at the base of the brain, so that we have failure of respira-
8 THE PREVENTION OF DISEASE
tion and circulation in alcoholic poisoning, or drunkenness.
In fact, alcohol acts like ether, only its action is much
slower, because it has to be absorbed from the stomach in-
stead of being absorbed in the form of vapor by the lungs.
It is a well-known physiologic fact that the functions
of the brain which have most recently developed in the
evolutionary course of ages are the first to succumb to the
action of drugs. Alcohol decreases or depresses the higher
brain functions of will, self-control, reason and judg-
ment, and sets us back on the animal plane. This is seen
in the conduct of one under the influence of alcohol, when
modesty is lost, demeanor and speech become free and
uncontrolled (in vino veritas), and the subject is thought-
less of others, is reckless, oversanguine and confident, and
deficient in reasoning power and judgment.
The false feeling of stimulation comes from the more
ready effect of outside stimuli, as through mental excite-
ment produced by social intercourse, the warmth of the
skin and stomach, and enhanced emotional and imagina-
tive functions. In many persons, especially when alone,
and in animals alcohol only produces depression, dulness,
and stupor from the start, and is frequently used for this
reason to overcome sleeplessness.
The depression of the higher brain centers by alcohol is
also seen in the impairment of sight, hearing, and touch,
although the subject feels that the contrary is true. Type-
setters make more errors, musicians strike more false
notes under alcohol. On the other hand, muscular power
is increased for a short time (up to half an hour) by alcohol,
but later there is a corresponding loss of strength as great
as 50 per cent, sometimes. For sustained effort alcohol
is inadvisable. Soldiers endure longer on the march with-
out it, and the Germans have found that sugar or chocolate
is superior.
ALCOHOL 9
The removal of abnormal constraint and self-conscious-
ness by alcohol may be of advantage to public speakers, in
allowing greater freedom of speech and gestures, and in
giving the musician greater power of emotional expression
and^abandon. But the danger of overstepping the mark
and producing stupefaction, and the greater peril of form-
ing an unconquerable habit, make such use of alcohol
unwise.
In removing the normal restraint exercised by the brain
over the sexual desires alcohol is the chief means of leading
youth into immorality. This it does in two ways first, by
diminishing the will power, and, second, by increasing the
animal desires hence, "weib" is the natural corollary of
"wein" ("wein, weib, und gesang").
The word "stimulant" is almost synonymous with alco-
hol in the popular mind. In reference to the circulation, al-
cohol in concentration (as when whisky or brandy are given
with an equal amount of water) stimulates the heart by
irritating the mouth and throat. This stimulation is
marked, yet lasts but a few moments. After the alcohol
is absorbed it has very slight stimulating effect on the
heart.
Alcohol is no longer habitually employed as a heart
stimulant in fevers, exhausting disease, and conditions of
acute heart weakness (pneumonia), but is one of the best
agents for use by the layman in emergencies, for its fleeting,
stimulant action in faintness, after emotional and nervous
shocks, and after accidents. But do not give such an
amount as to depress and intoxicate the patient, as only
too frequently results from the overwillingness of the
anxious layman. Two to four tablespoonfuls of whisky or
brandy, with an equal amount of water, constitute a suit-
able dose.
The action of alcohol in imparting a sensation of warmth
10 THE PREVENTION OF DISEASE
to the skin, stomach, and face gives one a false sense of its
stimulating effect. This is not stimulation, but dilatation
of the blood-vessels. So far from being an evidence of
stimulation, relaxation of the vessels results in fainting from
lack of blood in the brain, if excessive. The injurious action
of alcohol in those exposed to cold is accounted for by its
influence on the blood-vessels. The lowest temperatures
ever seen in the human body have occurred in intoxicated
persons exposed to cold. Alcohol is tabooed in Arctic
exploration on this account. By dilating the blood-vessels
of the skin alcohol permits of the largest amount of cooling
of the blood by external cold.
There is the now classic example of the effect of alcohol
upon an Alpine party, spending the night at a high altitude
after a hard day's climb, related by Brunton. Some of the
party refused alcohol and turned in cold and miserable;
others drank whisky in moderation, and retired feeling
wanner and more comfortable; while the remainder par-
took freely and slept oblivious to all hardship. In the
morning those who had refrained from alcohol awoke
refreshed and well, those who had taken a small amount
of alcohol found themselves cold and wretched, while
those who had indulged freely did not awake at all because
they were dead.
