condition or even infection of air cavities in the skull can be brought about by the constant use of sprays and douches. Where special conditions render it necessary, these should be used only on the advice of a physician. When the nose is clogged with soot or dust, a very gentle spray of a warm, weak solution of salt and water, in the anterior nostrils, may do no harm. Picking of the nose should be strictly avoided. This is a fertile cause of infection. In blowing the nose care should be taken to close one nostril completely and to blow through the other without undue force. Otherwise, infection may be carried into the ear passages or the cavities communicating with the nose and give rise to serious trouble. When suffering from a cold, gauze or cheese-cloth should be used instead of a handkerchief and burned after use. Sneeze into the gauze, and thus avoid spraying infection into the surrounding atmosphere.

[Sidenote: Emergency Treatment of Colds]

After one has actually caught cold the rules above given for preventing a cold are in most particulars reversed. One should then avoid drafts, variable temperature and any severe "skin gymnastics." The paradox, that exposure to drafts is preventive of colds, but is likely to add to the cold after it is caught, is not more surprizing than the paradox that exercise keeps a man well, but that when he is sick it is better to rest.

After a cold has actually been contracted, the great effort should be to keep the body thoroughly warm, especially the feet. To accomplish this it is often the wisest course for one who has a cold to remain in bed a full day at the outset.

Medical treatment by a physician can always mitigate and shorten the duration of a cold and lessen the danger of complications, the symptoms of which can not always be appreciated by the patient.

Among the most effective home remedies for a cold are the hot foot-bath, 110-115 degrees F., a hot drink (e.g. hot flaxseed tea), a thorough purge, and rubbing the neck and chest with camphorated oil. The hot foot-bath should usually last 20 minutes, and be taken in a very thorough manner, the body enveloped in a blanket. After taking the bath, the patient should go directly to bed, and not move about and neutralize its good results.

A general neutral bath not above 100 or below 95 degrees is very restful to the skin and nerves as they have absolutely nothing to do to cope with temperatures above or below that of the body, since the neutral bath has the same as that of the body. One can remain in such a bath even for hours, if one has the time, but in getting out, it is very important to be in a very warm room and to dress quickly. In fact there is very considerable danger of catching cold at this time if great care is not taken.

If one does not remain in bed, it is generally safer to keep indoors. The air of the room should be kept as fresh as possible without subjecting one's self to a draft and should also be kept humidified, especially in winter when it is apt to be exceedingly dry. Either excessive dryness or excessive moisture is a strain on the mucous membrane, which is the directly diseased organ in the case of a cold. If the day is still and sunny, being out of doors, if well protected from any chill, may help to get rid of one's cold, but on a damp windy day the chances are one will add to the cold.

As to eating, it is sometimes wise to absolutely fast by skipping a meal or two, using nothing but water or water with agar-agar, or food which has bulk but little food value, such as green vegetables or fruit. The common idea that one should "stuff a cold and starve a fever" is most erroneous and comes apparently from a misunderstanding of the meaning of this adage which, originally, it would appear, was not meant in the imperative sense at all, but as follows: "If you stuff a cold, you will have to starve a fever."

It should be added that whisky and heavy doses of quinine are distinctly deleterious and should be avoided, as should all quack remedies and catarrh cures; there are more effective remedies which carry no possibilities of harm.

When one is getting over a cold it is a good time to resolve to avoid catching colds altogether, which for the average person can be substantially accomplished by following the above suggestions. The tax on one's time thus required is far less than the tax required by the colds themselves. The authors of this book know of persons who have scarcely lost a day's work from colds or other ailments for decades at a time simply by using a little self-control and common sense at critical times.

SECTION VII

SIGNS OF INCREASE OF THE DEGENERATIVE DISEASES

The fact that in the United States the general death rate has steadily fallen for the past several decades, a phenomenon common to all civilized countries, is accepted by many as evidence of a steady gain in National Vitality. That there has been a gain in vitality in the younger age groups is unquestionably true, but this gain has served to mask a loss in vitality at the older age periods.

This latter phenomenon, a rising mortality in elderly life, is something almost peculiar to the United States. It is not exhibited in the mortality statistics of the leading European countries. In those countries the fall in the death rate has not been due solely to a reduction of mortality in infancy and adult life through the conquest of diseases of children, tuberculosis and other communicable diseases. England and Wales, Denmark, Norway, Sweden and Prussia show improved mortality at every age period.

