THE COLLEGE AND PHYSICAL FITNESS*

II A Report of Progress, First Semester, 1924-5

Medical Consultant in Nutrition and Physical Fitness,At Dartmouth College

Attention is called to the first article in this series which appeared in the Dartmouth ALUMNI MAGAZINE for February, 1925. In this article was presented a statement of the problem of physical fitness with reference to causes, extent, methods of identifying' the unfit and the program worked out for bringing them up into normal condition.

In the February issue of this magazine we stated the problem of physical fitness at Dartmouth College and our plan for dealing with those men found to be seriously underweight. At the present time from the records of the first semester we are able to make a preliminary report of progress. At the end of the year more data will be available from which it will be possible to show what we have learned from this experimental year and to present a definite program for the more complete attack to be made in 1925-26.

We have never experienced such adequate co-operation in any other situation as has come to us in Hanover. The administration of the college has accomplished not only the efficiency which comes from definite and stable organization but it also shows an unusual appreciation of the significance of ability to recognize new problems and new aspects of old problems together with the necessity of adjustment and reconstruction in order to deal with them constructively. This is the essence of the experimental method in the very best sense of the term.

This does not mean that no difficulties have appeared in working out the program but the spirit of all concerned has been such as to make it clear that nothing will be allowed to stand in the way of overcoming them.

There were not at hand at the opening of this year the data necessary for iden- tifying the men in need of our program. For this reason the first step was a meet- ing of the whole Freshman Class in two sections. In presenting the matter to them emphasis was laid upon the practi- cal problem of physical fitness in relation to study, athletics and other college inter- ests as well as to enjoyment of life and efficiency in business and professional activity. Adequate health was discussed, not as a matter of taking life more easily but rather as a desideratum in meeting four years of college life with efficiency and satisfaction, and in making sure of going out from Dartmouth physically and mentally fit.

An opportunity was given those who already knew themselves to be underweight to report for conference. One hundred men appeared at the time assigned for weighing and measuring and three classes were at once organized including in all sixty men. Dr. Bowler, in whose department the work is organized and who has given his cordial support from the beginning, immediately volunteered to assume the conducting of two classes and Dr. French of the other class.

These classes met once a week. Each man was weighed and his gain or loss recorded on his individual weight chart. For the convenience of the physician conducting the class these charts are hung in order of the gains accomplished, the one showing the greatest progress is placed at the head. Twice during the term men gained 5.75 pounds in a single week. Seldom, however, did any one make more than 3 or 4 pounds gain. In case of failure to gain the cause was sought both at the time of weighing and in class. Chief among the causes for lack of progress were over-activity, failure to take rest periods before meals, examinations, late hours, irregular eating, faulty food habits, etc.

To one unaccustomed to work of this kind it may seem that there might be some embarrassment arising from the personal evidence called for and brought out in the meetings and conferences. This is true, but, as we all know, so do recitations at times afford occasion for embarrassment and the right kind of embarrassment may be the best means of accomplishing correction. Care is always exercised not to bring out points about which the individual might in any way be sensitive. All became interested not only in their own weight charts but also in the evidence brought out by the other men. I believe there is no more convincing way of demonstrating and evaluating factors affecting health than by one of these class meetings. The men gain and in gaining receive a health education of the greatest value.

No more delightful contacts could be had than with these serious minded men. For example, the following questions were asked. "Why do you suppose I didn't gain ? I have been taking my extra lunches and rest periods regularly."

"How about eating, How much time do you take for breakfast?"

"I'm afraid the time- is rather abbre- viated—s or 6 minutes perhaps."

"You know you would not feed a good animal like that. You can't gain unless you take plenty of time to eat your food. How about getting to bed at night ?"

"I'm afraid I go rather late—12 o'clock usually."

"Try getting to bed not later than eleven and attend to the breakfast and see what happens."

So the student takes it all very seri- ously and the next week every one is happy when he has made a good gain.

Another man asks, "How about smok- ing?"

"'How much do you smoke?"

"Ten to twenty cigarettes a day."

"There is very little medical evidence that moderate smoking does harm in an adult, but during the period of adolescence the effect of stimulants and narcotics is especially bad upon growth and development. Tobacco apparently does harm chiefly by interfering with the appetite. Therefore it is especially bad to smoke just before meals. I would suggest that you do not smoke until after meals if at all, but as you are only 17 it would be much better not to smoke until you get up to normal weight and still better not until you are 21."

"Well, I really haven't a settled habit and I guess I had better cut it out entirely."