The only time that alcohol is indicated in such cases is
after the exposure to cold is past and when one enters a
warm house or bed.
Then one may overcome the chilliness by a glass of hot
water and whisky, and perhaps prevent "taking cold" by
dilating the vessels on the surface of the body, thus re-
storing the circulation to normal or equalizing the
circulation.
Alcohol has been truthfully called both a food and a
poison usually by opposing advocates. It is both. It
ALCOHOL 11
may take the place of starch and fat as a nutrient by sup-
plying energy in its combusion in the body, but without
requiring any digestive action of the stomach. Thus, in
states of severe exhaustion or disease, or following great
muscular or nervous strain, and in the aged it may be used
to advantage as a food.
In continued fevers alcohol is employed for this purpose
and for its narcotic action in allaying nervousness, rest-
lessness, and in promoting sleep.
Alcohol excites the appetite and enables one to eat more
than is good for him. It does not affect digestion notably,
unless in the case of strong alcoholic liquors, which increase
the acid of the gastric juice and favor the occurrence of
gastric catarrh. The starchy matters in malt liquors and
acids in some wines may retard digestion. The continu-
ous use of alcohol as a beverage must be condemned from
the food viewpoint because it destroys the vital organs,
produces chronic inflammation of the stomach, and tends
toward dulness and lessened capacity for muscular or
mental work and results in a vicious habit. So it is
probable that those who call alcohol a poison are nearer
the truth than those who affirm it to be a food.
It is a common experience among humans, and is as
frequently seen in experiments upon rabbits, that some
individuals may drink large quantities of alcohol for
years without inducing perceptible deterioration of their
vital organs.
Others soon break down with various disorders fatty
degeneration of the heart, liver, and kidneys, hardening
of the liver (cirrhosis) and arteries, Bright's disease of the
kidneys in some cases, and chronic catarrh of the stomach.
Inflammation and degeneration of the nervous system are
common meningitis, neuritis (inflammation of the surface
of the brain and nerves) , and hardening of the brain and
12 THE PREVENTION OF DISEASE
spinal cord. Great nervousness, insomnia, digestive dis-
turbance, or pain in the legs or elsewhere (neuritis) are
the symptoms which bring the drinker to the doctor.
To realize most poignantly the enormous number of
persons wrecked by alcohol one should be attending physi-
cian at a large city hospital.
The ordinary well-to-do and well-behaved individual has
no means of appreciating the true significance of drink.
Daily to see innumerable patients with delirium tremens
and its immediate sequel ("wet brain") in the more invet-
erate cases, with death or insanity resulting as a matter of
course, has a most impressive influence upon the Jeast
thoughtful. The insane asylum is another splendid place
to view the end-results of alcohol in the subject or his
progeny. Alcohol renders persons less resistant to infec-
tions, notably consumption and pneumonia. The latter
is also a peculiarly fatal disorder in the alcoholic.
While scientists may differ as to many details concern-
ing alcohol, there are some basic facts upon which all are
agreed. These are as follows: That alcohol is not of bene-
fit to any healthy person under normal conditions. That
the habitual use of a moderate amount of alcohol, or the
occasional use of an excessive quantity of alcohol, is dam-
aging to the health of normal individuals. That while the
moderate and occasional employment of alcohol by most
persons will produce no visible harm, in others there is
such an inherent and inborn demand for alcohol that it is
impossible for them to take it in moderation, and an in-
curable habit results. While technically a food, its intrin-
sic harmfulness is so great that alcohol may with pro-
priety be termed a poison. It is especially damaging to
women and children, though it may be of positive benefit
to the aged. As a stimulant, alcohol may be used to ad-
vantage for its immediate effect in reflexly stimulating the
TOBACCO 13
heart in emergencies (through its irritation of the mouth
and throat before absorption). Its use as a stimulant after
absorption from the stomach has been given up because
such action does not exist to any extent. It is not a stimu-
lant, but a stupifierof the nervous system, and its medicinal
influence in this direction is taken advantage of for the
production of sleep and quieting nervous excitement and
restlessness. Its frequent use for any reason is dangerous
in establishing a vicious habit.
