9. Bathing establishments should be under permit of the Department of Health to include construction and operation.

10. Adequate shower-bath and toilet facilities must be provided; also hot water for showers in indoor pools. Toilets must be screened against flies, unless water-flushed and covered by toilet lids.

11. Sanitary drinking fountains with pure water must be supplied. III. Sanitary Control of Premises and Bathers, etc.—1. Adequate light and ventilation must be provided.

2. A temperature of the air during the winter in indoor pools of between 70° and 80° F., must be maintained.1

3. No common towels, combs, brushes or drinking cups may be provided.

4. All towels, suits, etc., provided by the establishment for public use must be sterilized after each separate use.

5. Anti-spit signs must be conspicuously posted. Signs in large letters must be posted in dressing compartments directing all bathers, men and women, to take a preliminary cleansing shower in the nude with warm water and soap and to empty the bladder before going into the pool. Bathers must rinse off all soap before entering the pool

room.

6. No diseased or intoxicated person should be permitted to use a swimming pool.

7. Only those persons dressed or undressed for bathing may enter the pool room.

8. Men and boys must bathe in the nude or be provided with sterilized suits. Suits for men and women must be of fast color and of a lintless material.

9. A lifeguard must be present at all times. He must be acquainted with the technic of resuscitation of the apparently drowned and have equipment at hand for rescuing and resuscitating. He, or some attendent must supervise the incoming bathers to enforce the regulation concerning the preliminary bath and to exclude undesirable and diseased persons.

10. The room must be locked during the emptying and refilling of the pool (or other steps be taken), so that bathers will not dive into an empty pool.

11. The pool when emptied must be well scrubbed.

12. No smoking should be allowed in indoor pools.

13. Cuspidors must be provided in the dressing rooms and pool

rooms.

14. If tub baths are supplied they must be disinfected after each separate use.

1 It is usually deemed necessary to maintain a higher temperature in bath buildings, than in living rooms, school rooms, etc.

CHAPTER XIX.

PERSONAL HYGIENE.

BY EUGENE LYMAN FISK, M.D.

IN the early stages of public health work, the health officer was confronted with formidable and often insoluble problems relating to the prevention or eradication of communicable disease. With the growth of knowledge as to the causation of these maladies, the task of the health officer in the protection of the community has been much simplified.

While the prevention and stamping out of communicable disease still makes heavy demands upon the resourcefulness and scientific equipment of the health officer, his problems in this relation are so simplified that a by-product of tremendous value would be wasted if the opportunity more completely to safeguard the public health by education in personal hygiene were neglected. In fact, so tremendous is the opportunity in this direction offered the public health officer that instead of his work dwindling in importance as methods of sanitary control and the prevention of epidemic disease become standardized and easily applied, it may be said to have greatly broadened and also risen to a greater dignity and importance in its possible influence on human life and public welfare. While here and there some reactionary may object to such activities on the part of the health officer, the enlightened tax-paying citizen will be very grateful to such an official for making readily available, the knowledge of how to live so that illness, physical inefficiency and premature breakdown may be avoided. It is surely quite as much a proper function of public health administration to acquaint the people with the dangers of overfeeding as it is to protect the community from adulterated and impure food. Without in the least belittling the good results of the administration of pure food laws, it is conservative to state that more injury has been sustained by the public through improper feeding than through adulterated food.

The family physician who warns his patient does not always receive attention, but the utterance of an official health department will in time command public attention and gradually mold public opinion in a way that cannot be done by the scattered, unstandardized and varying efforts of individual physicians. The health officer who is alive to these opportunities and desirous of improving them will do well carefully to survey the field of knowledge on these subjects and plan his educational campaign along systematic lines, following no

fads and marshalling adequate scientific support to the principles inculcated. At the outset it is important to obtain a correct viewpoint of the possibilities of this work and of the ultimate goal that should be its object.

WHAT IS PERSONAL HYGIENE?

Personal or individual hygiene implies "high ideals of health, strength, endurance, symmetry and beauty; it enormously increases our capacity to work, to be happy, and to be useful; it develops, not only the body, but the mind and the heart; it ennobles the man as a whole."

In order to be free to carry forward this work with proper flexibility and openness of mind, it is necessary to rid ourselves of much accumulated tradition and of the paralyzing influence of the classification and terminology of disease. Current classifications of disease still reflect the influence of the outworn theory that diseases are entities arising without specific cause, afflictions in the nature of "acts of God." There is needed a thorough revision of the classification of disease with more attention to etiology. As one general disease after another is found to be actually due to infection, we are led closely to analyze all forms of physical deterioration or impairment, and as we do this we are led to see the folly of regarding any form of disease as self-initiated, as having any possibilities of progression without the continuous operation of some specific cause or group of causes. As our vision clears on these points, we are led to seek and analyze these causes with greater precision, and we have forced upon us the conviction that the term disease is a misleading one, that in so-called disease, we are dealing with an organism manifesting various forms of impairment, tissue change or disturbance of function. Whether these changes rise to the dignity of a disease is partly a matter of degree and partly a matter of opinion.

