«Siw {3) Could man survive without this influence? What would con- ditions be like without the influence of research and education? d. The Power of Economic Resources (1) Relation to housing; foed; shelter; education; reserrch; medical training and medical care; stable government; re- lations to individual, group, and intergroup constructive hygiene, e. The Pa_r of Government (1) Organized, stable government is an enormous force in control of human environment through mobilization of: scientific information; control of education; defending people against health injuries; etc. f. The Power of Public Opinion (1) Relation to government; local, state, national. (2) Relation to education; to health control; to health defenses; to living standards. (3) Relation of education to public opinion; relation of public opinion to each of the above. 5, Prevention and Care of Health Iniuries and to Alleviate Svffering a. The power to prevent or alleviate health injuries grows out of factors discussed above: viz., scientific information, balanced education, economic resource, government, public opinion. be The advances in medicine; growth in facilities to train scientific physicians and competent nurses; provisions for hospitals; clinics; sanitaria; conquest of pain and disease through anesthetics, vaccines, serums, etc.,; better methods in surgery, etc. ce. These statements relate more specifically to defensive hygiene and will be taken up in more detail in Course 151. REFERENCES: *Storey, TeA.--Principles of Hygiene, Chaps. X and XI, pp 205-224 *Reauired INDIVIDUAL HYGIENE Syllabus for Course 152 School of Hygiene and Physical Education for Men STANFORD UNIVERSITY C) | : : 1933 INDIVIDUAL HYGIENE — COURSE 152 The courses in Constructive and Defensive Hygiene have been concerned in presenting to the student the various influences that serve to maintain, protect . and promote health. From these studies it became apparent that both health and disease are governed by certain general principles. The collection, analysis and classification of these principles have resulted in a body of knowledge known as General Hygiene. These principles should form the basis of every sound health program — individual, group, or community. I. QBJECTIVE OF COURSE IN INDIVIDUAL HYGIENE During this course We will endeavor to seek the ways in which the principles of hygiene may be tested by and adapted to the needs of the individual. This can be done most successfully by exploring the extent of our health knowledge and evaluating our health practices. II. PLAN OF THE COURSE Our experience leads to the conclusion that the student will receive the greatest benefit (a) if the work is arranged to permit the greatest amount of class discussion of the major problems of hygiene; (b) 4 series of definite readings on the problems; (c) a careful mental and physical inventory of the individual; (d) a definite written health program, constructed by each member of the class based upon his factual studies. III. FIELD OF INDIVIDUAL HYGIENE In order to clarify the field to be covered by this course it is desirable to review briefly the ground covered by Constructive hygiene and by Defensive Hygiene. You will be ready then to see the need for special application of the principles of hygiene to the individual. Individual hygiene is the government instituted by the mature, relatively indevendent individual for his own mental, physical, and social health. This distinction serves to differentiate it from the term frequently used——-personal hygiene. This latter term includes the dependent period of childhood when our varents or guardians control our environment and largely direct our habits. Uur discussion will be focussed upon the facts and methods whereby a mature individual can protect himself against disease and raise his health levels. IV. SOURCES OF GOVERNMENTS OF INDIVIDUAL HYGIENE The first step in acquiring a sound health program for the individual is to explore the sources from which we derive the ideas, attitudes and habits that govern our hygiene practices. Our daily hygiene practices are controlled definitely by the habits, attitudes, and memories acquired during infancy, childhood, and youth, by our acquired powers of judgment, and by the sources from which we receive our health information and advice. 1. Sources of Habits and Attitudes Relating to Hygiene It has been amply demonstrated that the individual begins to form habits and Course 152 — V. Re attitudes toward important hygienic practices quite early in life. The soundness and degree of fixation of these habits and attitudes is a matter of vital importance to the mature individual. The character of the individual's environment and education will frequently determine whether he acquired the ability to judge wisely with reference to matters relating to health. The college student should be eager to test the source and soundness of all of these habits and attitudes. Sources of Health Information health information meets the individual at every turn. Its source may be either safe or unsafe. One of the difficult tasks of the individual is to decide from what sources he will accept his information. a. Unsafe Sources (1) Customs and superstitions (2) Ignorance and prejudice (3) Pseudo-religious cults (4) Quacks and fake systems of healing (5) Commercialized health information b. Safe Sources (1) Scientific facts presented by recognized experienced authorities. (2) Health organizations managed by scientifically trained