Again, "How can I get ready for 'exams' and still gain?" "How do you work?" "All the time. I"try to keep constantly at it."

"That is wrong. It is better to work and then rest. For example, study hard for one hour, rest twenty minutes by a little walk and deep breathing or lie down flat on your bed for a complete rest and then go on studying again. If you have a hard evening's work, eat a fairly light dinner, then fill up at eleven when you have finished your work. You cannot study effectively after a hearty meal. Be careful not to have your study too warm. 60 to 66 degrees is best. An eye shade helps you to concentrate. Remember you must take time to eat and sleep in order to do your best work."

"I guess I will have to organize my day !"

"You certainly will if you are to get the best results. Regularity is most important."

The result of this advice was a gain of 2½ pounds the following week. (See Figure 3, Student C.)

In this way the social causes of physical unfitness are found and each man confronted by his weight chart as a challenge for their correction. If then there is no gain in weight it is evident that there may be undetected physical causes and the most common are those of inflammatory conditions in the nasopharynx. Therefore, every man was given a special nose and throat examination by-Dr. Carleton and all questionable cases needing operations were rounded up and the diagnosis confirmed by Dr. Harold Tobey of Boston. Arrangements were made at the hospital for such operations as might be found necessary, unless the student preferred, as in most instances, to have the operation performed during vacation time at home.

All this meant delay but the excellent attack made by the members of the classes showed immediate progress. For the first six weeks the sixty students in the classes averaged over four pounds gain in weight. At this time, however, difficulties with which we had not reckoned began to appear.

In passing it may be well for the Alumni to remember that "times have changed" at Dartmouth. The selective admission system is in full operation. I have seen no finer group of young men anywhere than our present freshman class. But along with this selective process there has come a remarkable activity of competition not only in academic work with its rewards of high rating and of scholarships assigned on the basis of scholastic standing, but also there is an extraordinary organization of almost numberless extra-curricular activities. We had many diversions and distractions in our time but they were much less systematic and formidable than are the interests which appeal to the student of the present day and in which he cannot help becoming seriously involved.

It is easy to say that these activities are not required or essential but the quality of college life is determined in large part by them and however much we may deplore their abuse the Alumni would be far from failing to count them of great importance" in forming character and in giving significance to college life. Yet we found in one of our classes twentythree men who made losses amounting to forty-three.pounds in the three weeks of "chinning season!" There were some who gained during this period but the net loss for the group was five and threequarters pound. There were in the three classes of Freshmen as many losses as gains at this time. When account is taken of the late hours kept by the men it only seems strange that the losses were no greater. One man, for instance, was up all night and many did not get to bed until four or five in the morning. We are glad to know that one of the many by-products of our work this year has been to furnish data which have been of assistance to the administration in making the changes accomplished during the present year to modify this serious waste.

All this time there was the strain of competition in the many fields of college activities. Every Freshman feels that success in college life depends in a large degree upon what he accomplishes in the things he goes out for. Football, hockey, boxing, cross-country run, cabin and trail, college publications—each of these interests demands hours of work in order to enter upon the road to college distinction. We must bear in mind that while we have some measure of the strain of definite college requirements any estimate of what these other activities cost in nerve wear, over-fatigue, depression of status in physical and mental fitness is very difficult for the most expert observer to make.

The remarkable organization of the coaching staff is one'of the brightest factors in this difficult situation. Each one was ready to co-operate "for the good of the men!" and refused to allow the underweight student to sacrifice himself in training for competition beyond his strength. Without this high standard on their part the problem could never be handled adequately. It is desirable that the machinery for extending the scope and range of such control in this and other activities be given much careful consideration. The results secured by the group of men constituting the class of athletes as compared with the other classes illustrate this point as well as another—the value of a definite end in view to which the discipline of the class will lead.

Holidays of any kind offer many health difficulties. Even a week-end badly used will dissipate the hard earned progress of the rest of the week. Dartmouth men are, for the most part, away from home and the vacation period brings them back to indulgent parents and excessive social attractions. One man attended fifteen dances during the Christmas recess. In a group of eighteen men fourteen did not get to bed any night before twelve and four were out later than this hour every night. Here again it is extraordinary that so many of them did succeed in making some gains during the time they were away from college.

When the holidays were over we had hopes that once more it would be possible to get down to a reasonable program but our hopes were dashed by the conditions that were prevalent during midyear examinations. Those coming earlier in the semester had proved to be a serious problem for the men in the underweight classes but when the mid years came on students who were ordinarily able to keep their balance and work on a rational program became practically obsessed by apprehension, fear and worry. Everything else yielded to this custom—even classes for recovering physical fitness were compelled to give up their sessions!

