A Handbook of Health

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[Illustration: DEATH-RATE FROM DIPHTHERIA AND CROUP

Statistics from the City of New York. Antitoxin was used largely from
1893-95, during which time there was a steady decrease (from 60% to 30%)
in the death-rate. After the Board of Health took up the matter,
furnishing antitoxin without cost, the death-rate continued to decrease
to less than 10% of the total number of cases, in 1909.]

With this remedy, our entire feeling toward diphtheria is changed.
Instead of dreading it above all things, we know now, from hundreds of
thousands of cures, that, if a case is seen on the first day of the
disease, and this antitoxin injected with a hypodermic needle, it is
almost certain that the patient will recover; not more than two or three
cases out of a hundred will fail. If the case is seen and treated on the
second day, all but four or five out of a hundred will recover; and if
on the third day, all but ten. In fact, the average death rate of
diphtheria has been cut down now from forty-five per cent to about six
per cent.

We now have antitoxins, or _vaccines_, for blood-poisoning; for typhoid
fever; for one of the forms of rheumatism; for boils; for the terrible
_cerebro-spinal meningitis_, or "spotted fever"; and for tetanus, or
lock-jaw. And every year there are one or two other diseases added to
the list of those that have been conquered in this way.

None of these vaccines is so powerful, or so certain in its effects, as
the diphtheria antitoxin. But they are very helpful already; and some of
them, particularly the typhoid vaccine, are of great value in preventing
the attack of the disease, as small doses of it given to persons who
have been exposed to the infection, or are obliged to drink infected
water, as in traveling or in war, very greatly lessen their chances of
catching the disease.

Vaccination, the Great Cure for Smallpox. Another valuable means of
preventing disease by means of its germs is by putting very small doses
of the germs into a patient's body, so that they will give him a very
mild attack of the disease, and cause the production in his blood of
such large amounts of antitoxin that he will no longer be liable to an
attack of the violent, or dangerous, form of the disease. Vaccines, for
this purpose, usually consist either of a very small number of the
disease germs, or of a group of them, which have been made to grow upon
a very poor soil or have been chilled or heated so as to destroy their
vitality or kill them outright. When these dead, or half-dead, bacilli
are injected into the system, they stir up the body to produce promptly
large amounts of its antitoxin. In some cases the reaction is so prompt
and so vigorous that the antitoxin is produced almost without any
discomfort, or disturbance, and the patient scarcely knows anything
about it. In others there will be a slight degree of feverishness, with
perhaps a little headache, and a few days, or hours, of discomfort. When
this has passed, then the individual is protected against that disease
for a period varying from a few months to as long as seven or eight
years, or even for life.

The best-known and oldest illustration of the use of these vaccines is
that of _smallpox_. A little more than a hundred years ago, an English
country doctor by the name of Jenner discovered that the cows in his
district suffered from a disease accompanied by irritation upon their
skins and udders, which was known as "cowpox." The dairymaids who milked
these cows caught this disease, which was exceedingly mild and was all
over within four or five days; but after that the maids would not take
smallpox, or, as we say, were immune against it. Smallpox at that time
was as common as measles is now. Nearly one-fourth of the whole
population of Europe was pock-marked, and over half the inmates in the
blind asylums had been made blind by smallpox. So common was it that it
was quite customary to take the infectious matter from the pocks upon
the skin of a mild case and inoculate children with it, so as to give
them the disease in mild form and thus protect them against a severe, or
fatal, attack; just as in country districts, a few years ago, some
parents would expose their children to measles when it happened to be a
mild form, so as to "have it over with."

It occurred to Dr. Jenner that if this inoculation with cowpox would
protect these milkmaids, it would be an infinitely safer thing to use to
protect children than even the mildest known form of inoculation. So he
tried it upon two or three of his child patients, after explaining the
situation to their parents, and was perfectly delighted when, a few
months afterward, these children happened to be exposed to a severe case
of smallpox and entirely escaped catching the disease. This was the
beginning of what we now call _vaccination_.