people. (3) Public and private health institutions with scientifically trained personnel. (4) Men and women trained and experienced in the science and art of hygiene. (5) Intelligent religion. SELECTION OF SOURCES OF HEALTH INFORMATION The choosing of reliable sources of health information as a guide to individual hygiene practices is a mental progess reyuiring powers of critical evaluation. This implies an understanding of, and an ability to apply, the scientific method. Among the important questions to which this method should be applied l. - ares Identification of Scientific information in the Field of Hygiene Under modern conditions, the eyes and eurs of every individual is con- stantly bombarded with every conceivable form of so-called health information. a. Health literature--pamphlets, books, newspaper and magazine articles b. Lectures, movies, and radio broadcasts. This material originates from a great variety of individuals and organiza- tions, official and voluntary and commercial. It is impossible for every individual to be master of the technical knowledge necessary to pass critical judgment upon this stream of materials. The best we can do is to become familiar with the vital principles of hygiene and then secure some basis for evaluating the particular sample. Course 152 - Re CN | One can secure a basis for judgment of the materials from an organization if he will consider the: a. Character, training, and experience of personnel b. Methods of selecting and presenting materials Cc. Motives of organization Selection of a Health Adviser From the beginning of recorded history, we find in every epoch 4 group of persons whose function was that of a health adviser. Under modern conditions this single group has become a large number of specialized groups, The selection of a health adviser should be a deliberate, intelligent, dis-— criminating procedure. It should involve an appraisal of the qualities of the individual as to: a. Education d. Skill b. Experience e. Personality c. Judgment f. Character The Wise selection of 2 health adviser wil] be made with greater assurance if we have some conception of the evolution of this important group of individuals. a. Ancient History of the Health Adviser A brief survey reveals tie health adviser under a variety of names: Priests, magicians, medicine-men. b. Origin and History of the Physician. c. Origin and History of the Dentist. d. Origin and History of the Nurse, e. Standards for Judgment of Heaith Advisers The selection of an individual of such vital importence should be made by drawing upon all the accumulated experience of organ- ized society. Among the facts to be considered may be mentioned: (1) Education - medical, dental and nursing (2) Organizations - professional standards (3) Ethics - illustrate motives (4) Legal standards - oxpress group rating. f. Selection of a Physician The physician is one of our most important health advisers. His selection is frequently made either in a haphazerd fashion or on an emotional basis. The individual cun secure some valuable guidance if he will make the selection by the application of a set of speci- fications which may be summed up as follows: (1) Licensed to practice by the State (2) Graduate of Grude A medical School (3) Hospital experience or its equivalent (4) Member of medical. society (5) Member of hospital staff (6) Personality, character, and cthical standards. The search for an individual who ean fulfill these specifications is a difficult but worth while effort. One may be assisted by consulting a Grade A medical school, health department, secretary of county medical society, reputable apothecaries and A.M.A. Directory. Course 15ée -~-4- The finding of a satisfactory physicien will be made more certain ie we familiarize ourselves with the signs of an unsafe physician. g. Selection of a Dentist or Nurse Selection should be approached by the same method, for each of these professions have similar standards and qualifications. References: Storey—-Individual Hygiene, Chapters 3-10 and Appendix American Med. Assn.--Quacks and Quackery, Vols. 1& @ Fishbein, M.-- Tne Medical Follies Fishbein, M.-- The New Medical Follies Williams—-Personal Hygiene Applied, Chapters 1-5 Moore-—American Medicine and the People's Health Meredith--Hygiene, Chapters 1-6 VI. BaSIS FOR AN INDIVIDUAL HYGIENE PROGRAM While the ability to select our health advisers wisely and to discriminate intelligently as to our sources of health information is fundamentally neces-— sary, it is of equal importance for the individual to have a sound, working knowledge of the facts and applications of hygiene. It is most useful to have a brief resume of the minimum essentials of health knowledge and health prac- tices. 