Chapter XII: Part 12

Taste Organs.--The surface of the tongue is folded into a number of little projections known as papillae. These may be more easily found on your own tongue if a drop of vinegar is placed on its broad surface. In the folds, between these projections on the top and back part of the tongue, are located the organs of taste. These organs are called _taste buds_.

Each taste bud consists of a collection of spindle-shaped neurones, each cell tipped at its outer end with a hairlike projection. These cells send inward fibers to other cells, the fibers from which ultimately reach the brain. The sensory cells are surrounded by a number of projecting cells which are arranged in layers about them. Thus the organ in longitudinal section looks somewhat like an onion cut lengthwise.

How we Taste.--Four kinds of substances may be distinguished by the sense of taste. These are sweet, sour, bitter, and salt. Certain taste cells located near the back of the tongue are stimulated only by a bitter taste. Sweet substances are perceived by cells near the tip of the tongue, sour substances along the sides, and salt about equally all over the surface. A substance must be dissolved in fluid in order to be tasted. Many things which we believe we taste are in reality perceived by the sense of smell. Such are spicy sauces and flavors of meats and vegetables. This may easily be proved by holding the nose and chewing, with closed eyes, several different substances, such as an apple, an onion, and a raw potato.

Smell.--The sense of smell is located in the membrane lining the upper part of the nose. Here are found a large number of rod-shaped cells which are connected with the brain by means of the olfactory nerve. In order to perceive odors, it is necessary to have them diffused in the air; hence we sniff so as to draw in more air over the olfactory cells.

The Organ of Hearing.--The organ of hearing is the ear. The outer ear consists of a funnel-like organ composed largely of cartilage which is of use in collecting sound waves. This part of the ear incloses the auditory canal, which is closed at the inner end by a tightly stretched membrane, the _tympanic membrane_ or ear drum. The function of the tympanic membrane is to receive sound waves, for all sound is caused by vibrations in the air, these vibrations being transmitted, by the means of a complicated apparatus found in the middle ear, to the real organ of hearing located in the inner ear.

Middle Ear.--The middle ear in man is a cavity inclosed by the temporal bone, and separated from the outer ear by the tympanic membrane. A little tube called the _Eustachian tube_ connects the inner ear with the mouth cavity. By allowing air to enter from the mouth, the air pressure is equalized on the ear drum. For this reason, we open the mouth at the time of a heavy concussion and thus prevent the rupture of the delicate tympanic membrane. Placed directly against the tympanic membrane and connecting it with the inner ear is a chain of three tiny bones, the smallest bones of the body. The outermost is called the _hammer_; the next the _anvil_; the third the _stirrup_. All three bones are so called from their resemblances in shape to the articles for which they are named. These bones are held in place by very small muscles which are delicately adjusted so as to tighten or relax the membranes guarding the middle and inner ear.

The Inner Ear.--The inner ear is one of the most complicated, as well as one of the most delicate, organs of the body. Deep within the temporal bone there are found two parts, one of which is called, collectively, the _semicircular canal region_, the other the _cochlea_, or organ of hearing.

It has been discovered by experimenting with fish, in which the semicircular canal region forms the chief part of the ear, that this region has to do with the equilibrium or balancing of the body. We gain in part our knowledge of our position and movements in space by means of the _semicircular canals_.

That part of the ear which receives sound waves is known as the _cochlea_, or snail shell, because of its shape. This very complicated organ is lined with sensory cells provided with cilia. The cavity of the cochlea is filled with a fluid. It is believed that somewhat as a stone thrown into water causes ripples to emanate from the spot where it strikes, so sound waves are transmitted by means of the fluid filling the cavity to the sensory cells of the cochlea (collectively known as the _organ of Corti_) and thence to the brain by means of the auditory nerve.

The Character of Sound.--When vibrations which are received by the ear follow each other at regular intervals, the sound is said to be musical. If the vibrations come irregularly, we call the sound a noise. If the vibrations come slowly, the pitch of the sound is low; if they come rapidly, the pitch is high. The ear is able to perceive as low as thirty vibrations per second and as high as almost thirty thousand. The ear can be trained to recognize sounds which are unnoticed in untrained ears.

The Eye.--The eye or organ of vision is an almost spherical body which fits into a socket of bone, the _orbit_. A stalklike structure, the _optic nerve_, connects the eye with the brain. Free movement is obtained by means of six little muscles which are attached to the outer coat, the _eyeball_, and to the bony socket around the eye.