The charts in this section show the trend of mortality in this country during 30 years at the various ages of life, and also the trend of mortality in the two great classes of diseases: the communicable, which affect more emphatically the young lives, and the degenerative or regressive class of diseases, which affect chiefly those in middle life and old age.

It seems evident that unless this increased mortality is due to some unknown biologic influence or to the amalgamation of the various races that constitute our population, it must be ascribed, in a broad sense, to lack of adaptation to our rapidly developing civilization.

Whether or not there is one principal cause that determines the unfavorable trend of mortality in this country as compared to other civilized nations has not yet been conclusively shown.

This chart exhibits the trend of the death rate from all causes, by age periods. The decreases are below the center line and the increases above it.

It will be noted that the American decreases in the younger ages were not as great as in England and Wales, that they changed to _increases_ about age 45 and continued to increase in each age group thereafter, while in England and Wales the decline _occurred at all ages_.

NOTE.--Massachusetts and New Jersey are used as a basis because they were the only States in 1880 where sufficiently reliable comparative statistics could be had. These records were accepted by the national government, and these States really constituted the registration area in that year. There were also fifteen cities outside these States where comparisons were possible.

This chart shows that in the United States registration area, the mortality from diseases of the heart, blood vessels and kidneys increased 41 per cent. during the period 1890-1910, while in England and Wales (shown by the dotted lines) during the same period there was a decrease in the mortality from these maladies.

This chart comparing 1900 with 1890 (1900-1910 not yet available) shows the sharp upward trend in the mortality from organic disease among males in gainful occupations, and the downward trend in the mortality from communicable disease in the same group. This heavy and increasing loss from chronic disease occurs among our most valuable lives--those of the breadwinners.

SECTION VIII

COMPARISON OF DEGENERATIVE TENDENCIES AMONG NATIONS

DEATH RATE PER 1,000 OF POPULATION BY AGE PERIODS IN THE UNITED STATES[N] AND IN VARIOUS EUROPEAN COUNTRIES.[O] +-------+------+--------------+--------------+--------------+--------------+ | | | | | | | | | U. S.| PRUSSIA | FRANCE | ITALY | SWEDEN | | | Reg. | 1900-01 | 1899-1902 | 1899-1902 | 1891-00 | | Ages | Area | | | | | | | 1900 | | | | | | |P'sons|--------------+------+-------+------+-------+------+-------+ | | | Males| Fem. | Males| Fem. | Males| Fem. | Males| Fem. | +-------+------+------+-------+------+-------+------+-------+------+-------+ |Under 1|165.4 | 221.8| 189.4 | ... | ... | 174.8| 158.3 | ... | 101.6 | |1 | 46.6 | ... | ... | ... | ... | ... | ... | ... | ... | |2 | 20.5 | ... | ... | ... | ... | ... | ... | ... | ... | |3 | 13.2 | ... | ... | ... | ... | ... | ... | ... | ... | |4 | 9.4 | ... | ... | ... | ... | ... | ... | ... | ... | |Under 5| 52.1 | 24.3| 23.4 | 56.9| 48.5 | 38.4| 39.8 | ... | 36.9 | | 5-9 | 5.2 | 4.9| 5.1 | 4.6| 4.6 | 6.1| 6.7 | ... | 5.9 | |10-14 | 3.3 | 2.7| 3.0 | 2.9| 3.5 | 3.2| 3.8 | ... | 3.6 | |15-19 | 5.2 | 4.2| 3.7 | 4.9| 5.2 | 4.6| 5.4 | 4.6| 4.7 | |20-24 | 7.5 | 5.8| 4.7 | 7.8| 6.4 | 6.8| 7.0 | 6.7| 5.7 | |25-29 | 8.6 | 5.8| 6.0 | 8.0| 8.0 | 6.7| 7.6 | 6.6| 6.1 | |30-34 | 9.4 | 6.7| 6.7 | 8.5| 7.8 | 6.7| 7.9 | 6.7| 6.5 | |35-39 | 11.0 | 9.0| 7.8 | 10.5| 8.8 | 7.5| 8.6 | 7.6| 7.2 | |40-44 | 12.2 | 12.1| 8.6 | 12.7| 9.7 | 9.3| 9.1 | 8.8| 7.9 | |45-49 | 15.2 | 15.9| 10.0 | 15.1| 10.9 | 11.4| 9.6 | 10.7| 8.6 | |50-54 | 19.1 | 21.2| 13.8 | 19.1| 14.5 | 15.7| 12.9 | 13.7| 10.9 | |55-59 | 26.3 | 28.3| 20.4 | 26.6| 20.5 | 21.0| 17.7 | 18.6| 14.3 | |60-64 | 35.1 | 39.5| 31.4 | 37.4| 30.5 | 33.5| 30.9 | 26.1| 21.3 | |65-69 | 52.2 | 57.8| 50.3 | 54.5| 47.1 | 50.2| 48.8 | 39.5| 33.8 | |70-74 | 75.2 | 87.0| 78.9 | 86.9| 77.7 | 85.4| 87.4 | 62.0| 54.8 | |75-79 |110.5 | 132.5| 125.3 | 130.7| 120.6 | 134.3| 138.5 | 101.3| 90.1 | |80-84 |165.8 | 199.3| 186.6 | ... | ... | 214.5| 215.6 | ... | ... | |85-89 |241.3 | 283.6| 271.4 | 221.9| 219.8 | 317.1| 307.3 | 197.8| 179.6 | |90-94 |339.2 | 395.2| 345.6 | ... | ... | ... | ... | ... | ... | |95-over|418.9 | 404.8| 402.1 | ... | ... | 391.7| 369.1 | ... | ... | +-------+------+------+-------+------+-------+------+-------+------+-------+