The germ of cowpox, which is believed to be either the cow or horse
variety of human smallpox, is cultivated upon healthy calves. The matter
formed upon their skin is collected with the greatest care; and this is
rubbed, or scraped, into the arm of the child. It is a perfectly safe
and harmless cure; and although it has been done millions of times,
never has there been more than one death from it in 10,000 cases. In a
little over a hundred years it has reduced smallpox from the commonest
and most fatal of all diseases to one of the rarest. But in every
country in the world into which vaccination has not been introduced,
smallpox rages as commonly and as fatally as ever. For instance, between
1893 and 1898 in Russia, where a large share of the people are
unvaccinated, 275,000 deaths occurred from smallpox; in Spain, where the
same condition exists, 24,000. In Germany, on the other hand, where
vaccination is practically universal, there were in the same period only
287 deaths--1/1000 as many as in Russia; and in England, only a slightly
greater number.

Another illustration, which comes closer home, is that of the Philippine
Islands. Before they were annexed by the United States, vaccination was
rare, and thousands of deaths from smallpox occurred every year. In
1897, after the people had been thoroughly vaccinated, there was not a
single death from this cause in the whole of the Islands.

[Illustration: BILL OF HEALTH

No outgoing ship may "clear the port" without a Bill of Health, signed
by the Collector of Customs and the naval officer of the Port.]

This discovery of Jenner's was most fortunate; for vaccination remains
until this day absolutely the only remedy of any value whatever that we
possess against smallpox.

Quarantine, inoculation, improvement of living and sanitary conditions,
the use of drugs and medicines of all sorts other than vaccination, have
no effect whatever upon either the spread or the fatality of the
disease. The author, when State Health Officer of Oregon, saw the
disease break out in a highly-civilized, well-fed, well-housed
community, and kill eleven out of thirty-three people attacked, just as
it would have done in the "Dark Ages." Not one of the cases that died
had been vaccinated; and, with but one exception (and in this the proof
of vaccination was imperfect), every vaccinated case recovered.
Vaccination will usually protect for from five to ten years; then it is
advisable to be re-vaccinated, and in six to eight years more, another
vaccination should be attempted. This third vaccination will usually not
"take," for the reason that two successful vaccinations will usually
protect for life.

Unexpected as it may seem, vaccination is not only a preventive of
smallpox, but a cure for it. The reason being that _vaccinia_, the
disease resulting from successful vaccination, being far milder than
smallpox, runs its course more quickly,--taking only two days to
develop,--while smallpox requires anywhere from seven to twenty days to
develop after the patient has been infected, or exposed. So, if anyone
who has been exposed to smallpox is vaccinated any time within a week
after exposure, the vaccine will take hold first, and the patient will
have either simple vaccinia, with its trifling headache and fever, or
else a very mild form of smallpox.

Some persons object to having children deliberately infected with even
the mildest sort of disease; but this is infinitely better than to
allow, as was the case before vaccination, from one-fourth to one-fifth
of them to be killed, twenty-five per cent of them to be pock-marked,
and ten per cent of them to be blinded by this terrible disease. So far
as any after-effects of vaccination are concerned, careful investigation
of hundreds of thousands of cases has clearly shown that it is not so
dangerous as a common cold in the head.

Infantile Paralysis. Another disease that has been unpleasantly
famous of late is also caused and spread by a germ. This is a form of
laming or crippling of certain muscles in childhood known as _infantile
paralysis_. It is not a common disease, though during the last two years
there has been an epidemic of it in the United States, especially in New
York and Massachusetts. The only things of importance for you to know
about it are that it begins, like the other infections, with headache,
fever, and usually with "snuffles" or slight sore throat, or an attack
of indigestion; and that its germ is probably spread by being sneezed or
coughed into the air from the noses and throats of the children who have
it, and breathed in by well children. The best known preventive of
serious results from this disease is the same as in the rest of
infectious diseases, namely, rest in bed, away from all other children,
which at the same time stops the spread of it. It furnishes one more
reason why all children having the "snuffles" and sore throat with fever
and headache should be kept away from school and promptly put to bed and
kept there until they are better.

The reason why the disease produces paralysis is that its germs
specially attack the spinal cord, so as to destroy the roots of the
nerves going to the muscles. Unless the harm done to the spinal cord is
very severe, other muscles of the arm or the leg can very often be
trained to take the place and to do the work of the paralyzed muscles,
so that while the limb will not be so strong as before, it will still be
quite useful.