The wall of the eyeball is made up of three coats. An outer tough white coat, of connective tissue, is called the _sclerotic coat_. Under the sclerotic coat, in front, the eye bulges outward a little. Here the outer coat is continuous with a transparent tough layer called the _cornea_. A second coat, the _choroid_, is supplied with blood vessels and cells which bear pigments. It is a part of this coat which we see through the cornea as the colored part of the eye (the _iris_). In the center of the iris is a small circular hole (the _pupil_). The iris is under the control of muscles, and may be adjusted to varying amounts of light, the hole becoming larger in dim light, and smaller in bright light. The inmost layer of the eye is called the _retina_. This is, perhaps, the most delicate layer in the entire body. Despite the fact that the retina is less than 1/80 of an inch in thickness, there are several layers of cells in its composition. The optic nerve enters the eye from behind and spreads out to form the surface of the retina. Its finest fibers are ultimately connected with numerous elongated cells which are stimulated by light. The retina is dark purple in color, this color being caused by a layer of cells next to the choroid coat. This accounts for the black appearance of the pupil of the eye, when we look through the pupil into the darkened space within the eyeball. The retina acts as the sensitized plate in the camera, for on it are received the impressions which are transformed and sent to the brain as sensations of sight. The eye, like the camera, has a lens. This lens is formed of transparent, elastic material. It is found directly behind the iris and is attached to the choroid coat by means of delicate ligaments. In front of the lens is a small cavity filled with a watery fluid, the _aqueous humor_, while behind it is the main cavity of the eye, filled with a transparent, almost jellylike, _vitreous humor_. The lens itself is elastic. This circumstance permits of a change of form and, in consequence, a change of focus upon the retina of the lens. By means of this change in form, or _accommodation_, we are able to distinguish between near and distant objects.

Defects in the Eye.--In some eyes, the lens is in focus for near objects, but is not easily focused upon distant objects; such an eye is said to be nearsighted. Other eyes which do not focus clearly on objects near at hand are said to be farsighted. Still another eye defect is astigmatism, which causes images of lines in a certain direction to be indistinct, while images of lines transverse to the former are distinct. Many nervous troubles, especially headaches, may be due to eye strain. We should have our eyes examined from time to time, especially if we are subject to headaches.

The Alcohol Question.--It is agreed by investigators that in large or continued amounts alcohol has a narcotic effect; that it first dulls or paralyzes the nerve centers which control our judgment, and later acts upon the so-called motor centers, those which control our muscular activities.

The reason, then, that a man in the first stages of intoxication talks rapidly and sometimes wittily, is because the centers of judgment are paralyzed. This frees the speech centers from control exercised by our judgment, with the resultant rapid and free flow of speech.

In small amounts alcohol is believed by some physiologists to have always this same narcotic effect, while other physiologists think that alcohol does stimulate the brain centers, especially the higher centers, to increased activity. Some scientific and professional men use alcohol in small amounts for this stimulation and report no seeming harm from the indulgence. Others, and by far the larger number, agree that this stimulation from alcohol is only apparent and that even in the smallest amounts alcohol has a narcotic effect.

The Paralyzing Effects of Alcohol on the Nervous System.--Alcohol has the effect of temporarily paralyzing the nerve centers. The first effect is that of exhilaration. A man may do more work for a time under the stimulation of alcohol. This stimulation, however, is of short duration and is invariably followed by a period of depression and inertia. In this latter state, a man will do less work than before. In larger quantities, alcohol has the effect of completely paralyzing the nerve centers. This is seen in the case of a man "dead drunk." He falls in a stupor because all of the centers governing speech, sight, locomotion, etc., have been temporarily paralyzed. If a man takes a very large amount of alcohol, even the nerve centers governing respiration and circulation may become poisoned, and the victim will die.

Effect on the Organs of Special Sense.--Professor Forel, one of the foremost European experts on the question of the effect of alcohol on the nervous system, says: "Through all parts of nervous activity from the innervation of the muscles and the simplest sensation to the highest activity of the soul the paralyzing effect of alcohol can be demonstrated." Several experimenters of undoubted ability have noted the paralyzing effect of alcohol even in small doses. By the use of delicate instruments of precision, Ridge tested the effect of alcohol on the senses of smell, vision, and muscular sense of weight. He found that two drams of absolute alcohol produced a positive decrease in the sensitiveness of the nerves of feeling, that so small a quantity as one half dram of absolute alcohol diminished the power of vision and the muscular sense of weight. Kraepelin and Kurz by experiment determined that the acuteness of the special senses of sight, hearing, touch, taste, and smell was diminished by an ounce of alcohol, the power of vision being lost to one third of its extent and a similar effect being produced on the other special senses. Other investigators have reached like conclusions. There is no doubt but that alcohol, even in small quantities, renders the organs of sense less sensitive and therefore less accurate.

Effect of Alcohol on the Ability to Resist Disease.--Among certain classes of people the belief exists that alcohol in the form of brandy or some other drink or in patent medicines, malt tonics, and the like is of great importance in building up the body so as to resist disease or to cure it after disease has attacked it. Nothing is further from the truth. In experiments on a large number of animals, including dogs, rabbits, guinea pigs, fowls, and pigeons, Laitenen, of the University of Helsingsfors, found that alcohol, without exception, made these animals more susceptible to disease than were the controls.

One of the most serious effects of alcohol is the lowered resistance of the body to disease. It has been proved that a much larger proportion of hard drinkers die from infectious or contagious diseases than from special diseased conditions due to the direct action of alcohol on the organs of the body. This lowered resistance is shown in increased liability to contract disease and increased severity of the disease. We have already alluded to the findings of insurance companies with reference to the length of life--the abstainers from alcohol have a much better chance of a longer life and much less likelihood of infection by disease germs.

Use of Alcohol in the Treatment of Disease.--In the London Temperance Hospital alcohol was prescribed seventy-five times in thirty-three years. The death rate in this hospital has been lower than that of most general hospitals. Sir William Collins, after serving nineteen years as surgeon in this hospital, said:--

"In my experience, speaking as a surgeon, the use of alcohol
is not essential for successful surgery.... At the London
Temperance Hospital, where alcohol is very rarely
prescribed, the mortality in amputation cases and in
operation cases generally is remarkably low. Total
abstainers are better subjects for operation, and recover
more rapidly from accidents, than those who habitually take
stimulants."

