[Ill.u.s.tration: A COMPARATIVE DEATH-RATE OF CONTAGIOUS DISEASES

Note the number of deaths from tuberculosis to one from smallpox; yet smallpox before the days of vaccination and quarantine, was the universal scourge. Similarly, by preventive measures, we are controlling the other diseases. Why not also tuberculosis? (Statistics for greater New York, 1908; total number of deaths from all causes, 73,072.)]

Why the Fear and Danger of Consumption have been Lessened. Terrible and deadly as consumption is, we no longer go about in dread of it, as people did twenty-five years ago, before we knew what caused it; for we know now that it is preventable and that two-thirds of the cases can be cured after they develop. The word consumption is no longer equivalent to a sentence of death. The deaths from tuberculosis each year have diminished almost one-half in the last forty years, in nearly every civilized country in the world; and this decrease is still going on.

The methods which have brought about this splendid progress, and which will continue it, if we have the intelligence and the determination to stick to them, are:--First, the great improvements in food supply, housing, ventilation, drainage, and conditions of life in general, due to the progress of modern civilization and science, combined with a marked increase in wages in the great working two-thirds of the community. Second, the discovery that consumption is caused by a bacillus, and by that alone, and is spread by the scattering of that bacillus into the air, or upon food, drink, or clothing, to be breathed in or eaten by other victims. Third, increase of medical skill and improved methods of recognizing the disease at a very early stage. A case of consumption discovered early means a case cured, eight times out of ten.

Its Cure and Prevention. Fortunately, the same methods which will cure the disease will also prevent it. The best preventatives are food, fresh air, and sunshine. Eat plenty of nourishing food three times a day, especially of milk, eggs, and meat. Sit or work in a gentle current of air, keep away from those who have the disease, sleep with your windows open, take plenty of exercise in the open air, and you need have little fear of consumption.

In the camps, or sanatoria, for the cure of consumption, these methods are simply carried a little further, to make up for previous neglect.

The patients sit or lie out of doors all day long, usually in reclining chairs, in summer under the trees, and in winter on porches, with just enough roof to protect them from rain or snow. They sleep in tents, or in shacks, which are closed in only on three sides, leaving the front open to the south. They dress and undress in a warm room, or the curtains of the tent are dropped, or the shutters of the shack closed night and morning until the room is warmed up. In cold climates they dress day and night almost as if they were going on an arctic relief expedition, and spend twenty-four hours out of the twenty-four in the open air.

[Ill.u.s.tration: A TUBERCULOSIS TENT COLONY IN WINTER]

They eat three square meals a day, consisting of everything that is appetizing, nutritious, and wholesome, with plenty of b.u.t.ter, or other fats; and in addition, drink from one to three pints of new milk and swallow from six to twelve raw eggs a day. You would think they would burst on such a diet, but they don't; they simply gain from two to four pounds a week, lose their fever and their cough, get rid of their night sweats, and usually in from two to five weeks are able to be up and about the camp, taking light exercise. When they have reached their full, normal, or healthy weight for their height and age, their amount of food is reduced, but still kept at what would be considered full diet for a healthy man at hard work. If sick people can be made well by this open air treatment, those of us that are well ought not be afraid to have a window open all night.

Two-thirds of the treatment that would cure you of consumption will prevent your ever having it. While tuberculosis chiefly attacks the lungs, it is really a disease of the entire body, or system, and cannot attack you if you will keep yourself strong, vigorous, and clean in every sense of the word.

How to Recognize the Disease in its Early Stages. To recognize the disease early is, of course, work for the doctor; but he must be helped by the intelligence of the patient, or the patient's family, or he may not see the case until it is so far advanced as to have lost its best chance of cure. We can now recognize consumption before the lungs are seriously diseased. Among the most useful methods with children is the rubbing or scratching of a few drops of the toxin of the tubercle bacillus, tailed _tuberculin_, into the skin. If the children are healthy, this will leave no mark, or reddening, at all; but if they have tuberculosis, in two-thirds of the cases it will make a little reddening and swelling like a very mild vaccination. But in order to get any good from this, cases must be brought to a doctor, early, without waiting for a bad cough, or for night sweats.