When a man's kidneys and circulation prove obviously insufficient we label him as having "Bright's disease." Slowly developing changes may have been taking place in his tissues for many years, not because he had Bright's disease, but because some one or more of a group of possible causes had been at work on his body. It will be helpful in clarifying this subject to group the various factors or types of influences that are responsible for physical deterioration, substandard health conditions, chronic disease, premature old age and death. 1. Heredity.

2. Physical strain. Muscular excess and organic strain. Mental and emotional strain or imbalance.

3. Physical apathy, muscular disuse, faulty physical posture, skin disuse (improper clothing). Mental and emotional apathy, and disuse, faulty mental posture.

4. Food excess, quantitative, and qualitative. Food deficiency, quantitative and qualitative (food accessories). Hormone deficiency.

5. Poisoning:

Drugs.

Metabolic poisons.

True auto-intoxication.

Hormone excess.

6. Infections, bacterial and parasitic.

Focal: Teeth, tonsils, sinuses, urethra, seminal vesicles, etc. General: Syphilis, typhoid, tuberculosis and all communicable diseases.

7. Trauma, mental and physical.

In the above probably infection plays the largest part. Mayo has truly said: "Life is one long struggle with microorganisms."

A careful consideration of these causative factors, clears the way for a formulation of the fundamental principles of personal hygiene which can be brought into play for the most complete protection of the individual as well as for the up-building of his health.

The first great commandment in personal hygiene is to have your body periodically examined so that the rules of hygiene may be applied with precision. Exercise, diet, all may be without avail if you are working against a septic tonsil or a tooth abscess. What has built up your neighbor may break down your own health. After your physical condition is ascertained, the following rules of hygiene as prescribed in the Institute's book How to Live, may be taken as a suggestive guide.

(a) Air.

1. Ventilate every room you occupy.

2. Wear light, loose and porous clothes.

3. Seek out-door occupations and recreations.
4. Sleep out if you can.

5. Breathe deeply.

(b) Food.

6. Avoid overeating and overweight.

7. Eat sparingly of meats and eggs.

8. Eat some hard, some bulky, some raw foods.
9. Eat slowly.

(c) Poisons.

10. Evacuate thoroughly, regularly and frequently.

11. Stand, sit and walk erect.

12. Do not allow poisons and infections to enter the body.

13. Keep the teeth, gums and tongue clean.

14. Use sufficient water internally and externally.

(d) Activity.

15. Work, play, rest and sleep in moderation.

16. Keep serene.

A great deal of harm has been done by well-meaning people seeking to educate the public in right living. It happens all too frequently that an enthusiastic health reformer will take up some particular phase of personal hygiene and not only overemphasize its value but in

endeavoring to group all conditions of ill-health under its possible curative or preventive influence, discredit the whole movement for rational health reform. Well-balanced personal hygiene involves a practice of each phase of right living. There is no magic system of exercise, of diet, of mental hygiene, of psychotherapeutics, the practice of which alone will lead to perfect health.

While it is true that the health officer must rely chiefly upon educational methods in guiding the hygiene of the people, he can, nevertheless, emphasize as one of the fundamental requirements in intelligently applying the laws of right living, that people from early childhood on should be subjected to periodic physical examination so that individual needs and idiosyncrasies can be given due consideration in applying the various rules of hygienic living. The calm and supine acceptance of the seven ages of man as an inevitable limitation upon humanity is, of course, paralleled by many other ages-old abuses and traditions which have burdened the human race. In the past decade, however, the idea of periodically examining the human machine has gained great support. It is now very widely talked about although its benefits are only extended to a comparatively small number of people in proportion to the total population.

Pioneer Work. The first great experiment along these lines on any large scale was tried in an insurance company about nine years ago with results so startling that the proposal to extend such benefits to policy-holders generally was readily entertained by a group of scientific men and publicists who established the Life Extension Institute in 1914. A number of companies now extend this privilege of periodical examination and hygienic guidance by the Institute to their policy-holders. The practice of physical examination of employees before employment and thereafter has expanded quite widely and is now a matter of vital interest pertaining to the welfare and efficiency of industrial employees.

EXAMINATION OF INDUSTRIAL AND COMMERCIAL EMPLOYEES.