1. Tests of Knowledge and Practice of Hygiene Dr. Livingston Farrand's "10 points" end Smiley's "health ideal" meet the needs of practical "measuring rods." They will be repeated here as 4 method for measuring your own knowledge of hygiene and comparing your standards of health practices: Dr. Livingston Farrand, President of Cornell University, has summed up for us what he considers the minimum knowledge about hygiene that should be in the possession of every educated individual: (1) You should have a knowledge of the physiological basis for sound health habits, such as regular and sufficient hours of sleep, right posture, suitable exercise, and proper elimination. (2) You should know the types and amounts and proportions of the various food elements essential to the proper nurture of your body. (3) You should have en acquaintance with the principles of normal mental action and the conditions underlying the more common variations from normal state of mind. (4) You should have a general understanding of the sex instinct in man——-its stages of development, its normal expression and the values and penalties attached to it. (5) You should have a knowledge of the fuctors determining infection and resistance and the principles of artificial immunization in the case of certain of the common infectious diseases. (6) You should have a knowledge of the causes and prevention of the degenerative discases to offer a prospect of passing through middle life without a breakdown. Course 152 fs . (7) You should know and therefore be armed against health hazards lurking in the environment, such as polluted water and milk supply, congestion in housing, pcisonous dusts of certain industries, in- fected soil, etc. (8) You should appreciate the necessity for frequent medical and dental examination. (9) You should have an intelligent basis for choosing wisely your medical and dental advisers, and for realizing that the modern practice of medicine is grounded on science, and not on mystery, fancy, and tradition. (10) You should have a knowledge of the important health problems facing the community, of the methods of attacking these problems, and of the results to be expected from intelligent community action in the public health field. The student may have all of the knowledge outlined by Farrand, yet be on the way to chronic ,ill health and inefficiency. Health facts must be translated into health practices. This will be done only when the individual has a health ideal based upon sound knowledge built up by practice in the use of caiscriminating judgment. Such a health ideal has been well expressed by Smileys (1) To be able to carry out during each day a program of activity with great zest and without undue fatigue, nervousness, worry, or loss of weight. : (2) To be able to eat three well-balanced meals a day with enjoyment and without fear of digestive disturbance. (3) To be able to sleep soundly eight hours a night. (4) To be able to enjoy at least one hour's vigorous exercise. (5) Po be able to enjoy the society of others without irritability, boredom, or undue seif~consciousness. (6) To be able to enjoy legitimate escape into the world of unreality for at least two hours a Gey of literature, art, music, drama, hobbies, or games, Without eyestrain, nervousness, or boredom. (7) To be generally self-confident, optimistic, enthusiastic, free of unnecessary fears, expecting success and attaining it with reason- able frequency. (8) To have sex desire, normally active and properly directed and controlled. 2. Health wien Examination as a Basis for Program A periodic health examination by a skillful, competent, scientifically trained examiner with proper interpretation is the best basis for an individual hygiene program. If an individual has decided to make use of this highly important health procedure, he should give consideration to a number of the important details. Qe Examiner If the choice of the adviser has been a sound one, the individual should discuss with the examiner the nature and completeness of the examination. Frequency of Examinations’ _ This should be decided by the examiner based upon the age and physical condition of the individual. c. Nature of Health Examination While the details of the examination are best decided by the physician, it is well for the individual to be sufficiently familiar with what is ordinarily considered by well trained physicians as the main essentials for estimating the health level of an individual. (1) Family health history (2) Health history of individual (3) Health habits (4) Symptoms of health disturbances (5) Height, weight, age relations (6) General physical inspection (7) Vision and hearing (8) Nose and sinuses (9) Dental examination (10) Heart and circulation, including blood pressure (11) Lungs (12) Abdomen (13) Pelvic organs (14) Urinary analysis (15) Blood analysis, where indicated by examination or history (16) Special examinations for definite diagnosis (17) Immunity to certain diseases (18) Interpretation References: Storey--Individual Hygiene, Chapter 13 Fisher and Fiske~-How to Live, Chapters 1-5 Fiske, E.L.--Health Building and Life Extension, Chapter 7 Vil. VIII. uiltinn The daily behavior of the individual has a very direct and definite in- fluence on the degree of health possessed by that individual. For pur- poses of better understanding, workers in the field of hygiene have analyzed this behavior into the individual actions which they call health habits. These habits may be either volumtary or autonomic. While many of the latter are not under our control, we can influence them to a marked degree. Nature imposes certain biological necessities for the mere maintenance of life. They may be described as those imposed by heredity and those imposed by the requirements of growth, development, and integration of . body and mind. The human individual has developed a complex set of re- actions, physical and mental, that have had and are having a determining effect on his levels of health. For purposesof description, they may well be considered from the point of view of their influence upon the body and the mind. 1. Constructive Health Habits a. Habits of nutrition e. Habits of recreation and play. b. Habits of excretion f. Habits of exercise ce. Habits of cleanliness g. Habits of rest d. Habits of work © h. Habits of social relations 2. Defensive Health Habits The habits that defend the individual against ill health are truly safety devices of great values. They may be considered under the following heads: a. Defenses against pathogenic genes b. Defenses against chemical causes of ill heaith c. Defenses against physical causes of ill health d. Defenses against mechanical causes of ill health e. Defenses against living causes of ill health References: Storey--Principles of Hygiene, Parts 1 and @. Storey—-Individual Hygiene, Chaps. 