Signs of Consumption. The signs that ought to make us suspicious of a possible beginning of tuberculosis are first, loss of weight without apparent cause; fever, or flushing of the cheeks, with or without headache, every afternoon or evening; and a tendency to become easily tired and exhausted without unusual exertion. Whenever these three signs are present, without some clear cause, such as a cold, or unusual overwork or strain, especially if they be accompanied by a rapid pulse and a tendency to get out of breath readily in running upstairs, they should make us suspect tuberculosis; and if they keep up, it is advisable to go at once and have the lungs thoroughly examined. Nine cases out of ten, seen at this stage, are curable--many of them in a few months.

Even if we should not have the disease, if we have these symptoms we need to have our health improved; and a course of life in the open air, good feeding, and rest, which would cure us if we had tuberculosis, will build us up and prevent us from developing it.

[Ill.u.s.tration: AN OUTDOOR CLa.s.sROOM FOR TUBERCULOUS CHILDREN

The roof and the side awnings are the only obstructions to the outer air.]

PNEUMONIA

Its Cause and Prevention. The other great disease of the lungs is _pneumonia_, formerly known as inflammation of the lungs. This is rapid and sudden, instead of slow and chronic like tuberculosis, but kills almost as many people; and unfortunately, unlike tuberculosis, is not decreasing. In fact in some of our large cities, it is rapidly increasing. Although we know it is due to a germ, we don't yet know exactly how that germ is conveyed from one victim to another. One thing, however, of great practical importance we do know, and that is that pneumonia is a disease of overcrowding and foul air, like tuberculosis; that it occurs most frequently at that time of the year--late winter and early spring--when people have been longest crowded together in houses and tenements; and that it falls most severely upon those who are weakened by overcrowding, under-feeding, or the excessive use of alcohol. How strikingly this is true may be seen from the fact that, while the death-rate of the disease among the rich and those in comfortable circ.u.mstances, who are well-fed and live in good houses, is only about five per cent,--that is, one in twenty,--among the poor, especially in the crowded districts of our large cities, the death-rate rises to twenty per cent, or one in five; while among the tramp and roustabout cla.s.ses, who have used alcohol freely, and among chronic alcoholics, it reaches forty per cent. The same steps should be taken to prevent its spread as in tuberculosis--destroying the sputum, keeping the patient by himself, and thoroughly ventilating and airing all rooms.

As the disease runs a very rapid course, usually lasting only from one to three weeks, this is a comparatively easy thing to do.

Though pneumonia is commonly believed to be due to exposure to cold or wet, like colds, it has very little to do with these. You will not catch pneumonia after breaking through the ice or getting lost in the snow, unless you already have the germs of the disease in your mouth and throat, and your const.i.tution has already been run down by bad air, under-feeding, overwork, or dissipation. Arctic explorers, for instance, never catch pneumonia in the Frozen North.

CHAPTER XV

THE SKIN

OUR WONDERFUL COAT

What the Skin Is. The skin is the most wonderful and one of the most important structures in the body. We are p.r.o.ne to think lightly of it because it lies on the surface, and to speak of it as a mere coating, or covering--a sort of body husk; but it is very much more than this. Not only is it waterproof against wet, a fur overcoat against cold, and a water jacket against heat, all in one, but it is also a very important member of the "look-out department," being the princ.i.p.al organ of one of our senses, that of touch.

The eyes in the beginning were simply little colored patches of the skin, sunk into the head for the purpose of specializing on the light-rays. The smelling areas of the nose also were pieces of the skin, as were also the ears. Not only so, but--although it is a little hard for you to understand how this could have happened--the whole brain and nervous system is made up of folds of the skin tucked in from the surface of the back; so that we can say that the skin, with the organs that belong to it and have grown from it--the eyes, nose, ears, brain, and nerves--forms the most wonderful part of the body. Everything that we know of the world outside of us is told us by the skin and the look-out organs that have grown out of it. The skin is not only the surface part and coating of the body, far superior to any six different kinds of clothing which have yet been invented, but it is related to, and a.s.sists in, the work of nearly half the organs in the body. Not only all that we learn by touch and pressure, but everything that we know of heat and cold, of moisture and dryness, and most of pain, comes to us through our skin, through the little bulbs on the ends of the nerve twigs in it. It also helps the lungs to breathe, the kidneys to purify the blood, and the heart to control the flow of blood through the body.

