THE COLLEGE AND PHYSICAL FITNESS

Medical Consultant in Nutrition and Physical Fitness

Dartmouth was one of the earliest of the colleges in concerning itself with offering its students opportunities for healthy physical exercise. It is a long journey from the wood sawing facilities of the beginning days of the college to its present elaborate provision for physical training and athletics including coaches and trainers, teachers and physicians—all working for physical efficiency in one form or another.

With this background it is natural that the first definite attack upon physical unfitness made by a college should have its setting at Hanover. The extensive physical examinations given the men selected by the draft during the late war awoke the country to the fact that a third of these young men were in various ways unfit for full war service. For several years we had been reporting this percentage of unfitness among children as we had worked with them in hospital clinics and in schools but the spectacular confirmation of our figures by the army physicians gave an immediate impetus to forwarding the program which we had worked out as a means of correcting this abnormal condition.

The significance of underweight is not yet well understood. The usual idea is that it may be perfectly natural for a growing young man to be "thin." It is often taken for granted that he may run 10 to 40 pounds under the average for his height and yet because he is "wiry" he must, of course, be strong. A thin ancestor who has lived to a fabulous old age can always be found to justify this abnormal condition. Another popular instance to be cited is the "thin" athlete who because of certain distinguished accomplishments must be "normal." "Dead men tell no tales" and it is the few survivors whom we remember. Heredity is not so simple a matter as all this would indicate. One may inherit thinness without having inherited the resistance of the remarkable survivor. When we come to compare the person now in the growing period with the "thin" father, uncle, or grandfather so often brought in as reference we forget to take into account what might have been the growth of these relatives had they been placed upon a practical health program when they were in their growing years. In hundreds of cases the child of "thin" parents has shown an immediate ability to advance in height and weight beyond the expectation of the family.

Again it must be remembered that these types often have difficulty in securing life insurance and frequently fail in their efforts to secure it. The "thin" athlete has been found to be especially subject to tuberculosis. A striking confirmation of this fact has appeared in a significant recent publication of a study made by the Carnegie Institution under the direction of Dr. Davenport. In this study a comparison was made of various types of "body build" and it was shown that the "very slender" and "slender" types are from six to twelve time as susceptible to tuberculosis and from three to six times as susceptible to respiratory disorders as is an unselected group of ten thousand of the general population.*

The search for the causes of this general physical unfitness as evidenced by underweight has been most interesting and absorbing. We started as many have done with the line offered by simple, single causes but soon found that the problem was very complex. Many factors were considered and the results of thousands of our physical-growth and social examinations were studied before we were able to formulate a group of causes which explain fully 90% of the cases of physical unfitness appearing in any section of social life. These are five in number and are here given in the order of their frequency of appearance: (1) Physical defects especially obstructions to breathing; (2) Lack of control—personal and home (in this group appear, many of the problems that are coming to be studied under mental hygiene) ; (3) Over-fatigue; (4) Faulty food habits and improper food; (5) Faulty health habits.

The type of persons suffering from this condition was found everywhere but it became evident at an early stage that some method of comparatively simple diagnosis was necessary to aid in the program of educating the public to-the importance of frequent and adequate physical-growth examinations for all members of the growing years. This was found in the relationships existing between weight and height. The matter of securing even fairly satisfactory tables of weight and height has offered many practical difficulties. This subject has been fully discussed elsewhere* and it will suffice to say that for practical purposes the main point to be borne in mind is the distinction between "average" weight and height made up from great numbers of carefully taken measurements and "optimum" weight and height which is the result of clinical studies of many individuals and in general runs from five to ten per cent above the average. The "average" is vitiated by the inclusion in its making of the large number of persons who are below par. The "optimum" is fairly near to what would be the average if all were in satisfactory condition of growth and development.

When these facts had been taken fully into account it was found that in about 90% of the cases of serious physical unfitness studies the individuals were habitually seven per cent or more below the average weight for their height. While about 10% of the cases are not selected by this measure it has been found to be true that practically every growing individual who is habitually seven per cent or more underweight for height shows other evident signs of inadequate development and of physical unfitness.

With a method of discovering the greater proportion of these cases and a classification of the'*causes of their condition it became necessary to put into form a program by means of which the causes of the physical unfitness of the individual might be discovered and eliminated. To accomplish this end we have made use of two important forms of examination—physical-growth and social. The first of these goes fully into the present physical status of the individual with especial reference to physical defects. This involves in many cases the cooperation of specialists, most frequently those concerned with nose and throat. A history of the case is also secured in which are included all matters having bearing upon present needs especially diseases suffered and operations performed.

This problem is primarily medical and failure to secure results in many campaigns against malnutrition has been due usually to the fact that attention has not been given to these significant medical factors. But it is also true that the situation is educational in its nature and calls for social readjustments and re-education in habits and customs. For this reason the social examination has been devised to get the necessary data in these matters. It begins with a study of the activities and feeding of the individual for a period of forty-eight consecutive hours and involves questions of living, work, and study conditions. In certain instances a third examination is necessary dealing with the mental status of the individual.