11 and 12. HEALTH STATUS OF COLLEGE STUDENTS It is of considerable importance for the student interested in attempting to build for himself a satisfactory individual hygiene program, that he have a reasonably definite idea of the health status of the studentsin his own and other educational institutions. A further basis of comparison may be secured from the study of the results of physical examinations of school children, men drafted for military ser- vice and industrial and commercial workers. 1. School Children Physical examinations of large groups of school children have been made by city and state health authorities. A typical result of the examination of these children in the first and fifth grades of Detroit schools follows: With one or more defect 64.0% Defective tonsils 41.4% Defective teeth 33.0% Defects of nutrition 7.4% Defects of vision 7.2% Defects of thyroid 2.7% 2. Drafted Men (18 - 30 years of age) The much quoted results of the draft examinations will bear repeating here: Defective 47% Rejected 21% Minor defects 26% Non-defective 53% 5. Men examined by Life Extension Institute The results of the examination of over 100,000 men by the Life Extension Institute presents a vivid picture of the physical condition of a large group of men drawn principally from the more prosperous economic groups and who were in the prime of active life. Omitting the defects found in only a small percentage of men, the following table gives the proportion of men having each defect: EYES AND EARS DOTOGEI Ve VISLON—AMCOFTOCted isc cisssssvcccccscsecccsscese O96 MNT 4 si nds ola-n4d0edn ses ckesescescascccceces 1S NOSE AND THROAT SLOPE, CFPUt1O, Triad Tense occ isiccscacacedsccccecccce 45 Hypertrophic rhinitis (enlarged turbinates) ...sececscecccce 37 TEETH Heavy denistry (X-ray recommended) ....cccccccccscccccsecccee 39 clits, is Bee ree ae COREY WORE, BUPTLE POUEE onc i cidccveencccsssccssscecencas BB Pe NEO 055065001 006s 44 0kbneesinsceksdcicdccicen 8 HEART AND PULSE SOOULORA. DRPUREP OF LerORerity coc cccsccvcccvscuavccceces 6 MIND i hho 6 hie 6c ks sone 6cdedcddesscdseedccccasccace 8 ee CE hb iney oe rikbndeieexndinssedceasscessnee £ BLOOD VESSELS , PUMPER) WRUGRMIIR ESE cc icsacccecceaveccevécescssccecs 16 BOURTSGL TRCROIRE—COTOTOER boc nccscccnpesrcccsescaceacese 53 Lapis certain Pere ne te SE bib eeehiikenes 04460 nks 00 06sesceenn becbsececsces 8 ile RESPIRATORY SUES CODES beciceeniecscscnesedecstsccciseveee 168 STOMACH AND ABDOMINAL SDN 2 id ig 600 Wid 0000400ss0sdens eawecsesss ON 5 0 Gk 6406. in 640 0h e i 0a wedscanevesn 20 ee I 6000 oi 6d on eka dedccinsca UD OS I ikkc ik iodine ic cecucccrcesevinns 2B I ik i ko os ok 0 04 bie csdsccee 8 GENITO-URINARY PEOOURUC GNIOPGOd, TORMSS 2c ccccencscaceccesccesss 8 BRAIN AND. NERVOUS Neurasthenia and "nervousness" ...cccccccsccccsvcese 7 I Pe hve aids 6 id he vos ceesiccecsccerss & ENDOCRINE DISTURBANCES Ee BRS ROUT OGL ic ccsccecsccscccccccuses 2@ MISCELLANEOUS OO OTE a oink 6 os 6006s icidwacscas 10 0A 6 66 hk oe ones edidicciacs 8 URINALYSIS (given to 79,126 men) Albumin (slight, definite or marked) ...........6. 22 leash ne ee re DN OCPROG CF RPI bieiccacdcessccvicescsssncce 7 With the results of the examinations reported above as a basis for comparison, we are now in a position to interpret the reports of the findings of the physical examinations of: a. Stanford students b. Students of other colleges and universities References: Mills, Alden B.--The Extent of Illness and of Physical and Mental Defects Publication 2. The Committee on the Cost of Medical Care Fisk, E. L.--Health Building and Life Extension IX. ADAPTATION OF HEALTH KNOWLEDGE AND HEALTH HABITS TO THE INDIVIDUAL The great variation in the physical and mental capacities of individuals renders the application of standardized health rules and health practices unsatisfactory. The wise procedure is for the individual to study his own capacities and to adapt to his particular needs the scientifically proven facts of hygiene. Our accumulated knowledge and experience with reference to the normal and abnormal functioning of the various organs and systems of the body furnish an excellent basis upon which the individual can construct or re-construcs a sound, workable individual hygiene program. hte With the above facts in mind, we will focus our attention upon the hygiene of the important systems of the body. In selecting the following topics, it is recognized that they do not cover the entire field. Our effort has been to present the most important and fundamental topics. HYGIENE OF NUTRITION Satisfactory nutrition is fundamental to health. The individual must have a reasonable knowledge of the physiological processes involved. This should include familiarity with practical methods of determining the food requirements of the individual; a working knowledge of the composition and nutritive values of foods; and, a satisfactory under- standing of the hygiene of the diet with some practical guides to adequate nutrition. 