i bf STANFORD UNIVERSITY SCHOOL OF HYGIENE AND PHYSICAL EDUCATION Men Students’ Health Service University Health Service Divi o~ Physical Education (Including Athletics) Dive of Informational Hygiene STANFORD UNIVERSITY, CALIFORNIA Noe Wes treble te gt acope df may ffepter © in Digan rante fou yom pT Me patent Frais 2k oo. Cady pd ae te oho Die a weal GROUP HYGIENE Stanford University California COURSE 153 ~ GROUP HYGIENE TiTRODUCTORY Modern life is dominated by group activities. The health hazards and the health safeguards involved in these relationships justify a special con- sideration from the standpoint of hygiene. Scientific investigation fur- nishes a sound foundation for the special application of the proven princi- ples of hygime to the group. Objective of Course ee pee The objective of this course is to illustrate the method of application of the principles of constructive and’ defensive hygiene to group life with particular reference to the family, school, and occupational groups. Hygiene and Group Life The evolution of present day society has led to the development of certain groups or mits. Because of their vital relatimships to the preservation and the improvement of the race, certain of these groups have been selected for the study of how the principles of hygime can be adapted to the life of any groupe 1. Family group 2e School group Se Occupational group Method of Study of the Group oe ee The coursé is not primarily interested in social organization, We will, therefore, consider the organization of these groups insofar as they have a rather direct bearing on the problems of hygiae. A brief outline of certain characteristics of any group will be essential for consideration in attennting the application of the principles of hygiene to that particular ZTOUD. 1. History of development. 2. Composition - numbers, age and sex, economic and social relation- ships. 3. Government of group - source and sanctions of group regulation, 4. Health resources of group. 5. Health liabilities of grow. 6. Environment of group - physical, biological, and social. References: Storey, T. A. -— Group Hygiene, Part I. ee Bogardus - Introduction to Sociology, Chaps. a Fairchild — Foundations of Social Life, Chaps 7. Blackman and Gillin — Outlines of Sociology, Part 2, Chaps. 4-6. Gilletts, M. iM. - The Family and Society. — Jones, T. Js — Four Essentials of Education, Chaps. 4—5. FAMILY GROUP Thre family is the most significant of our social institution, In many ways it is more important than the school, the church, the industrial order and the ae 2 he (Course 153) State, It is the almost universal. institution through which our biological inheritance is preserved and our social heritage is passed on. The family, more than eny other Mikerited institution, is feeling the shock of demands for change brought about by modern conditions. The family should not be considered as a static institution. As the spirit of youth is chal~ lenzing our institutions, the family cannot and should not be exempt. It is our duty, however, to explore the actual and pot ential social values of the family and note whether its evolution is not tending toward more perfect expression for our constructive and defensive needs. The monogamic, private family is a priceless inheritance from the past and it should be preserved. -Its inherited custans and mechanisms are gradually being modified to suit new social demands, This section of the course will be concerned with the relationships of the family group, History of the Family A very brief consideration of the evolution of the family is essential to an understanding of its hygienic significance. 1. Primitive family. Developed many forms and varied more than the modern family. Some of the important elemats were: ae Position of women b, Sex relations ce Marriage 2. American family. We are primarily interested in the evolution of the famly in our own country. @.». European backgraund bs Colonial period e. Frontier famly d. Present American family. References: Spencer, Av Ge - The Family and Its Members, Chaps. I ee Groves, E. R..—- Social Problems of the Family, Chaps. 1; 2, 5, lb. Rich, M. B. - Family Life To-day, Part I, Chaps, 1-é. Family Government The bong and changing government of the family during its evolution has had a marked influence upon the physical and mental characteristics of the individual. Inthe earlier forms of the family, either the father or mother was the absolute master of the fate of the members of the group. In present day development toward a democratic form, this is being exchanged for group opinion. 1, Heal th beliefs of the family, sources and validity. &¢ Health habits of the family. $, Health regulations of the family. ae Constructive b. Defensive , “8 (Course 153) References: Spencer, Ae Ge ~The Family and Its Members, Chaps. 1-5. | “—" Groves and Ogbum - American Marriage and Family Relation- : ships, Chaps. 2-4. Sumner, W. G. ~ Folkways. Groves, E. R. ~ The Marriage Crisis. Health Resources of the Family Group er oe The family with its intimate relationships from before birth to old age has potentially the largest amount of teal th resaurces of any human institution. It affords the greatest opportunity for the application of the principles of hygiene at the most impartent times. These health re~ sources are dependent upon: - Character of the menbers. - Economic status. — « Social status. - Intelligence and edveation of group, « Ideals and practices. Me wr Health Liabilities of the Family Grow oe ee The canstant close association of the maabers of the family group carries with it mamy potential health tazards, These may be prevented or neutralized if the government of the family provides an effective program of defensive hygiene. 