NOTE: In 1900 or thereabouts, the death rates at the middle ages of life were heavier in the United States than in Prussia, France, Italy, and Sweden. Since then the death rates in the United States at these ages have grown even greater.

In the foreign countries the death rate by persons can be approximated by adding the rates for males and females of same age and dividing by two.

[N] 12th Census. U. S., 1900, iii. _Vital Statistics_, p. LXXIX.

[O] _F. Prinzing Medizinische Statistik_, Verlag von Gustav Fischer in Jena, 1906.

ENGLAND AND WALES

Annual Standardized Death Rates, Death Rates at Twelve Groups of Ages, and Infant Mortality, 1841-1910.[P] -----+----+------------------------------------------------------------- |All | |Ages| |(S | DEATHS PER 1,000 PERSONS AT SUBJOINED AGES | t | | a | | n | | d |----+----+----+----+----+----+----+----+----+----+-----+----- Year | a |0- |5- |10- |15- |20- |25- |35- |45- |55- |65- |75- |85 | r | -5| -10| -15| -20| -25| -30| -45| -55| -65| -75| -85|and | d | | | | | | | | | | | |up- | i | | | | | | | | | | | |wards | z | | | | | | | | | | | | | e | | | | | | | | | | | | | d) | | | | | | | | | | | | -----+----+----+----+----+----+----+----+----+----+----+----+-----+----- 1841-|20.6|63.7| 8.7| 5.0| 7.2| 8.8| 9.7|12.1|16.1|28.7|62.0|137.1|295.3 45 | | | | | | | | | | | | | 1846-|22.4|68.7| 9.4| 5.6| 7.7| 9.8|10.9|13.6|18.1|31.4|65.9|145.8|306.6 50 | | | | | | | | | | | | | 1851-|21.7|68.9| 8.6| 5.2| 7.4| 9.0|10.1|12.7|17.2|29.6|62.9|143.2|299.5 55 | | | | | | | | | | | | | 1856-|20.7|66.9| 8.3| 4.7| 6.7| 8.3| 9.4|12.0|16.1|28.4|60.9|136.6|293.4 60 | | | | | | | | | | | | | 1861-|21.4|69.1| 8.4| 4.7| 6.6| 8.4| 9.8|12.6|17.1|30.2|62.4|139.1|298.8 65 | | | | | | | | | | | | | 1866-|21.2|68.1| 7.6| 4.3| 6.2| 8.0| 9.9|12.9|17.6|30.6|63.2|141.7|294.3 70 | | | | | | | | | | | | | 1871-|20.9|64.9| 6.9| 4.0| 5.8| 7.7| 9.6|13.1|18.0|31.6|65.3|141.6|305.2 75 | | | | | | | | | | | | | 1876-|19.8|61.9| 6.1| 3.5| 4.9| 6.5| 8.4|12.3|17.5|31.6|64.7|142.9|311.5 80 | | | | | | | | | | | | | 1881-|18.7|56.6| 5.7| 3.2| 4.6| 6.0| 8.0|11.8|17.2|31.0|63.5|136.1|277.7 85 | | | | | | | | | | | | | 1886-|18.5|56.9| 4.9| 2.8| 4.1| 5.3| 7.2|11.1|17.1|31.8|66.3|139.0|290.3 90 | | | | | | | | | | | | | 1891-|18.5|57.8| 4.6| 2.6| 4.0| 5.0| 6.8|11.0|17.3|32.5|67.3|140.8|274.1 95 | | | | | | | | | | | | | 1896-|17.6|57.6| 4.1| 2.4| 3.5| 4.5| 6.0|10.1|16.2|30.5|64.1|133.6|267.5 1900| | | | | | | | | | | | | 1901-|16.0|50.2| 3.7| 2.2| 3.1| 4.0| 5.4| 8.9|14.9|28.7|59.4|127.3|258.6 05 | | | | | | | | | | | | | 1906-|14.4|41.7| 3.4| 2.0| 2.9| 3.6| 4.8| 7.8|13.7|27.5|58.1|127.0|262.4 10 | | | | | | | | | | | | | -----+----+----+----+----+----+----+----+----+----+----+----+-----+-----

