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diff --git a/old/64237-0.txt b/old/64237-0.txt deleted file mode 100644 index de92be6..0000000 --- a/old/64237-0.txt +++ /dev/null @@ -1,21760 +0,0 @@ -The Project Gutenberg eBook of Old Age Deferred, by Arnold Lorand - -This eBook is for the use of anyone anywhere in the United States and -most other parts of the world at no cost and with almost no restrictions -whatsoever. You may copy it, give it away or re-use it under the terms -of the Project Gutenberg License included with this eBook or online at -www.gutenberg.org. If you are not located in the United States, you -will have to check the laws of the country where you are located before -using this eBook. - -Title: Old Age Deferred - The causes of old age and its postponement by hygienic and - therapeutic measures - -Author: Arnold Lorand - -Release Date: January 08, 2021 [eBook #64237] - -Language: English - -Character set encoding: UTF-8 - -Produced by: Turgut Dincer, Barry Abrahamsen, and the Online Distributed - Proofreading Team at https://www.pgdp.net (This file was - produced from images generously made available by The Internet - Archive) - -*** START OF THE PROJECT GUTENBERG EBOOK OLD AGE DEFERRED *** - - - Old Age Deferred - - THE CAUSES OF OLD AGE AND ITS POSTPONEMENT BY HYGIENIC AND THERAPEUTIC - MEASURES - - - - Man does not die, - he kills himself. - —Seneca - - - BY - _ARNOLD LORAND, M.D._ - - - - - _FIFTH EDITION_ - - Translated, with additions, by the Author - from the Third German Edition - - - - - - Publisher’s Logo - - - - - PHILADELPHIA - F. A. DAVIS COMPANY, PUBLISHERS - 1920 - - ------------------------------------------------------------------------- - - - - - ────────── - COPYRIGHT, 1910 - COPYRIGHT, 1916 - BY - F. A. DAVIS COMPANY - ─── - Copyright, Great Britain. All Rights Reserved - ────────── - - - -REPRINTED: February, April, October, 1911; May, November, 1912; May, -1913; February, 1914; January, June, November, 1915; March, September, -1916; February 1917; February, June, September, 1920. - - - - ─────────── - PRESS OF - F. A. DAVIS COMPANY - PHILADELPHIA, U.S.A. - ─────────── - - ------------------------------------------------------------------------- - - - - - PREFACE TO NEW REVISED EDITION. - - -THE sudden and premature deaths in recent years of numerous prominent -people, through arteriosclerosis, impressed me strongly that these -persons might be still alive if they had been better informed of -hygienic living. This gave me the idea of preparing a special section in -this new edition, dealing with the prevention of this high mortality -from arteriosclerosis and also with the prevention and treatment of high -blood-pressure. At the same time, I am availing myself of this -opportunity with an endeavor to augment, so far as possible, the general -purpose of this book, which is to fight old age by all means that are at -our disposal. I am also adding a few suggestions on the treatment of old -looks. - - DR. ARNOLD LORAND. - - ------------------------------------------------------------------------- - - - - - PREFACE. - ── - - -WHOEVER takes up this book with the idea that the aged can be -transformed into sprightly adolescents will be disappointed. A work -based entirely on evidence of a scientific nature, as is the present -volume, cannot have such an end in view, since it is altogether -unattainable—at least with what knowledge is now available. - -But while it is still impossible for us to create a young man out of an -old one, it is quite within the bounds of possibility, as we shall -endeavor to demonstrate herein, to prolong our term of youthfulness by -ten or twenty years. In other words we need no longer grow old at forty -or fifty; we may live to the age of ninety or one hundred years, instead -of dying at sixty or seventy. All this can be brought about by the -observance of certain hygienic measures, and by improving the functions -of a certain few of the glandular structures in our body, provided -incurable organic disorders have not already too gravely compromised one -or more of our main organs. - -In a communication to the Paris Biological Society, presented in our -name by Dr. Gley, Professor of Physiology at the University of Paris, -and in an address delivered before the Brussels Royal Society of Medical -and Natural Sciences, we described old age as a chronic disease due to -degeneration of the glands with internal secretions (hereinafter -frequently referred to as the ductless glands), of the thyroid, the -sexual glands, and the adrenals in particular. In this work we will show -that this degeneration is amenable to treatment, just as are chronic -diseases in general. - -The facts herein presented are illustrated and sustained by numerous -experimental and clinical observations. Being desirous of proving the -correctness of all our statements, we have had to enter, sometimes very -fully, into the question of the ductless glands, in order to point out -the marvelous influence they exert upon the various vital functions. - -In view of the fact that the ductless glands have already been treated -in a very elaborate and exhaustive manner by a well-known American -author, Professor C. E. de M. Sajous, of Philadelphia, in his work on -the “Internal Secretions” (2 volumes) which introduces many new thoughts -and important discoveries, we have paid particular attention to the -thyroid and sexual glands, which we have carefully studied anatomically, -histologically, experimentally and clinically. - -Not being a native of, or even resident in, either America or England, -though possessed of a fair knowledge of the English language—having -delivered addresses in several universities, and before numerous medical -societies in the United States, Canada, England, and Scotland—it was -very difficult for us to avoid idiomatic errors. We take great pleasure -in acknowledging, therefore, our indebtedness to our friend, Col. Frank -Haddan, of London, who, being impressed with the importance of our -subject and its humanitarian aspect, kindly volunteered to look through -our manuscript and correct most of our errors of style and grammar, -thereby rendering us valuable assistance. Our thanks are also due to Dr. -Leo Rosenthal, of New York, for the adjustment of many technical -sentences. - -Every one will admit that the subject treated in this work is not an -easy one. It might be urged also that its presentation here is based on -entirely novel lines, scientific literature on old age being very -scarce. - -Considering also that it has been necessary for us to take up questions -beyond the ordinary sphere of a medical practitioner, sometimes of a -philosophical, technical and physical nature, it is to be expected that -certain imperfections will be found. But, whatever may be the opinion of -the reader, he will not deny that none should fail to derive some -benefit from the numerous hints we have given for the preservation of -health and prolongation of life. If by reason of our advice we succeed -in saving but a single human life from a premature grave, our aim will -have been attained. - - - DR. ARNOLD LORAND. - - ------------------------------------------------------------------------- - - - - - CONTENTS. - ─── - - - CHAPTER I. - - PAGE - - ON THE APPEARANCE OF SYMPTOMS OF OLD AGE IN YOUNG 1 - PERSONS - - - CHAPTER II. - - ON THE AGENCIES WHICH GOVERN OUR EXTERNAL 11 - APPEARANCE AND THE NUTRITION OF THE TISSUES - - - CHAPTER III. - - ON THE AGENCIES WHICH GOVERN IMMUNITY AGAINST 21 - INFECTIONS AND INTOXICATIONS—THE ORIGIN OF FEVER - - - CHAPTER IV. - - ON THE AGENCIES THAT GOVERN THE CONDITION OF THE 35 - NERVOUS SYSTEM AND MENTALITY - - - CHAPTER V. - - ON THE INFLUENCE OF THE SEXUAL GLANDS UPON 45 - VITALITY AND LONG LIFE - - - CHAPTER VI. - - ON HEREDITY AND LONGEVITY 55 - - - CHAPTER VII. - - ON MEANS WHICH CAN HELP US TO DETERMINE THE 64 - PROBABLE DURATION OF LIFE - - - CHAPTER VIII. - - ON THE CAUSATION OF OLD AGE 90 - - - CHAPTER IX. - - THE RATIONAL PREVENTION OF PREMATURE OLD AGE AND 114 - THE TREATMENT OF OLD AGE - - - CHAPTER X. - - THE DESTRUCTION AND ELIMINATION OF TOXIC PRODUCTS 134 - FROM THE BODY AND HYGIENIC MEASURES FOR THE - IMPROVEMENT OF THESE FUNCTIONS - - - CHAPTER XI. - - ON THE DESTRUCTION OF POISONOUS PRODUCTS THROUGH 138 - THE THYROID AND PARATHYROID GLANDS - - - CHAPTER XII. - - HYGIENE OF THE THYROID GLAND 145 - - - CHAPTER XIII. - - THE DESTRUCTION OF TOXIC PRODUCTS BY THE LIVER AND 149 - THE IMPROVEMENT OF ITS PROTECTIVE FUNCTIONS - - - CHAPTER XIV. - - THE HYGIENE OF THE LIVER 155 - - - CHAPTER XV. - - ON THE DESTRUCTION OF TOXIC PRODUCTS BY THE 159 - ADRENALS - - - CHAPTER XVI. - - HYGIENE OF THE ADRENALS AND OF THE CIRCULATORY 164 - SYSTEM—A FEW REMARKS ON THE CAUSE, PREVENTION, - AND TREATMENT OF ARTERIOSCLEROSIS - - - CHAPTER XVII. - - THE ELIMINATION OF TOXIC PRODUCTS THROUGH THE 170 - INTESTINES AND THE IMPROVEMENT OF THIS FUNCTION - - - CHAPTER XVIII. - - ON THE PREVENTION AND TREATMENT OF HABITUAL 175 - CONSTIPATION - - - CHAPTER XIX. - - HYGIENE OF THE INTESTINES 182 - - - CHAPTER XX. - - HYGIENE OF THE INTESTINES—A FEW REMARKS ON THE 192 - CAUSE AND PREVENTION OF APPENDICITIS - - - CHAPTER XXI. - - ON THE ELIMINATION OF TOXIC PRODUCTS THROUGH THE 197 - KIDNEYS - - - CHAPTER XXII. - - HYGIENE OF THE KIDNEYS, AND THE PREVENTION OF 203 - RENAL DISEASE - - - CHAPTER XXIII. - - ON THE ELIMINATION OF TOXIC PRODUCTS THROUGH THE 209 - SKIN - - - CHAPTER XXIV. - - THE HYGIENE OF THE SKIN—AIR BATHS 215 - - - CHAPTER XXV. - - ON RATIONAL CLOTHING 219 - - - CHAPTER XXVI. - - IMPROVED HYGIENE OF THE SKIN AND KIDNEYS THROUGH 231 - BATHING—FOOT-BATHS - - - CHAPTER XXVII. - - HYGIENE OF THE SKIN AND KIDNEYS BY MEANS OF 237 - PERSPIRATION - - - CHAPTER XXVIII. - - ON EXERCISE, SWEDISH GYMNASTICS—MASSAGE—SPORT, AND 244 - WALKING AND RUNNING EXERCISE - - - CHAPTER XXIX. - - A FEW REMARKS ON COLD FEET—THEIR CAUSE AND 252 - TREATMENT - - - CHAPTER XXX. - - ON THE BENEFITS OF SUNLIGHT 255 - - - CHAPTER XXXI. - - ON THE ADVANTAGES OF AN OPEN AIR LIFE AND OF 262 - BREATHING EXERCISES - - - CHAPTER XXXII. - - ON THE DANGERS OF LIVING IN CONFINED AND 271 - ILL-VENTILATED QUARTERS - - - CHAPTER XXXIII. - - HYGIENE OF ARTIFICIAL HEATING—THE DANGERS OF HEAT 275 - BY STEAM AND A FEW HINTS ABOUT THEIR PREVENTION - - - CHAPTER XXXIV. - - FOOD HYGIENE—GENERAL REMARKS 280 - - - CHAPTER XXXV. - - ON PROTEID FOOD, ANIMAL FOOD, MEAT, FISH, EGGS, 294 - MILK, ETC. - - - CHAPTER XXXVI. - - ON CARBOHYDRATES AND FATS, AND THE GREAT 301 - ADVANTAGES OF VEGETABLES AND FRUIT - - - CHAPTER XXXVII. - - ON THE ADVANTAGES AND DISADVANTAGES OF A 309 - VEGETARIAN DIET - - - CHAPTER XXXVIII. - - ON THE DANGERS OF A TOO ABUNDANT MEAT DIET—A FEW 317 - HINTS ON THE DIETETICS OF MEAT - - - CHAPTER XXXIX. - - ON THE GREAT ADVANTAGES OF MUCH MILK IN THE DIET 325 - FOR THE PREVENTION AND TREATMENT OF OLD AGE - - - CHAPTER XL. - - ON BLOOD AS AN ARTICLE OF FOOD CONTAINING IRON AND 333 - ANIMAL EXTRACTS—SAUSAGES AND BLOOD PUDDINGS - - - CHAPTER XLI. - - SOME REMARKS ON THE HYGIENE OF EATING—HOW TO 339 - OBTAIN AN APPETITE—ON MASTICATION - - - CHAPTER XLII. - - ON THE USES OF SMALL DOSES, AND THE DELETERIOUS 347 - ACTION OF LARGE QUANTITIES OF ALCOHOL - - - CHAPTER XLIII. - - SOME REMARKS ON THE CAUSES AND PREVENTION OF THE 356 - ALCOHOL HABIT - - - CHAPTER XLIV. - - ON OTHER STIMULANTS—TEA, COFFEE, COCOA, TOBACCO: 362 - THEIR MERITS AND DISADVANTAGES - - - CHAPTER XLV. - - ON SLEEP, AND ITS IMPORTANCE IN RIDDING THE BODY 368 - OF TOXIC PRODUCTS - - - CHAPTER XLVI. - - ON THE CAUSATION OF SLEEP, SLEEPINESS, AND 372 - INSOMNIA - - - CHAPTER XLVII. - - HYGIENE OF SLEEP—PREVENTION OF INSOMNIA 377 - - - CHAPTER XLVIII. - - THE TREATMENT OF SLEEPINESS AND INSOMNIA 383 - - - CHAPTER XLIX. - - HYGIENE OF THE SEXUAL GLANDS—THE DANGERS OF SEXUAL 389 - OVERACTIVITY AND OF TOTAL SEXUAL ABSTINENCE - - - CHAPTER L. - - ON MARRIED LIFE AS AN IMPORTANT MEANS FOR 400 - PROLONGING LIFE - - - CHAPTER LI. - - HYGIENE OF THE MIND—EMOTIONS AND WORRY AS CAUSES 404 - OF OLD AGE - - - CHAPTER LII. - - HYGIENE OF THE MIND—RELIGIOUS BELIEF AS A MEANS OF 414 - PROLONGING LIFE - - - CHAPTER LIII. - - DISEASE CONSIDERED AS A SELF-DEFENCE OF NATURE 419 - - - CHAPTER LIV. - - HYGIENE OF THE MIND—ADVICE TO BRAIN WORKERS 423 - - - CHAPTER LV. - - ON THE PREVENTION OF PREMATURE OLD AGE, AND THE 426 - TREATMENT OF OLD AGE, THROUGH CERTAIN DRUGS: - ARSENIC, IRON, AND IODIDES - - - CHAPTER LVI. - - ON THE PREVENTION OF PREMATURE OLD AGE AND ON THE 434 - TREATMENT OF OLD AGE BY ANIMAL EXTRACTS - - - CHAPTER LVII. - - A FEW HINTS ON YOUTHFUL APPEARANCE 449 - - - CHAPTER LVIII. - - THE “TWELVE COMMANDMENTS” FOR THE PRESERVATION OF 455 - YOUTH, AND THE ATTAINMENT OF A GREEN OLD AGE - - GLOSSARY 459 - - INDEX 467 - - ------------------------------------------------------------------------- - - - - - SPECIAL ANNOUNCEMENT - - TO THE READERS OF “OLD AGE DEFERRED.” - - -WE have just recently received the manuscript for the following -introductory pages, which are intended as a message direct to the -American people by Dr. Lorand. Their importance justifies a careful -reading. - -Although, in accordance with his duty as a citizen of Austria, Dr. -Lorand has had to practically abandon his private practice, and devote -his energies and his abilities to the service of his country in the time -of trial, he has, nevertheless, been so situated as to have a pretty -intimate knowledge of American affairs. He has been especially grieved -and shocked to learn of so many sudden, untimely, and in his judgment, -unnecessary deaths among prominent Americans since the great war began. -Counting as he did, a great number of friends, not only among American -physicians, but among American tourists, and knowing, as he does, so -intimately, the peculiar physical characteristics of the high-grade -American citizen, he is appalled at the wastage of valuable lives in a -country teeming with prosperity and incidental home comforts. - -The following introduction is designed as a warning to high-pressure -Americans that by a little care and the exercise of reasonable judgment -a large number of these premature deaths may be prevented. - -Even if you were to read no further, the careful perusal of this -introduction is well worth while, as it deals directly with the most -important personal problems. - - THE PUBLISHERS. - - ------------------------------------------------------------------------- - - - - - PREMATURE OLD LOOKS: - - THEIR PREVENTION AND TREATMENT. - - ──── - - -IN the previous editions of this book I have attributed premature old -age to the degeneration of certain glands of our body, such as the -thyroid gland and the ovaries. It is my intention now to show, that -precocious old looks can often be caused by certain faulty habits; thus -for instance by not drinking daily a sufficient amount of liquids. There -are many women, who be it by an unjustified fear of obesity, or for -other reasons, scarcely drink any liquids except possibly a cup of tea -or coffee for breakfast. They neither drink with their meals nor much at -other times. In such cases the tissues of the face will lack the -necessary amount of fluids to which is due, mainly, the roundness and -fullness of the cheeks which we so much admire in the fresh faces of -young girls and children. In consequence the face will appear lean and -haggard, the skin shrivelled and folded, and lines and wrinkles will -appear already in the faces of young women. Besides, as the sufficient -amount of fluids will be wanting, the toxic products formed daily in our -bodies is not washed out through those natural channels, the kidneys and -the intestines, but will take their way through the skin, and eruptions -and pimples will develop, much to the damage of the complexion. An -obstinate constipation will be another consequence, which, giving