1. Functions of Food in the Body The functions of food in the body may be summed up under the following heads: a. To furnish energy b. To build or repair tissues c. To regulate body processes &- Quantity of Food Requirements The adaptation of the quantity of food intake to the actual needs of the individual is the first step in assuring adequate nutrition. This adaptation requircs the use of some unit of measurement common to foodstuffs and the human organism. We have this unit in the calorie. The actual amount of food intake required for a particular individual varies with the: a. Size and shape or body b. Age Cc. Sex d. Degree of activity e. Glandular activity f. Efficiency of the digestive and assimilative mechanisms A crude, but satisfactory, method of estimating the theoretical needs of the individual is to use the age, sex and bodily activity factors by the following formula: 7 Energy values based on activity a. Light exercise 40-45 calories per kilogram of body weight '"! b. Vigorous exercise 45-50 " . " . . Cc. Severe exercise 50~60 " " " " " " 4. Se lt sa Distribution of Food Intake While quantity is important, balance is equally so. Sherman has summarized a chemically adequate food intake as follows: a. Sufficient organic nutrients to yield needed energy b. Protein sufficient in amount and quality c. Adequate amounts and proper proportions of inorganic foodstuffs d. Sufficient of each of the essential vitamins ‘Standards Proteins ~-- 10% of total calories or approximately 75 grams of protein for the average sized man. Or, expressed in another way, 1.5 grams of protein per kilogram of body weight. Carbohydrates -- 55% of total calories or approximately 300 grams daily. Fats 35% of total calories - 200 grams maximun. Inorganic Salts - Sufficiently varied diet to assure adequate calcium, iron, phosphorus and iodin. (See Bradley, Food Tables for "shares" or Rose's Foundation of Nutrition. ) Vitamins Assurance by actual check of presence in food supply of reasonable amounts of essential vitamins. Water Sufficient water to replace daily excretion through kidneys, skin and lungs. 6 to 7 glasses of fluid daily may be used as a guide. Hygienic Applications It takes more than adequate food intake to build and maintain a healthy body. Nutrition is affected in many by the interrelation between the fodd and body. Some of the important factors in applying the principles of hygiene to individual nutrition are: a. Estimation of total energy requirements b. Checking the adequacy and distribution of the chemical constituents of the diet. ce. Understanding relation of emotional and physical status in relation to food. d. Checking on habits of eating. e. Establishing a satisfactory set of guides for the judgment of levels of nutrition. a. and b. have been sufficiently discussed, c., and d., and e. may now be outlined: nD ico Ca Emotional status It has been demonstrated in both man and animals that emotional states have a very definite relationship to digestion. Physical status Fatigue, either acute or chronic, has a very immediate and important influence upon digestion. d. Habits of Eating The influence of environment and character of service. Rate of eating is important. e. Guides to Adequate Nutrition (1) Hunger and appetite - regular not capricious (2) Weight curve - with allowance for family characteristics or type. (3) Objective signs of successful nutrition (4) Subjective signs of successful nutrition References: Bogert--Nutrition and Physical Fitness Meredith--Hygiene Kirkpatrick and Huettner--Fundamentals of Health Bradley--Tables of Food Values XT. a eae HYGIENE OF MUSCULAR aN BONY SYSTEMS The evolution of the bony systems made »ossible the functioning of the muscles for the purpose of locomotion. Coupled with the development of the nervous system animals became distinguished from ind superior to plants. For we noW associate plants with unconsciousness and immobility and animals with consciousness and movement. Modern civilized life with its tendency to sedentary habits demands proper adaptation of our personal hygiene programs. The purpose of this section is to outline the relation of hygiene to muscular and bony systems. 1. Exercise a. Beneficial Effects of Rational Exercise Williams has summarized the benefits of a rational program of exercise. (1) Increased circulation local or general (2) Increased respiration (3) Increased elimination through kidneys, lungs, intestines, and skin. (4) Increased metubolic activity (5) Increased neurel activity b. Adaptation of Exercise to Individual Exercise should be adapted to the age, sex, and occupation of the individual. (1) Exercise for children (2) Exercise for adolescents (3) Exercise for adults (4) Exercise for middle aged (5) Exercise in relation to occupation ce. Regulation of Exercise The proper regulation of the exercise involves the selection of the forms of exercise and the extent to which it shall be carried. Rational exercise should not produce undue fatigue, muscle soreness or muscle stiffness. d. Danger Signals in Exercise (1) Muscle soreness (2) Fatigue - A reasonable amount of fatigue is a desirable result of exercise. Excessive fatigue either acute or chronic is a danger signal of over exercise. Forms of Fatigue (a) Acute (b} Chronic - 14 “ e. Hygiene of the Bony System The bones of the skeleton are for the purpose of protection of certain parts of the