1. Communicable diseases 2. Food excesses and deficiencies 3- Feulty matal hygiene. References: Storey, T. A. - Constructive Hygiene - Book l. Defensive Hygiene - Book @. “Bstablishment of a Family we ee ee Trere is a widespread skepticism regarding matrimony and the establishment of a family. In the changing situation in which we found ourselves, it would seem wise to try ami separate the major from the minor, and the fundamental from the trivial in this mtter, Arter due consideration of all the conflicting opinions, it would appear to be a fundamental privilege and duty for the individual to seek a proper mate and establish a fanily. The reasms why people marry may be controlled by certain instinctive urges, but there are more obvious motives which seem to be operative; such as: 1. For scial standing ee For money 3e For suppart by mate 4, For labor of mate 5. For custom 6. For sensuous satisfaction 7. For children and home buil ding 8. For spiritual satisfaction. (Course 153) Preparation for Home Building The establishment of .a home and family is a complex, delicate undertaking. Jt requires for its successful accomplishment a preparation that touches every aspect of human life and knowledge. This preparation should be an essential part of the education of every American young man and young woman. -For purposes of our discussion, we will consider some of the basic prepara- tionsnecessary to meet modern conditions. 1. Economic preparation. While it may appear materialistic to begin with the economic side of the home, it is surely practical. ae Cost of home keeping. The first step in a sound prepara~ tion for home-keeping is an accurate intelligent under— standingof the actual cost involved in a well-organized, well-conducted home, This means a working knavledge of budgets and budget making with particular reference to relative evaluation, One of the separate projects of this course will be the cmstruction and criticism of budgets for various planes of living. be Support of the home. A cmsideration of the preparation of one or both mates to produce a sufficient income seems obvious. It mens forethought in choosing and securing the necessary education and experience to attain the level of income desired. References: Bossard, Je He Se — The Protlems of Social Well-Being, Chaps. 2-6-6 Groves, E. R. — Social Problems of the Family, Chap. 5. Rich, M. BE. -— Pamily Life Today, Part I, Chaps Ze Abel, Ms He - Successful Family Life. fs Educational preparation. The scope of the educational preparation is a bra@d@ one. It may be divided for purposes of discussion into general and special. a. General preparation. The health information necessary for ie wise administration of a home which has been presented to you in the courses on Constructive, Defensive, and Individual Hygiene may be oitlined here as: (1) Constructive hygiene, with its information with Toference to the enatmy and vhysiology of the cell; relation of heredity to health; and the determining powers of nutrition, excretion, exercise, rest, and playe {2) Defensive hygiene, with its information of the -Fnjuries that can come to health by excesses and de- ‘ficiencies; by mechanieal means; by physical means; through living micro-organisms and the remedies and methods of prevention which science has provided for them. {3) Individual hygiene. To the above may be added the asic faets about the indivadual, including an understanding ef the sources of his health practice; (Course 153) where to secure reliable guides to health thragh literature and health advisers; the value of a periodic health examination ani the hygiene of the special orgams. References: Storey, Ts A. = Constructive Hygiene, Book I. Defensive Hygiene, Book IT Individual Hygiene, Book III. be Special preparation. Tie intimate, eomplex relationships of the family make it desirable to consider some special types ef preparation which are important for those who would attain the highest form of mrried life. (1) Qualifications for marriage, These should include the assurance on the part of both mates that there is: on {a} Physical health ({b}) Mental health amd stability {e) Social status in keeping with group. {2} Selection of a mate. While the selection of a mate has Senind if strong instinctive urges, these are not alone safe guides for successful mating. The impli- cations and responsibilities involved need all of the intelligence and discriminating judgment that the individual can secure. - {a) Courtship is not an emotional joy-ride. It can aa should be a period of frank facing of facts of personality, disposition, tastes, adaptability, for if it results in marriage it is for a lifetime, References: Groves, EH, — “holesome Marriage, Chaps. 3~4. Popenoe, P. + The Conservation of the Family, Part I. Galloway, T. - Lowe and Marriage. (3) Marriage and parénthood. Marriage completes the First step toward establishment of the family with the potential responsibilities of parenthood. The adjustments necessary to a happy marriage and the intelligent rearing of children require sound basic information, plus unusual skill. {a} Proper conception of mirriage. {b) Physical and mental adjustments, {ec} Saund information and guidance for parenthood. | ‘References? Groves, E. ~ Wholesome Marriage, Chaps. 5-12. | sae Popenoe, P. — Modern Marriage : Popenoé, Ps ~ Conservation of the Family, Part 2. Rich, M. -— Femily Life To-day, Part 2, Chap. &. Groves, E. — he Marriage Crisis. es ‘March, N. He Towards Racial Health, Chaps. 9~10. “Von Gruber - Hygiene of Sex me =~ 6 @ (Course 153) _{4) Preparation for the care of children, All too ‘Frequently we wave assumed that it was only necessary for the mother to have a Imo wledge of the growth and development of children. very father should be thoroughly familiar with principal facts of both physical and mental hygiene of children, The intelligent teamwork of both parents pays large dividends in healthier, happier children. fa) Pre-natal period (b} Natal period {ce} Pre-school period {d) Adolescent period {e) School period Refer ences: Rich, M. — Family Life Today, Chap. 9. es Lucas,’ W. P. - The Rumbat Child. Groves, B & G. ~— Wholesome Childhood. Richardson, F. H. — Parenthood ad the Newer Psychology. Spencer, A. G. — The Family and Its Members, Chaps. 