to the -skin of the face a dirty yellow-brown hue, naturally contributes to -produce an old appearance of the face. More and more, am I convinced -that a generous purging, as for instance by certain mineral waters, is a -most efficacious remedy to prevent old looks and at any rate to improve -them. Drugs as a general rule are far less wholesome and effective for -this purpose. - -By not drinking sufficiently, such substances as, for example, uric -acid, cannot be washed out and their retention will cause a serious -damage to health, facilitating the origin of arteriosclerosis, which -very frequently is associated with such conditions. Persons suffering -from uric acid present frequently an older aspect than corresponds to -their years and the falling out of the hair, or the appearance of gray -hair, in early years, is often the case with them. - -It is erroneous to think that water produces fatness. If this were the -case we would advise the poor people to drink plenty of water that costs -nothing, to get fat. It is not water that makes fat, but water that is -taken with the meals, together with copious food, thus aiding the -absorption and assimilation of the same. To avoid obesity after rich -food it is therefore advisable not to drink with the meals, but at other -times. Copious food must be avoided, especially fat, starchy food and -sweets. A diet consisting of plenty of meat, fats, and above all milk -and butter and sweets, is the surest road to obesity. They must be -avoided and the preference given to a diet of little meat, green -vegetables and fruits. For further details of such a diet I must refer -to the chapter, “The Treatment of Obesity,” in my book, “Health and -Longevity through Rational Diet,” publishers, F. A. Davis Co., -Philadelphia. I must emphasize the necessity of great prudence in -reducing cures, for, as I know from my practice in Carlsbad, there is -scarcely anything, unless a serious disease, that can produce so rapidly -the appearance of age in young persons and the more in riper years, than -imprudent and reckless obesity cures, causing wrinkles and the hanging -and sunken cheeks. - -I must certainly blame the eagerness of many ladies to transform their -fresh, round and elastic forms into lean and skinny ones, thinking that -thus they will look younger. No; I am certain that many young women look -considerably older after these atrocious and imprudent diet-cures. -Dieting is more permissible with older persons, if not exceeding certain -limits; but young women and girls I would strongly advise to eat hearty -meals of mixed food, for, as I also show in my above-mentioned book on -Diet, we are introducing in our systems very valuable substances, which -are in reality useful remedies with certain articles of food. Most -important among these are fresh milk (uncooked), numerous fruits, -certain kinds of animal food, which all contain considerable quantities -of important mineral salts, indispensable to our well-being, and to the -freshness and elasticity of mind and body. Besides these salts and -valuable ferments these articles of food contain also a most important -substance, called _vitamines_, which, as its name shows, conveys a kind -of vitality to the tissues. It is indispensable to the well-being of the -nervous system and also of the muscles, and thus also to the most -important muscle of the body, the heart. The vitamines are largely -represented in the outer coverings of the rice, of the corn, and also in -eggs, potatoes, etc. In fine white bread there is scarcely any, but -there is far more in the brown bread containing all parts of the grain. -Milk also contains them, but mainly fresh, uncooked milk; strong cooking -destroys the vitamines in the plants and the animal food, and besides -such cooking, as I show in the chapter on “Rational Cooking” of my book -on Rational Diet, also destroys other valuable ferments of great -importance for our body. It is certain that our looks, the beauty and -size of the human body and of animals, and even the color of the -feathers of the birds, depend very much, as I show in the same book, on -the wise selection of the food which we eat. Not only in young growing -persons, but also in the adult and even in aged persons. - -Of the different faulty habits there is probably none that would produce -so rapidly the premature appearance of old age in young women as -smoking. - - - THE DANGERS OF SMOKING IN WOMEN. - -If excessive smoking is deleterious to man, in the woman moderate -smoking may cause serious alterations. We must not forget that the -tissues of women are more delicate and tender than those of men, and -especially young women can in this respect be put in the same class with -children. The woman is not so well protected against the influence of -poisons such as nicotine as the man, for in her some of those glands -whose duty is to destroy such poisons, as, for instance, the thyroid, -are kept in much greater activity on account of the frequent changes in -the ovaries with each menstruation, pregnancy, the climacteric, etc., -and with their consequent repercussion upon the thyroid gland, with -which the ovaries are closely related. If to this comes such extra work -by the daily introduction of poisonous substances, although even in -small quantities, the gland may the more readily lose its efficiency. -After my own observations which I made upon my patients in Carlsbad -coming from eastern countries in Europe, I know that smoking women -present a much older aspect, if they have indulged in this habit to a -large extent and for years. They soon fade, the cheeks are pale, as a -rule, and sunk in. The general nutrition suffers, there is loss of -appetite, frequently a catarrh of the stomach and very often pains in -the stomach; indeed there is often neurasthenia with sleeplessness. With -more excessive smoking there will appear all the symptoms which are -common to the chronic nicotine poisoning of men. - -I am not prepared to maintain that, _after the dinner_, a cigarette or -sometimes two are dangerous to adult women. The aspect of a lady smoking -a cigarette after dinner surely cannot be called attractive, and it -certainly does hurt the æsthetic feelings of a normal man to see a woman -smoking one big cigar after another. It looks too masculine in a woman, -as I have observed in a ladies’ club in Copenhagen, where most of the -women sat with big cigars in their mouths. Such habits take away all -charm even from the finest looking women, and as a normal woman is -attracted by all that is manly in man and is repelled by an effeminate -man, we men dislike masculine women, just as we dislike a woman having a -mustache and whiskers. If I were a married man, I know I would not like -to kiss my wife if she strongly smelled of tobacco, just as it would be -repulsive to kiss a man; the smell of strong tobacco creating -involuntarily the sensation of associating with a man. Until recently -women have presented far less frequently the symptoms of -arteriosclerosis than men, excessive smoking being rare with them. But -as the effects of smoking are more deleterious to them, naturally -arteriosclerosis will arise much sooner in them, and as through the -hardening of the arteries the nutrition of the tissues suffer, the -nourishing blood not rendering them in sufficient amount—necessarily -such persons will begin to look old at a comparatively early period of -life. - - - A FEW COSMETIC HINTS FOR THE REMEDYING OF OLD LOOKS. - -In the previous editions of this book I have shown that it is possible -to improve old looks through hygienic measures, the use of the extracts -of certain glands, like the thyroid and ovaries and also by the -employment of certain drugs like arsenic and the preparations of iodine. -I would like to add now a few cosmetic hints against old looks some of -which I had already published a few years ago, as a collaborator to the -handbook of cosmetics of the dermatologist, Prof. M. Joseph, of Berlin -(M. Joseph, Handbuch der Kosmetik, Leipzig, 1912). - -In persons of certain age and also in younger persons with a fading -expression of the face and beginning wrinkles I have found, as -efficacious in producing an immediate improvement, the gentle -application to the face of any kind of fats of pure quality and the -rubbing thereon of some reliable preparation of white powder. The powder -should afterward be wiped off very carefully. It should not be put on in -thick layers, for then, as after the use of pastes and paints in -general, lines may be created where they are not yet present and lines -already existing may be hollowed out to veritable wrinkles. No powder -should be visible on the face. The object is to add to faces with dry -skin the best variety of fat with reference to its animal origin so as -to make up for the wanting secretion of the sebaceous glands and to -replace, if possible to a certain extent, the fat wanting in the -tissues. All kinds of massaging of the skin should be avoided; only a -gentle rubbing is allowed. In fact, I consider massage as deleterious to -the face, except it is done by a qualified masseur who is an expert in -this kind of massage with a correct anatomical knowledge of the muscles -of the face and of the direction they are running. Special care must be -taken that the massage of the face should never be done with fats, as -this would promote the formation of lines and wrinkles and even of deep -ones, if done unskillfully. The massage of the face should consist in -gentle strokings of the face with the end of the fingers and always -following the direction of the muscles. - -The powders used should be of the best possible quality. Before all they -should not contain any metallic salts and especially not lead. Unhappily -some of the very best powders are prepared with it, as lead gives to the -powders a specially white and attractive aspect. But I should like to -bring home to the ladies the fact, that these powders are the most apt, -especially in persons who perspire easily, to create lines and wrinkles -and to give to young faces in a short time an old appearance. - -The best powders I consider those which consist of fine rice-powder, -amylum, or talcum, and they produce the best effect, if they are not -visible on the face. I have often seen the finest complexions ruined by -the frequent usage of thick powders, pastes, and paints. The -above-mentioned procedure of rubbing in fats and thereupon some of the -finest hygienic powders should only be done every other day. To give to -fading faces a certain tonicity I recommend the use of alcohol, diluted -with three times as much water, which, in the same manner as diluted -vinegar, will also improve the complexion. I have found that a very -strongly diluted solution of the extract of the suprarenal glands has -also a marked effect in toning up the muscles of the face, if rubbed in -gently. Only small quantities of the diluted solution should be used for -this purpose. - -As gray hairs create, even in persons still young, an elderly -appearance, it might appear to their advantage to color them. It is best -to use such coloring only in regions of small extent rather than in a -general way. As the most inoffensive coloring of gray hair among dark -hair, I would consider the preparations containing nitrate of silver. -Those which contain lead or copper should be condemned. - -After all the best weapon against old looks is a hygienic life by which -we can best avoid the development of a condition which already at an -early age gives an old aspect to the tissues, i.e., of arteriosclerosis, -or hardening of the arteries. - - - RAPID AND EARLY DEATH THROUGH ARTERIOSCLEROSIS AND ITS PREVENTION. - -For most arteriosclerotic persons there can be only little hope to live -up to a green old age, to become 80 or 90 years old or even to pass on -to still higher years. But there are exceptions not so very seldom, and -it gives comfort to my patients suffering from this disease and -apprehension of the future, when I tell them that nearly all the -brothers and sisters of both my parents suffered from this disease for -many years, which did not prevent them from attaining ages varying -between 80 and 96 years and more. My father ever after his forty-fifth -year suffered from attacks of asthma. As a child I was often awakened -through his nightly asthmas, but in spite of many symptoms of -arteriosclerosis he lived to a great age. - -One of my aunts is still living, not very far from 100 years old, -although suffering in a high degree from arteriosclerosis for many -years. Such protracted cases generally happen in families of longevity -and they are only due to, as a rule, regular habits, although it is true -that my father was a great smoker in his younger years and even in his -last years enjoyed one or two light cigars daily. - -Such long survivals constitute, however, a great exception in -arteriosclerosis, and it usually happens only in cases where there are -no symptoms of that most dreaded form of arteriosclerosis, i.e., the -sclerosis of the coronary arteries of the heart. These arteries are -probably the most important ones of our body, for they provide the -muscles of the heart with the nourishing blood without which they could -not do their work. It is the sclerosis—the hardening—of these arteries -which, causing an obstacle to the passage of the blood, is the most -frequent cause of rapid death in arteriosclerosis, often in -comparatively young people. It is a sad fact, that such a condition, as -so often is the case with arteriosclerosis, can exist without exhibiting -any marked symptoms of it being present. A very frequent symptom of -sclerosis of the coronary arteries is attacks of _genuine_ angina -pectoris (stenocardia),—to be distinguished from the pseudo-attacks of -angina pectoris of neurasthenic persons. In such attacks there are -strong radiating pains in the heart region, and a feeling of great -anxiety, of utter annihilation, and of instantaneous death; and indeed -not so seldom such attacks may terminate in death. These attacks may be -considered as a warning of nature that such persons stand on the verge -of a precipice and thus urging them to the greatest precautions to avoid -anything that may bring about such an attack. From my own observations, -rapidly fatal attacks of angina pectoris in such cases of -arteriosclerosis happen frequently after a heavy dinner. The stomach -being distended, the diaphragm is pushed upward and thus impeding the -movements of the heart, which has not sufficient space for the play of -its muscles. Such a condition may also be often caused by the ingestion -of dishes causing flatulence. In consequence heavy dinners and flatulent -foodstuffs must carefully be avoided, and I declare any person who -presents attacks of genuine angina pectoris as a determined suicide if -he continues to indulge in them. There should be taken 5 small meals a -day, so as to avoid the keen appetite which results in overloading the -stomach. Foodstuffs causing flatulence such as cabbage, fried potatoes, -etc., should, above all, be avoided. Food that is rich in cellulose -(wood fiber) is strictly forbidden in such cases. For further details on -food producing flatulence I must refer to my above-mentioned diet book, -which contains a special chapter on the best food in flatulency and also -a list on the amount of cellulose (wood fiber) in different articles of -food. For the treatment by drugs refer to the chapter of this book on -arteriosclerosis. Besides moderate habits, including the use of very -light cigars in the smallest possible quantity (if smoking cannot be -given up entirely), overexcitement of any kind, especially sexual, as -also overexertions (_hill climbing_), must strictly be avoided. -Transgression of these commands, especially hill climbing, may