In a paper read at the International Congress on Tuberculosis, in New York, 1906, Dr. Crothers remarked that alcohol as a remedy or a preventive medicine in the treatment of tuberculosis is a most dangerous drug, and that all preparations of sirups containing spirits increase, rather than diminish, the disease.

Dr. Kellogg says: "The paralyzing influence of alcohol upon the white cells of the blood--a fact which is attested by all investigators--is alone sufficient to condemn the use of this drug in acute or chronic infections of any sort."

The Effect of Alcohol upon Intellectual Ability.--With regard to the supposed quickening of the mental processes Horsley and Sturge, in their recent book, _Alcohol and the Human Body_, say:

"Kraepelin found that the simple reaction period, by which
is meant the time occupied in making a mere response to a
signal, as, for instance, to the sudden appearance of a
flag, was, after the ingestion of a small quantity of
alcohol (1/4 to 1/2 ounce), slightly accelerated; that there
was, in fact, a slight shortening of the time, as though the
brain were enabled to operate more quickly than before. But
he found that after a few minutes, in most cases, a slowing
of mental action began, becoming more and more marked, and
enduring as long as the alcohol was in active operation in
the body, _i.e._ four to five hours.... Kraepelin found that
it was only more or less automatic work, such as reading
aloud, which was quickened by alcohol, though even this was
rendered less trustworthy and accurate." Again: "Kraepelin
had always shared the popular belief that a small quantity
of alcohol (one to two teaspoonfuls) had an accelerating
effect on the activity of his mind, enabling him to perform
test operations, as the adding and subtracting and learning
of figures more quickly. But when he came to measure with
his instruments the exact period and time occupied, he
found, to his astonishment, that he had accomplished these
mental operations, not more, but less, quickly than
before.... Numerous further experiments were carried out in
order to test this matter, and these proved that _alcohol
lengthens the time taken to perform complex mental
processes_, while by a singular illusion the person
experimented upon imagines that his psychical actions are
rendered more rapid."

_Attention_--that is, the power of the mind to grasp and consider impressions obtained through the senses--is weakened by drink. The ability of the mind to associate or combine ideas, the faculty involved in sound _judgment_, showed that when the persons had taken the amounts of alcohol mentioned, the combinations of ideas or judgments expressed by them were confused, foggy, sentimental, and general. When the persons had taken no alcohol, their judgments were rational, specific, keen, showing closer observation.

"The words of Professor Helmholtz at the celebration of his
seventieth birthday are very interesting in this connection.
He spoke of the ideas flashing up from the depths of the
unknown soul, that lies at the foundation of every truly
creative intellectual production, and closed his account of
their origin with these words: 'The smallest quantity of an
alcoholic beverage seemed to frighten these ideas
away.'"--DR. G. SIMS WOODHEAD, Professor of Pathology,
Cambridge University, England.

Professor Von Bunge (_Textbook of Physiological and Pathological Chemistry_) of Switzerland says that:

"The stimulating action which alcohol appears to exert on
the brain functions is only a paralytic action. The cerebral
functions which are first interfered with are _the power of
clear judgment and reason_. No man ever became witty by aid
of spirituous drinks. The lively gesticulations and useless
exertions of intoxicated people are due to paralysis,--the
restraining influences, which prevent a sober man from
uselessly expending his strength, being removed."

The Drink Habit.--The harmful effects of alcohol (aside from the purely physiological effect upon the tissues and organs of the body) are most terribly seen in the formation of the alcohol habit. The first effect of drinking alcoholic liquors is that of exhilaration. After the feeling of exhilaration is gone, for this is a temporary state, the subject feels depressed and less able to work than before he took the drink. To overcome this feeling, he takes another drink. The result is that before long he finds a habit formed from which he cannot escape. With body and mind weakened, he attempts to break off the habit. But meanwhile his will, too, has suffered from overindulgence. He has become a victim of the drink habit!

"The capital argument against alcohol, that which must
eventually condemn its use, is this, that _it takes away all
the reserved control, the power of mastership, and therefore
offends against the splendid pride in himself or herself,
which is fundamental in every man or woman worth
anything_."--DR. JOHN JOHNSON, quoting Walt Whitman.

Self-indulgence, be it in gratification of such a simple desire as that for candy or the more harmful indulgence in tobacco or alcoholic beverages, is dangerous--not only in its immediate effects on the tissues and organs, but in its more far-reaching effects on habit formation. Each one of us is a bundle of appetites. If we gratify appetites of the wrong kind, we are surely laying the foundation for the habit of excess. Self-denial is a good thing for each of us to practice at one time or another, if for no other purpose than to be ready to fight temptation when it comes.

The Economic Effect of Alcoholic Poisoning.--In the struggle for existence, it is evident that the man whose intellect is the quickest and keenest, whose judgment is most sound, is the man who is most likely to succeed. The paralyzing effect of alcohol upon the nerve centers must place the drinker at a disadvantage. In a hundred ways, the drinker sooner or later feels the handicap that the habit of drink has imposed upon him. Many corporations, notably several of our greatest railroads (the Pennsylvania and the New York Central Railroad among them), refuse to employ any but abstainers in positions of trust. Few persons know the number of railway accidents due to the uncertain eye of some engineer who mistook his signal, or the hazy inactivity of the brain of some train dispatcher who, because of drink, forgot to send the telegram that was to hold the train from wreck. In business and in the professions, the story is the same. The abstainer wins out over the drinking man.