8-11 O*Shea - The Child, His Nature, and His Needs. Location and Maintenance of Home. ee ce The physical surroundings of the family has a’ very definite influence upon the health levels of the grow. Consequently, the parents should be capable of judging the values of: 1. Snvironmat of house 4, Water supply 2. Construction 5. Sewage disposal Se Heating and ventilation 6. Household cmveniences References: Broadhurst, Jean — Home and Community Hygiene Taber, C. W. — The Business of the Household Balderston, Re — Housewifery Health Service for the Family The influence of health ami sickness upon the integrity and happiness of the family is coming to be seen more clearly as a matter repaying forethought and planning. In common with the advances in other lines of professi onal service, the medical sciences have developed rapidly to meet the needs and problems of modern life. ‘With our increased knowledge of health and disease, there las emerged-a number of groups of health advisers, who are’ capable not only of treating disease but also of preventing. More imp ortant, they are rapidly changing the objectives of the services to the promotion of health. This aoplies partimlarly to the physician, dentist, and nursée Wvery weil infarmed person shouid understand how to select and how to use such advisers both as an imividual and as a responsible menber of the family group. “4. Selection of health advisers, The efficiency of the health service OF the family will depend largely upon whether discrimination has been exercised in the selection of health advisers for the family. It will be impossible to exercise this discrimination unless you have - gome standards by which to judge the individuals. , (Course 153} 46 Some of the accepted standards will be otlined for the selection of a family physician, but the sane principles apply to all sorts of health advisers. Selection of a fanily physician.. In the selection of a family physician, you should teke advantage of all of the standards and safeguards that are available. The State has done much to protect you along this line. . Your own a bility to judge the character of individuals. must be brought into play. Some of the important points may be outlined: a. Legal registration by the State. b. Character of medical college from which graduated. ce Character and amount of experience. d. Membership and standing in Medical Association. -e. Hospital connections. f. Personality, character, and ethical standards. The application of these standards can be accomplished by seeking the aid of the nearest Class A medical school, secre- tary of the County Medical Society, and educated, well-informed friends. Character of health service. The health service of the present day family should be in accord with modem scientific knowledge and practice. This means that we should take the term "health service” literally.- Such a service should include health supervision as well as sickness service. a. Health swpervision. This includes continuous health super- Vision based @n periodic health examinations. In such a supervision, the physician becomes a health counselor. b. Sickness service. Proper sickness service is also vital * Oa sound health service... It should be properly integrated with the health.supervision of the family. It should include adequate nursing and hospital care. Eeonomies of health service.- The financial problem of securing an adequate health service is a very real one. While it manifestly costs money, if it is high grade, it is a sound investment, The solution of this problem should preserve the fine idealism and traditions of the professions involved. A nationwide study is now being made by a committee of which the President of Stanford is chairman. In the meantime, it should be possible for individual families to secure group health service from individual physicians. A discussion of sane attempts to secure health service by group aétion will be discussed with the consideration of the Occupational Grow. References: Storey, T.-A. — Individual Hygiene, Chaps, 6-10, a ee Cabot, R..— Layman's Handbook of Medicine.- Williams, J. F. - Personal Hygiene Applied, Chape.5. Fisk, E,-L. — Health Building and Life Extension, Cabot, Re — What Men Live By, (Course 153) —_ae we 2 eee eee HRGEENE OF THs SCHOOL GROUP Time will not allow, nor is this the place for a discussion of the history of our sehool group. For the purposes of this carse it will suffice for - us to have in mind the fact that the schools are one of the five basic in- * herited social institutions; that they cannot and should not be static institutions but responsive tothe changing conditions and increasing knowledge of modern life. The purpose of this section is to present the hygienic potentialities of the schools with a view to familiarizing the student with the fundamentals of a sound school health program, it is hoped that a study of this subject will prepare him to intelligently participate in securing for his children the kind of health training and health instruction that will minister tO; rather than lower their health levels. + ow School Population and School Costs fhe very size and cost of the public school system would classify it as an important matter even if it did mot lmve many other important social relation- ships. . In 1925, the U. S, Bureau of Education reports that the child population be- tween 5-17 years was 30 millions, of which 24 millions were enrolled in the public schools, We employed 814,000 teachers and paid them in salaries over one billion dollars and added another billion for rumming expenses. If we © now state that the school properties are worth over four billion and a half, we need no further statistics to realize the size of the school problem. These figures do not incluie the private schools, colleges, and universities. From these statistics, it is evident tit America believes in education. It believes in it so strongly that we have adopted almost universal compulsory education. This provision in our modern life has brarght about a radical ‘change in the physical and mental ervironment of children, Much evidence has been accumulating that unless care is used the health and vigor of children can be injured by their sehool experience... It is no skepticism of the wisdom of universal education to insist that education must not be paght at the price of health. This is the negative side of the picture.