sometimes -mean instantaneous death in advanced cases. Persons suffering from -coronary sclerosis with attacks of angina pectoris will do very well to -give up their positions if heads of companies with great -responsibilities and heavy burdens resting upon their shoulders, as any -stormy shareholder meeting may prove fatal to them. As already said it -is a sad fact, that persons may suffer from coronary sclerosis without -even knowing it, as there are also thousands of victims of -arteriosclerosis who are utterly ignorant of their condition, as this -disease often presents no marked symptoms. I must deplore that most -stupid habit of seeking for medical aid only when the ravages of disease -have gone so far that reparation is impossible. How often do people -forget the wise English proverb: “An ounce of prevention is worth a -pound of cure.” Just the same as children are sent every three months to -the dentist to see if any of the teeth present may be decaying in order -to save them, people already before feeling ill ought to at least once a -year be examined thoroughly by a doctor to see if anything is wrong in -the human machinery. I feel certain that in such a case many thousands -of persons, instead of lying in their dark, cold graves below the earth, -could still tread the soil enjoying sunshine and the scent of the -flowers. There is no doubt that arteriosclerosis and especially coronary -sclerosis could be avoided in many cases, through such an examination, -for the onset of arteriosclerosis is generally insidious and slow, -especially if it develops in the younger years, when due to syphilis, -and thus, if in time recognized, it could be cured. But even without the -syphilitic infection, cases in young persons are more frequent than we -think. - -It is to the present terrible war, raging and destroying so many lives, -that we owe the observation made by many of the military doctors that a -goodly number of young soldiers present symptoms of arteriosclerosis, -many of them having never suffered from syphilis. Often it is but a -slight elevation of the blood-pressure, but which, if persistent, may -indicate a beginning arteriosclerosis. - - - THE PREVENTION AND TREATMENT OF HIGH BLOOD-PRESSURE AND THE PREVENTION - OF APOPLEXY. - -Apoplexy is the consequence of a condition, which may be considered as -the highest degree of a scale whose lowest step is often a slight -elevation of the blood-pressure, when in a younger person. Thus, if -before the 45-70 year period the blood-pressure is somewhat elevated and -remains so for a certain length of time, we must, if there are no -special reasons for this elevation, for instance, kidney trouble, be -suspicious of arteriosclerosis. It is true, that there are cases of this -disease without a high blood-pressure, but if we find, besides -considerably elevated blood-pressure, traces of albumin in the urine and -also renal elements, a swelled liver and an accentuated second sound at -the aorta, there cannot be much doubt that we have probably to do with -arteriosclerosis. A high blood-pressure can most frequently be caused -through difficulties in the circulation of the kidneys; therefore in -each such case the urine must carefully be examined. By improving the -circulation through the kidneys we can also influence favorably the -blood-pressure. Certain drugs producing a great flow of urine have -indeed given good results in high blood-pressure, like, for instance, -diuretin in some cases. I am, however, averse to the use of drugs if -there are more natural remedies, and so I would advise the use of a -quite harmless one like the juice of lemons. It is very diuretic and, as -I have observed, there are also cases of chronic inflammatory conditions -of the kidneys which are very favorably influenced through a treatment -by lemons, in the same way as also gout and the uric acid ailments in -general. I have found that with lemon-juice given in mineral water we -obtain still better results if a little glycerin is added. Besides -lemon-juice the juice of certain other fruits like grape-fruit, oranges, -and grapes can also give good results. Besides a good diuresis, a -thorough cleaning of the intestines is desirable, high blood-pressure -often being caused by habitual constipation with stagnation of the -intestinal contents and subsequent flatulence. I must repeat with -emphasis again that daily bowel movements do not prove at all a clean -intestine following a good evacuation, and I am sure that the good -results obtained in the treatment of arteriosclerosis in certain spas, -like Carlsbad, Marienbad, and Kissingen, are not so much due to the -action of these waters upon arteriosclerosis, but simply to their -eminently purging action. Neither of these springs has a direct effect -upon arteriosclerosis, but besides the dietetic advantages of the -installation of these spas, the waters from their springs evacuate -thoroughly the intestines, ridding them of toxic products most -deleterious to the arteries, and at the same time facilitating in a -powerful way the circulation of the blood through the abdomen with its -most wholesome repercussion upon the whole general circulation. A -thorough intestinal evacuation can relieve a high blood-pressure nearly -the same way as an extensive venesection. A good perspiration can also -give good effects; however, to produce it there would be necessary to -take hot-water or air bath, which may prove most deleterious. There are -means, however, to avoid this for, as I know it from my own experiences, -it is possible to have a profuse perspiration without the sensation of -great heat and a red head through application of electric light bath -with blue light. In this blue light bath, studying its action, I have -myself obtained, after about twenty minutes’ time, the desired effect -without the depressive feeling afterward as so often is the case with -the usual steam bath. These baths are the more indicated in cases of a -nervous heart. - -There are also different drugs, which may in many cases prove useful: -thus, a French preparation, prepared from the viscus kinds called -guipsin, then diuretin prepared by different concerns. Very valuable are -the nitrate preparations, especially in cases with coronary sclerosis, -also vasotonin, etc. But from my own experiences I give in many cases -the preference to preparations of iodine. But I have found that iodine -should not be given in too small doses and that they must also be taken -for a certain length of time. Besides iodine I have found, as most -efficacious in cases with very high blood-pressure, the application of -electric currents after the system of D’Arsonval (arsonvalization). In -each case of several patients I have seen the dropping of the -blood-pressure to the normal. As soon as we find a high blood-pressure -in a patient we must do our best to diminish it, for if we allow it to -become persistent the high blood-pressure will produce a loss of the -elasticity of the walls of the blood-vessels, there will arise -pathological alterations and arteriosclerosis may easily establish -itself. Aided by persistent, very high blood-pressure the degeneration -of the walls of the blood-vessels may in the long run go so far that a -destruction of their tissues can arise. Then by any sudden great -elevation of the blood-pressure it may come to a rupture of the vessel, -to apoplexy. If such a thing happens to a blood-vessel of the brain, -then such vital parts of the brain may be destroyed that sudden death -will follow. But in many cases, happily, other less important parts are -affected, without involving death, and then follows lameness of those -regions of the body which are provided with nerves coming or going to -these parts. Sclerosis and degeneration of arteries happen most -frequently in parts of the body where the circulation is the most -copious by hyperfunction of these parts; thus in the legs of country -people walking and climbing much (Romberg). - -Mental exertions produce a great afflux of blood toward the brain each -time, with deep thinking more blood arrives to the brain and it is -therefore not surprising, as I show in my book on “Human Intellect and -its Improvement through Hygienic and Therapeutic Measures.” Such an -appalling number of prominent brain workers, men of science and of -business, are suffering from hardening of the brain-vessels and are -struck by apoplexy of the brain, sometimes even at early ages, before or -shortly after their fiftieth year. Indeed a vast majority of the great -men of science and business are thus afflicted, as I show in this book, -apoplexy being very frequent amongst them. It is reckless overwork, -unhygienic methods of mental work that may with surety produce a -hardening of the arteries of the brain. It would exceed the short space -allowed to this chapter if I should enter here upon the hygienics of -mental work, which I am treating in several chapters of my book on the -“Human Intellect,” but it will suffice here to emphasize the necessity -of interpolating resting days between days of mental overexertion. It -would be too much for me to demand that a successful man of business -retire entirely from his affairs, but what he could do, especially if -the head of the business, is to leave the city on Saturday for the -country, with the custom of walking about in the fresh air, returning -Monday with fresh strength; and, further, to avoid anything that -produces high blood-pressure, hill climbing, hot or cold drinks, strong -coffee, tea, and above all tobacco, which is one of the very surest -means to increase the blood-pressure. There is no condition where -smoking can produce such fatal effects as in arteriosclerosis, and -especially if the arteries of the brain, as so often in brain workers, -are affected. In inveterate smokers, perhaps a few de-nicotinized -cigarettes or cigars may be allowed. In place of regular coffee or tea, -coffee without caffeine and the Brazilian tea, maté, whose properties I -have described in my book on Rational Diet, may be allowed, but also not -in indiscriminate quantities. If too much of them is taken, they may -prove not less harmful, therefore also caffeine-free coffee and maté -should be taken with wise moderation. Against the troublesome symptoms -of arteriosclerosis of the brain like dizziness, loss of memory, -difficulty of reasoning, headaches, feeling of pressure upon the brain, -etc., I have seen, as I described in special chapters of my book “The -Human Intellect,” very good results through the combined use of -preparations of iodine and extracts of the thyroid gland. The dizziness -disappeared and also the headaches, the memory got much better and also -the reasoning power. These effects were, however, obtained in cases not -too advanced. As a preventive against arteriosclerosis of the brain and -as a remedy against headaches and feeling of pressure in the head I am -recommending snuffing in my book on Intellect, showing that through its -use the circulation of the congested brain is much relieved. In -confirmed cases of arteriosclerosis of the brain, however, snuffing -should be avoided, for it may have fatal results. Excessive snuffing is -also deleterious to healthy men, especially when tobacco is used. To -prevent apoplexy the hygienic advice we have given in the beginning of -this chapter to avoid high blood-pressure must strictly be followed. I -should like to add to them hot foot-baths for about five minutes, to -which mustard powder could be added. There should also be a special care -for a wise diet, avoiding constipation; of meat only very little should -be taken, fish should be preferred, and of meat only chicken and veal -allowed. The best food against arteriosclerosis and heart trouble -consists of a milk and egg diet, with vegetables and fruit, to which -fish and cheese may be added. As a most valuable food for overwork of -the heart and the general circulation, I recommend honey, whose merits I -show in next chapter. - - - THE BEST FOOD FOR A FAILING HEART. - -There is one muscle in our body that never takes a rest. It never ceases -to work, either day or night, and the better for us, for if it should -stop it would mean the end of life. This muscle is the heart. Of course -we must feed well such a hard-working organ, and have special care to -select such a food that is the most genial for it and can the best -promote its activity. As the heart is a muscle we must give the food -that is best indicated for muscular activity. Observations have shown -that the muscles of our body are doing their work at the expense of a -certain sweet stuff (glycogen) contained in them. Experiments also prove -this, for it has been found that the heart of animals removed from the -body will survive for days the death of their owner if kept in a salt -solution, with grape- or fruit-sugar added. The addition of certain -mineral salts like lime and carbonate of sodium is also able to prolong -the survival of the cut-out heart of dead animals. So there can be no -doubt that the same elements must also prove useful to the heart of the -living, as is indeed the case. - -As I have shown in my diet book the ingestion of sweets promotes -muscular activity and fatigues from bodily exertion are better borne. -And this also holds good for our most important muscle the heart. I have -seen in my heart patients very good results through the addition of a -generous amount of sweets to their ordinary diet. On the other hand, I -have, as a rule, observed a weak activity of the heart with my patients -in Carlsbad suffering from the graver forms of diabetes who were kept on -a diet strictly excluding sweets and starchy food in general. Indeed a -weak heart is most frequent in severe diabetes, as in such a condition -the sugar ingested cannot be utilized and entirely eliminated in the -urine. For this reason I consider it unwise to place severe cases of -diabetes on a strict diet and I recommend to them the use of fruit sugar -(levulose), which is often well utilized and especially in a case of -diabetes with heart-failure I like to do this. Such persons should never -be strongly dieted. As the best food for the heart I recommend honey on -the base of the above-mentioned observations. Honey is easily digested -and assimilated; it is the best sweet food, as it does not cause -flatulence and can even prevent it, to a certain extent promoting the -activity of the bowels. It can easily be added to the 5 meals a day I -recommend in cases of arteriosclerosis and of weak heart. As it would be -unwise to leave such a hard-working organ as the heart without any food -over the long hours of the night, I recommend heart patients to take -before going to bed a glass of water with honey and lemon-juice in it -and also to take it when awaking at night (honey dissolves in warm -water). - -Before and after muscular exertion honey should be given in a generous -dose; no coachman would allow his horses to run for hours without giving -them food at the resting intervals. Only man is so unreasonable as to -undertake heavy exertions often with an empty stomach. No wonder that so -many sportsmen get a weak heart simply for just such a reason. The use -of sugar cannot well replace honey. In the same amount sugar is -chemically irritating to the stomach. At any rate the preference should -be given to cane-sugar; sugar of beet-root is chemically pure, although -through modern civilization it is, unhappily, deprived of the important -mineral salts the beet-root contains, and it has also been shown that -through the use of chemically pure sugar the body loses in lime, which -is eliminated in larger quantities. If honey is alone taken in larger -dose it is better borne if water is drunk afterward. Besides honey I -like to recommend grapes, as containing much sugar and also valuable -mineral salts like lime. If grape cures as conducted, for instance, in -Meran (Tyrol) give good results in arteriosclerosis and heart cases, the -results I think could be explained by the above observations. We can -best introduce lime in our bodies through milk, cheese, eggs, fruits, -and vegetables. The latter, especially fruits, are also rich in sodium -and potassium, which are also valuable elements for the activity of the -heart. I would especially insist upon the fact that the heart-muscle is -rich in lime, as it contains about seven times as much of it as the -other muscles. If we introduce in our system fresh, uncooked milk and -eggs we also introduce a very valuable substance of which we have spoken -before, vitamines. I believe that these substances must be very valuable -for the activity of the heart because in all the diseased conditions, -the deficiency diseases, arising, we have found, a want of this -substance (Funck). Besides, in nervous troubles a weakness of the heart -and muscles is common. If in one of this class of diseases, like -beriberi, even in the latent cases, strong muscular exertions are made, -then cardiac attacks will appear with great weakness of the heart. -According to Funck, chief of the laboratory of the London Cancer -Research Institute, muscular exertions are apt to make these diseases -break out at once in cases, until then latent, without any symptoms. He -also impresses upon the fact that when vitamines are wanting in the -food, it is the vitamine stores of the muscles which are attacked first -(Funck, “Die Vitamine,” Wiesbaden, 1914). But as the best proof for my -opinion that food containing vitamines is indisplaceable for the -heart-muscle I mention the fact, determined by Cooper and quoted by -Funck, _Journal of Hygienics_, 1913, that the heart-muscle is very rich -in vitamines. Beriberi and other deficiency diseases are the highest -degree of a condition that is due to the entire want of vitamines in the -blood. But no doubt there may be lower degrees due to the insufficient -amount of vitamines, in which may simply show symptoms of neurasthenia -with nervous heart troubles, as an expression of the craving of our -system after these substances. Milk containing vitamines, and also -containing a considerable amount of sugar and lime, it must be -considered as the most valuable food for the heart. But only fresh milk, -for by boiling it the vitamines are lost. Boiling above 100° C, and -especially in large apparatus under high pressure like in the autoclave -used in many of the large institutions and some of the big hotels, -destroys the vitamines. I have already in my diet book, in the chapter -on rational cooking, insisted upon the dangers of overcooking our food. -Another rich source of vitamines, the bran of wheat and rye, is taken -from us through another invention of our so-called modern civilization, -the machine milling, simply for technical reasons. Forty or fifty years -ago there was no cases of beriberi in the far east; the natives ate rice -with its wholesome outer layers; then modern civilization introduced -machine mills instead of the old hand mills, robbing the rice of the -silver fleece rich in vitamines, and beriberi appeared. It is true that -the bran presents obstacles to our intestinal juices, but there exist -certain methods by which it can be ground to a fine flour and all its -valuable parts assimilated and introduced in our body. We have quoted -here several instances of the fateful influence of our modern progress -upon our health. What is the good of the great progress of medicine if, -on the other hand, our modern progress through reckless inventions -separates us from Mother Nature and, inducing us to unnatural habits and -ways, exposes us to disease and untimely death. No wonder, then, if -arteriosclerosis and old age appear in relatively young people. - - ------------------------------------------------------------------------- - - - - - CHAPTER I. - - ON THE APPEARANCE OF SYMPTOMS OF OLD AGE IN YOUNG PERSONS. - - -AS a general rule the first symptoms of old age do not appear before the -fortieth or forty-fifth year. There are, however, many persons who, much -earlier, occasionally even before thirty, show some of the typical -symptoms of senility: corpulence, gray hair, wrinkles in the face, -falling out of the hair and loss of teeth, etc., for example. The gums -also are retracted from the teeth, which consequently appear greatly -lengthened; later on the teeth become loosened and fall out. This then -causes the jaw bones to atrophy, when the face becomes sunken, and the -individual appears many years older. The hair loses its original color -and becomes dry and gray, especially on the temples. The appearance of -bald spots surrounded by gray hair increases the aged appearance of the -face. On examination, the pulse of such persons may exhibit a high -tension, the temporal arteries may be tortuous, and the skin found to be -dry. A sensation of cold in the extremities is especially frequent. -There is, as a rule, a tendency to constipation. The mental faculties -are also altered; the memory weakens, and the mind is often depressed. -Neurasthenia or hysteria become frequent in such persons, while -impotence in men and menstrual disorders in women develop. The urine may -be found to contain traces of albumin and occasionally a few hyaline -casts. The presence of these, according to Professor Senator,[1] -indicates a degeneration of the convoluted tubules of the kidneys, and -thus the loss of important elements of the chief excretory organ of the -human body. - -Footnote 1: - - Hermann Senator: “Die Erkrankungen der Nieren;” Nothnagel’s “Handbuch - der praktischen Medicin,” ii Auflage, 1902. - -On examination of the state of nutrition in these persons, it may often -be found to be below the normal. It is certain that such a condition in -young people is abnormal, and, therefore, a pathological condition. - -The question now arises: In which category of diseases is this condition -to be classified? - -In typical cases of this class there is a diminution of metabolism, -i.e., of the assimilation and conversion of food into energy. We shall -have to think of the possibility of alterations in those organs which -govern the process of metabolism. - -These organs are the glands with internal secretion (especially the -thyroid gland, testicles, ovaries, the adrenals and pituitary body), -according to recent researches, among which those of the author of this -book may be mentioned. He was among the first to show the fact that -glands with internal secretion control all the processes of -oxidation,[2] and that the diseases of metabolism: diabetes, obesity, -gout, etc., are the direct consequence of alterations in these important -glands. This is further sustained by the labors of Sajous[3] who was the -first to describe the mechanism through which these organs govern -oxidation and metabolism, and to explain how they produce the disorders -just enumerated. - -Footnote 2: - - Intern. Congr. of Med., Madrid, April, 1903; and various Addresses to - the Brussels Royal Society for Med. and Nat. Sciences, 1903, the - Hamburg Med. Society, 1904, the Paris Biolog. Society, 1904, the - London Path. Society, 1905, etc. - -Footnote 3: - - Sajous: “Internal Secretions and the Principles of Medicine,” vol. i, - 1903, and vol. ii, 1907, and Philadelphia Medical Journal, March 7, - 1903. - -The most important part herein is taken by the thyroid gland, whose -increased activity is followed by an augmentation of the processes of -oxidation in the body, whereas its degeneration is followed by a -diminution of these processes. When the thyroid gland is degenerated -entirely, as in myxœdema, there is also a great diminution of all -oxidation processes. There are also cases where the thyroid is only -partially altered by the increase of connective tissue, cases called -partial myxœdema, and in these cases, accordingly, the diminution of the -processes of oxidation does not take place to the same extent as in -complete myxœdema. - -When we thus find symptoms of old age in young persons, together with, -in the most typical cases, a state of decreased oxidation, we have to -determine whether or not we are dealing with a degeneration of the -thyroid gland. And, indeed, such a condition is before us, for the -symptoms we have just mentioned are characteristic of myxœdema. - -If complete myxœdema, the highest degree of this condition, is rare, on -the other hand the incomplete forms, where the thyroid is only partially -replaced by connective tissue, are fairly common. - -This is shown by the fact that, after the fortieth or forty-fifth year, -the thyroid shows an increased amount of connective tissue, and thus -cannot be so active as a thyroid with more secreting elements and less -connective tissue. - -We have thus reasons to suppose that the persons above mentioned, who -only exhibit some but not all of the symptoms of old age, symptoms which -are also found as typical in myxœdema, are suffering from a partial -myxœdema or hypothyroidia. And it does not necessarily follow that in -all such cases the processes of nutrition will be diminished, as is the -rule in typical cases of myxœdema. - -The resemblance between senility and myxœdema was first pointed out in -1890 by Sir Victor Horsley, one of the foremost authors on myxœdema, and -afterward by Vermehren,[4] Ewald,[5] of Berlin, and the author. Horsley -ascribed old age to degeneration of the thyroid gland, and we have shown -(in a communication to the Paris Biological Society, presented by Dr. -Gley, Professor of Physiology at the University of Paris, December 4, -1904) that, besides the thyroid, there are also different other ductless -glands whose degeneration produces old age. These are the sexual glands, -the pituitary body, and the adrenals. - -Footnote 4: - - Over Myxœdemet, Kjöbenhavn, 1895. - -Footnote 5: - - Ewald: “Die Erkrankungen der Schilddrüse,” Nothnagel’s Handbuch, - Vienna, 1896. - -It is a well-known fact that extirpation of the testicles and of the -ovaries is followed by obesity and other symptoms of old age; in the -same way cessation of the menstruation with degeneration of the ovaries -at the climacteric is followed by all the symptoms of old age and -certain nervous disturbances, as, for instance, troublesome flushings, -which occur here, as after castration. Eunuchs, as a rule, look much -older than their age. The Oriental eunuchs, and also the members of a -religious caste in Russia, the Skopse, who castrate themselves through -fanaticism, because of their parchment-like face covered with -innumerable wrinkles, appear aged beyond their years. - -Degeneration of the pituitary body is also followed by premature -senility. This is shown by the fact that acromegalic persons, as a rule, -look much older than their age. This also holds good in the case of -myxœdematous patients. We have had opportunity to see, quite recently, -the skeleton of a female acromegalic patient of Dr. G. A. Gibson in -Edinburgh, and found typical indications of old age, an enormous -augmentation of connective tissue and vascularization of the bones, with -great porosity. - -It must be remembered that all the glands with internal secretions, -according to Pineles,[6] Sajous,[7] and the researches of the author, -stand in very close relation to one another. Thus, degeneration of the -thyroid is followed by that of the pituitary body. This was shown by the -experiments of Hofmeister,[8] Stieda,[9] Rogowitsch,[10] Benda, and many -others. Degeneration of the pituitary is followed by a similar lesion in -the thyroid. - -Footnote 6: - - Pineles: Volkmann’s klin. Vorträge, N. 242, 1899. - -Footnote 7: - - Sajous: “Internal Secretions,” Philadelphia, vol. i, p. 140, 1903. - -Footnote 8: - - “Beiträge zur klin. Chirurgie,” 1894. - -Footnote 9: - - Ziegler’s Beiträge, Bd. vii. - -Footnote 10: - - Ziegler’s Beiträge, vol. iv, 1889. - -Arteriosclerosis is a condition very frequently met with in elderly -persons, and, according to recent researches, this disease is caused by -a toxic agent with subsequent degeneration of the walls of the -blood-vessels. Such a change can be produced artificially, as shown by -Josué,[11] by injecting adrenal extract into rabbits. - -Footnote 11: - - Josué: C. R. Société de biologie, Nov. 14, 1903. - -That the ductless glands are closely related holds good also for the -thyroid and adrenals. This relation, however, is an antagonistic one. -The adrenals increase the blood-pressure (Oliver and Schäfer[12]), and -the thyroid diminishes it. It is an interesting fact, demonstrated by -Professor Eiselsberg[13] in Vienna, that extirpation of the thyroid -gland of dogs results in atheroma of the aorta. In connection with this -we also mention the clinical fact, that all those agencies which are -harmful to the thyroid gland, as syphilis, abundant meat food -(Breisacher,[14], Blum,[15] Lorand[16]), alcohol (Hertoghe and de -Quervain[17]), and tobacco (Hertoghe), are also those which are commonly -considered to be the causes of high tension and arteriosclerosis. -Infectious diseases are also brought in etiological relationship with -arteriosclerosis, and it has been shown by a series of authors, that in -infectious diseases the thyroid undergoes important alterations which -may involve its degeneration (Roger and Garnier, Crispino, Torri, Bayon, -de Quervain). - -Footnote 12: - - Oliver and Schäfer: Journal of Physiology, vol. xviii, 1895. - -Footnote 13: - - Eiselsberg: “Die Krankheiten der Schilddrüse,” Stuttgart, 1901. - -Footnote 14: - - Breisacher: Archiv für Anat. und Physiologie, Suppl., Bd., p. 509, - 1890. - -Footnote 15: - - Blum: Virchow’s Archiv, p. 495-514, 1899. - -Footnote 16: - - Lorand: Transactions of the Path. Society of London, vol. lvii, Part. - 1, 1906. - -Footnote 17: - - La Semaine Médicale, 1905. - -Infectious diseases also induce changes in the adrenals, as shown by -many authors (see Chapter III). - -Various toxic products, such as lead, alcohol, and tobacco, which are -considered causes of arteriosclerosis, are also able to produce -hypertrophy of the adrenals. - -And, if we consider those agencies which are commonly considered the -causes of premature senility, we notice the singular fact that they are -also considered to be especially harmful to the various glands with -internal secretion, particularly the thyroid and sexual glands. - -Among these agencies may be mentioned infectious diseases, sexual -excesses, frequent pregnancies, strong emotions continued for a long -time, such as grief and sorrow, chronic intoxications (by poisonous -products produced in the body, or introduced from without). We will show -later, in an exhaustive way, the action of these agencies upon the -glands with internal secretion. - -Between the thyroid gland and the ovaries, a close relationship also -exists. Thus, invariably, when we find the thyroid altered, we can also -see changes in the ovaries. Consequently in myxœdema and Graves’s -disease we find, with great frequency, disturbances in the functions of -the ovaries, e.g., cessation of the menses, or disorders of -menstruation. In such conditions the ovaries have often been found to be -atrophied. We also frequently find such disturbances in acromegaly, -where they may either be due to changes in the pituitary, associated -with an altered condition of the ovaries, or they may be ascribed -directly to changes in the thyroid which, as we have shown in a -communication to the International Congress in Madrid, 1903, is very -often altered in acromegaly. If microscopically examined it is probably -found changed in every case. Indeed, we have attributed acromegaly to -the primary changes in the thyroid which lead only secondarily to those -in the pituitary body. - -In diabetes, which