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endurance; its flexibility and power of adjusting to varying conditions may even be stimulated thereby. But even slight fatigue, if continued and especially if associated with anxiety or worry, has caused many nervous and mental breakdowns.

Work carried beyond the point of normal fatigue requires a proportionately longer time for recovery. For example, if the point of fatigue has been reached by a certain finger muscle after 15 contractions, and if half an hour is required to rest it completely, one might suppose that one hour would rest it after 30 contractions. This is not so, however; after 30 contractions 2 hours are required, or 4 times as much rest for twice the amount of work, if continued beyond the point of fatigue. Laboratory experiments and experience alike show that this principle holds true in other forms of fatigue. Thus the output of factories has been shown in many instances to be greater, other things being equal, when operatives work 8 hours a day than when they work longer. Excessive hours in any kind of work are the poorest economy.

Fatigue is increased in direct proportion not only to muscular exertion but also to the amount of speed, complexity, responsibility, monotony, noise, and confusion involved in an occupation. Ability to bear fatigue differs greatly with different people, as ability varies to bear other kinds of strain. Rest at night and on Sunday, and the annual vacation should be enough to keep a person in good condition. If not, there is probably something wrong with the worker's health, the nature of his work, or his adaptation to his particular kind of work. This statement is not only true of persons regularly employed, but of those living at home, including children in school, women in "society," and especially mothers of families.

Sleep.

—A sufficient amount of sleep is essential to health, but individual requirements vary widely. Each person should know and regard his own need, and children and young people should be obliged to go to bed early. Ability to sleep is largely habit; good habits should be formed and continued. Sleep-producing drugs should never be taken, except by a doctor's prescription.

Recreation.

—Owing to the speed, complexity, and worry of modern life among all classes, and to the monotony of work in industry, recreation has become a matter of vital importance for everyone. Some muscular activity, preferably in the open air, is needed by every healthy person. Recreation should be as unlike the regular occupation as possible: going to the theatre, for example, is not the best exercise for sedentary workers employed all day in artificially lighted offices. The element of pleasure is essential. Hoisting dumb-bells purely from conscientious motives is seldom beneficial, and is generally soon abandoned.

The part played by habit in matters of health is often overlooked. Although the body adjusts itself to widely varying conditions and even to unfavorable ones, the importance of forming desirable habits cannot be overemphasized. Sudden or radical changes in living, however, particularly among people no longer young, may play havoc. New and violent systems of exercise, weight reduction, and food fads forced on families by enthusiastic discoverers involve considerable risk.

Many elements enter into health; in no single one is found hygienic salvation. Temptation always exists to emphasize one element at the expense of others. For instance, people who insist upon overventilating rooms regardless of others' comfort may themselves be utterly careless in regard to necessary sleep, and more than one fastidiously clean person has disregarded the highly unclean condition of constipation. To maintain sound health only a rational program will suffice: properly balanced work and play, sleep and food and all other elements must be included in due proportion. And over-anxious health seekers might well remember that health is not so much an end in itself, as a means to a happy and productive life; even in concern over health, it is possible for him that saveth his life to lose it.

EXERCISES Explain the difference between an hereditary disease and hereditary susceptibility to a disease. How may hereditary susceptibility to a disease be combatted? What are the essentials of good ventilation? What is the proper temperature for a living room? What are the effects of higher temperatures? Of lower temperatures? Describe methods for maintaining household cleanliness. Discuss the importance from the point of view of health, of dust; of insects; of garbage; of sewage. What principles should guide one in deciding whether a certain water supply is safe to use for drinking purposes? What are the dangers of impure water? How can impure water be rendered safe? What diseases may be carried by milk? How can milk be rendered safe? Explain the health aspects of personal cleanliness. What care should be given the teeth and mouth? Why? What bad results frequently follow constipation? How should constipation be remedied? Name seven factors that are important in causing fatigue. Why is it uneconomical to continue work, either physical or mental, beyond the point of fatigue? What facilities for recreation, especially in the open air, does your community provide for little children? For school children? For working boys and girls? For grown people? FOR FURTHER READING Health and Disease—Roger I. Lee, Introduction and Chapters I, III-V, VII-IX. How to Live—Fisher and Fisk, Chapters I, III-V. The Human Mechanism—Hough and Sedgwick, Chapters V, XXII-XXIX. Disease and Its Causes—Councilman, Chapters X, XII. Fatigue and Efficiency—Goldmark, Chapters II, III. Preventive Medicine and Hygiene—Rosenau. A Manual of Personal Hygiene—6th Edition, Edited by Walter L. Pyle. Four Epochs of a Woman's Life—Galbraith. Hygiene and Physical Culture for Women—Galbraith. The Home and Its Management—Kittredge. Exercise and Health—F. C. Smith, Supplement 24 to the Public Health Reports, Government Printing Office, Washington. The Sanitary Privy—Farmers' Bulletin 463, United States Department of Agriculture, Government Printing Office, Washington. Safe Disposal of Human Excreta at Unsewered Homes—Lumsden, Stiles and Freeman, Bulletin 68, Public Health Reports, Government Printing Office, Washington. The Disposal of Human Excreta and Sewage of the Country Home—New York State Department of Health, Albany. Milk and Its Relation to Public Health—Bulletin 56, Hygienic Laboratory, Government Printing Office, Washington. Milk and Its Relation to Health—New York State Department of Health, Albany. Other Publications of the United States Public Health Service and of the Departments of Health of the different states and cities.