The graph on page 552 (Figure 1) shows the movement for one of our classes under the influence of these various difficulties. The steady gain of the first six weeks averaging two-thirds of a pound a week for each man showed a slump. For the last nine weeks of the semester the average gain was about onefifth of what it had been during the first six. Duringl the last six weeks about as much gain was accomplished in a week as had been made in a day the first six.

With the Dartmouth weight line is given another which records the progress of a representative class at the Massachusetts Institute of Technology during a similar period. It will be observed that the Tech class did not make so favorable a start. In their first six weeks they gained less than two-thirds of what the Dartmouth group succeeded in gaining but during the rest of the semester with less distraction and greater possibility for a concentrated and more rational program—despite the heavy technical requirements made upon them —they averaged five times as much gain as was made by the Dartmouth men. Even during the Christmas holidays the results were much more satisfactory at Tech since the latter group, living for the most part at home during term time, were not as much upset during the recess and averaged nearly three times as much gain as was accomplished by the Dartmouth men.

Two meetings were held with the coaches and men in the various athletic activities. At the first meeting definite directions were given for preventing over-fatigue (staleness) and for acquiring and keeping the best physical condition. 'At the second meeting the problem of the man who is underweight was explained to the athletic staff; namely, that he was underweight for a fundamental, adequate cause and unless this cause were removed he would not respond to the usual training methods, that the first step for such a man was to put on weight with rest and then gradually he could be allowed to train for a special event provided he avoided over-fatigue.

As a result of this meeting a fourth class was formed of 17 men. The graph numbered Figure 2, on page 554 shows their progress. At one of these meetings one of the charts showed that the man was well over the average weight line. I asked him why he was present in the class and he explained that he was out for baseball (pitcher) and since it was likely that he would have a hard season the coach had suggested that he would be better off if he were 10 pounds above average. He remarked, '"I have now gained 6 pounds and have 4 more to go."

At the request of students in the Tuck School and upper classmen a fifth class was formed but as this was organized late in the semester a report upon its resuits will be deferred until the next article.

So many requests came for advice and assistance that our representative in charge of the work, Miss Florence Taylor, has had conference hours for this purpose. The remarkable number of 194 men have come in for weighing and measuring and 143 have shown sufficient interest to secure definite instructions for improving their condition. One member of the faculty has gained twelve pounds and now weighs five pounds more than ever before.

Of the men in the central section, the sixty freshmen in three classes forty were enrolled thirteen weeks or more. The sixty averaged nineteen pounds underweight—more than thirty pounds under a reasonable "optimum" standard. Thirty-seven of them—nearly two-thirds of all—were ten per cent or more below minimum requirements for their height and age.

The average gain for the sixty was 5.1 pounds. The average gain for each week of enrollment was .42 pounds. A convenient method of representing gain accomplished is to determine the percentage of the load of underweight that has been removed during the period under care. On this basis the sixty men averaged a reduction of 28% of their initial underweight. Again emphasis should be laid upon the fact that nearly seventy per cent of the gain made came during the first third of the semester.

Another method of stating progress is through a comparison between the actual gain made by a group and the gain that would be expected of an average group of the same age in a similar period of time. Since, however, most of these men would already have practically attained full growth if they had not been retarded by the conditions causing their underweight, it has seemed best to make the comparison in this case with the gain in weight usually attained by the average boy of sixteen—usually the last year of striking increase in weight. On this basis the sixty freshmen made an average gain of 295% of this expectation—that is they gained at the rate of twenty-four pounds a year. Eight of them made less than 100% of the sixteen year old expectation but thirteen made 400% or more of this rate. The highest'percentage was 976.

The first necessity for adequate gain is the removal of physical defects in order that the men shall be "free to gain." Unfortunately very little was done in these three classes to accomplish this end. It is no easy matter to arrange for the time required for an operation upon diseased tonsils and in many cases family physicians have not yet come to see the significance of obstructions to breathing. The gains made by various groups classified on this basis is well illustrated in the following table: Groups Average gain Men "free to gain" 295% Operation deferred 152%

A group of nine students who had especially bad health histories including such conditions as thyroid trouble, tuberculosis, glycosemia, osteomyelitis, migraine, etc., made an average gain of only 157%.