disease, according to our investigations, is often -caused by changes in the thyroid,[18] and subsequently in the pancreas, -or _vice versâ_, amenorrhea or impotency is frequently met with. - -Footnote 18: - - Lorand: “Die Entstehung der Zuckerkrankheit und ihre Beziehungen zu - den Veränderungen der Blutgefässdrüsen,” Berlin, A. Hirschwald, 1903, - and French Translation, Maloine, Paris, 1904. - -On the other hand, changes in the ovaries are also, as a rule, followed -by changes in the thyroid gland, as may be seen in puberty, -menstruation, pregnancy, lactation, and the climacteric. We will enlarge -upon this later, in greater detail, but we will only briefly mention -here that we may frequently see a swelling of the thyroid gland as an -expression of increased activity during these conditions. We can also -see this in diseases of the ovaries, and, as certain authors show, even -sexual excesses can produce an altered state of the thyroid. This was -known to the ancient Hebrews, for they used to examine the neck of the -newly-married bride the morning following the wedding night to see if -the neck had become larger by the swelling of the thyroid gland. - -Thus we can readily understand that, frequently, swelling of the thyroid -is the consequence of overwork of this organ, and, as in the case of -great sexual excesses or frequent pregnancies, may lead to exhaustion of -the gland with its grave clinical consequences. - -Indeed it has been shown by the earliest authors on myxœdema, that this -disease is very frequently caused by too frequent pregnancies, -especially if connected with prolonged lactation (Ord, Morvan, Combe). -This will also explain why women more frequently show the symptoms of -precocious senility than men, whose sexual glands are not put to such -constant activity and change as are the female sexual glands. Similarly -women, after frequent pregnancies, especially with prolonged lactation, -or women with diseases of the ovaries, and also those addicted to -habitual sexual excess, such as prostitutes, very soon become fat and -fade before their time. Thus we may see symptoms of precocious senility -in such women even before the end of the third decade, especially if -they have begun to lead an immoral life at an early age. Even young -girls may look much older through the abuse of their ovaries from sexual -excesses. Their breasts become large and pendulous, and their faces -bloated and relaxed. Menstruation may likewise be made to appear in -early childhood by sexual abuses, as Pauline Tarnowska[19] has found -through the examination in St. Petersburg of 150 very young prostitutes. - -Footnote 19: - - Tarnowska: “Etudes antropométriques sur les prostitutées et les - voleuses,” Paris, 1889. - -We shall show in the next chapter that obesity, which has nothing to do -with overfeeding, can be caused by like agencies. - -That mental emotions, especially care, grief, sorrow, etc., powerfully -influence the different ductless glands, and are able to produce -degeneration of the thyroid, adrenals, and sexual glands, etc., is shown -by conclusive proofs in the chapter on the “Hygienics of the Mind.” - -Infectious diseases are especially liable to cause change in the -kidneys, and in various infectious diseases, sometimes even in -tonsillitis, we may find an inflamed condition of these organs. - -The kidneys can also be damaged by the passage of various toxic -products, which are either produced in the body (auto-intoxication) or -introduced with the food (condiments), or as stimulants—e.g., alcohol, -strong tea, etc. All these toxic agents are capable of doing damage to -the kidneys just as to the thyroid gland. We shall treat later on, in -separate chapters, of the action of these stimulants upon the ductless -glands. - -The condition termed auto-intoxication may be induced by many different -factors, among which may be mentioned the products of intestinal -putrefaction (Senator[20]) and the waste products from the processes of -oxidation, such as uric acid, for example. Animal food is more apt to -produce intestinal putrefaction than any of the various other -foodstuffs. - -Footnote 20: - - Senator: Berliner klin. Wochenschrift, Nu. 24, 1868. - -There are three important organs which protect us against such a -condition of auto-intoxication; these are the kidneys, liver, and -thyroid, and possibly also the parathyroids. - -The kidneys act by promptly eliminating such toxic products in the -urine. They are glands with internal secretion, as shown by the -experiments of Brown-Séquard,[21] E. Meyer,[22] and clinical -observations of Senator[23] and H. Strauss. - -Footnote 21: - - Brown-Séquard: Archives de physiologie norm. et path, p. 778, 1893. - -Footnote 22: - - E. Meyer: _Ibid._ p. 179, 1894. - -Footnote 23: - - Senator: Loc. cit. - -The liver, which, according to Gilbert, H. Strauss,[24] and others, is -also a gland with an internal secretion, is strongly antagonistic to -intestinal poisons. It destroys toxic products brought to it from the -intestine through the portal vein, and several authors, Professor Adami, -Sir Lauder Brunton and Bokenham,[25] show that it is also able to -eliminate such products with the bile after previous transformation. We -will treat of these protective functions of the liver in a separate -chapter, together with the hygienics of this important organ; but we -will just mention here that the liver plays a great rôle in the -transformation of the toxic end-products of albuminous food into -harmless substances, such as urea. - -Footnote 24: - - H. Strauss, Senator: Festschrift. - -Footnote 25: - - Sir Lauder Brunton and Bokenham: The Journal of Pathology and - Bacteriology, p. 50, Nov., 1907. - -The third important toxin-destroying organ is the thyroid gland, which, -as shown by the experiments of Dr. Leo Breisacher,[26] of Detroit, -formerly assistant to Professor Munk, of Berlin, and of Dr. F. Blum,[27] -of Frankfort, as well as Dr. Chalmers Watson,[28] of Edinburgh, destroys -those poisonous substances produced by the decomposition of proteid -food. Moreover, Sajous has shown that this is a prominent function of -the pituitary body, the thyroid and the adrenals, acting jointly as the -“adrenal system.” - -Footnote 26: - - Breisacher: Loc. cit. - -Footnote 27: - - Blum: Virchow’s Archiv, 1899. - -Footnote 28: - - Lancet, Feb. 11, 1905. - -It will be evident that these various glands can only do their work to -perfection so long as their parenchymatous tissue is not replaced to any -large extent by connective tissue. Of these glands the thyroid takes the -foremost rank, as it governs the other glands. As we have shown in a -communication to the French Congress of Medicine, in Liège, 1905, the -thyroid influences the liver, and in a paper before the Paris Biological -Society, February 25, 1907, we have shown that the thyroid also -influences the kidneys. In fact, the liver and kidneys are closely -allied to the thyroid, and when this organ is degenerated, the other two -glands follow suit. - -Accordingly we may expect that, when the thyroid undergoes a process of -degeneration, such an event may also take place in these two protective -organs, as we have shown in our above-mentioned two communications. In -consequence of the diminished activity of these organs the development -of a condition of auto-intoxication may be facilitated. Patients showing -symptoms of old age in early years, also show to a greater or less -extent symptoms of such a condition, as do myxœdematous persons. - -Meat food especially, if taken in large quantity, is a certain producer -of uric acid, and it is an interesting fact, shown by several authors -and also by the writer,[29] that by thyroid medication we can augment -the elimination of uric acid, and also prevent its formation in large -quantity, both in the case of uric acid formed in the body or introduced -from without by the food. - -Footnote 29: - - Lorand: Comptes Rendus de la Société de biologie de Paris, Février 25, - 1907. - -This fact stands in relation to the powerful influence exercised by the -ductless glands, and especially the thyroid, upon the process of -oxidation; and, as we are anxious to prove the assertions we here -advance, we shall show in the next chapter how these wonderful glands -influence the processes of nutrition in the tissues, and at the same -time the external appearance. We have already mentioned a form of -obesity that has nothing to do with overfeeding, as one of the symptoms -of precocious old age, and in the next chapter we will review in detail -the agencies which govern this condition. - - ------------------------------------------------------------------------- - - - - - CHAPTER II. - - ON THE AGENCIES WHICH GOVERN OUR EXTERNAL APPEARANCE AND THE NUTRITION - OF THE TISSUES. - - -AS a general rule infants of both sexes look very much alike, so much -so, indeed, that sometimes it is only possible, upon close inspection, -to determine the difference in sex. This, however, can only be so for a -certain period until certain changes take place in the ductless glands, -especially in the sexual glands and the thyroid. - -The latter contains but very little, if any, colloid substance in -infancy, and the colloid increases only gradually until it is present in -abundance at the time of puberty, when also the changes in the sexual -glands reach a climax coincident with the ripening of the follicles in -the ovaries and their rupture at a menstrual period. This latter process -is, as we have mentioned before, under the influence of the thyroid. -Puberty and menstruation do not take place, as a rule, in persons with a -degenerated thyroid gland. - -With the onset of puberty there is seen, also, a change in the external -appearance of the individual and the attributes of virility—e.g., -moustache, hair in the pubic region, alteration of the voice, etc., -appear. In the female the development of the breast, hair on the pubis, -etc., occurs. At the same time the features attain the peculiar -characteristic which distinguishes the male face from the female, even -without the aid of a moustache. - -In those persons in whom puberty has not occurred at the usual age -(fourteen to sixteen years in our climate) the attributes of sex are -absent. In these cases the male looks very much like the female. A -similar phenomenon may be seen in women after castration and the -climacteric, when they may even show a tendency to develop a moustache -and hair on their face in places, corresponding to the male beard. - -This we can also observe in women whose ovaries have been altered by -disease or by sexual excesses. - -These attributes of sex are also called external sexual characteristics, -and they are the direct result of the internal secretion of the sexual -glands. They only develop through the presence of such a secretion, and -this is easily demonstrated by the fact that after castration of the -infant, they do not appear at all. Hence, if we see grown-up men with no -trace of a moustache it may indicate an undeveloped condition of the -testicles. Again, we castrate a young cock, he will not grow a comb and -spurs, and other cocks will pass by, too proud to fight with a -degenerate deprived of its male attributes. If we now take the -extirpated testicle of such cock and graft it under his skin, the other -cocks will commence to fight with him, for his comb and spurs will -develop as in other normal cocks. - -That the whole external appearance of a castrated animal or man is -changed, is also demonstrated by important changes in the skeleton and -size of such animals or persons. - -As Poncet[30] has shown, the extremities of a castrated rabbit become -abnormally long, and it is a well-known fact that eunuchs have -abnormally long arms and legs. This also occurs in cases of infantilism, -which, as we know, is due to a non-development of the sexual glands. -Moreover, the thyroid of such individuals is also found to be in a -pathological condition, as was shown by Hertoghe. - -Footnote 30: - - Poncet: C. R. de la Société de biologie de Paris, 55. - -Men who have been castrated before puberty or whose testicles are -undeveloped, present such an external appearance. They have no -moustache, as above mentioned; their hair is dry and brittle and remains -short; their faces are pale, and of a yellowish hue; their hands are -cold and reddish blue. Often the skin of the face is like parchment and -has many wrinkles. Their intelligence is often diminished, as we will -show later on, and they are usually anæmic. - -Women with undeveloped ovaries have flat breasts and hips; their faces -are often irregular in structure, and their jaws are often prominent; -their gums are shrunken and their teeth are long and soon fall out. Some -cases may show a colossal obesity, but in the partial forms of ovarian -insufficiency they may be remarkably thin. They also are, as a rule, -anæmic or chlorotic. - -In some parts of the Orient, as in India, there are female eunuchs, such -as Roberts has seen on the way from Delhi to Bombay. Such eunuchs had no -bosom; the pubic hair was absent, and their buttocks were like those of -men; but the rest of the body was stouter. Of course these women had -been castrated during their childhood. - -If we make a Roentgen-ray examination of the skeleton of a person -castrated in childhood, we shall find that the epiphysial cartilages -remain unossified for a long time after puberty. - -It is a very interesting fact that, both after castration and in -myxœdema, the same persistence of the epiphysial cartilages and -retardation of ossification have been observed by means of the -Roentgen-rays: by Hertoghe in 1896; Springer and Serbanesco in 1897; -Gasne and Laude in 1898; Legry and Renault in 1902; Jeandelize in 1903. -The same thing has also been observed by Hertoghe in “Infantilism of the -Type of Lorraine.” - -The influence of the thyroid upon the skeleton and size of the body is -easily shown by simple observations. - -Children of parents with cachectic diseases like chronic tuberculosis, -syphilis, alcoholism, etc., in which the thyroid gland is, as a rule, -found degenerated (Gamier,[31] Hertoghe[32]), are (as shown by Prof. -Perrando[33] and Garnier) born with a congenital atrophy of the thyroid. -Just as young animals with an extirpated thyroid, so these children will -not grow, and we know that cretins (degeneration of the thyroid) remain -as a rule dwarfs all their life long. We can now produce in such persons -certain and very curious changes by feeding them with thyroid extract, -and we can see them, as Hertoghe has shown, grow inch by inch in a short -period; their mental faculties improving at the same time in an -incredible manner. - -Footnote 31: - - Garnier: “La Thyroide dans les maladies infectieuses,” Thèse de Paris, - 1899. - -Footnote 32: - - Hertoghe: Loc. cit. - -Footnote 33: - - Perrando: “Sulla struttura della Tiroide,” Sassari, 1900. - -The influence of the thyroid upon the skeleton is also shown by the -fact, established by Gauthier,[34] that in a fracture with but little -tendency to the formation of a callus, union takes place much more -quickly after administration of thyroid extract. - -Footnote 34: - - Les Médications thyroidiennes, 1902. - -In Graves’s disease, with exaggeration of the thyroid activity, there -is, on the other hand, an increased elimination of the most important -constituent of the skeletal tissues: calcium carbonate, and this occurs -also in acromegaly and diabetes, in which conditions the thyroid is very -frequently altered (Lorand[35]). - -Footnote 35: - - Lorand: Loc. cit. - -Osteomalacia, which is associated with an enormous elimination of -calcium carbonate is, as we at present consider, due to an exaggerated -ovarian activity (Fehling), and can be favorably influenced by -castration or, by what would be more