CHAPTER III

BABIES AND THEIR CARE

The principles of hygiene are fundamentally the same for young and old. The applications, however, differ at different ages. From the time when physical growth and development are complete until changes due to old age appear, an individual commonly has greater resistance than at other ages, and is able in consequence to endure unfavorable conditions of life with more success.

Babies, on the other hand, are exceedingly sensitive to their environment. Surroundings that are even slightly unfavorable are likely to make babies sick. In order to remain healthy, they must have exactly the right kind of food, in the right quantities and at the right times; their sleep, exercise, and clothing must be carefully regulated; they must be protected from careless handling, from nervous strain, and above all, from the many kinds of infection to which they are peculiarly susceptible. The life of a baby fortunately can be controlled almost completely; when properly regulated it offers, therefore, an unequalled opportunity to see how hygienic principles work out in actual practice.

The primitive mother's instinct to nourish and protect and succor her helpless child was the original form of nursing. Instinct alone, unfortunately, has never accomplished much in preserving health. The human race has now had an experience in the care of infants that extends over thousands of years. Yet today we are still, on the whole, less successful in keeping babies alive than we are in raising domestic animals; we still allow society to continue, like a modern Herod, in its ruthless career of slaughtering the innocents.

About 14 babies out of every 100 born in the registration area[1] of the United States die before reaching the age of one year, while in some of our industrial cities as many as 25 out of every 100 born die before they are a year old. Most of these deaths are preventable. Thus, in a few American cities, the death rates have been so reduced that fewer than 10 babies out of every 100 die before completing the first year; while in Dunedin, New Zealand, as a result of the work of the Society for the Health of Women and Children, the infant death rate has been so reduced that in 1912 only about 4 out of every 100 babies died before they were a year old.

While ignorant mothers, who may or may not be uneducated women, and contaminated milk, are as a matter of fact, chiefly responsible for our high infant death rates, yet as we have already seen, every factor in the environment has its effect upon a baby. This fact has led Sir Arthur Newsholme, an eminent English authority, to say:

"Infant Mortality is the most sensitive index we possess of social welfare. If babies were well born and well cared for, their mortality would be negligible. The infant death rate measures the intelligence, health, and right living of fathers and mothers, the standards of morals and sanitation of communities and governments, the efficiency of physicians, nurses, health officers, and educators."

Care of the child should begin at the earliest possible moment: that is, nearly nine months before he is born. Care before birth, for want of a better name, is called prenatal care of the mother. Every woman who thinks that she is pregnant should put herself at once under the care of a competent physician, so that he can make the necessary examinations as early as possible. If she follows his advice in regard to hygiene and proper regulation of her life, she may be free from anxiety, and may justly expect that her delivery will be a safe and normal process.

A demonstration of the value of prenatal care was recently made by the Boston District Nursing Association. During the year 1915 prenatal care was given to 751 expectant mothers in 5 wards of the city; each woman attended a pregnancy clinic, where she was under the care of an experienced obstetrician, and was visited at intervals by a nurse who kept careful watch of her general condition and gave necessary advice and encouragement. In consequence the death rate among the babies whose mothers had prenatal care was only half as great, through the whole first year of life, as the death rate of babies in the same wards whose mothers had not had prenatal care. Moreover, the rate of still-births was only half as great as the rate among the general population of Boston. If prenatal care can save so many lives, surely it ought to be available for every pregnant woman in the land, including even that generally neglected class of people who are neither very rich nor very poor.

Each baby's birth should be recorded by the registrar of births, and parents should make sure that registration has been attended to in the city or town where they live. In some states birth registration is already obligatory, but in any case it is required by the child's own interest. For instance, in later life it may be necessary for him to prove the date and place of birth in order to establish, among other things, his right to vote and to inherit property, and to settle the question of his liability to military service. Moreover, complete and accurate birth registration is needed by every community because it is essential to such reforms as reducing infant mortality and abolishing child labor.

GROWTH AND DEVELOPMENT

Statements in regard to growth and development are based on observations of many children. It should be remembered that

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