Malaria. Practically the only disease due to animal germs, which is
sufficiently common in temperate or even subtropical regions to be of
interest to us, is _malaria_, better known perhaps as _ague_, or
"chills-and-fever." This disease has always been associated with swamps
and damp marshy places and the fogs and mists that rise from them;
indeed its name, _mal-aria_, is simply the Italian words for "bad air."
It is commonest in country districts as compared with towns, in the
South as compared with the North, and on the frontier, and usually
almost disappears when all the ponds and swamps in a district are
drained and turned into cultivated land or meadows.

About four hundred years ago, the Spanish conquerors of America were
fortunate enough to discover that the natives of Peru had a bitter,
reddish bark, which, when powdered or made into a strong tea, would cure
ague. This, known first as "Peruvian bark," was introduced into Europe
by the intelligent and far-sighted Spanish Countess of Chincon; and, as
she richly deserved, her name became attached to it--first softened to
"cinchona" and later hardened to the now famous "quinine." But for this
drug, the settlement of much of America would have been impossible. The
climate of the whole of the Mississippi Valley and of the South would
have been fatal to white men without its aid.

[Illustration: GERMS OF MALARIA

(Greatly magnified)

These germs are animal germs and are in the red blood corpuscles,
feeding on them.]

But although we knew that we could both break up and prevent malaria by
doses of quinine large enough to make the head ring, we knew nothing
about the cause--save that it was always associated with swamps and
marshy places--until about forty years ago a French army surgeon,
Laveran, discovered in the red corpuscles of the blood of malaria
patients, a little animal germ, which has since borne his name. This,
being an animal germ, naturally would not grow or live like a plant-germ
and must have been carried into the human body by the bite of some other
animal. The only animals that bite us often enough to transmit such a
disease are insects of different sorts; and, as biting insects are
commonly found flying around swamps, suspicion very quickly settled
upon the mosquito.

[Illustration: CULEX

Position on the wall.--After Berkeley.]

By a brilliant series of investigations by French, Italian, English, and
American scientists, the malaria germ was discovered in the body of the
mosquito, and was transmitted by its bite to birds and animals. Then a
score or more of eager students and doctors in different parts of the
world offered themselves for experiment--allowed themselves to be bitten
by infected mosquitoes, and within ten days developed malaria. At first
sight, this discovery was not very encouraging; for to exterminate
mosquitoes appeared to be as hopeful a task as to sweep back the
Atlantic tides with a broom. But luckily it was soon found that the
common piping, or singing, mosquito (called from his voice _Culex
pipiens_) could not carry the disease, but only one rather rare kind of
mosquito (the _Anopheles_), which is found only one-fiftieth as commonly
as the ordinary mosquito. It was further found that these
malaria-bearing mosquitoes could breed only in small puddles, or pools,
that were either permanent or present six months out of the year, and
that did not communicate with, or drain into, any stream through which
fish could enter them. Fish are a deadly enemy of the mosquito and
devour him in the stage between the egg and the growth of his wings,
when he lives in water as a little whitish worm, such as you may have
seen wriggling in a rain-barrel.

[Illustration: ANOPHELES

Position on the wall.--After Berkeley.]

It was found that by hunting out a dozen or twenty little pools of this
sort in the neighborhood of a town full of malaria, and filling them up,
or draining them, or pouring kerosene over the surface of the water, the
spread of the malaria in the town could be stopped and wiped out
absolutely. This has been accomplished even in such frightfully malarial
districts as the Panama Canal Zone, and the west coast of Africa, whose
famous "jungle fever" has prevented white men from getting a foothold
upon it for fifteen hundred years. Since the young mosquitoes, in the
form of wrigglers, or _larvae_, cannot grow except in still water,
draining the pools kills them; and, as they must come to the surface of
the water to breathe, pouring crude petroleum over the water--the oil
floating on the surface and making a film--chokes them.

The common garden mosquito, while not dangerous, is decidedly a nuisance
and can be exterminated in the same way--by draining the swamps and
pools, or by flooding them with crude petroleum,--or by draining swamps
or pools into fresh-water ponds and then putting minnows or other fish
into these ponds. There is no reason why any community calling itself
civilized should submit to be tormented by mosquitoes if it will spend
the few hundred, or the thousand, dollars necessary to wipe them out. It
is prophesied that the use of quinine will soon become as rare as it is
now common, because malaria will be wiped out by the prevention of the
mosquito.