-----------+-------------------- Year | Deaths of Infants | under 1 yr. of Age | per 1,000 Births -----------+-------------------- 1841-45 | 148 1846-50 | 157 1851-55 | 156 1856-60 | 152 1861-65 | 151 1866-70 | 157 1871-75 | 153 1876-80 | 145 1881-85 | 139 1886-90 | 143 1891-95 | 151 1896-1900 | 156 1901-05 | 138 1906-10 | 117 -----------+--------------------

Note improvement since 1890 in death rate at every age period of life.

[P] Seventy-fifth Annual Report of the Registrar General of the Births, Deaths, and Marriages in England and Wales, 1912, p. 28.

DEATH RATES CLASSIFIED BY SEX, AGE, AND GENERAL NATIVITY, NEW YORK STATE: 1900 AND 1910[Q]

MALE ----------+-------------------+-------------------+------------------- | Native White. | Foreign | Colored. | | Born White. | +---------+---------+---------+---------+---------+--------- Age | 1900 | 1910 | 1900 | 1910 | 1900 | 1910 Period. | Death | Death | Death | Death | Death | Death | Rate. | Rate. | Rate. | Rate. | Rate. | Rate. ----------+---------+---------+---------+---------+---------+--------- All ages | 18.6 | 17.3 | 20.6 | 17.0 | 27.9 | 26.5 Under 1 | 180.3 | 154.9 | 166.6 | 104.6 | 410.5 | 313.2 1-4 | 23.0 | 17.5 | 31.6 | 21.7 | 57.0 | 46.6 5-9 | 5.0 | 4.0 | 5.3 | 3.4 | 11.0 | 7.4 10-14 | 3.0 | 2.3 | 2.5 | 2.5 | 8.1 | 7.1 15-19 | 4.6 | 3.9 | 4.9 | 4.3 | 10.2 | 11.3 20-24 | 7.4 | 5.9 | 6.8 | 5.2 | 13.8 | 11.2 25-29 | 9.4 | 7.5 | 7.9 | 5.6 | 14.0 | 11.8 30-34 | 11.3 | 9.6 | 9.3 | 6.9 | 15.5 | 19.6 35-39 | 12.4 | 12.3 | 12.2 | 9.8 | 15.1 | 19.8 40-44 | 13.6 | 13.7 | 15.0 | 13.2 | 19.3 | 23.9 45-49 | 14.7 | 16.6 | 19.8 | 17.7 | 30.9 | 28.7 50-54 | 17.2 | 19.6 | 26.0 | 23.6 | 32.0 | 32.4 55-59 | 22.3 | 27.0 | 34.3 | 35.4 | 43.8 | 45.3 60-64 | 31.0 | 37.4 | 43.4 | 46.9 | 40.5 | 57.4 65-69 | 46.3 | 53.5 | 61.9 | 65.6 | 72.4 | 76.5 70-74 | 67.5 | 72.3 | 82.2 | 85.2 | 90.2 | 77.5 75-79 | 109.4 | 118.1 | 119.4 | 115.7 | 125.0 | 130.6 80-84 | 156.1 | 163.9 | 182.4 | 190.7 | 163.1 | 163.5 85-89 | 243.8 | 246.0 | 239.0 | 243.3 | 122.8 | 183.7 90 & over| 366.7 | 394.9 | 351.0 | 367.6 | 280.0 | 263.2 ----------+---------+---------+---------+---------+---------+---------

[Q] Willcox, Walter F., Special Report on Vital Statistics, 33d annual report, State Department of Health, State of New York, 1912.