- The positive side of the picture presents the possibilities of health building in the schools. With the recognition of the importance of vigorous health by the educator, we are gradually Mmving instituted in the schools mae well- rounded health programs. The educators need the intelligent, understanding support of parents to back them up in this aspect af education. References: Jones, T..J..~ Four Essentials of Bdvweation, Chap. 1. Wood, Thomas -— The Child in School.- Bovernment of School Group The government of the school group has been delegated to the elective members of school boards or committees. it is self-evident that the qual ity of the schools, including the health program, is dependent upon the character of the individuals elected to office. We should select the members of the Board of Education with great care. They are respons ible for our most valuabie ‘billion dollar corporation." (Course 153) . The health regulations and health conditions in the school system is entirely in the hands of the local boards of education, They mst meet certain minimum standards established by the State Board of Education. Familiarize yourself with the health sections of your state school laws. References: State and Local “ducational Codes. awe oe ee Health Resources of the School Group The schools by their very nature and function can marshal great resources for the preventio of disease and the correction of physical Ser Oeees More important are their possibilities fér health building. le Health instruet ion ee Health training Oe Health service. Health Liabilities of School | Group a ce re By the very nature of the composition of the school group, it involves certain health hazards. These can be neutralized if they are recognized and proper provision is made. 1. Communicable diseases 2. Unsanitary environment. Environment of the School Group ee eee ee ee The necessity for a child to sped such a large portion of his life during the growth period in the school renders attention to this aspect of school life of great importarce. 1. Physical environment influences the health levels of the child at many points. Be Lighting e.. Sewage disposal b. Ventilation f.. Food supervision ce. Seating g. Play space d. Water supply Re Social environment. The mental as well as physical effects of the social environment is one of the real health factors in the school growe References: Egbert, S..- Hygiene and Sanitation Newmayer, S. - Medical Inspection of Schools. Health service for School Group eR I A Nm RR NE a ET The objective of the school health work shaid be normal, robust children free from defects and disease, with wholesome ideals built upon a groundwork of healthful habits. 1. Scope of school health work. oe wee ee ee ee eee —_ 10 a (Course 153) &@- Health training and instruction. This means a training in health habits, acquisition of health knowledge and the formation of health ideals tending to promote personal and commnity health, b. Physical education as it is related to health. we c, Health supervision of teachers and pupils. (1) Health inspection daily for the detection of communicable diseases. (2) Health examinations to chart the physical and mental condition of the child. (3) Health correction includes all the necessary sts to secure the correction or alleviation of all the defects of the child. d. Hygienic administration of school program. (1) Length and arrangement of school day. (2) Length of periods, recesses, etc. (3) Examinations and tests. (4) Discipline. e, Menkal hygiene. (1) Training in norml mental hygiene - (2) Mental tests (3) Discovery and training of mentally subnormal. f. Hygiene of the school plant. (1) Construction and equipment of school buildings. (2) Adequate, sanitary toilet facilities. (3) Hygienic operation of school plant. {a} Heating and ventilation (vb) Sanitary cleaning of Miiding (c} Lighting (4) Adjustment of fumiture. ge. Cost of school health work. The importance of school health work justifies a sufficient budget to provide adequate, trained personnel. While exact figures can only be based on the individmal school, it has been demonstrated that it requires from $2.75 to $5.00 per child per school year to provide for a well-rouded program. References: Baker, S. - Child Hygiene, : Chaps. 10-13. mee, Y. Ventilation Commission - Report on Ventilation Bureau of Education ~ Health for School Children (Pamphlet in Document Room] e- Wood and Rowell — Health through Prevention and Control of Disease. « o~ = (Course 153) The Home. and, the School Health Program No health program can possibly reach its highest usefulness that is not intimately linked up with the home. This is particularly true because it involves: 1. Training in practice of health habits 2. Medical and nursing supervision This relationship between the home and school is now being accomplished in many communities through the medium of such organizations as the Parent- Teachers Association. we B+ By the time this point is reached, there should be no need to point out the importance of the hygime of the oceupational group. Frequently where this subject is considered, it is interpreted to mean only the industrial worker. In this course it is proposed to point out the application of the principles of hygiee to all employed persons—industrial, commercial, and professional. It will not be possible to consider jn detail each of the sub groups. We will use the method of typical examples. History of Groups Only the very briefest mention can be made of the history and development of industry, commerce, and the professions, The interested student will be curious to trace their evolution in their relationship to present day health resources and liabilities of the various groups. 