Perhaps one of the most impressive statements concern-
ing the effect of a moderate use of alcohol is found in that
made by the actuary of the New York Life Insurance Co.,
who affirms that among the dpaths of 2,000,000 policy-
holders during a period of twenty-five years the "total
abstainers have a mortality during the working years of
life of about one-half that among those who use alcohol to
the extent of at least two glasses of whisky daily."
The world-wide prohibition movement depends upon
the exact knowledge of alcohol derived from the experi-
ments and experience of the medical profession, and its
altered attitude in respect to the use of alcohol, more than
upon any other factor.
TOBACCO
Tobacco is essentially a narcotic. In large amounts
narcotics (as bromids, opium, alcohol) produce stupor and
unconsciousness, but in small doses are sedative and sooth-
ing. Thus it is with tobacco. The narcotic influence is
exerted upon the brain. The action of tobacco upon the
circulation consists first in slowing and strengthening the
heart and contracting the blood-vessels, but this effect is
soon followed by depression and increased frequency of the
heart and dilatation of the blood-vessels. After- ^action
comes reaction, and long after the influence of tobacco just
14 THE PREVENTION OF DISEASE
described has worn off there is a period of nervous irrita-
bility and instability.
This is the "morning after" phenomenon, as seen fol-
lowing excessive smoking, more especially when the habit
is suddenly stopped.
The ill effects of the abuse of tobacco are well established
and are briefly as follows: (1) Disturbance of the cir-
culation. This is more commonly evidenced by pain about
the heart and a feeling of fluttering or beating in this
region, with shortness of breath on exertion and rapid,
irregular pulse. In some cases the pulse may be slow and
the blood-pressure unusually low. (2) Disturbance of the
nervous system. Headaches, dizziness, and a tremulous
condition of the hands are often observed. Lack of energy
and ambition, together with nervous irritability and men-
tal depression, result from overuse of tobacco. (3) Various
forms of indigestion may be occasioned by excessive smok-
ing, particularly that accompanied by increased acidity in
the stomach and heart-burn. (4) The paralyzing action
on special nerves. This is occasionally seen in partial
blindness or deafness, owing to the direct action of nico-
tin upon the optic or auditory nerves. In this form of
blindness the patient can see better in a dim light. (5)
Local action of tobacco smoke. Tobacco smoke irritates
the throat and also the eustachian tubes, which connect the
upper part of the throat with the middle ear. In this
way deafness from catarrh of the middle ear is not infre-
quently produced by excessive smoking.
Cigarette smokers have often a loud, ringing or barking,
dry cough, with harshness or hoarseness of voice from the
effects of the smoke upon the vocal cords. Then, in so-
called "smoker's tongue" there are formed white patches
(leukoplakia) not only on the tongue, but also upon the
inside of the cheeks in some cases. One of these patches
TOBACCO 15
is very prone to become cancerous after years unless smok-
ing is stopped and treatment begun. Cancer of the lower
lip, seen almost wholly in men, is thought to be due to
pressure of a pipe-stem. Of course, it goes without saying
that these troubles are not frequent occurrences in indi-
vidual smokers, or the hafoit would soon lose favor, but, in
the aggregate, there are great numbers of such cases. One
can never tell where the lightning will strike. The dis-
orders caused by tobacco are usually cured by complete
abstention from its use, and by living in a healthy manner,
with plenty of outdoor exercise and sleep.
But, since these troubles may also be attributed to other
causes, it will be impossible for a doctor to be sure that
tobacco is the source of any disorder until after complete
abstention from the weed for weeks.
There are still other serious physical and moral dangers
threatening the young who use tobacco. In a study of the
students at Yale and Amherst it has been found that
smokers are stunted in height, weight, and chest measure
as compared to non-smoking students. Meylan, at Co-
lumbia, concluded from a careful investigation that the
use of tobacco among the students leads to idleness, lack
of application, ambition, and scholarship.
Charles B. Towns, who is the most celebrated specialist
in drug habits in this country, insists that the harm done
by tobacco is greater in the aggregate than that from alco-
hol, cocain and opium, and that "nothing else at the pres-
ent time is contributing so surely to the degeneration of
mankind as tobacco."
This may seem like an extreme statement, but Towns
finds that he can rarely cure the alcoholic unless the patient
gives up smoking, because the smoker finds that alcohol is .
necessary to relieve the irritability and nervous depression
caused by the excessive use of tobacco.