Certain definite instructions are given the members of the classes but naturally there is considerable difficulty in deter- mining the extent to which these direc- tions are carried out. The item which was most satisfactorily checked was that concerning additional feedings which are recommended in order that by means of these lunches and additional rest per- iods the day may be better divided and waste more readily prevented and over- come. The following relation was found between the grading given for attention to lunches and the rate of gain: Groups marked Average gain "Excellent" 302% "Good" 266% Less than "good" 232%

Those men who were least careful about late hours made an average gain of only 197% and those who suffered from colds and other sickness accomplished only 188%. Tobacco users averaged 263% while non-users ran up to 307%.

Nine men who were "separated" from the physical fitness classes at the end of the semester because of lack of adequate co-operation had made an average gain of 145%. Nine others placed on "probation" averaged 217%. Thirty-two men who were especially effective in cooperation averaged 305%.

Any attempt to get at the relationship between scholarship and the weightheight index offers many difficulties but all the material thus far investigated shows very clearly that the obese menthose" who are 20%, over average weight for height—win fewer honors and suffer more failures than do the members of any other group. In the Dartmouth class of 1928 the average scholarship for the entire class was 1.81 while the obese men had an average of only 1.40. It is also evident that the underweight men form a most desirable group from the standpoint of the attainment of honors. For example, they had only half as many low marks as did the obese men and four times as many honors. The problem of the underweight students working "upon their nerve" amid constant pressure leading 'to over-fatigue and staleness is the central issue of this undertaking.

An article concluding the report of this year's work will appear in a later number.

DARTMOUTH-TECHNOLOGYFRIDAY CLASS FIGURE I—lllustrating1—Illustrating the Effect of Extra-Curricular Activi- ties on Rate of Gain. The Dartmouth class gained an average of 7½ pounds in 7 weeks* and then because of "chinning season," examinations and holidays made no gain in the following 8 weeks. The Technology class shows a steady gain, passing Dartmouth at 15 weeks. *The average gain is charted from the actual gains and losses of each week. The average gain reckoned at the end of the class on the basis of full time attendance would be somewhat less.

ATHLETES FIGURE 2—Illustrating the Effect of "Making the Team" on Rate of Gain. This chart shows the remarkable gain of 17 underweight athletes from the freshman and sophomore classes. These men had the special objective of gaining weight in order to "make the team."

STUDENT C FIGURE 3—Illustrating the Effect of Entering College in Poor Physical Condition and Not "Free to Gain." Student C lost 17 pounds in the summer and then 4 pounds more after entering college. When, because of his depression and nervous condition he was referred by the Dean to the class for physical fitness, he tried hard to gain but was in constant fear of failing in his examinations and, studied "all the time." (See page 552.) His chart shows a gain of 2% pounds following directions how to study. The next week he had a cold and lost 2¼ pounds, then 3 pounds more from examinations and late hours of study. Although he succeeded in passing examinations he became discouraged and left college. Besides entering coflege 15¼ pounds underweight he was further handicapped by diseased tonsils which his family physician objected to having removed.

STUDENT A FIGURE 4—Illustrating the Effect of "Chinning Season," Competitive Athletics, and Examinations. Student A gained 12¼ pounds in 7 weeks. Then, because of "chinning season," examinations, and taking part in six athletic contests—four of them out of town—he made no gain for the following 15 weeks.

STUDENT B FIGURE 5—Illustrating 5—Illustrating the Relationship of Physical Un- fitness to College "Mortality." Student B entered college 24¼ pounds—14%—underweight. The second week in class he had a "cold with temperature and lost 2y2 pounds. He then made a gain of spounds in thefollowing 4 weeks when he had another "cold' and failed to gam. He had badly diseased tonsils and arrangements were made to have them removed when it was found that he had a chronic sinus infection which accounted for his repeated colds. He was advised to have an operation for his sinus during the Christmas but failedto do so. He returned to college and had another "cold.' At midyear examinations he failed in 4 subjects. He was one of those students who would have been, in the ordinary course of events, summarily "flunked out." However, a knowledge of his true physical condition explained the cause of his failure.

STUDENT D FIGURE 6—Illustrating the Effect of Extra-Curricular Activities. Student D entered college 17 pounds—10%—underweight. He lost weight at both Yale and Harvard games. Then he gained until the Glee Club tour when he lost because of extra work of rehearsals, late hours, and strain of tour, as he sang solo parts. He was promiment in his class, nominated class president, wrote feature articles for college publication, and was only 16 years of age on enteringcollege. In spite of his efforts to gain, at mid-years he was still 15 pounds, underweight.