1, Industrial group. Forms the lamgest single group of occupied persons. a. Prehistoric period. “Shall mounds and flint heaps” were really primitive factories for the manufacture of imple- . ments of offense and defense. b. Domestic period. Covered the time that industry was in and for the house out of raw materials furnished by the nouse.s c. Handicraft period. Carried on in or outside of the house, usually by free workers, Always works for the consumer.- d, Modern factory system. Supplies the economic wants of per- Sons, communities, and nations by wholesale production in especially constructed plants operated by wage earne rs Re Commercial group, This group is not so large as some other occupa- tional groups, but the rapid growth of cities ms increased both its size and relative importance from a health point of view, fhe evolution of our commercial groups does not stand out in periods quite so clearly as is the case with the industrial groups. During the past 50 years,.with growth of cities the health problems of the commercial groups have assumed more definite form, im FO ue (Course 153) 3 Professional groups, The evolution of thewrious professional groups has inevitably brought in its train some specialized pro-— blems to each one of the various groups. JIxamples of these problas will be discussed, References: Kober and Hayhurst — Industrial Health, Preface Rich, M. E. - The Family To~day, Chap. 6.. Rice, T. - Race Hygiene, Chap. 15. Composition of Oceupi ed Groups ee ee The relative ne of the various occupational groups is readily accepted but we seldom realize what a large percentage of our population in U. S. is gainfully employed..- Further attention should be called as to how rapidly this group has increased during the last milf century. An examination of the Federal statistics from 1880 to 1920 reveals the fact that the number of individuals over 10 years gainfully employed has increased from approximately 17 million in 1880 (34% of total’ population) to 41 million in 1920 (39% of population). Of this latter number, 8,540,000 are females. This sub-group increased by 2 millions from 1910 to 1920. A look at the distribution of workers in U.S. by occupation in 1920 will be of practical importance, i Number q, All occupations, both sexes ~ - - 41, 614,248 160.0 Agriculture, forestry and animal industry ~--~- - 10,953,158 26.05 Extraction of minerals e---- £1,090,223 me Manufacturing and mechanical industries ----—----- 12,818 ,524 50.8 Transportation --+-+-+----- 3g065,562 7 A aid aware so ------ 4 242,979 10.2 Public service ---------- 770,460 be3 Professional service —- ~- --- -— — - 2,145,889 sr Domestic and personal service ~ ~ 3,404,892 6,2 Clerical occupations - —- - — - - — 3,126,541 a0 Health Government of the Groups The extent of the health problems within the various groups are influenced definitely by the character of health knowledge and practices of the group. These in turn are largely controlled by the regulations gradually mde and enforced by or within the sroups.. Health and Disea LS in the Occupational Group a The consideration of the health status of the occupational group should be based upon complete and accurate statistics of both morbidity and mortality.. Unfortunately, our morbidity reports are quite incomplete though rapidly improving because of the activities of: i» Bureau of Census, S. Dept. of Commerce 2e Industrial Accident Boards {State}. . Se Insurance Companies. 4. Highway Commissions. | ~ 2S. . (Course 153) 5. Automobile Associations 6. Safety Organizations. Character of Health Liabilities. 1. Accident a4. One of the enormous costs.of our modern machine age has been the frightful toll of accidents. Our record in America during the past 50 years is-not one of which we can be proud, This problem has been discussed in Course 151. 2. Sickness, We need to repeat here the burden of our sickness rates that causes over 2% of our wage earners to be constantly too ill to be at their employment. _ 3. Economic cost of sickness and accidents. The enormous estimated cost of two billion dollars is what we pay annually for failure to pro- vide and enforce proper defensive hygiene programs. References: Kober and Hayhurst - Industrial Health, Chaps, 5 and stn i Dublin, L. J.-- Health and Wealth. Rosenau, M. 1.:- Preventive Medicine, Section 14. Lauck and Sydenstricker - Conditions of Labor in American : Industries. Bossard, Jo He Le ~ The Problems of Social Well-Being, Chaps. 1920. ; Occupat ional Environment The influence of the environment of the factory, store, or office upon the health of the worker has been demonstrated beyond any dobt,. These influences may be classified as: {a} direct - such as industrial poisons, and {(b) indirect such as the standards of sanitation. 1, Direct. The problems of chemical poisos remain an important factor in the health of workers as was pointed out in Course 151. Le tia Tett. a. Water supply, both for washing and drinking purposes. bs Sewage disposal, adequacy and efficiency. c. Lighting. d. Heating and ventilation. e. Rest and lunch rooms. Personal Hygiese of the Worker The state of health of the worker is largely conditioned by his own health habits, Any worthwhile occurmtional hygiene program will give cons iderat ion to the state of health knowledge and health practices of the group. Such a progrem should be made available for the group through a proper co-operative plan. It should include: 1. Periodic health examination. A careful, scientific health exam- ination is the only sound basis for e personal hygiene program. At the present time, it is required in many factories for the primary purpose of rejecting unsatisfactory individmals. The more (Course 153) oh modern progress uses it for classification of employees, and as a basis for a group hygiene program, f+ Sickness and accident service. The second of these is now practically “required and the first should be made available. 