reasonable, thyroid treatment. - -No less powerful than that of the thyroid is the influence of the -pituitary body upon the skeleton, especially upon the hands, feet, and -skull. And if we wish to demonstrate how much the ductless glands -influence the looks of a person, it is sufficient to point out the great -changes that take place in the face of a patient with acromegaly. This -disease makes such persons look very much as “Punch” is depicted. - -The skin and complexion of persons suffering from changes in the -ductless glands are also very different from normal. Thus Addison’s -disease, due, as well known, to a degeneration of the adrenals, makes a -white man look more or less like an Indian, and there is a pigmented -skin also in persons affected by the - -partial form of that rare disease. We can also easily show that changes -in the thyroid are followed by changes in the condition of the skin. -Thus, with thyroid degenerations, as in myxœdema, the skin is pale with -a yellowish tinge. In Graves’s disease pigmentation of the skin can -often be observed, and not rarely cutaneous eruptions. - -In affections of the sexual organs in woman similar conditions of the -skin can occur. Such persons often present wrinkles at a very early age, -and certainly look older than their years. Infants suffering from -congenital degeneration of the thyroid gland often look withered and -present a face as wrinkled as a sexagenarian. We see this also in -congenital syphilis (atrophy of the thyroid). - -The hair also very often shows alterations in diseases of the thyroid, -or ovaries. Thus, in myxœdema there is an atrophy of the follicles of -the hair, which falls out, even in the case of the eye-brows. - -It is particularly interesting that, by thyroid medication, a new growth -of hair has been observed in places where it had fallen out years -previously, as we have observed, with other authors, in several cases -after thyroid medication. And, very strange to say, this newly-grown -hair was quite dark while the hair that had previously been in its place -was gray in color. It has been authentically stated by several -authorities that old persons of sixty or seventy have acquired black -hair under thyroid treatment. - -On the other hand, in much younger persons, perhaps under thirty, who -are suffering from complete or partial degeneration of the thyroid -gland, the hair very often turns gray; so much so that Hertoghe -considers this to be one of the typical symptoms of such a condition. - -The falling out of hair, or its turning gray, after acute infectious -diseases or after grief and sorrow, may have some connection with the -well-known changes in the ductless glands, especially in the thyroid, in -these conditions. This is made quite clear by Sajous’s demonstration -that these glands collectively govern the activity of general oxidation, -that is to say the vital process itself. - -As we have previously mentioned, a moustache or whiskers may grow in -women suffering from disease of the ovaries, just as after castration or -the climacteric. It is also very interesting that a premature grayness -often occurs in cases of insanity, and can be attributed to the frequent -changes in the thyroid and sexual glands in these conditions. - -The nutrition of the skin is entirely under the influence of the -thyroid. After extirpation or degeneration of the thyroid, there occurs -atrophy of the sebaceous and sudorific glands. - -In myxœdema the skin is dry and never perspires. On the contrary, in -Graves’s disease, or after thyroid medication in large doses, there is -abundant perspiration. - -Deposits of tartar are common symptoms in all forms of thyroid -degeneration. Retraction of the gum follows and the teeth loosen and -fall out. This is also a common symptom in diabetes, but here only in -advanced cases. In such cases there is, as we[36] have shown, an -exhaustion of the thyroid gland, which develops as a consequence of the -previous hyperactivity of the thyroid gland in the early stages of the -disease. As a rule the teeth of a diabetic only fall out in the severer -form of the disease, generally after acetone has begun to show itself in -the urine. - -Footnote 36: - - Lorand: “Die Entstehung der Zuckerkrankheit,” Berlin, 1903, and in - French translation, Paris, 1904. - -Important changes take place in the subcutaneous tissue after -extirpation of the thyroid gland. In such cases there is either -augmentation of connective tissue or of fat. Thus, in the case of a -young bull, whose history we followed, there has been an increase of -thirty pounds of fat within a few months after extirpation of the -thyroid. The same thing happened in the case of a young horse, whose -thyroid was also extirpated. - -There are, however, still more facts which show the great influence of -the thyroid upon the metabolism of fat. Thus we know very well that by -thyroid medication we are able to reduce fat considerably. This is due -to the action of the thyroid which, as shown by many authors, increases -the process of oxidation. In Graves’s disease these processes are -augmented. In the opposite condition (myxœdema) they are diminished. By -giving thyroid extract we are able to augment, positively, the processes -of oxidation in the tissues, as shown by Professor Magnus-Levy,[37] of -Berlin, and many others. - -Footnote 37: - - Magnus-Lévy: “Der Stoffwechsel bei Erkrankungen einiger Drusen ohne - Ausführgang,” in v. Noorden’s “Handbuch der Pathologie des - Stoffwechsels”, vol. ii, Berlin, 1907. - -As we have shown in our previous researches, there is an abundant -formation of fat in the early cases of degeneration of the thyroid -gland, which sometimes progresses to a colossal obesity, which obesity -has nothing to do with overfeeding. Such individuals have, as a rule, -but poor appetites, and eat very little. Therefore, in a communication -to the French Congress of Internal Medicine in Paris, 1904, we -differentiated two kinds of obesity: 1. _Exogenous obesity_—i.e., -arising by agencies coming from without by the food we introduce into -our body. 2. _Endogenous obesity_, having its origin within our economy, -and depending on changes in certain glands which govern the processes of -oxidation—e.g., thyroid sexual glands, pituitary body. This second form -is independent of our feeding. As we have shown, this latter can be -produced by any of those agencies which are harmful to the ductless -glands, especially the thyroid and sexual glands, as, for example, -infectious diseases, frequent pregnancies, certain toxic products -(alcohol), sexual excesses, climateric. All these conditions may have -the effect of producing obesity, which can be explained by an exhaustion -of the thyroid and ovaries following a pre-existing hyperactivity. - -The influence of the ovaries upon the production of obesity can be -demonstrated by the sequels of castration, and also by the fact that -women, after one or more, especially several pregnancies, or after -sexual excesses, may become very fat. In such women this obesity may be -only partial and limited (as we have shown in a recent communication to -the International Congress of Medicine in Lisbon, 1906) to certain -parts—e.g., the mammary glands or hips. - -There can be no doubt that the sexual glands influence the nutrition of -the tissues in a powerful manner, and this has also been shown, -experimentally, by the researches of two Berlin experimenters, -Professors Loewy and P. I. Richter,[38] performed in the physiological -institution of Professor Zunz. These savants have shown that after -castration there is a diminution of oxidation. By giving extracts of -dogs’ testicles to castrated male dogs, they were able to augment the -processes of oxidation. These processes, however, were still more -increased after the administration of female extracts to these castrated -male dogs. The administration of ovarian extracts to the spayed bitch -has, of course, given still better results. Thus there was here an -increase of 67.7 per cent. after castration, and 37.6 per cent. of the -original value. The increase of the oxidation in male dogs was 44.5 per -cent. after castration, by the treatment with ovarian extracts, and 24.8 -per cent. above the normal value. If the results after feeding with male -extracts were not so successful, it must be attributed to the -circumstance that we are at present unable to produce testicular -extracts of the same efficacy as ovarian extracts. - -Footnote 38: - - Loewy and Richter: Archiv für Anat. u. Physiologie, Supplement, 1899, - and Berliner klin. Wochenschrift, 1899. - -The action of the pituitary body upon metabolism has been shown by -Narbuth, who found a diminution of oxidation after degeneration of the -pituitary body, and an increase after medication with extracts of the -same organ. This fact is also shown clinically by cases of obesity after -degeneration of the pituitary body in acromegaly, and by the interesting -fact (shown by a great number of authorities and recently by -Fröhlich,[39] Berger,[40] and Erdheim[41]) that cases of pituitary tumor -may be met with, associated with obesity, and without any of the -symptoms of acromegaly. Especially interesting is the case of -Madelung[42] showing a colossal obesity in a girl aged 9 years, after a -gunshot injury of the pituitary body. This observation sustains, and is -clearly explained by, Sajous[43] who showed that the posterior or neural -lobe of the pituitary body contained a nerve center which governed the -functional activity of the thyroid, and that the secretion of the latter -insured the catabolism of fats by increasing their vulnerability to -oxidation. - -Footnote 39: - - Wiener klin. Rundschau, p. 78, 1901. - -Footnote 40: - - Zeitschrift für klin. Med., liv, p. 5, 6. - -Footnote 41: - - Ziegler’s Beiträge, 1903. - -Footnote 42: - - Archiv für klin. Chirurgie, p. 1066, 1904. - -Footnote 43: - - Sajous: “Internal Secretions, etc.,” vol. ii, 1907. - -The external appearance of such cases of obesity, which we have -described before the French Congress of Medicine in 1904, and the London -Pathological Society, February 21, 1905, as endogenous obesity, is also -clinically different from the appearance of those caused by overfeeding. -As we have shown, persons addicted to rich food, with little exercise, -are often red in the face, and are plethoric; they easily become -overheated and perspire freely. They seldom complain of constipation. On -the other hand persons suffering from endogenous obesity generally look -pale, always complain of cold and dry skin, and perspire very seldom, if -at all. As a rule they are also very constipated. - -There is still another ductless gland which influences metabolism in a -powerful way. This is the pancreas which, by its three enzymes, brings -about the assimilation of the proteid carbohydrate and fatty materials. -To these may also be added its production of labferment. By its internal -secretion, which is probably produced by the islands of Langerhans, it -aids in the oxidation of the sugar, introduced into our alimentary canal -in the shape of starchy food, or contained in the carbohydrated radicle -of the albuminous molecules, as demonstrated by Pavy. The entire -degeneration of the pancreas, especially of the part containing the -islands of Langerhans, produces a disease that is, as a rule, -characterized by loss of weight and the production of emaciation often -to an astonishing degree—i.e., diabetes. - -Persons suffering from the milder form of this disease often present a -rosy and healthy appearance, and as we have pointed out previously, -often look younger than their age. We believe that, as we shall show -further on, this fact is not without relation to the condition of the -thyroid in this disease. We have shown by researches made in the -laboratory of Professor Minkowski, then of the Augusta Hospital in -Cologne, that in diabetes the thyroid contains large, sometimes -enormous, quantities of colloid substance, thus indicating a condition -of thyroid hyperactivity. - -As we have mentioned in the first chapter, corpulence is often one of -the first symptoms of old age, and we have also insisted upon the fact -that this can be brought about by infectious diseases (e.g., typhoid, -pneumonia, scarlet fever, etc.). As we have also mentioned the fact, in -the first chapter, that old age can be brought about by an infectious -disease which acts upon the ductless glands, especially the thyroid, we -believe it will be necessary to enter a little more in detail into this -subject, to which we will devote the next chapter. We will enlarge upon -the fact that our immunity against infectious diseases is entirely -dependent on the proper working order of certain ductless glands. - - ------------------------------------------------------------------------- - - - - - CHAPTER III. - - ON THE AGENCIES WHICH GOVERN IMMUNITY AGAINST INFECTIONS AND - INTOXICATIONS—THE ORIGIN OF FEVER. - - -FROM the moment of our birth we are constantly exposed to the incessant -attacks of innumerable bacteria and to the effects of a large amount of -poisonous material formed within our body or introduced from without, -and if we survive this ceaseless battle it is due to the powerful weapon -we possess in the internal secretion of the ductless glands, especially -of the thyroid gland. That this gland possesses very energetic antitoxic -properties can be shown by the fact that when it is extirpated animals -or persons very readily acquire infectious diseases of all sorts. Thus, -the late Professor Charrin,[44] of Paris, showed several years ago how -readily dogs that have lost their thyroid succumb to all possible -infections. Professor W. S. Greenfield,[45] of Edinburgh, has found that -persons suffering from myxœdema (athyroidia) very often die from -tuberculosis, and Professor Pel,[46] of Amsterdam, found a great -frequency of tuberculosis in the families of myxœdematous persons. This -coincides with the conclusions of Prof. G. R. Murray,[47] Professor -Lanz, and ourself, that the properties of the thyroid can be inherited. -Sajous has shown, moreover, that the pituitary, the adrenals and the -thyroid constituted the autoprotective mechanism of the body against -disease, a fact not only sustained by the above evidence, but also by a -vast number of additional facts. - -Footnote 44: - - Charrin: “Les Defenses naturelles de l’organisme,” Paris, 1898 - (Masson). - -Footnote 45: - - Greenfield: Quoted after Ewald, “Die Erkrankungen der Schilddrüse,” - Nothnagel’s Handbuch, Wien. p. 159, 1896. - -Footnote 46: - - Pel: “Myxœdema,” Volkmann’s Sammlung klin. Vorträge, 1895, No. 123. - -Footnote 47: - - Murray: “Diseases of the Thyroid Gland,” Part i, London, 1901. - -As we showed at the last Congress of Tuberculosis in Paris, 1905, -tuberculosis is especially frequent as a sequel to any process -deleterious to the thyroid gland, as after the puerperium, especially -with prolongated lactation; after sexual excesses, as there is a -relation between the sexual glands and the thyroid; after various -infectious diseases; after rapid growth in puberty, due to hyperactivity -of the thyroid which influences the growth of the body; after severe -diabetes due to exhaustion of the thyroid; and after previous -hyperactivity in chronic alcoholism due to the action of alcohol upon -the thyroid. On the other hand, all those agencies which excite thyroid -activity may be a preventive against tuberculosis, such as raw meat and -milk. It has been shown that milk contains the internal secretion of the -thyroid. - -The thyroid protects us against poisons of different origin, such as the -products of decomposition of protein food. This fact is shown by the -experiments of Dr. Leo Breisacher, of Detroit,[48] formerly assistant of -the late Professor Munk, of Berlin, and from those