Effect of Alcohol on Ability to do Work.--In _Physiological Aspects of the Liquor Problem_, Professor Hodge, formerly of Clark University, describes many of his own experiments showing the effect of alcohol on animals. He trained four selected puppies to recover a ball thrown across a gymnasium. To two of the dogs he gave food mixed with doses of alcohol, while the others were fed normally. The ball was thrown 100 feet as rapidly as recovered. This was repeated 100 times each day for fourteen successive days. Out of 1400 times the dogs to which alcohol had been given brought back the ball only 478 times, while the others secured it 922 times.

Dr. Parkes experimented with two gangs of men, selected to be as nearly similar as possible, in mowing. He found that with one gang abstaining from alcoholic drinks and the other not, the abstaining gang could accomplish more. On transposing the gangs, the same results were repeatedly obtained. Similar results were obtained by Professor Aschaffenburg of Heidelberg University, who found experimentally that men "were able to do 15 per cent less work after taking alcohol."

Recently many experiments along the same lines have been made. In typewriting, in typesetting, in bricklaying, or in the highest type of mental work the result is the same. The quality and quantity of work done on days when alcohol is taken is less than on days when no alcohol is taken.

The Relation of Alcohol to Efficiency.--We have already seen that work is neither so well done nor is as much accomplished by drinkers as by non-drinkers.

A Massachusetts shoe manufacturer told a recent writer on temperance that in one year his firm lost over $5000 in shoes spoiled by drinking men, and that he had himself traced these spoiled shoes to the workmen who, through their use of alcoholic liquors, had thus rendered themselves incapable. This is a serious handicap to our modern factory system, and explains why so many factory towns and cities are strongly favoring a policy of "No license" in opposition to the saloons.

"It is believed that the largest number of accidents in shops and mills takes place on Monday, because the alcohol that is drunk on Sunday takes away the skill and attentive care of the workman. To prove the truth of this opinion, the accidents of the building trades in Zurich were studied during a period of six years, with the result shown by this table":--

Another relation to efficiency is shown by the following chart. During the week the curve of working efficiency is highest on Friday and lowest on Monday. The number of accidents were also least on Friday and greatest on Monday. Lastly the assaults were fewest in number on Friday and greatest on Sunday and Monday. The moral is plain. Workingmen are apt to spend their week's wages freely on Saturday. Much of this goes into drink, and as a result comes crime on Sunday because of the deadened moral and mental condition of the drinker, and loss of efficiency on Monday, because of the poisonous effects of the drug.

Effect of Alcohol upon Duration of Life.--Still more serious is the relation of alcohol as a direct cause of disease (see table).

It is as yet quite impossible, in the United States at least, to tell just how many deaths are brought about, directly or indirectly, by alcohol. Especially is this true in trying to determine the number of cases of deaths from disease promoted by alcohol. In Switzerland provision is made for learning these facts, and the records of that country throw some light on the subject.

Dr. Rudolph Pfister made a study of the records of the city of Basle for the years 1892-1906, finding the percentage of deaths in which alcohol had been reported by the attending physician as one cause of death. He found that 18.1 per cent of all deaths of men between 40 and 50 years of age were caused, in part at least, by alcohol, and this at what should be the most active period in a man's life, the time when he is most needed by his family and community. Taking all ages between 20 and 80, he found that alcohol was one cause of death in one man in every ten who died.

Another study was made by a certain doctor in Sweden, from records of 1082 deaths occurring in his own practice and the local hospital. No case was counted as alcoholic of which there was the slightest doubt. Of deaths of adult men, 18 in every 100 were due, directly or indirectly, to alcoholism. In middle life, between the ages of 40 and 50, 29; and between 50 and 60 years of age, 25.6 out of every 100 deaths had alcohol as one cause, thus agreeing with other statistics we have been quoting.--From the _Metropolitan_, Vol. XXV, Number 11.

The Relation of Alcohol to Crime.--A recent study of more than 2500 habitual users of alcohol showed that over 66 per cent had committed crime. Usually the crimes had been done in saloons or as a result of quarrels after drinking. Of another lot of 23,581 criminals questioned, 20,070 said that alcohol had led them to commit crime.

The Relation of Alcohol to Pauperism.--We have already spoken of the Jukes family. These and many other families of a similar sort are more or less directly a burden upon the state. Alcohol is in part at least responsible for the condition of such families. Alcohol weakens the efficiency and moral courage, and thus leads to begging, pauperism, petty stealing or worse, and ultimately to life in some public institution. In Massachusetts, of 3230 inmates of such institutions, 66 per cent were alcoholics.

The Relation of Alcohol to Heredity.--Perhaps the gravest side of the alcohol question lies here. If each one of us had only himself to think of, the question of alcohol might not be so serious. But drinkers may hand down to their unfortunate children tendencies toward drink as well as nervous diseases of various sorts; an alcoholic parent may beget children who are epileptic, neurotic, or even insane.