16 THE PREVENTION OF DISEASE
The bad moral effect of tobacco upon boys is brought
about in various ways. They are often forced to smoke
surreptitiously, and to do this frequent the tobacco
shop, pool, or barroom, where they obtain cigarettes
and are naturally dragged downward by their surround-
ings.
A few words as to the composition of tobacco and the
effect of different methods of using it. The chief constit-
uent is one of the most powerful poisons known (nicotin),
an oily, colorless, pungent, volatile liquid, existing to the
extent of from 1 to 7 per cent, in tobacco. Virginia
tobacco is one of the strongest. The taste and flavor of
tobacco depend upon the development of a volatile oil in
the curing. The injury arising from tobacco is due to
nicotin and allied substances (pyridin and collidin), and
also to furfurol, an ingredient of fusel oil in raw whisky,
which causes the headache and other bad after-effects.
But much of the nicotin is destroyed by its combustion in
smoking, and there is said to be no furfurol in most of the
Turkish tobacco ("London Lancet").
The harmfulness of smoking depends in part upon the
amount of nicotin in the smoke. There is least in cigar-
ette smoke and most in pipe smoke, while the smoke from
cigars occupies an intermediate place. It has been found
that even when the same amount of tobacco is smoked in
the form of a cigarette and cigar, and the cigarette tobacco
is much the richer in nicotin, the resulting cigarette smoke
contains considerably less nicotin than the smoke from
the cigar. This follows because in the cigarette the to-
bacco is finer and drier and in a form to burn completely.
In the cigar, especially if green and moist, the nicotin
volatilizes in the damp area behind the flame and is in-
haled in the smoke. The black, moist, acrid mixture of
tobacco and saliva in the bowl of an old pipe distils off its
TOBACCO 17
nicotin when it becomes hot and produces the strongest
smoke. The thinner and drier a cigar, the milder it is,
because of its more complete combustion.
But cigarettes are most pernicious in their general
results chiefly because they are so mild that their smoke is
almost always inhaled. Inhalation increases the effect
of nicotin many times. The area with which the smoke
comes in contact in the lungs is enormous, and the lungs are
made for absorption of gas (air), and the action is extremely
rapid.
The opium habitue long ago discovered that he got more
speedy and effective action by smoking than by swallowing
the drug. Then, again, the cheapness and mildness of
cigarettes causes them to be smoked at all available mo-
ments, when a pipe or a cigar would require too much time
or expense. This applies particularly to boys, who now
take more frequently to cigarettes, when formerly they
would have had to smoke cigars or pipes. The danger of
the overwhelming nausea and depression, and the expense
involved in the use of these, was a great natural preventive
which has been done away with in the introduction of the
cigarette.
Cigarettes are most injurious, then, on account of the
custom of inhaling their smoke and the temptation to
smoke them continuously. There is about as much
tobacco in one cigar as in five or six cigarettes.
Smoking is partly a narcotic, or drug habit and partly
a psychic habit. The narcotic effect is seen in its soothing,
comforting action, in its relieving anxiety and worry, and
inducing a pleasant frame of mind. Its psychic influence
is brought about by holding an object in the mouth (as is
seen in the marvelous influence of sucking a blind nipple
in the case of an infant), by the rhythmic inhalation and
exhalation of the smoke, and by the hypnotic effect in
2
18 THE PREVENTION OF DISEASE
watching the smoke curl into fascinating and fantastic
shapes and rings.
The physiologic demand of the system for tobacco is
not so great as that for alcohol, cocain, or opium in
habitue's. In other words, on stopping the use of tobacco
part of the craving is psychic, and this may be relieved by
chewing gum, gentian, quassia, or lovage. The actual
demand of the system for the drug effect of tobacco can
then be resisted without great force of will, except in the
case of the inveterate smoker. One who smokes one
cigar daily after dinner may be classed a moderate smoker.
The harmful effect of smoking is much less after a hearty
meal.
The most practical result of smoking is lessened personal
efficiency. Towns goes so far as to state that smoking
diminishes the efficiency of an individual about 15 per
cent. Smoking is indubitably opposed to the highest de-
velopment of vigor and energy, or "pep," to use the pic-
turesque slang of the day. This result must be presented
forcibly to the youth who naturally desires to succeed in
business and sports.