of Dr. Blum,[49] of -Frankfort. The experimental results of Dr. Chalmers Watson,[50] showing -alteration of the thyroid in certain animals after an exclusive diet of -raw meat, and those of Dr. D. Forsyth[51] concerning the pituitary body -in some animals, may be correlated with this fact. As is well known, the -thyroid and pituitary body stand in very close relationship. Galeotti -and Lindemann,[52] in 1897, have also shown that the products of -decomposition of meat produce an increase of the colloid substance of -the thyroid. - -Footnote 48: - - Breisacher: “Untersuchung über die Gland Thyroidea,” Archiv für - Anatomie und Physiologie, Suppl., Bd., p. 509, 1889. - -Footnote 49: - - Blum: Pflüger’s Archiv, vol. xc., p. 285, 1902; Archiv für die - Gesammte Physiologie, p. 617, 1902. - -Footnote 50: - - Chalmers Watson: The Lancet, p. 347, Feb. 11, 1905. - -Footnote 51: - - Forsyth: The Lancet, p. 154, Jan. 19, 1907. - -Footnote 52: - - Lindemann: Virchow’s Archiv, p. 202, 1897. - -The antitoxic properties of the thyroid against different products is -also shown by the observations of Lanz[53] and Walter Edmunds,[54] who -have found that animals without thyroid resist narcosis badly; and, as -we have shown in a communication to the Paris Biological Society,[55] -chloroform, like alcohol, produces a condition of hyperactivity in the -thyroid gland, which results also in an excited mental condition. The -observation that cases of Graves’s disease and of severe diabetes cannot -stand narcosis may be related to this fact. - -Footnote 53: - - Lanz: Zur Schilddrüsenfrage, Leipzig, 1894. - -Footnote 54: - - W. Edmunds: The Lancet, May 11th, p. 1317; 18th, p. 1381; 25th, p. - 1449, 1901. - -Footnote 55: - - Lorand: C. R. de la Société de biologie, 1906. - -It has been shown recently by Hunt[56] that the thyroid protects us -against poisons like acetonitril, and that iodine acts through the -thyroid. Garnier,[57] of Paris, has found that certain chemical -products, such as iodine, produce great alterations in the thyroid. As -is well known, cases of Graves’s disease (hyperthyroidia) have been -observed after iodine treatment. That the thyroid fulfils a protective -rôle against infectious diseases may already be considered proved by the -fact that, as Roger and Garnier,[58] Crispin,[59] Torre,[60] Bayon,[61] -of Würzburg; de Quervain, and others have found, the thyroid is, as a -rule, altered in infectious diseases. As Roger and Garnier have shown by -a series of investigations confirmed by the above-named authors, the -thyroid shows in acute infectious diseases with fever an increased -activity with enlargement of the follicles, which are filled with a -large quantity of colloid substance which may even enter into the -adjacent lymphatic spaces. However, this hyperactivity of the thyroid -gland may be followed by its exhaustion, and thus after a certain -duration of high fever there may be no colloid substance at all in the -folliculi. - -Footnote 56: - - Hunt: International Congress of Physiology, Heidelberg, 1907. - -Footnote 57: - - Garnier: “La Thyroide dans les maladies infectieuses,” Thèse de Paris, - 1899. - -Footnote 58: - - Roger et Garnier: Presse médicale, April 19, 1899. - -Footnote 59: - - Crespin: Giornale dell’ Associazione Napolitano di Medici, xii, 3. - -Footnote 60: - - Torre: “La Tiroide nei Morbi Infettivi,” Il Policlinico, No. 6, p. - 145; No. 8, p. 226; No. 10, p. 280. - -Footnote 61: - - Bayon: Würzburger Abhandlungen, 1904. - -It is only logical to suppose that with anatomo-pathological alterations -of the thyroid, indicating a condition of hyperactivity, there must be -corresponding clinical symptoms and that these must necessarily be -similar to those found in another condition of hyperactivity of the -thyroid gland—i.e., in Graves’s disease, the condition of -hyperthyroidia. And, indeed, such must be the case, for, as we shall try -to show, fever and Graves’s disease have similar clinical symptoms. Thus -their most typical symptom is the same: tachycardia or increased -frequency of the pulse, without which no case of Graves’s disease should -be diagnosed. There is a sensation of heat in most of the cases of -Graves’s disease, and the temperature sometimes reaches a dangerous -degree in fully developed cases of this disorder. Thirst, frequent in -fever, is also a frequent symptom in Graves’s disease (polydipsia in 14 -out of 59 cases recorded by Albert Kocher[62]), and can also be produced -by thyroid feeding (Lanz,[63] Georgiewski,[64] and others). After a -certain duration of fever further symptoms of an increased activity of -the thyroid appear, such as abundant perspiration—a typical feature of -Graves’s disease. Vaso-dilatation and excessive perspiration can also be -produced by thyroid feeding. The latter symptom of fever is a device by -which nature tries to eliminate toxic products, and accordingly there -generally follows upon it a fall in the temperature and an amelioration -of the symptoms of fever. The diarrhœa which we find in some infectious -diseases, like that of typhoid fever, trypanosomiasis, etc., is also a -typical symptom in Graves’s disease. When the fever subsides there -appears another typical symptom of this condition: polyuria. To complete -this analogy we may mention toxic decomposition of proteins, diminution -in the body weight, great muscular weakness, and increased elimination -of urea and uric acid as typical symptoms of both conditions. As in -Graves’s disease, there is also in fever an augmentation of the -processes of oxidation. Glycosuria is frequent in both conditions, and -acetonuria may occur in fever and also in Graves’s disease. Glycosuria -and diabetes in consequence of infectious diseases are, as we have shown -in a paper read before the London Pathological Society,[65] probably due -to the increased activity of the thyroid, and their disappearance, -occasionally after a high fever, may be ascribed to the exhaustion of -the thyroid after a previous hyperactivity. We know that a condition of -Graves’s disease may be followed by a myxœdematous condition in which, -as we have shown previously, glycosuria is very rare. In the few -hitherto published cases there was no complete myxœdema. - -Footnote 62: - - A. Kocher: “Mittheilungen aus den Grenzgebeiten,” etc., 1901. - -Footnote 63: - - Lanz: Quoted after Buschau, Wein, 1895. - -Footnote 64: - - Georgiewski: Zeitschrift für klin. Medicin, Bd., xxxiii, f. 1-2, p. - 153, 1897. - -Footnote 65: - - Lorand: Transactions of the Pathological Society of London, vol. lvii, - part 1, 1906. - -Both in Graves’s disease and fever there is an augmentation of the -processes of oxidation. After convalescence, however, oxidation may be -diminished, and this explains, as we have shown at the French Congress -of Medicine in 1904,[66] why obesity so frequently occurs after -infectious diseases on the basis of degenerative changes of the thyroid, -which governs oxidation; during the course of infectious disease with -fever increased activity of the thyroid and loss of weight occur, and -these are followed by exhaustion of thyroid activity and obesity. - -Footnote 66: - - Lorand: Congrès Français de Médecine, Paris, 1904. - -The conditions of delirium and maniacal exaltation in cases of high -fever are analogous to the condition of mental exaltation that may occur -in Graves’s disease. According to the late Moebius,[67] in cases of -Graves’s disease there are sometimes symptoms like those of alcoholic -intoxication due to the toxins of the thyroid. We believe that the -mental exaltation in chloroform narcosis and alcoholic intoxication -stands in relation with the action of these drugs upon the thyroid. That -alcohol acts upon the thyroid has been shown by de Quervain, -Hertoghe,[68] and others. Sajous in his work on the “Internal -Secretions,” urges that the thyroid is not directly excited by toxins -and other poisons which produce fever, but that these toxics excite -primarily the thyroid center (or better the adreno-thyroid center, for -he holds that the adrenals are also governed by this center) thus -increasing the secretory activity of the gland. The correctness of this -view is proved by the fact that, as shown by Sawandowski,[69] section of -the basal tissues, and, therefore, between the pituitary and the bulb, -prevented the production of fever, due to putrid materials, and also the -influence of antipyretics, antipyrin, for instance. - -Footnote 67: - - Moebius: “Die Basedow’sche Krankheit,” Nothnagel’s Handbuch, second - edition. - -Footnote 68: - - Hertoghe: “Die Rolle der Schilddrüse,” etc., München, 1900; and - “Paludisme et Myxœdème,” Progrès médical Belge, No. 2, 1902. - -Footnote 69: - - Sawandowski: Centralbl. f. d. med. Wissensch. B. xxvi, S. 145, 161, - 1889. - -Cutaneous eruptions may occur in fever or in Graves’s disease. In the -same way as in many skin diseases they may be considered as the -expression of an elimination of toxic products through the skin. - -All the above symptoms of fever may be considered as expression of the -efforts of nature to defend herself by eliminating toxic products. All -toxic products which are the causes of infection act upon the thyroid -gland, this organ, through increased activity, produces symptoms such as -we see in Graves’s disease. That these symptoms, especially abundant -perspiration, polyuria, and diarrhœa, typical in some infectious -diseases, may be considered as the direct consequence of thyroid -activity, can best be shown by the fact that the thyroid gland governs -the functions of the skin, intestines, and kidneys. - -That the symptoms of fever may be considered as due to increased thyroid -activity is also shown by the fact that nearly all such symptoms may be -produced by thyroid preparations. We have personally taken for -experimental purposes, during ten months, thyroid tablets and -experienced the sensation of heat, flushings, and abundant perspiration. -It is interesting to note that all kinds of wounds and contusions we got -during the time we took these tablets, healed with surprising rapidity -with fine granulations far better than previously; on the other hand, we -very frequently suffered from tonsillitis and acne eruptions. - -Symptoms similar to fever have also been produced in animals by thyroid -feeding; thus, very often elevation of the frequency of the pulse from -100 to 140-160 beats (Lanz), and from 150 to 200 beats (Georgiewski), -while Ballet and Enriquez[70] produced regular fever in their animals; -Easterbrook[71] also produced “some pyrexia” in his animals and an -increase of pulse-rate of about 40 a minute. As Dr. Tanberg, former -assistant of the Physiological Institute in Christiania, told us, he has -produced an increase of the temperature of two and a half degrees in -animals, whose thyroid he had extirpated, after giving very large -quantities of thyroid gland. - -Footnote 70: - - Ballet and Enriquez: Quoted after Buschau. - -Footnote 71: - - Easterbrook: The Lancet, p. 546, August 27, 1898. - -It is of great interest to the question at issue that the remedies which -we employ to fight fever should also produce symptoms like the thyroid -does when it is in increased activity. Thus salicylates produce a -vaso-dilatation and abundant perspiration, and afterward diminution of -the temperature. We have, ourself, taken salicylates or acetonitril -preparation and felt the sensation of heat and afterward perspiration. -When we take a hot air or steam bath for cold or gouty pains we produce -first, great heat, tachycardia, and then abundant perspiration, and the -typical symptoms of fever or increased thyroid activity. - -We know that certain drugs, as found by Garnier, have an exciting action -upon the thyroid, such as iodine, and what is especially important, -pilocarpine. The great sudorific action of this drug may stand in some -relation to its effect upon the thyroid. It is permissible to suppose -that the different drugs which antagonize fever do so by acting first -upon the thyroid gland and exciting its increased activity to fight -infection. But if we gave too much of these we might exhaust the -activity of the gland in the same way as Garnier found an exhaustion of -the colloid of the thyroid after too much iodine. This shows that we -should not give antipyretics in too large doses. We should excite -thyroid activity but not overdo it. - -That the thyroid is able to protect us against infectious diseases can -be best shown by the fact that it exercises a great influence upon -phagocytosis. According to the findings of Fassin, the alexins disappear -from the blood after the extirpation of the thyroid gland; and, -according to Sir Almroth Wright, the production of opsonins is dependent -upon internal secretions. Hence, it is of the greatest value to us that -Stepanoff[72], and Marbé have proved by experiments conducted in the -Pasteur Institute of Paris that the opsonins disappear after the -extirpation of the thyroid gland but increase after thyroid treatment, -these experiments thus proving the correctness of our clinical -observations on the rôle of the thyroid gland as an organ for protection -against infections, as published in _The Lancet_ two and one-half years -ago. Sajous, who was first (1907) to point out that the thyroid -secretion was the agent which Wright termed “opsonin,” is also shown to -have been right by the investigations of Fassin, Stepanoff and Marbé, -thus proving further the intimate relationship between the thyroid and -our immunizing functions. - -Footnote 72: - - Stepanoff: Comptes Rendus de la S. B. de Paris, 1908. - -Fever can be produced with similar symptoms by toxic products of -different origin, as from small elements of the vegetable kingdom like -bacteria, certain plants, and even fruits, as is shown by the urticaria -which follows in some persons after eating strawberries. Certain minute -elements of the animal kingdom have a similar power, such as protozoa -like trypanosomes, and we may also instance certain kinds of animal food -like oysters in certain persons, the poison of snakes, and certain -insects like tarantulas and scorpions; also certain minerals like -arsenic and phosphorus can produce fever. Besides these poisons coming -from without, fever with similar symptoms can also be produced by -poisons formed within our body by the hyperactivity of a gland—the -thyroid. When so many different poisons produce the same result it lies -near to suppose that they do this by means of the same agency, which, -according to the aforesaid observations, is very probably a thyroid -hyperactivity. The _modus operandi_ of all these agents is well studied -in Sajous’s work, to which the reader is referred. - -As is well known, a condition of hyperactivity of the thyroid may be -followed by its exhaustion, and thus Graves’s disease may often be -followed by myxœdema, i.e., athyroidia. In the same way the -hyperactivity of the thyroid gland in infectious diseases may also be -followed by its exhaustion and a myxœdematous condition. Even complete -myxœdema most frequently appears after a previous infectious disease—a -fact recognized by the earliest English authors on this disease. -Accordingly, it is not surprising if an infectious disease like -trypanosomiasis is followed by a condition like sleeping sickness, -which, as we have shown at the German Congress for Internal Medicine in -1905, presents all the clinical symptoms of, and identical -anatomico-pathological alterations of the central nervous system noted -in, myxœdema. On the other hand, trypanosomiasis presents all the -typical symptoms of Graves’s disease. In syphilis also, after the fever -with eruptions in the secondary stage, in which we not infrequently see, -especially in women, a swelling of the thyroid, we find in the tertiary -stage many symptoms of a condition of myxœdema