In the State of New York there are at the present time some 30,000 insane persons in public and private hospitals. It is believed that about one fifth of them, or 6000 patients, owe their insanity to alcohol used either by themselves or by their parents. In the asylums of the United States there are 150,000 insane people. Taking the same proportions as before, there are 30,000 persons in this country whom alcohol has made or has helped to make insane. This is the most terrible side of the alcohol problem.

REFERENCE READING

ELEMENTARY

Hunter, _Laboratory Problems in Civic Biology_. American
Book Company.
Overton, _General Hygiene_. American Book Company.
The Gulick Hygiene Series, _Emergencies, Good Health, The
Body at Work, Control of Body and Mind_. Ginn and Company.
Ritchie, _Human Physiology_. World Book Company.
Hough and Sedgwick, _The Human Mechanism_. Ginn and Company.

XXIV. MAN'S IMPROVEMENT OF HIS ENVIRONMENT

_Problems.--How may we improve our home conditions of living?_
_How may we help improve our conditions at school?_
_How does the city care for the improvement of our environment?_
_(a) In inspection of buildings, etc._
_(b) In inspection of food supplies._
_(c) In inspection of milk._
_(d) In care of water supplies._
_(e) In disposal of wastes._
_(f) In care of public health._

LABORATORY SUGGESTIONS

_Home exercise._--How to ventilate my bedroom.
_Demonstration._--Effect of use of duster and damp cloth
upon bacteria in schoolroom.
_Home exercise._--Luncheon dietaries.
_Home exercise._--Sanitary map of my own block.
_Demonstration._--The bacterial content of milk of various
grades and from different sources.
_Demonstration._--Bacterial content of distilled water, rain
water, tap water, dilute sewage.
_Laboratory exercise._--Study of board of health tables to
plot curves of mortality from certain diseases during
certain times of year.

The Purpose of this Chapter.--In the preceding chapters we have traced the lives of both plants and animals within their own environment. We have seen that man, as well as plants and other animals, needs a favorable environment in order to live in comfort and health. It will be the purpose of the following pages first to show how we as individuals may better our home environment, and secondly, to see how we may aid the civic authorities in the betterment of conditions in the city in which we live.

Home Conditions.--The Bedroom.--We spend about one third of our total time in our bedroom. This room, therefore, deserves more than passing attention. First of all, it should have good ventilation. Two windows make an ideal condition, especially if the windows receive some sun. Such a condition as this is manifestly impossible in a crowded city, where too often the apartment bedrooms open upon narrow and ill-ventilated courts. Until comparatively recent time, tenement houses were built so that the bedrooms had practically no light or air; now, thanks to good tenement-house laws, wide airshafts and larger windows are required by statute.

Care of the Bedroom.--Since sunlight cannot always be obtained for a bedroom, we must so care for and furnish the room that it will be difficult for germs to grow there. Bedroom furniture should be light and easy to clean, the bedstead of iron, the floors painted or of hardwood. No hangings should be allowed at the windows to collect dust, nor should carpets be allowed for the same reason. Rugs on the floor may easily be removed when cleaning is done. The furniture and woodwork should be wiped with a damp cloth every day. Why a _damp_ cloth? In certain tenements in New York City, tuberculosis is believed to have been spread by people occupying rooms in which a previous tenant has had tuberculosis. A new tenant should insist on a thorough cleaning of the bedrooms and removal of old wall paper before occupancy.

Sunlight Important.--In choosing a house in the country we would take a location in which the sunlight was abundant. A shaded location might be too damp for health. Sunlight should enter at least some of the rooms. In choosing an apartment we should have this matter in mind, for, as we know, germs cannot long exist in sunlight.

Heating.--Houses in the country are often heated by open fires, stoves or hot-air furnaces, all of which make use of heated currents of air to warm the rooms. But in the city apartments, usually pipes conduct steam or hot water from a central plant to our rooms. The difficulty with this system is that it does not give us fresh air, but warms over the stale air in a room. Steam causes our rooms to be too warm part of the time, and not warm enough part of the time. Thus we become overheated and then take cold by becoming chilled. Steam heat is thus responsible for much sickness.

Lighting.--Lighting our rooms is a matter of much importance. A student lamp, or shaded incandescent light, should be used for reading. Shades must be provided so that the eyes are protected from direct light. Gas is a dangerous servant, because it contains a very poisonous substance, carbon monoxide. "It is estimated that 14 per cent of the total product of the gas plant leaks into the streets and houses of the cities supplied." This forms an unseen menace to the health in cities. Gas pipes, and especially gas cocks, should be watched carefully for escaping gas. Rubber tubing should not be used to conduct gas to movable gas lamps, because it becomes worn and allows gas to escape.

Insects and Foods.--In the summer our houses should be provided with screens. All food should be carefully protected from flies. Dirty dishes, scraps of food, and such garbage should be quickly cleaned up and disposed of after a meal. Insect powder (pyrethrum) will help keep out "croton bugs" and other undesirable household pests, but cleanliness will do far more. Most kitchen pests, as the roach, simply stay with us because they find dirt and food abundant.

Use of Ice.--Food should be properly cared for at all times, but especially during the summer. Iceboxes are a necessity, especially where children live, in order to keep milk fresh. A dirty icebox is almost as bad as none at all, because food will decay or take on unpleasant odors from other foods.