body, for points of attachment of muscles and for support to organs and structures of body. 3. Posture The subject of posture is important because of its indirect as well as its direct bearing upon the normal functioning of the body. It is an expression - of the mental and physical state and it may modify and control mental states. Its values may be indicated: (a) Hygienic - Organs properly suspended and functions better {b) Economic - Good posture pays, appearance counts. (c) Social - Bizarre attitudes do not wear well (a) Spiritual - Influences attitude toward life a. Causes of Faulty Posture (1) Malnutrition (2) Habit (3) Chronic Fatigue (4) Disease (TB - Poliomyelitis) (5) Contributory (a) School seating {b) Clothing (c) Defective eyes b. Results of Poor Posture (1) Bones - Curvature of spine (2) Joints - Inflamation and pain from strain (3) Circulation - Cramping and crowding of chest {4) Abdominal orgens - Pressure with interference c. Prevention of Postural Defects (1) Diet (2) Exercise (3) Rest 4. Hygiene of Feet A large number of vigorous individuals are handicapped by foot weakness and deformities. &e Problem of Prevention involves a consideration of (1) Correct mechanical use of feet. (2) Correct shoeing (3) Correct care of feet oo 1 b. Causes of Flat Feet (1) Paralysis (2) Improperly fitting shoes (3) Improper standing or walking (4) Lack of exercise of leg miscles c. Treatment The following outline may be used: (1) Examination for anatomical soundness (2) Analysis of shoes (3) Adjustment of any overweight (4) Form of walking (5) Exercises (6) Mechanical supports References Meredith ~ Hygiene, Chaps. 25 - 28 Williams — Personal Hygiene Applied, Chap. 6 Kirkpatrick « Heuttner - Fundamentals of Health, Chap. 6 XII. HYGIENE OF EXCRETION 1. ge Nature and Function of the Excretory Organs a. Kidneys b. Lungs c. Large intestines de Skin Standards of Normal Excretion Every intelligent individual should have some practical knowledge of stan- dards of normal excretion for each of the important organs of excretion. a. Kidneys (1) Amount of urine (2) Physical character of urine (3) Cuemieal composition of urine b. Lungs are not often thought of as excretory organs, yet carbon dioxide is one of the most important waste products of the body. Standards here cannot be quantitative - they must deal with assurance of securing edequate ventilation of all of the lung tissue with proper air. (1) Character of breathing - thoracic - abdominal (2) Rate end character of breathing - Resting rate 12-15 per minute, maintaining at least a vital capacity 230 cu. in. in men and 145 cue in. for women. c. Intestines - A serious lack of knowledge of normal levels of excretion through intestines. i co (1) Regularity of excretions (2) Size and shape of stools (3) Amount (4) Odor (5) Causes of constipation d. Skin - The excretory function of the skin is comparatively unimportant. Its levels of function cannot be measured like other excretory organs. The skin is a valuable index to health by its looks. Healthy skin ee a usually represents internal health. 5. Hygiene of Excretory Organs The hygiene of the excretory organs may be presented in outline: S Che Ce — References Storey - ‘Kidneys (1) (2) (3) (4) (5) Lungs (1) (2) (3) Intestines. up in three (1) (<) (5) (4) (5) Skin. Care (1) (2) Ample fluid intake Proper diet Exercise Posture Periodic examination of urine Normality of air passages Breathing habits Character of air intake The hygiene of excretion by way of intestines may be summed words -— food, water, and habit. Food - with adequate fiber and proper stimilating effects Water intake Habit - Regularity can be established by use of a definite plan Exercise Laxatives of skin has its aesthetic as well as its hygienic aspects. Cleanliness - While organic health does not require a high degree of cleanliness, it is desirable for its psychological aspects. This includes a regime of warm cleansing baths at regular intervals under proper temperature conditions. Stimulation by use of baths, aids in securing free action of skin glands, and active responses of temperature regulating functions of skin. Cold adjusted by reaction of individual and not by the thermometer is useful here. (3) Defense. A full use of the skin as a defense against local and general infection involves the maintenance of a high degree of body cleanliness including the "cult of the clean hand." Individual Hygiene, Chen. 19 Meredith - Hygiene, Chaps. 31, 35, 39, 40 Williams - Personal Hygiene Applied, Chap, 10 Kirkpatrick & Heuttner - Fundamentals of Health, Chaps. 8-9 DEFENSIVE HYGIENE Syllabus for Course 151 School of Hygiene and Physical Education STANFORD UNIVERSITY | DEFENSIVE HYGIENE--COURSE 151 T. INTRODUCTORY General hygiene has been described by Storey as "the accumulation of scientific facts...