3, Control of communicable diseases, There is no possible excuse A Ae 4. Health information service. This kind of service should be conducted’ through every modern means-—-lectures, personal talks, bulletins, posters, etc. It should cover: ae Personal hygiene e. Recreation be. Proper clothing f» Prevention of communicable Ce Pood diseases and accidents. d,. Rest Combined Indust rial and Home Health Service — ae ee The intimate relationship of the home of the worker to his efficiency and health has led to a number of experiments in attempting by co-operation to secure the advantage of group resources in meeting the total health problem of the worker.. ka tk Johnson Shoe Co. Plan, This comyeay has approximately ° ee ae 5,000 Workers, receiving an average wage of $1441 amually. The aaaee owner by adding a few cents to wholesale price of each pair of shoes furnishes a complete health service for both its employees and their families, including: © Ae de &e ad. Ce Fe &» Health examinations Sickness and accident service Nursing service Dental service Pre-natal and obstetrical care Social relief {1} Retirement pension (2} Widow's pension {3) Social relief Cost 352,60 per capita annually, or 25 cents on each pair of shoes, References; Fisk, I, L. - Health Building and Life Extension Bmaons, A, B. — Health Control in Mercantile Life Rosenat, J, I. — Preventive Medicine, Section 14, O'Niel, D. G, - Medical Service for the Industrial Worker, ere eS Journal of American Med. Assn., Nov'. 17, 1%8, page 1516 (Magazine room). Kober and Hayhurst - Industrial Health, Chap. 8.6 CONSTRUCTIVE HYGIENE Syllabus for Course 150 Sehool of Hygiene and Physical Education STANFORD UNIVERSITY Revised - December 1931 ce INTRODUCTORY: (Note: These introductory remarks apply to the entire series of Informational Hygiene Coursess) Every educated person should have some measure of ordered knowledge of each of the main fields of human interests This can best be attained by securing some degree of mastery in the physical sciences, the social sciences, and the arts. Hygiene, growing out of the biological sciences, is in part physical and part social. The application of its principles may well te considered an art. The study and practice of hygiene should, therefore, form an important part of the student's general education. The objectives of the ¢ourses in hygiene are to offer the student an opportunity to understand the basic facts that determine physical and mental health and of the application of those facts for the benefit of the individual, his group, and society. A. OBJECTIVES OF COURSES IN HYGIENE. The immediate objectives of the courses in hygiene may be indicated under two heads: 1. The cultivation of discriminating judgement in matters that pertain to health advice, health service, health literature, and health practices. The enormous social and economic waste due to unnecessary sickness and death has been shown in a large percentage of cases to be due to lack of such judgment in the use of modern scientific means and of avoiding such misfortunes. Modern medicine and hygiene are based upon scientific facts. Sound judgment can only be exercised by those who are familiar with these facts. ediiesdil above mentioned facts and of acquiring lasting habits of constructive hygiene. All of the scientific knowledge in the world will not guarantee either mental or physical health. To be of real value it must be per- sonally tested and accepted as a part of your every day health practices. Yeur hygiene courses are for your use in your college life here and now. They are practical as well as informational. 2. The practice of a rationa] health program as a_.means of testing the Be OUTC.ME OF COURSES The student who desires to acquire a reasonable mastery of the field of hygiene as a basis for efficient living, should acquire a working knowledge of ¢ertain basic principles of hygiene and out of them construct for him- self a health program. Doctor Livingston Farrand, President of Cornell University, has summed up for us what he considers the minimum knowledge about hygiene that should he in the possession of every educated individual. 1s You should have a knowledge of the physiological basis for sound health habits, suth as regular and sufficient hours of sleep, right posture, suit- able exercise, and proper ¢limination. ee You should know the types and amounts and proportions of the various food élements essential to the proper nurture of your bodys 3. You should have an acquaintanee with the principles of nortml mental ac- tion and the tonditions underlying the more common variations from normal state of mind. , oe 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 factors 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 diseases to offer a prospect of passing through middle life without a breakdown, 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, poisonous dusts of certain industries, infected 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 sciences, 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 probiems, and of the results to be expected from intelligent conmunity 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 program based upon sound knowledge built up by practice in the use of discrim- inating judgment. Such an objective has been well expressed by Smiley: 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. To be able to enjoy the society of others without irritability, boredom, or undue self-consciousness,. 6. To be able to enjoy logitimate sscape into the world of unrestity for at least two hcurs a day of literaturc, art, music, drama, hobbies, cr g-mes without evestrain, n orvousness, or boredom. 