A healthy skin is of very great importance; and part of this health we can secure directly, by washing and bathing, scrubbing and kneading and rubbing, because the skin lies right on the surface, where we can readily get at it. But, on the other hand, no amount of attention from the outside alone will keep it healthy. All the organs inside the body must be kept healthy if the skin is to be kept in good condition.

Although the external washing and cleaning are very important, the greater part of the work of developing a healthy skin and a good complexion must be done from the inside.

The Two Layers which Make Up the Skin. Like our "internal skin," the mucous membrane, which lines our stomach and bowels, the skin is made up of two layers--a deeper, or bas.e.m.e.nt, sheet, woven out of tough strands of fibrous stuff (_derma_); and a surface layer (_epidermis_) composed of cells lying side by side like the bricks in a pavement, or the tiles on a floor, and hence called "pavement" (_epithelial_) cells. These pavement cells are fastened on the bas.e.m.e.nt membrane much as the kernels of corn grow on a cob; only, instead of there being but one layer, as on a cob of corn, there are a dozen or fifteen of them, one above the other, each one dovetailing into the row below it, as the corn kernels do into the surface of the cob. As they grow up toward the surface from the bottom, they become flatter and flatter, and drier, until the outer surface layer becomes thin, fine, dry, slightly greasy scales, like fish-scales, of about the thickness of the very finest and driest bran.

We are continually Shedding our Skin. One way in which the skin keeps itself so wonderfully clean and fresh is by continually shedding from its surface showers of these fine, dry, scaly cells, which drop, or are rubbed off, as they dry. This is the reason why no mark, not even a stain or dye, upon the skin, will stay there long; for no matter how deeply it may have soaked into the layers of the pavement-cells, every cell touched by it will ultimately grow up to the surface, dry up, and fall off, carrying the stain with it.

If you want to make a mark on the skin that will be permanent, you have to p.r.i.c.k the colors into it so deeply that they will go through the bas.e.m.e.nt layer and reach cells which will not grow toward the surface.

This "p.r.i.c.king-in" operation is known as _tattooing_; and it is as foolish as it is painful, for blood-poisoning and other diseases may be carried into the system in the process.

[Ill.u.s.tration: THE LAYERS OF THE SKIN

_E_, epidermis; _C_, capillaries; _D_, dermis; _F_, fat globules and connecting fibres.]

Perhaps you will wonder why, if you are shedding these scales from all over your surface every day, you don't see them. This is simply because they are so exceedingly small, thin, and delicate, that you cannot see them unless you get a large number of them together; and when you are changing your clothing, bathing, etc., they are rubbed off and float away. If a part of the body has been shut in--as when a broken arm, for instance, is in a cast, which cannot be changed for several weeks--when finally you take off the bandage, you will find inside it spoonfuls--I had almost said handfuls--of fine scales, which have been shed from the skin and held in by the wrappings.

THE GLANDS IN THE SKIN

Sweat Glands. Like all the pavement (epithelial) surfaces of the body, inside and out, the skin has the power of making glands by dipping down little pouches or pockets into the layers below. In the skin, these little gland-pockets are of two kinds, the _sweat glands_ and the _hair glands_.

The sweat glands are tiny tubes which go twisting down through the different pavement layers, through the bas.e.m.e.nt layer, and right into the coat of fat, which lies just under the skin. The tube of the sweat gland soaks, or picks, out of the blood some of the waste-stuff--just as the kidney tube does in the kidney,--together with a good deal of water and a small amount of delicate oil, and pours them out on the surface of the body in the form of the "sweat," or _perspiration_.