-econcerning the sequences of cause and effect that im- prove, modify, conserve, or defend health.” Constructive hygiene includes those relations that produce, maintain, or improve health. Defensive hygiene will concern itself particularly with those influ- ences that prevent disease or protect and defend the individual or group against injury or destruction. In order to understand the full significance of defensive hygiene, it will be necessary for the student to become familiar with the modern con- ception of disease, its causes, treatment, and methods of transmission; methods of prevention of physical, chemical and mechanical injuries; and the defensive measures egainst hereditary disease and defect. II. VITAL STATISTICS AND DEFENSIVE HYGISNE Vital statistics in order to be of value should be studied critically. It is necessary to know the nature and source of the original data and the method and unit of tabulation. In constructive hygiene certain statistical facts were presented as general evidence for the need of a hygiene program. In the present course we need to study them as a basis fora defensive programe For purpeses of study the various vital statistical tables should be studied to determine how much of the disease, defect and death is prevent- able or postponable. This will involve not only an analysis of the various rates but also a cmsidevation of our knowledge of the cause and possibili- ties of nrevention. Mortality Statistics. The study of the causes of death by cause will furnish valuable infor~ mation as to the general directions in which defensive hygiene is most need~ ed. It is varticularly important to review mortality statistics since the time of the development of the modern public health movement. Review the 10 most frequent causes of death in the U. S. Classify them as to their preventability. Infant Mortality is one of our important problems. Where does the U. S. stand? Why? Maternal Mortality. Compare mternal mortality in the U. S. with that in other countries. Look up causes of maternal mortality. References: Mortality Statistics--U. S. Census {Document Room). Barker and Sprunt-—Degenerative Diseases, Parts 1 and 3 McLaughlin--Communicable Diseases, Chapters 1 and oe Moore, H. He--Public Health in Use S., Chapter 2. oe Baker--Child Hygiene, Chapters 6, 7, &. Meigs, G.--"Maternal Mortality,” Childrens Bureau Publi- cation No. 17 (Document Room). Woodbury, R.--Maternal Mortality, Childrens Bureau Publi- cation No. 158 (Document Room). Baker=-Child Hygiene, Chapter 5. Morbidity Statistics Sickness surveys have revealed 2% of persons in the U. S. are sick at any given time. Review the principal causes of these sicknesses with reference to cause and preventability. References: Public Health Reports——Weekly report issued by the U. 5S. Public Health Service 1 Heese’ me Fisk--Health Building and Life Extension, Shenae 5. Physical Defects The large numbers of individuals reported to be handicapped by physical defects challenge our defensive nygiene program. References: Moore, H. 3.--Public Health in U. S., Chapter 4. Love and Davenport--Defects Fotnd in Drafted Men, Govern- ment Printing Office, 1920. Baker, S. Je—Czild Hygiene, Cnapter 15. Fisk--Health Building and Life Extension, Chapters 5 and 4, DISCUSSION QUESTIONS: 1. Re Discuss the contrast between Constructive Hygiene and Defensive Hygiene. How many of the 10 most frequent causes of death can be classified as preventable? ; Discuss any change in relative death rates from particular causes during the last 25 years. Name some diseases from which deaths are not numerous and yet are of importance from point of view of defensive hygiene. What are some of the most important causes of infant mortality? Why do so many American mothers die as a result of child birth? Jhat do you consider the most important causes of sickness as revealed by surveys? Discuss reported numbers of physical defects in children and adults. a a TIT, DEVELOPMENT OF DEFENSIVE HYGIENE FACILITIES. Man's powers to defend himself against the ravages of disease and death have revolved around the evolution of the physician. In every age the methods of defense have been dominated by theories of disease in vogue at the particular time. To understand modern medicine it is necessary to trace its history. 1. Se Ce Primitive Medical Practice and the Demonic Theory. Demons and disease linked in minds of primitive folk, No know- ledge of disease from within. Cures in the form of charms, in- cantations, etc. Early Greek Medicine (500 3. C.) Pestilences endowed with life and thought to be present in the air. To be controlled by sacrifices and prayers. Little ad- vance in anatomy and physiology. Hippocrates--the Father of Medicine (460-377 B. C.), influenced thought intensely for 500 years. (a) His theory of healing power of nature. {(b) His theory of 4 humors. (c) His theory thet disease caused by natural causes, not supernatural. (a) His physician's code of ethics. Early Roman Medicine (A. D. 150) The age of campilations. Blind followers of tradition. Galen——the first noted experimental physician. Influenced medi- cine for 1000 years. (a) Discovered that brain was center of nervous system. (vb) Discovered function and purpose of kidneys. (c) Discovered action of heart valves. Medicine in Middle Ages (400-1453 A. D.) Reversion to mysticism ani demons in early part of Middle Ages, Church sole arbiter of mowledge. No particular advance in medi~ cine. Medical dogmas held sway. Medicine in 16th Century. Révival of learning came with explorations and the invention of the printing presse Verselius--with his studies revived anatomy. Galen's teachings ques- tioned. Empiricism held sway. Medicine in 17th Century. Great advance in matomy. Rebirth of medical interest. The micro- scope in use. Physiology as a science, wh = (a} Harvey (1568-1657); discovery of circulation of the bloods (b) Sydenham (1624-1689); the English Hippocrates; developed diagnosis. (c) Leeuwenhoek (1632-1723); Father of scientific microscopy e (a) Hunter (1728-1793) Father of Surgical Pathology. Studies of inflamation. Skillful operations. Collections of surgical specimenSe 7. Medicine in 18th