7, To be generally self-confident, optimistic, cutnusiastic, free of unnecessary fear, expecting success and attaining it with reasonable frequency. C, -3- 8. To have sex desire, normally active and properly directed and controlled. THE FIELD OF HYGIENE Hygiene is based upon:both the physical sciences and the social sciences. It has been built from the sciences of biclory, anatomy, physiology, chemistry, physics, bacteriology, sociology, psychology, and statistics. The problem of hygiene is to so present sum facts as a basis for rational living that they may influence the manner of life of the individual and the group ina way to prevent unnecessary disease and premature death. The field of hygiene may be divided for purposes of discussion into several parts, Definitions of terms: General hygiene; constructive hygiene; defensive hygiene; group hygiene; societal hygiene; individual hygiene. Avplied hygiene means the application of the scientific facts of hygiene to the individual, the group, and to society in generals Some other groupings of hygiene are sometimes used, such as: Personal hygiene; school hvgiene; occupational hygiene; public hvgiene; sanitary science. EVIDENCE OF NEED FOR A HYGIENE PROGRAM In considering the advisability of a hygiene program for the individual, group, or community, the student should wnsider and weigh cerefully the evidence which is available to justify the expenditure of the time and money involved in the adoption of such a program. This evidence may be considered under three heads: (1) Statistical; (2) biological; (3) economic. le Statistical Evidence The statistical evidence for a hygiene program is secured through a recording, tabulating, and studying of the births, deaths, and sick- nesses occurring in the various political divisions of the United States. The reports upon which these statistics are based are secured by laws requiring sud reports. For greater accuracy and to sécure a more com- plete picture the Registration Areas for Births and Deaths have been established. These births, deaths, and sidrnesses are tabulated according to a defin- ite standardized classification. International Classification of Causes of Death is revised every ten years, For comparative purposes, the tabu- lations of these reports are expressed in various rates: Birth rate, erude death rate, specific death rate, standardized or adjusted death rate, infant mortality rate. Mortelity Statistics. Diseases may be classified as Communicable and Non-communicable, A large percentage of Communicable diseases can be prevented. An analysis of the mortality tables for the Registration Area of the United States since 1900 indicates some interesting and significant changes in the relative numbers of deaths from various causes, Compare the 10 most frequent causes of death in United States during the year of 1900 with those of 1926. Other causes of death of impertance are: Typhoid fever, diphtheria, diabetes, syphilis, and puerperal causes. ~he Life Tables. One of the most valuable evidences for a health program is found in the tables constructed showing the expectation of life for the average individual. They reveal a gradually lengthening span of life. These tables are available for most of the important countries of the world. They form the basis for establishing life insurance rates. Morbidity Statistics. Only communicable and occupational diseases are required to be reported to the health authorities. Consequently we have no accurate record of sickness. Certain sickness surveys made by private organizations and the United States Public Health Service have given us valuable information. Physical defects have been revealed by examination of school children and by the examination of the men for military service during the World War. 2. Biological Evidence The biological evidence bearing upon a hygiene program can be found in the state of mental normality of our population. It raises the whole question of mental deficiency. We should consider the number and character of the various mental abnormalities, particularly as to their cause and prevention. 3. Economic Evidence One of the ways of justifying a hygiene program is to calculate the cost of sickness and death based upon the actuarial values of human lifes Certain diseases are now known to be preventable by definitely known methods, With this as a basis the value of a hygiene program can be ascertained in financial terms, REFERENCES : Statistical: *Moore--Public Health in U.»S., Chaps» 1-5. = *U,.S,. Census Bureau--Mortality Statistics (1900~1928) (Document Room) Baker, S. J e--Child Hygiene, Chaps ae Sedgewick, W. He--Principles of Sanitary Science, Chapss 1 & 4 Bossard=--Problems of Sodial Well-Being, Chaps. 7-206 | -Ravenal, M. P.e--Half Century of Public Health, pp. 94—117. “Whipple, G. C.-Vital Statistics. 2 ee *Kirkpatrick & Huettner--Fundamentals of Health, pp. 496+503. Biological: Rosenau-~Preventive Medicine, Section on Mental Defectives (p. 552, edition 1927) *Rossard--Problems of Social Well-Being, Chaps. 21-20. Economic and Social: ee en Fisher, -Ie--Report on National Vitality. - --- Moore, -He Hen=American Medicine and Public Health. *Dublin, Le Is--Health and Wealth, Chap. 1. * Required reading * Il. safe Recognition of the cell was one of the great fundamental discoveries in science, for it offered the key to solution of every biological problem. William Robert Hooke (1668) first applied the term "cell" and is credited Realization of its significance gradually became clearer to biologists, until Schleiden and Schwann formulated the so-called "cell theory" in Fourteen years later (1852), Remak and Virchow demonstrated that living matter could come only from other living matter, a revolutionary con- Advances in this field had awaited the development of the campound microscope. Lister is credited with the achievement in 1850. Early stages of the development of the microscope lead back to ancient Ninevah, Greece, and Rome. Application of microscope for scientific a. Galileo--for his work with use of lenses (1609). b. Kircher--first to report living micré-organisms (1646). ec. Van Leeuwenhoek--improvement of microscope (1632-1723). Modern period of microscopy dates from 1830. With improvements in magni- fication, illumination, and control, it became a perfected instrument The development of laboratory technique was of equal importance with the improvement of the microscope, Hundreds of patient, devoted, and un= known laboratory workers devised the methods for fixing, hardening, sec=- tioning, mounting, and staining specimens, and for their study in the BIOLOGICAL BASIS OF HYGIENE ~ THE CELL A. HISTORICAL le Discoveries with its discovery. 