FEMALE ----------+-------------------+-------------------+------------------- | Native White. | Foreign | Colored. | | Born White. | ----------+---------+---------+---------+---------+---------+--------- Age | 1900 | 1910 | 1900 | 1910 | 1900 | 1910 Period. | Death | Death | Death | Death | Death | Death | Rate. | Rate. | Rate. | Rate. | Rate. | Rate. ----------+---------+---------+---------+---------+---------+--------- All ages | 16.1 | 14.4 | 19.7 | 16.2 | 24.7 | 21.7 Under 1 | 149.7 | 128.7 | 160.1 | 92.0 | 335.6 | 265.0 1-4 | 21.0 | 16.3 | 30.5 | 18.6 | 49.6 | 40.1 5-9 | 4.8 | 3.8 | 5.0 | 3.9 | 10.1 | 8.6 10-14 | 2.9 | 2.3 | 2.7 | 2.4 | 12.3 | 7.2 15-19 | 4.5 | 3.2 | 3.6 | 3.2 | 8.8 | 9.7 20-24 | 6.8 | 4.9 | 5.8 | 4.0 | 8.8 | 10.9 25-29 | 8.1 | 6.1 | 7.6 | 5.3 | 10.1 | 10.4 30-34 | 8.9 | 7.0 | 9.3 | 6.6 | 12.4 | 11.4 35-39 | 9.3 | 7.7 | 11.0 | 7.9 | 15.1 | 14.3 40-44 | 10.1 | 9.6 | 13.3 | 9.9 | 19.7 | 20.2 45-49 | 12.4 | 11.3 | 16.9 | 13.5 | 19.1 | 20.8 50-54 | 14.9 | 15.0 | 22.2 | 19.1 | 25.4 | 29.8 55-59 | 19.4 | 19.8 | 31.3 | 28.8 | 39.3 | 36.4 60-64 | 25.4 | 27.5 | 41.7 | 41.0 | 52.2 | 49.8 65-69 | 38.2 | 42.7 | 57.0 | 59.4 | 62.0 | 69.6 70-74 | 58.7 | 64.5 | 83.1 | 85.2 | 86.3 | 49.7 75-79 | 93.4 | 96.0 | 117.5 | 115.0 | 110.7 | 96.0 80-84 | 148.7 | 152.7 | 167.5 | 170.2 | 136.8 | 131.7 85-89 | 224.2 | 223.9 | 246.9 | 242.1 | 117.6 | 175.8 90 & over| 326.4 | 339.0 | 355.0 | 348.5 | 183.3 | 222.2 ----------+---------+---------+---------+---------+---------+---------

The tables on this and the opposite page show the same general trend of mortality in New York State that is exhibited in the Registration States generally and wherever reliable statistics are obtainable. It will be noted, however, that there is little change in the mortality rate among women until age sixty, when a decidedly increased mortality rate is shown comparing 1910 with 1900. It will also be noted that this unfavorable trend in mortality in later life is manifested among native whites, foreign born and colored citizens alike.

COMPARISON OF EXPECTATIONS OF LIFE, NEW YORK CITY, ENGLAND AND WALES, AND LONDON

---------+------------------------------------------------------------- | New York City[R] || England and || London[S] | 1909-1911. || Wales[S] || 1911-1912. Ages | || 1910-1912. || +---------+---------||---------+---------||---------+--------- | Males | Females || Males | Females || Males | Females ---------+---------+---------||---------+---------||---------+--------- At birth| 44.55 | 48.8 || 51.50 | 55.35 || ... | ... 10 | 46.95 | 50.4 || 53.08 | 55.91 || ... | ... 20 | 38.26 | 41.7 || 44.21 | 47.10 || 42.35 | 46.71 30 | 30.34 | 33.6 || 35.81 | 38.54 || 33.87 | 37.94 40 | 23.34 | 26.2 || 27.74 | 30.30 || 26.03 | 29.67 50 | 17.11 | 19.1 || 20.29 | 22.51 || 19.09 | 22.17 60 | 11.71 | 12.9 || 13.78 | 15.48 || 13.09 | 15.39 70 | 7.66 | 8.2 || 8.53 | 9.58 || 8.17 | 9.57 80 | 4.66 | 4.9 || 4.90 | 5.49 || 4.79 | 5.39 90 | 2.24 | 2.8 || 2.87 | 3.16 || 2.75 | 3.10 ---------+---------+--------------------+--------------------+---------

The above tables show, both among males and females, that the expectation of life is greater at every ago period in England and Wales and in London than in New York.

[R] Annual Report, Department of Health, City of New York, 1912, pp. 176-177.

[S] Supplement to the Seventy-Fifth Annual Report of the Registrar-General of Births, Deaths and Marriages in England and Wales.