Tennis and billiard players know that smoking inter-
feres with their accuracy of play and nervous power.
The matter of tobacco is in like case with other harmful
habits, for no sensible person will affirm that smoking
improves the health. Then it simply becomes a question
as to how much injury tobacco does. This depends upon
the personal constitution, the amount of nicotin absorbed,
and the occupation. Its effects may be imperceptible in a
parent, and yet lead to defective nervous organization in
the offspring, as is indisputably true of alcohol. If we are
smokers, we must confess ourselves fools to our sons in
order that they may improve upon their fathers.
OPIUM AND COCAIN 19
OPIUM AND COCAIN
Prevention of the morphin and cocain habits lies largely
with the medical profession. Morphin is taken by means
of the hypodermic syringe in most cases. It is first given
by physicians for the relief of pain. After morphin has
been administered for a month the patient has acquired the
habit and will need outside assistance to free himself from
it, even if he is no longer in pain from other causes.
Statutes to prevent the purchase of the hypodermic syr-
inge should be enacted. Only in New York at present
does such a law exist, owing to the benevolent energy of
Charles B. Towns. Physicians should hesitate to inject
morphin except for unbearable pain of short duration.
They should never entrust a patient with a hypodermic
syringe except under most unusual circumstances. There
appear to be over 100,000 opium habitues in the United
States, averaging over 8 grains of morphin as a daily
dose.
The cocain habit is begun because of the exhilaration
and relief afforded when the drug is used by doctors for
treatment of cold in the head or other nasal troubles.
It is very stimulating for a short time, and depression,
which follows within about twenty minutes, excites a
demand for more. It is the most difficult of all habits to
break. Patent remedies containing morphin and cocain
are also responsible for initiating the habit.
Members of the underworld acquire the morphin and
cocain habits from association with habitues. It is pos-
sibly kinder to the race to let them perish as soon as pos-
sible. Most of the other thousands of drug addicts in this
country are to be pitied and deserve treatment at the best
hands. Their suffering is incredible, and nobody desires
a cure more than the patient himself.
CHAPTER II
PERSONAL HYGIENE (Continued)
Care of the Teeth and Mouth: Pyorrhea (Riggs' Disease).
Hygiene of the Digestion : Causes of Indigestion, Cooking, Value of
Food Elements, Meat, Fish, Milk, Eggs, Cereals, Fats, Vegetables,
Fruits, Vegetarian Diet, Salt, Necessity of Water, Purity of Water
and Ice.
CARE OF THE TEETH AND MOUTH
THE care of the teeth and mouth has taken on a new
significance of late owing to great progress in treatment of
abnormal conditions, and because it has become evident
that inflammations in the mouth including decay of the
teeth, and inflammation of the gums and tonsils are the
cause of many serious remote diseases. These include acute
rheumatism, chronic joint diseases, heart disease, etc. In
fact, because of the importance of this subject a separate
chapter is devoted to it in another place (see p. 145).
Care of the teeth has hitherto been chiefly directed to-
ward the prevention of decay, but it is of the greatest con-
sequence that irregularities of the teeth and jaws should be
avoided in childhood.
It is thought that adenoid growths, so common in chil-
dren, produce a narrow upper jaw with a high or gothic
roof of the mouth, and it is also probable that our use
of soft, prepared foods in modern life leads to disuse of
the jaws and their muscles, so that the jaws are not large
enough to contain the teeth. It is certainly a striking fact
that the fine, large, impressive jaws of our ancestors are not
so commonly seen today. The first teeth must be watched
20
CARE OF THE TEETH AND MOUTH 21
so that the second teeth may come regularly, or otherwise
deformity of the jaw may be produced. Too early or
late loss of the first teeth disturb the eruption of the
permanent teeth. If one jaw is narrow, its teeth will
not meet those of the other jaw, and the deformed
jaw must be spread by the dentist. A narrowing of the
upper jaw, with high, arched roof of the mouth, inter-
feres with the breathing through the nose, and may
thus lead to adenoid growth and pinched nostrils. Tonsils
and adenoids must be removed to prevent extension of in-
flammation from them into the eustachian tubes which
lead to the ears. Deafness in children, recurring colds,
abscess of the ears, and mastoid disease of the bone of the
skull behind the ears are usually caused by diseased tonsils
and adenoids.
. Protrusion of the teeth of the upper jaw may be induced