1838, a major step in scientific progress. ception at that time. 2. The Microscope purposes is associated with a few great names: d. Hooke--first used term "cell". (1668). of scientific investigation. 3. Laboratory Technique living state. B. THE UNITS OF LIFE The mystery of life is bound up in minute bodies or particles we have come to call cells. The cell is the smallest unit of living matter. Our bodies may be resolved into a vast assembly of these units. Out of them, with their great variations in structure and function, are built all of the complex organs and systems of the human body. If we are to have an intelligent understanding of our bodies as a basis for sound constructive hygiene we should be familiar with: a, The anatomy or structure of the cell... be The physiology or functions of the cell, l. Be _ Anatomy of the Cell. The cell is of varying shape and size in accord- ance with its specialized function or location, It is bounded by a protoplasmic film called the plasma membrane and it may have a non- protoplasmic, true membrane or wall. Contained within the membrane are the two important parts of the cell-=cytosome and nucleus. Qe be Protoplasm is that peculiar material which possesses the properties the sum total of which is L-I-F-E. Chemically it is a complex mix ture of proteins, lipoids or fatty bodies, carbohydrates, inorganic salts, and water. Physically it displays the properties of a com- plex colloidal system and behaves as a viscid liquid, sometimes colored, but often practically colorless. The cytosome and nucleus are composed of various kinds of protoplasm. "Cytoplasm" and "nucleoplasm" express this fact. Cytosome Within this protoplasm (cytoplasm) are a number of organized, visible structures some of which participate in cell division while others are either formed anew by each cell or are inclusion bodies only. Nucleus is usually surrounded by the cytosome and varies in shape. It always contains a peculiar protein material known as chromatin believed to be the specialized vehicle which transmits hereditary characteristics. (1) Chremosomes. Within the nucleus the tiny granules of chromatin (2) are arranged in units called chromosomes. These are the units of mechanism for the transmission of life in accordance with the laws of heredity. Function and Number of Chromosomes. The ¢ells of various species have a characteristic and fixed number and variety of chromosomes. This number is spoken of as "diploid." The human fertilized ovum has 48 and every resultant cell has 48 chromosomes. When a new individual is to appear, the germ cell of each parent loses one half of its chromosomes and contributes the other half to the union. By this means heredity goes back through the ages to the beginning of life. Physiology of Cells. "Physiologically, we note that, in general, all cells exhibit (a) synthetic functions, that is, anabolic or constructive functions, that are performed chiefly by or because of the nucleus; and (b) dissociative functions, that is to say, destructive or katabolic functions that are performed chiefly by the cytoplasme Thus the nucleus is chiefly an organ of growth, construction, repair, reproduction, and heredity. The cytoplasm is chiefly an organ of power-production and dynamic service through energy transformations."=-Thomas A. Storey "Principles of Hygiene." Se tes a, Every cell must receiis a complete heredity. Any structural defect of a cell roszits in faulty function. be ivery cell must recive food, water, and free oxygen. “ith Chemical bodies broustht to it by the blood, it: = indi \- its om structure and supplies its fuactional oe mat:cr‘al. ce. Every tissue cell mut be relieved »f its wasse products. ds. Every tissue cell uet be functionally aciiv.. e. Every tissue cell must have periodic rust. Specialized Cell Function Cells have specialized furctions in tie body. aa underst-ndine of this is essential to a proper grasp of the laws of heredity and the appli- cations of the principies of hygiene. Somatic or souy cell. are ti specialized cells of various types that compose all of the organs and structures of the body. A small grour, called germ cells, are set aside in the early stages of developrent for the single purpose of reproducing the next generation, Cell Division Cell division is the biological process going on within the cells upon whieh depends reproduction, the transmission of heredity, the development of organs, the growth of structures, and all of the possibilities of differentiated function, The steps by woich these units of life produce the individual can best be understood sy a study of the two principal processes of cell division, a. Mitosis or indirect division of nucleus. Phases: a, Prophase c. Anaphase b. Metaphase d. Telophase b. Meiosis is the term applied to the process by which the chromos‘:zc nivinsr in the germ cells is reduced by half, or from diploid ‘v haploid ° Phases: Reduction division Equation division These two divisicns res.it in (1) Four sperms, or male gametes, all capab!e uf participating in fertilization (2) zour ova, only one capable of fertilization. The other three ova thus formed are immature cell.» and are discarded by the body. Meiusis is vie physiological organiz2tion for the proéuction of differert assortments of hereditary faetors in the chromosomes of the germ ceils. in (Note: Some types of cells undergo division by a process known as amitosis, which Coes not sencern us here.) REFERENCES: *Storey--Principles of Hygiene, Chaps. 5 and 4, *Burlingame and Martin--General Siology, Chap. 2. Dorsey--Why We Behave Like Human 3eings, Pp. 1-54. Guyer--Being Wel’-Born, Chap. 3%, Conklin--Tieredity and Envivonnent, Pp. 6-32 (1922 ed. ) *Kirkpatrick and Huettner~