Disposal of Wastes.--In city houses the disposal of human wastes is provided for by a city system of sewers. The wastes from the kitchen, the garbage, should be disposed of each day. The garbage pail should be frequently sterilized by rinsing it with boiling water. Plenty of lye or soap should be used. Remember that flies frequent the uncovered garbage pail, and that they may next walk on your food. Collection and disposal of garbage is the work of the municipality.

School Surroundings.--How to Improve Them.--From five to six hours a day for forty weeks is spent by the average boy or girl in the schoolroom. It is part of our environment and should therefore be considered as worthy of our care. Not only should a schoolroom be attractive, but it should be clean and sanitary. City schools, because of their locations, of the sometimes poor janitorial service, and especially because of the selfishness and carelessness of children who use them, may be very dirty and unsanitary. Dirt and dust breed and carry bacteria. Plate cultures show greatly increased numbers of bacteria to be in the air when pupils are moving about, for then dust, bearing bacteria, is stirred up and circulated through the air. Sweeping and dusting with dry brooms or feather dusters only stirs up the dust, leaving it to settle in some other place with its load of bacteria. Professor Hodge tells of an experience in a school in Worcester, Mass. A health brigade was formed among the children, whose duty was to clean the rooms every morning by wiping all exposed surface with a damp cloth. In a school of 425 pupils not a single case of contagious diseases appeared during the entire year. Why not try this in your own school?

Unselfishness the Motto.--Pupils should be unselfish in the care of a school building. Papers and scraps dropped by some careless boy or girl make unpleasant the surroundings for hundreds of others. Chalk thrown by some mischievous boy and then tramped underfoot may irritate the lungs of a hundred innocent schoolmates. Colds or worse diseases may be spread through the filthy habits of some boys who spit in the halls or on the stairways.

Lunch Time and Lunches.--If you bring your own lunch to school, it should be clean, tasty, and well balanced as a ration. In most large schools well-managed lunch rooms are part of the school equipment, and balanced lunches can be obtained at low cost. Do not make a lunch entirely from cold food, if hot can be obtained. Do not eat only sweets. Ice cream is a good food, if taken with something else, but be sure of your ice cream. "Hokey pokey" cream, tested in a New York school laboratory, showed the presence of many more colonies of bacteria than _good_ milk would show. Above all, be sure the food you buy is clean. Stands on the street, exposed to dust and germs, often sell food far from fit for human consumption.

If you eat your lunch on the street near your school, remember not to scatter refuse. Paper, bits of lunch, and the like scattered on the streets around your school show lack of school spirit and lack of civic pride. Let us learn above all other things to be good citizens.

Inspection of Factories, Public Buildings, etc.--It is the duty of a city to inspect the condition of all public buildings and especially of factories. Inspection should include, first, the supervision of the work undertaken. Certain trades where grit, dirt, or poison fumes are given off are dangerous to human health, hence care for the workers becomes a necessity. Factories should also be inspected as to cleanliness, the amount of air space per person employed, ventilation, toilet facilities, and proper fire protection. Tenement inspection should be thorough and should aim to provide safe and sanitary homes.

Inspection of Food Supplies.--In a city certain regulations for the care of public supplies are necessary. Foods, both fresh and preserved, must be inspected and rendered safe for the thousands of people who are to use them. All raw foods exposed on stands should be covered so as to prevent insects or dust laden with bacteria from coming in contact with them. Meats must be inspected for diseases, such as tuberculosis in beef, or trichinosis in pork. Cold storage plants must be inspected to prevent the keeping of food until it becomes unfit for use. Inspection of sanitary conditions of factories where products are canned, or bakeries where foods are prepared, must be part of the work of a city in caring for its citizens.

Care of Raw Foods.--Each one of us may cooperate with the city government by remembering that fruits and vegetables can be carriers of disease, especially if they are sold from exposed stalls or carts and handled by the passers-by. All vegetables, fruits, or raw foods should be carefully washed before using. Spoiled or overripe fruit, as well as meat which is decayed, is swarming with bacteria and should not be used.

An interesting exercise would be the inspection of conditions in your own home block. Make a map showing the houses on the block. Locate all stores, saloons, factories, etc. Notice any cases of contagious disease, marking this fact on the map. Mark all heaps of refuse in the street, all uncovered garbage pails, any street stands that sell uncovered fruit, and any stores with an excessive number of flies.

In addition to food inspection, two very important supplies must be rendered safe by a city for its citizens. These are milk and water.

Care in Production of Milk.--Milk when drawn from a healthy cow should be free from bacteria. But immediately on reaching the air it may receive bacteria from the air, from the hands of the person who milks the cows, from the pail, or from the cow herself. Cows should, therefore, be milked in surroundings that are sanitary, the milkers should wear clean garments, put on over their ordinary clothes at milking time, while pails and all utensils used should be kept clean. Especially the surface exposed on the udder from which the milk is drawn should be cleansed before milking.

Most large cities now send inspectors to the farms from which milk is supplied. Farms that do not accept certain standards of cleanliness are not allowed to have their milk become part of the city supply.