Century. Progress slow, Period noted for systems of medicine. Opposing views. Mechanical and physical against mystical and animistice Jemer (1749-1823); discovered vaccination against small pox. 8. Medicine in 19th Century. Progress accelerated, Distrust of systems. Emphasis on cure rather than prevention, Rapid strides in surgery and bacteriology. (a) Pasteur (1822-1895); Father of Bacteriology. (b) Lord Lister (1827-1912); Father of Modern Surgery. (ec) Koch, Bacteriologist (1843-1910), 9. Medicine in 20th Century. Prevention rather than cure coming to the fore. Emphasis on personal hygiene and the human being as a carrier of disease. ~ Development of public health departments. Rapid advance in surgery and medicine. (a) Discovery of specific causes of disease. (b) Development of preventive medicine. (c) Development of organized forces for attack on diseases. References: Sedgwick--Principles of Sanitary Science and Public Health, Chapters 1-4. Newsholme--Evolution of Preventive Medicine. Moore, He He--American Medicine and People's Health, Chapters 1 and <. : Moore, He H.--Public Health in Us S.,.Chapters 6-8... Macfie, Re C.—The Romance of Medicine. DISCUSSION QUESTIONS: 1. What are some superstitions of preventive medicine that persist today? 2. Who is called the Father of Medicine? What were some of his contributions that are important in present day medicine? 3. Who were some of the outstanding figures in the 17th Century? What did they contribute to medicine? IV. CONCEPTIONS OF HEALTH AND DISEASE The study of defensive hygiene will be rendered more effective if we have a definite cmception of the terms “health” and "disease," Both are relative terms. The history of the human organism reveals that life is a contimous emflict between tvo sets of tendencies-- one mking for life; the other making for death. Health Health is a positive, not a negative thing. It is that ouality of our physiology that gives us normal growth, normal development and normal function. It has been defined in many ways. “Complete health is mental, physical and spiritual. It is the product of the team work of cells and organs." (Storey) “The maintenance of physiological normals at their highest potency is health." (MacKenzie). Objective signs of Health. (a) Readiness to act without external stimulus. (b) Capacity to act for long periods without undue fatigue. (c) Regularity in daily physiological cycles of: 1. Appetite 2. Muscular activities 36 Excretion 4, Sleep 5. Rest Subjective Signs of Health. (a) Feeling of satisfaction ani ease in activities. (b) Freedom from sense of environmental oppression. (c) Freedom from feeling of being obsessed by work. (a) Freedom from inner uncontrollable moods and temperse Disease Our conceptions of disease have undergone many changes during the ages. These conceptions have controlled the easures for defensive hygiene which were in use at the time of the acceptance of the particular conc eptions. The modern conception may be summed in the words of White-~"Disease is a failure of adaptation both to conditions without the organism and to conditions within. It is a form of partial activity," or in state- ment of MacKenzie as--“Any departure from the normal that destroys the structure of an organ or impairs its capacity to repeat its function is disease." Theories of Disease A cursory review of the evolution of the various theories of di- sease will form an excellent background for an understanding and eval- uation of the present status of our efforts in the field of defensive hygiene. Demonic Theory _ The earliest theories of disease are found among the savage races. They interpret sickness ani death as due to the occupancy of the body by an evil spirit or demon. Demonic theory regards disease as a super~ natural entity, not primarily as a process or condition. ; Humoral Theory Originated by Hippocrates, the Father of Medicine, and was based upon the theory that the body was mde up of four humors: (a) Blood, (b) Phlegm, (c) Black bile, (d) Yellow bile. A right mixture and pro- portion of these constituted health; improper proportion and irregular distribution, disease. . Medieval Theories With the development of cnatomy and physiology, there arose two theories of importance: (a) mechanical causes of disease, and (b} chemical causes for disease. Germ The ory The foundation for this theory was laid when it was proven that al- coholic fermentation was caused by a living plmt {yeast). ‘The germ theory was firmly established by the work of Louis Pasteur on wine, silk worms and anthrax.. The studies ani demonstrations of Pasteur stirred the entire scientific world ami led to the extension of the germ theory to the problem of human disease. It led to the birth of the pre- sent day science of bacteriology. References: Sedgwick, W. T.--Principles of Sanitary Science and Public Health, Chapters 1-4.. Rice, T. B.--Conquest of Disease, Chapter 1. Binder=-Health and Social Progress. Bossard——Problems of Socicl Well-Being, Chapter 7. DISCUSSION QUESTIONS: 1. What is your own definition of good health? 2. Give your own conception of disease. 3. What would you consider the most important objective sign of health? Why? Subjective sign of health? Why? 4, Why have the theories of disease controlled the progress of health work? 5. Do you recognize any survivals of ancient theories of disease in the medical terms or superstitions of today? 6. Which one of the theories of disease is the basis for present day defensive hygiene measures?