Disinfectants. So far we have been considering how to attack the germs
after they have got into our bodies, or to prevent them from spreading
from one patient to another; but there is still another way in which
they may be attacked, and that is by killing, or poisoning them, outside
the body. This process is generally known as _disinfection_, and is
carried out either by baking, boiling, or steaming, or by the use of
strongly poisonous fluids or gases, known as _disinfectants_.

While fortunately none of these disease germs can breed, or reproduce
their kind, outside the human body, and while comparatively few of them
live very long outside the human body, they may, if mixed with food or
caught upon clothing, hangings, walls, or floors, remain in a sort of
torpid, but still infectious, condition for weeks or even months.
Consequently, it has become the custom to take all the bedding,
clothing, carpets, curtains, etc., that have touched a patient suffering
from a contagious disease, or have been in the room with him, and also
any books that he may have handled, any pens or pencils that he may have
used, and either destroy them, or bake, boil, or fumigate them with some
strong germicidal, or disinfectant, vapor.

[Illustration: OILING A BREEDING GROUND OF MOSQUITOES

The photograph shows work done in the Panama Canal Zone. The swamp has
already been drained by ditches, and the work of destroying the larvae is
being completed by the use of oil.]

This is usually done by closing up tightly the sick-room, putting into
it all clothing, bedding, pictures, books, hangings, and other articles
used during the illness (except wash-goods, which, of course, can be
sterilized by thorough boiling; and dishes and table utensils, which
also can be scalded and boiled); draping the carpet over chairs so as
to expose it on all sides, opening closets and drawers, and then filling
the room full of some strong germ-destroying fumes.

One of the best disinfectants, and the one now most commonly used by
boards of health for this purpose, is _formaldehyde_--a pungent,
irritating gas, which is an exceedingly powerful germ-destroyer. This,
for convenience in handling is usually dissolved, or forced into water,
which takes up about half its bulk; and the solution is then known as
_formalin_.

When formalin is poured into an open dish, it rapidly evaporates, or
gives up its gas; and, if it be gently heated, this will be thrown off
in such quantities as to completely fill the room and penetrate every
crevice of it, and every fold of the clothing or hangings. One pound, or
pint, of formalin will furnish vapor enough to disinfect a room eight
feet square and eight feet high, so the amount for a given room can thus
be calculated. The formalin vapor will attack germs much more vigorously
and certainly if it be mixed with water vapor, or steam; so it is
usually best either to boil a large kettle of water in the room for half
an hour or more, so as to fill the air with steam, before putting in the
formalin, or to use a combination evaporator with a lamp underneath it,
which will give off both formalin and steam. This, if lighted and placed
on a dish in the centre of a wash-tub or a large dishpan, with two or
three inches of water in the bottom of it, can be put into the room and
left burning until it goes out of its own accord.

Another very good method is to take a pan, or basin, with the required
amount of formalin (not more than an inch or two inches deep) in the
bottom of it, get everything ready with doors and windows fastened tight
and strips of paper pasted across the cracks, pour quickly over the
formalin some permanganate of potash (about a quarter of a pound to each
pound of formalin), and then bolt for the door as quickly as possible
to avoid suffocation. The resulting boiling up, or effervescence, will
throw off quantities of formaldehyde gas so quickly as to drive it into
every cranny and completely through clothing, bedding, etc. The room
should be left closed up tightly for from twelve to thirty-six hours,
when it can be opened--only be careful how you go into it, first
sniffing two or three times to be sure that all the gas has leaked out,
or holding your breath till you can get the windows open; and in a few
hours the room will be ready for use again.