Tuberculosis and Milk.--It is recognized that in some European countries from 30 to 40 per cent of all cattle have tuberculosis. Many dairy herds in this country are also infected. It is also known that the tubercle bacillus of cattle and man are much alike in form and action and that _probably_ the germ from cattle would cause tuberculosis in man. Fortunately, the tuberculosis germ does not _grow_ in milk, so that even if milk from tubercular cattle should get into our supply, it would be diluted with the milk of healthy cattle. In order to protect our milk supply from these germs it would be necessary to kill all tubercular cattle (almost an impossibility) or to pasteurize our milk so as to kill the germs in it.

Other Disease Germs in Milk.--We have already shown how typhoid may be spread through milk. Usually such outbreaks may be traced to a single case of typhoid, often a person who is a "typhoid carrier," _i.e._ one who may not suffer from the effects of the disease, but who carries the germs in his body, spreading them by contact. A recent epidemic of typhoid in New York City was traced to a single typhoid carrier on a farm far from the city. Sometimes the milk cans may be washed in contaminated water or the cows may even get the germs on their udders by wading in a polluted stream. Diphtheria, scarlet fever, and Asiatic cholera are also undoubtedly spread through milk supplies. Milk also plays a very important part in the high death rate from diarrhoeal diseases among young children in warm weather. Why?

Grades of Milk in a City Supply.--Milk which comes to a city may be roughly placed in three different classes. The best milk, coming from farms where the highest sanitary standards exist, where the cows are all tubercular tested, where modern appliances for handling and cooling the milk exist, is known as certified or, in New York City, grade A milk. Most of the milk sold, however, is not so pure nor is so much care taken in handling it. Such milk, known in New York as grade B milk, is pasteurized before delivery, and is sold only in bottles. A still lower grade of milk (dipped milk) is sold direct from cans. It is evident that such milk, often exposed to dust and other dirt, is unfit for any purpose except for cooking. It should under no circumstances be used for children. A regulation recently made by the New York City Department of Health states that milk sold "loose" in restaurants, lunch-rooms, soda fountains, and hotels must be pasteurized.

Care of a City Milk Supply.--Besides caring for milk in its production on the farm, proper transportation facilities must be provided. Much of the milk used in New York City is forty-eight hours old before it reaches the consumer. During shipment it must be kept in refrigerator cars, and during transit to customers it should be iced. Why? All but the highest grade milk should be pasteurized. Why? Milk should be bottled by machinery if possible so as to insure no personal contact; it should be kept in clean, cool places; and no milk should be sold by dipping from cans. Why is this a method of dispensing impure milk?

Care of Milk in the Home.--Finally, milk at home should receive the best of care. It should be kept on ice and in covered bottles, because it readily takes up the odors of other foods. If we are not certain of its purity or keeping qualities, it should be pasteurized at home. Why?

Water Supplies.--One of the greatest assets to the health of a large city is pure water. By pure water we mean water free from all _organic_ impurities, including germs. Water from springs and deep driven wells is the safest water, that from large reservoirs next best, while water that has drainage in it, river water for example, is very unsafe.

The waters from deep wells or springs if properly protected will contain no bacteria. Water taken from protected streams into which no sewage flows will have but few bacteria, and these will be destroyed if exposed to the action of the sun and the constant aeration (mixing with oxygen) which the surface water receives in a large lake or reservoir. But water taken from a river into which the sewage of other towns and cities flows must be filtered before it is fit for use.

Typhoid fever broke out in North Chelmsford and about two weeks later cases began to appear in Lowell until a great epidemic occurred. Explain this outbreak. Each black dot is a case of typhoid.]

Typhoid fever germs live in the food tube, hence the excreta of a typhoid patient will contain large numbers of germs. In a city with a system of sewage such germs might eventually pass from the sewers into a river. Many cities take their water supply directly from rivers, sometimes not far below another large town. Such cities must take many germs into their water supply. Many cities, as Cleveland and Buffalo, take their water from lakes into which their sewage flows. Others, as Albany, Pittsburgh, and Philadelphia, take their drinking water directly from rivers into which sewage from cities above them on the river has flowed. Filtering such water by means of passing the water through settling basins and sand filters removes about 98 per cent of the germs. The result of drinking unfiltered and filtered water in certain large cities is shown graphically at right. In cities which drain their sewage into rivers and lakes, the question of sewage disposal is a large one, and many cities now have means of disposing of their sewage in some manner as to render it harmless to their neighbors.

Railroads are often responsible for carrying typhoid and spreading it. It is said that a recent outbreak of typhoid in Scranton, Pa., was due to the fact that the excreta from a typhoid patient traveling in a sleeping car was washed by rain into a reservoir near which the train was passing. Railroads are thus seen to be great open sewers. A sanitary car toilet is the only remedy.

Sewage Disposal.--Sewage disposal is an important sanitary problem for any city. Some cities, like New York, pour their sewage directly into rivers which flow into the ocean. Consequently much of the liquid which bathes the shores of Manhattan Island is dilute sewage. Other cities, like Buffalo or Cleveland, send their sewage into the lakes from which they obtain their supply of drinking water. Still other cities which are on rivers are forced to dispose of their sewage in various ways. Some have a system of filter beds in which the solid wastes are acted upon by the bacteria of decay, so that they can be collected and used as fertilizer. Others precipitate or condense the solid materials in the sewage and then dispose of it. Another method is to flow the sewage over large areas of land, later using this land for the cultivation of crops. This method is used by many small European cities.