As you will remember, when the muscles work hard and pour more waste into the blood, then the heart pumps larger amounts of blood out into the skin; and this causes it to redden. The sweat glands work harder to purify this extra blood, and they pour out the waste and oil and water on the surface. As soon as this water gets upon our hot skin, it begins to evaporate and cool us off, as well as to carry off some of the waste in the form of gas. The trace of oil in the perspiration helps to lubricate the skin and keep it soft; but when too much of it is poured out we have that greasy feeling, which we have all felt after perspiring freely.

From all this cooling and breathing and blood-purifying work going on upon the surface of our skin, you can easily see why it is so important that all our clothing should be loose and porous and that next the skin easily washed; else it will very soon become clogged up and greasy, and shut off the breathing and blood-purifying work of the skin and make it dirty and unhealthy. This continual mist of water, rising and bubbling up through our skin like springs out of a hillside, is another of nature's wonderful ways of cleansing the skin and of preventing any kind of dirt from permanently sticking to or lodging in it. Remember, you do not need to dig below the surface when you wash.

Hair Glands. The other kind of skin glands, the hair glands, are also pouches growing out from the deepest part of the stem of the hair, known as the root, or _hair bulb_.

[Ill.u.s.tration: THE GLANDS IN THE SKIN

_S_, sweat gland; _H_, hair bulb; _O_, oil gland; _T_, touch bulb at tip of nerve.]

From the root of the hairs, two or three little bundles of muscle run up toward the surface of the skin. When these contract, they pull the root of the hair up toward the surface, causing the hair to stand erect, or "bristle," as we say. This is what makes the hair on a dog's or a cat's back stand up when he is angry; but the commonest use of the movement is, when animals are cold, to make their coats stand out so as to hold more air and retain the body-heat better. We have lost most of our hairy coating, but whenever we get chilly, whether from cold or from fright, these little muscles of our hair bulbs contract and pull the hair glands of our skin up toward the surface, so that it looks all "pimply" or "goose-skinned."

Each hair pouch has sprouted out from its sides a pair of tiny pouches, which form _oil glands_ to lubricate the hair and keep it sleek and flexible. It is hard to beat nature at her own game, and her method of oiling the hair is far superior to any hair oil that can be put on from the outside. Keep your hair well brushed and washed, and nature will oil it for you much better than any hair oil or scalp reviver ever invented.[19]

THE NAILS

How the Nails are Made. Another "trade," which our wonderful skin has literally "at its fingers' ends," is that of making nails. Indeed, every kind of scale, armor, fur, feather, and leather coating possessed by bird, beast, or fish was made by, and out of, the skin. Nail-making, however, is one of its simplest feats, as it is carried out merely by turning a little patch, or area, of itself into a horn-like substance.

This, the skin of insects, of fishes, of crocodiles, etc., does all over the surface of their bodies; but in animals and birds only a number of little patches at the tips of the toes harden up in this way, to form the claws or nails; and in birds, the beak; and in some animals, the horns. So it is quite correct to call the substance of our nails "horn-like."

In some animals and birds, these little h.o.r.n.y patches at the ends of the toes grow out into long, curved hooks, or broad, digging chisels and scoops; but on our own fingers, they simply make a little mould over the finger-tip. If, however, they are protected from being broken off, they will grow four or five inches long; in fact, they are carefully trained to do this by some of the upper cla.s.ses in China, merely for the purpose of showing that they have never been obliged to degrade themselves, as they foolishly regard it, by working with their hands.

You can easily prove that the nails do grow constantly from the root or base, out toward the tip, by watching, some time when you have pounded one of your nails, how the black or discolored patch in it will grow steadily outward toward the tip, where it will be broken off and shed.

You cannot see the softest and youngest row, or layer, of the nail cells at the base, because a fold of skin, the _nail fold_, has been doubled, or folded, over them to protect them while they are young and soft. It is not best to push this fold of skin back too much, as, by so doing, you may uncover the young nail cells while they are soft and tender, and expose them to injury. The reason why there is a little whitish crescent at the base of the nail is that the cells of the nail do not grow hard and horn-like and transparent until they have grown out a quarter of an inch or so from under the fold, but at first look whitish, or opaque, like the rest of the skin.