Another older and much less expensive disinfectant for this purpose is
common _sulphur_. From one to three pounds of this, according to the
size of the room, is burned by a specially prepared lamp in a pan placed
in the centre of a dishpan of water, and the vapor thus made is a very
powerful disinfectant. This, however, is a very poisonous and
suffocating gas (as you will remember if you have ever strangled on the
fumes of an old-fashioned sulphur match) and, compared with formalin, is
nearly five times as poisonous to human beings, or animals, and not half
so much so to the germs. Where formalin cannot be secured, sulphur is
very effective; but its only merit compared with formalin is that it is
cheaper, and more destructive to animal parasites and vermin such as
bugs, cockroaches, mice, rats, etc., when these happen to be present.
Formalin has the additional advantage of not tarnishing metal surfaces,
as sulphur does.

It is a good thing for every household and every schoolroom to have a
bottle of formalin on hand, so that you may sniff the vapor of it into
your nostrils and throat if you think you have been exposed to a cold,
or other infectious disease, or make a solution with which to wash your
hands, handkerchiefs, pencils, etc., after touching any dirt likely to
contain infection. Half a teaspoonful in a bowl of water is enough for
this. A saucerful of it placed in an air-tight box, or cabinet, will
make a disinfecting chamber in which pencils, books, etc., can be placed
over night; and a teaspoonful of it in a quart of water will make an
actively germ-destroying solution, which can be used to soak clothing,
clean out bedroom utensils, or pour down sinks, toilets, or drains. It
is a good thing also to pour a few teaspoonfuls occasionally on the
floor of the closets in which your shoes, trousers, dresses, and other
outdoor clothing are kept, as these are quite likely to be contaminated
by germs from the dust and dirt of the streets.

Formalin is one of the best and safest general disinfectants to use. Its
advantages are, that it is nearly ten times as powerful a germicide as
carbolic acid, or even corrosive sublimate, so that it may be used in a
solution so weak as to be practically non-poisonous to human beings. It
is so violently irritating to lips, tongue, and nostrils as to make it
almost impossible for even a child to swallow it, while the amount that
would be absorbed if taken into the mouth and spit out again would be
practically harmless, so far as danger to life is concerned, though it
would blister the lips and tongue.

Bacteria, our Best Friends. While, naturally, the bacteria that do us
harm by producing disease are the ones that have attracted our keenest
attention and that we talk about most, it must never be forgotten that
they form only a very, very small part of the total number of bacteria,
or germs. These tiny little germs swarm everywhere; and the mere fact
that we find bacteria in any place, or in any substance, is no proof
whatever that we are in danger of catching some disease there.

All our farm and garden soil, for instance, is full of bacteria that not
only are harmless, but give that soil all its richness, or fertility. If
you were to take a shovelful of rich garden earth and bake it in an
oven, so as to destroy absolutely all bacteria in it, you would have
spoiled it so that seeds would scarcely grow in it, and it would not
produce a good crop of anything. These little bacteria, sometimes called
the soil-bacteria, or bacteria of decay, swarm in all kinds of dead
vegetable and animal matter, such as leaves, roots, fruits, bodies of
animals, fishes, and insects, and cause them to decay or break down and
melt away. In doing this they produce waste substances, particularly
those that contain ammonia, or nitrates, or some other form of nitrogen,
which are necessary for the growth of plants or crops.

This is why soil can be made richer by scattering over it and plowing
into it manure, waste from slaughter houses, or any other kind of
decaying animal or vegetable matter. This is promptly attacked by the
bacteria of the soil and turned into these easily soluble plant foods.
The roots of the plants grown in the soil could no more take this food
directly from dead leaves or manure than you could live on sawdust or
cocoanut matting.

So, if it were not for these bacteria, or lower plants, there could be
no higher, or green, plants. As animals live either upon these green
plants, such as grass and grains, or upon the flesh of other animals
that live upon plants, we can see that without the bacteria there would
be no animal life, not even man. No bacteria, no higher life. It would
be safe to say that, out of every million bacteria in existence, at
least 999,999 are not only not harmful but helpful to us.

One large group of bacteria produces the well-known souring of milk; and
while this in itself is not especially desirable, yet the milk is still
wholesome and practically harmless, and its sourness prevents the growth
of a large number of other bacteria whose growth would quickly make it
dangerous and poisonous. Many races living in hot countries deliberately
sour all the milk directly after milking, by putting sour milk into it,
because, when soured, it will keep fairly wholesome for several days,
while if not soured it would entirely spoil and become unusable within
twenty-four hours.

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