The Work of the Department of Street Cleaning.--In any city a menace to the health of its citizens exists in the refuse and garbage. The city streets, when dirty, contain countless millions of germs which have come from decaying material, or from people ill with disease. In most large cities a department of street cleaning not only cares for the removal of dust from the streets, but also has the removal of garbage, ashes, and other waste as a part of its work. The disposal of solid wastes is a tremendous task. In Manhattan the dry wastes are estimated to be 1,000,000 tons a year in addition to about 175,000 tons of garbage. Prior to 1895 in the city of New York garbage was not separated from ashes; now the law requires that garbage be placed in separate receptacles from ashes. Do you see why? The street-cleaning department should be aided by every citizen; rules for the separation of garbage, papers, and ashes should be kept. Garbage and ash cans should be _covered_. The practice of upsetting ash or garbage cans is one which no young citizen should allow in his neighborhood, for sanitary reasons. The best results in summer street cleaning are obtained by washing or flushing the streets, for thus the dirt containing germs is prevented from getting into the air. The garbage is removed in carts, and part of it is burned in huge furnaces. The animal and plant refuse is cooked in great tanks; from this material the fats are extracted, and the solid matter is sold for fertilizer. Ashes are used for filling marsh land. Thus the removal of waste matter may pay for itself in a large city.

An Experiment in Civic Hygiene.--During the summer of 1913 an interesting experiment on the relation of flies and filth to disease was carried on in New York City by the Bureau of Public Health and Hygiene of the New York Association for improving the condition of the poor. Two adjoining blocks were chosen in a thickly populated part of the Bronx near a number of stables which were the sources of great numbers of flies. In one block all houses were screened, garbage pails were furnished with covers, refuse was removed and the surroundings made as sanitary as possible. In the adjoining block conditions were left unchanged. During the summer as flies began to breed in the manure heaps near the stables all manure was disinfected. Thus the breeding of flies was checked. The campaign of education was continued during the summer by means of moving pictures, nurses, boy scouts, and school children who became interested.

At the end of the summer it was found that there had been a considerable decrease in the number of cases of fly-carried diseases and a still greater decrease in the total days of sickness (especially of children) in the screened and sanitary block. The table and pictures speak for themselves. If such a small experiment shows results like this, then what might a general clean-up of a city show?

Public Hygiene.--Although it is absolutely necessary for each individual to obey the laws of health if he or she wishes to keep well, it has also become necessary, especially in large cities, to have general supervision over the health of people living in a community. This is done by means of a department or board of health. It is the function of this department to care for public health. In addition to such a body in cities, supervision over the health of its citizens is also exercised by state boards of health. But as yet the government of the United States has not established a Bureau of Health, important as such a bureau would be.

The Functions of a City Board of Health.--The administration of the Board of Health in New York City includes a number of divisions, each of which has a different work to do. Each is in itself important, and, working together, the entire machine provides ways and means for making the great city a safe and sanitary place in which to live. Let us take up the work of each division of the health board in order to find out how we may cooperate with them.

The Division of Infectious Diseases.--Infectious diseases are chiefly spread through _personal contact_. It is the duty of a government to prevent a person having such a disease from spreading it broadcast among his neighbors. This can be done by _quarantine_ or _isolation_ of the person having the disease. So the board of health at once isolates any case of disease which may be communicated from one person to another. No one save the doctor or nurse should enter the room of the person quarantined. After the disease has run its course, the clothing, bedding, etc., in the sick room is fumigated. This is usually done by the board of health. Formaldehyde in the form of candles for burning or in a liquid form is a good disinfectant. In disinfecting the room should be tightly closed to prevent the escape of the gas used, as the object of the disinfection is to kill all the disease germs left in the room. In some cases of infectious disease, as scarlet fever, it is found best to isolate the patients in a hospital used for that purpose. Examples of the most infectious diseases are measles, scarlet fever, whooping cough, and diphtheria.

Immunity.--In the prevention of germ diseases we must fight the germ by attacking the parasites directly with poisons that will kill them (such poisons are called _germicides_ or _disinfectants_), and we must strive to make the persons coming in contact with the disease unlikely to take it. This insusceptibility or _immunity_ may be either natural or acquired. Natural immunity seems to be in the constitution of a person, and may be inherited. Immunity may be acquired by means of such treatment as the antitoxin treatment for diphtheria. This treatment, as the name denotes, is a method of neutralizing the poison (toxin) caused by the bacteria in the system. It was discovered a few years ago by a German, Von Behring, that the serum of the blood of an animal immune to diphtheria is capable of neutralizing the poison produced by the diphtheria-causing bacteria. Horses are rendered immune by giving them the diphtheria toxin in gradually increasing doses. The serum of the blood of these horses is then used to inoculate the patient suffering from or exposed to diphtheria, and thus the disease is checked or prevented altogether by the antitoxin injected into the blood. The laboratories of the board of health prepare this antitoxin and supply it fresh for public use.

It has been found from experience in hospitals that deaths from diphtheria are largely preventable by _early use_ of antitoxin. When antitoxin was used on the first day of the disease no deaths took place. If not used until the second day, 5 deaths occurred in every hundred cases, on the third day 11 deaths, on the 4th day 19 deaths, and on the 5th day 20 deaths out of every hundred cases. It is therefore advisable, in a suspected case of diphtheria, to have antitoxin used at once to prevent serious results.