When the person concerned is relieved of the immediate cause of his condition he is said to be "free to gain." He now needs the "essentials of health" and such assistance as he may require in the process of correcting his faulty habits and otherwise giving himself an adequate health education. These "essentials of health" are fresh air, by day and night, sufficient food for growth, adequate exercise, and proper rest.

It was with this background of experience that the college work was begun. College men are a selected group but we had already found that the type of families from which they are recruited while in general of the class which is socially more fortunate than the average yet from the standpoint of health they show more rather than less physical unfitness than appears in less "well-off" groups of society. When the members of the Dartmouth class of 1928 were weighed and measured it was shown that 645 men were distributed as follows:

Men % Overweight (more than 20%) 19 3 Safety-weight zone (0 to 20% overweight) 271 42 Borderline zone (less than 7% underweight) 159 25 Seriously underweight (7% or more) 196 30 Total 645 100

This means that 30% of these picked men were at the time of the inquiry seriously underweight. When the more certain test of "optimum" weight is applied to the class the borderline group is also included in the number requiring care. This places more than half the class—55%* of all—in this division. At the Massachusetts Institute of Technology, where the nutrition program is in successful operation, the class of 1928 last year showed a combined "seriously underweight" and "borderline" group of 51%.

The method of approach at Dartmouth has been first of all an address to all members of the freshman class in which the meaning of this situation was fully explained to them. It is important that the men realize that this is a problem of training for more adequate physical and mental living and not in any way a matter of "coddling" or taking life more easily. They are quite ignorant of reasonable standards of physical fitness and have become so accustomed to living on a lower plane of physical efficiency that they take the strain and stress by means of which they keep going as a necessary matter and not as a condition for which they are responsible although scarcely conscious of the fact, and which they can remedy when once they know the "rules of the game."

Following this presentation a meeting is held for the underweight men who are interested in undertaking the program. When these men are organized into classes the regular routine is undertaken. This involves weekly weighing followed by class conferences. Each man is confronted by his own weight chart and he has the responsibility of determining the reasons for the change in his weight as compared with what he had accomplished in previous weeks. The reasons for progress are most interesting. Not only the individual who has gained acquires clinching arguments in favor of more wholesome living with reference to the removal of physical defects, better control of the day's program, freedom from occasions for over-fatigue, more adequate food and health habits and better food, but all the members of the group have had more convincing material on these subjects than they would have assimilated from a long course of lectures.

The high spots of the class meeting come, however, when the men at the foot of the class are called on to study themselves and find out why they are not making reasonable gain. With children the weight of the period under consideration is compared with what would be expected of the average child of the same age under normal conditions. As these men, for the most part, would normally have attained practically full growth by the time they are in college it has seemed best to make the basis of comparison the average attained during the same period by a boy of sixteen. Any man who does not make at least double this standard is considered to be placed on the defensive and his reasons for failure to do so are sought with the greatest care.

There is a natural skepticism with reference to what can be accomplished with these "grown" men. It is necessary to come back again and again to the facts in the case. One of our leading authorities in nutrition, Prof. Lafayette B. Mendel of Yale University, was called to England early in the war and on his return reported his experience with company after company of British "Tommies" who had before enlisting attained to the full height and weight reached by their fathers and older brothers. For the first time, however, in the history of their families representatives were under fairly normal conditions of growth. Physical defects were removed, their programs were good with reference to rest, sleep, exercise, food, etc- As a result whole companies grew out of their uniforms and had to be reclothed entire.

Two members of the Dartmouth staff have already taken institute courses designed to further one's preparation for conducting these classes. An especially hearty welcome came from those who are in charge of athletics. In the football team there was the problem of possible staleness appearing in the face of an unusually hard series of contests. When this matter was discussed from the standpoint of physical fitness the staleness appeared as one phase of overfatigue. A better margin of weight was allowed the men and a change in the practice schedule made provision for rest before the midday and evening meals and some other important points. Trainers and players entered heartily and appreciatively into these arrangements and utilized every suggestion offered in working out their remarkable victories.

Four classes for physical fitness are already in operation. Those which were started at the beginning of the college year show an average gain of from six to seven times the gain expected in the same time of a normal boy of sixteen, despite the low averages made at the time of college examinations and of especially exciting games. The purpose of the work is not the accumulation of statistics but careful records are being kept and after the first semester a second article in the ALUMNI MAGAZINE will present the results that have been secured.

Below the bridge on the river

*There should be no confusion between the problem of underweight during the growing years and an evident advantage in a small percentage of underweight when one has passed middle life.

*The New Weight-Height Tables and nutrition by Wm. R. P. Emerson, M. D. and Frank A. Manny in Archives of Pediatrics, October, 1924.