or hypothyroidia, and -with the iodine treatment we add to the blood the main element of the -thyroid gland. Iodine is also especially active, if not given in too -large doses, in exciting thyroid activity, and sometimes it even -provokes Graves’s disease. - -Persons of healthy constitution with a good working thyroid may get the -sensation of heat and perspiration spontaneously after a cold, or gouty -pains, even without salicylates, and feel better afterward, whereas -persons with a deficient thyroid have difficulty in producing the -symptoms of fever. Recently we observed a young man, aged 22 years, with -symptoms of hypothyroidia as described by Hertoghe, who had follicular -tonsillitis. He presented none of the symptoms of fever, but it took him -ten days to get over it and he felt very weak afterward. There was this -summer an epidemic of typhoid fever in the lunatic asylum of Colorno, -near Pavia. We have it from Dr. Gassenghi, of the University of Pavia, -that half of the patients died; but it is very interesting to note that -there was no fever. This may be explained by the fact that many cases of -insanity and idiocy stand in etiological relation to alterations of the -thyroid gland, and may get better after the hyperactivity of the thyroid -through fever. Indeed, by some authors,—e.g. Wagner—an improvement has -been observed to occur in insanity by producing fever through injections -with tuberculin. We feel sorry not to be able to enter more fully into -this interesting subject, but we may briefly mention that, as we have -stated in the Neurological Society of New York (April 2, 1906), we have -observed several cases of dementia præcox and melancholia with -alterations of the thyroid and sexual glands in each case. Alcoholics -suffering from pneumonia seldom get high fever, but often die in a short -time. Alcohol in large quantities not only causes degenerative changes -in the heart, but also in the thyroid. And we should not forget that -there exist very close relations between the activity of these two -organs. - -It seems to follow from these observations that persons with a good -sound thyroid have a better chance in fighting infections and -intoxications than persons with a degenerated thyroid. In persons with -an active thyroid, an increased activity of the gland, and thus a better -functioning of the eliminative organs which are governed by it, can take -place more easily than in persons with a degenerated thyroid, and, in -consequence, with a dry skin, constipated bowels, and lazy kidneys. Some -hints may be derived from these observations in the interest of -prophylaxis and prognosis, and also for the purposes of life insurance. - -It seems to us that the conclusion is not unjustified, that fever is a -beneficial process of our organism which is produced by an increased -activity of the thyroid gland as a reaction against toxic products and -poisons in general. The symptoms of fever are the expression of this -increased activity, and they are directed toward the elimination of -noxious elements. It would be unreasonable to oppose this spontaneous -healing tendency of nature by fighting these salutary symptoms, unless -there be hyperpyrexia. Fever, as probably disease in general, serves the -ends of nature in the interest of our conservation. In addition to the -thyroid, the other ductless glands protect us from infections and -intoxications. Thus, the pituitary body which Casselli,[73] -Guerrini,[74] Torri, and many others found, as a rule, altered through -infectious diseases. Torri noticed a hyperplasia of the chromophile -cells of the pituitary body, and disappearance of the colloid from the -follicles in the majority of cases of pneumonia, typhoid fever, -tuberculosis, diphtheria, and other infectious diseases. Garnier also -noted changes in this gland in chronic tuberculosis. Thaon,[75] in his -recent thesis, also found changes in the pituitary body in many cases of -various sorts of infectious disease, and, what is most interesting, also -in intoxications from intestinal origin. We must conclude with Sajous -(1903) that the pituitary body reacts to the effects of infections and -intoxications and that these anatomo-pathological alterations of the -pituitary also provoke clinical symptoms. Renon[76] and Delille have -drawn attention to the fact that the decrease of the blood-pressure, and -increase in the number of pulsations, in fever, as also the other -symptoms of this condition, such as insomnia, heat, perspiration, etc., -are due to the alteration of the pituitary body. When this is active and -healthy it augments blood-pressure, according to Oliver and Schäfer,[77] -Cyon, Livon, Garnier, Thaon, Hallion, and Carrion, etc. At the same time -the pulse is diminished, but when this gland is degenerated the pressure -naturally falls and the pulsation goes up. - -Footnote 73: - - Studie anatomici e sperimentali sulla psycho-pathologia della glandula - pituitaria, Reggio Emilia, 1900. - -Footnote 74: - - Revista di Patol, nerv. e mentale, Nov., 1904; and La Sperimentale, - lviii., 1904. - -Footnote 75: - - Thèse de Paris, 1907. - -Footnote 76: - - Société de therapeutique, Jan. 22, 1902. - -Footnote 77: - - Journal of Physiology, t. xviii, 1895. - -It is also very interesting that Renon, with his assistants, Delille and -Azam,[78] were able to increase blood-pressure in numerous cases of -infectious diseases and diminish the pulse, and also produce a marked -improvement in the feverish condition through the administration of -extracts of the pituitary body. - -Footnote 78: - - Azam: Thèse de Paris, 1907. - -We must insist on the fact that the thyroid and the pituitary body are -antagonistic; the thyroid diminishes, the pituitary augments, -blood-pressure. The same antagonistic relations exist also between the -thyroid and adrenals, as already mentioned. - -The adrenals play an important rôle also in the defense of the organism -against infections and intoxications, as we will point out in a separate -chapter. We will only recall here that already (1903) Sajous[79] has -insisted upon the important rôle of the adrenals in the production of -fever. - -Footnote 79: - - “Internal Secretions,” vol. i, p. 33. - -The co-operation of the sexual glands in protecting the body from -infectious disease can be shown by the fact found by Professor -Cornil,[80] of Paris, that in infectious diseases, such, for instance, -as typhoid fever, there is frequently sudden menstruation, with abundant -metrorrhagia, the autopsy often showing hypertrophy of the corpus -luteum. - -Footnote 80: - - Quoted after Loisel. - -Metschnikoff[81] and Matschinski found, after injections of the bacilli -of tetanus, or of diphtheria, the greatest number of them in the -ovaries, or in the testicles, of the animals. It is also of great -interest that Lingard[82] found that the subcutaneous injection of -testicular extracts into cattle induces a resistance to infection from -bovine plague, against which other cattle can also be rendered immune -through the serum of the treated animals—which seems very important to -us. Brown-Sequard and d’Arsonval employed testicular extracts with good -result in tuberculosis, and Uspenski in cases of Asiatic cholera.[83] - -Footnote 81: - - Metschnikoff: Annales de l’institut Pasteur, 1900. - -Footnote 82: - - Lingard: Centralblatt für Bacteriologie, vol. xxxviii, Nu. 2, p. 246. - -Footnote 83: - - Comptes Rendus de la Société de Biologie de Paris, Nov. 5, 1896. - -In the chapter on the treatment of old age by organic extracts, we -submit evidence showing that infectious diseases have been treated -successfully by several authors by these extracts. Many others have also -shown that spermin, prepared by Professor Poehl from the testicles of -various animals, has also a marked effect against different infectious -diseases, sometimes even in cases of desperate septicæmia. It has been -shown by Professor Loewy and Dr. Richter, that after giving spermin -there is at first a great diminution of the leucocytes in consequence of -leucolysis, which is soon followed by hyperleucocytosis, and at the same -time there was considerable increase of alkalinity in the blood.[84] - -Footnote 84: - - Richter: Organotherapie. - -Loewy and Richter were able to cure animals by injecting spermin even in -cases of experimental pneumonia, where they had received three or four -times the fatal dose of pneumococci. These observers also tried spermin -in diphtheria, but here the results were less marked, although in some -cases where the exact fatal dose was given, a cure was effected. -According to Professor Poehl[85] the increase of alkalinity of the blood -through spermin, explains its action to increase immunity against -infection. Sajous also urges that immunity is closely related with -alkalinity. - -Footnote 85: - - Poehl: Organotherapie, vol. i, St. Petersburg, 1905. - -It is interesting to observe that spermin has also given good results in -intoxication through leucomaïnes, which play a great rôle in -auto-intoxications in the body. This applies to neurin and cholin, as -noted by Professor Prince Tarchanow, and Dr. Poehl. - -We have already mentioned that the thyroid protects us against various -poisons, such as chloroform, and it is of interest to note that the -testicles may also have a similar action; for, as Tarchanow has shown in -frogs, and also dogs, after injection of spermin, these animals were -better able to resist chloroform narcosis, and could also withstand a -greater dose of it. Weljaminoff found the same also in man. Krüger found -that this applied also to ether narcosis. - -The liver, as we shall show later in a separate chapter, also -antagonizes intoxication. Another organ in close relation to the -ductless glands—especially in infants—the thymus, must also be -considered in the same way as the spleen as taking an important part in -our protection against infections. As well known, the spleen is a -foremost organ for the production of protective substances, the frequent -swelling of the spleen in infectious diseases shows its co-operation in -the defense of the body (see also Chapter X). Respecting the thymus, it -has been shown by Brieger, Kitasato, and Wassermann, that cultures of -cholera bacilli lose their toxic action in extracts of the thymus. - -There can be no doubt whatever, from the foregoing, that our immunity -against infections and intoxications depends on the intact condition of -the ductless glands, the great importance of which, as defensive organs, -has been demonstrated and explained by Professor Sajous in 1902.[86] As -he says: “The overactivity of the adrenal system is the inciting factor -of leucocytosis, and, therefore, of phagocytosis;” and later in the -second volume: “that the adrenal system, composed of the pituitary body, -the adrenals, and the thyroid apparatus, constitutes the immunizing -mechanism of the body.” - -Footnote 86: - - Sajous: “Internal Secretions,” vol. i, p. 624, 1903 (see also vol. ii, - p. 13, 1907). - -When the ductless glands are not in good working condition, there are -three principal things which can occasion infection or intoxication. -These are deficient nutrition, exposure to cold, and a depressed mental -condition. By these the resistance of the cells against the energy of -the invading microbes is lowered, and the greater the invasion the -easier will be their victory. - -We will often refer to this in the chapters on personal hygiene, and -propose certain remedies for avoiding these predisposing sources of -infection and intoxication. - - ------------------------------------------------------------------------- - - - - - CHAPTER IV. - - ON THE AGENCIES THAT GOVERN THE CONDITION OF THE NERVOUS SYSTEM AND - MENTALITY. - - -BY treating with thyroid extracts a child that has remained backward in -his mental development we can make a curious observation. The child who -had previously been a cretinous idiot will not only improve bodily but -also mentally, and he will be transformed into an intelligent being with -normal mental faculties. The logical deduction is that the thyroid must -influence powerfully the condition of our nervous system and mentality. -Indeed, the physiological activity of the nervous system and mentality -depends entirely on the co-operation of the ductless glands with -internal secretion. In fact, we do not think we are going too far in -saying that the condition of the nervous system and mentality is mainly -governed by these glands. The truth of this assertion is shown by the -fact that any alteration of these glands, especially the thyroid and -sexual glands, and pituitary body, is always followed by alterations of -the nervous system. This is strikingly sustained by the elaborate -researches of Sajous who found that the reactions of fluids circulating -in all nervous elements corresponded with those of internal secretions -and particularly that of the adrenals. - -Removal of the thyroid also produces far-reaching anatomical changes in -the central part of the nervous system which, as we have mentioned, has -been described by Albertoni, Tizzoni[87] Blum,[88] Walter Edmund,[89] -and others. These consisted of the destruction of nervous cells and -nervous processes, chromatolysis, and also the augmentation of the -neuroglia, which increases in the same way as the connective tissue in -all other organs and tissues. - -Footnote 87: - - Arch. per le scienze Mediche, vol. x., p. 45, 1886. - -Footnote 88: - - Blum: Virchow’s Archiv, 1899. - -Footnote 89: - - Walter Edmunds: Transact. of the Path. Soc. of London, vol. liii., - Part 3, p. 343, 1902. - -These changes have been found by Whitwell[90] also in myxœdematous -persons. In accordance with these anatomo-pathological changes we must -also expect clinical symptoms, and we shall thus find in persons with -degenerated thyroids an idiotic condition termed cretinism, while in -persons suffering from myxœdema mentality is considerably altered. Thus -Pilcz[91] notes as typical symptoms of myxœdema: slowness of thought, -apathy, defective memory, and somnolence. In fact, after removal of the -thyroid gland or after its degeneration by disease, we observe changes -in all those functions which, according to our present knowledge of -physiology, are situated in the cortex cerebri, such as intelligence, -power of imagination, will power, memory, sleep, etc. The thyroid must -govern these functions, as they are seriously damaged after the -degeneration of this gland. Thus, myxœdematous people think and speak -very slowly, have a weakened intelligence, are completely apathetic, and -have no will-power, and the memory is either gone or is defective. In -the same way, as in old age, myxœdematous people can remember events -which have happened a long time ago, but cannot do so as regards recent -events—all facts we explain by assuming they are able to remember what -has happened at the time prior to the degeneration of the thyroid; but -after such a condition they are not able to mirror recent events in the -greater brain. The wonderful effect of the thyroid on intelligence can -be observed, as above mentioned, in backward or cretinous children who, -by means of the thyroid extract, become intelligent children gifted with -a better memory. We, ourselves, through personal observation and -experiments, observed the fact that thyroid tablets improve the memory -(see also Chapter LIII), and it is interesting to mention here the case -of a very stout patient who, after the first day of thyroid treatment, -felt in such a condition of mental activity that he sat down, in the -middle of the night, at his writing table to compose a scientific -article instead of going to sleep. We did not mention to this -gentleman—a lawyer—anything about the effects that the thyroid might -have. Dr. Hertoghe, the well-known authority on the thyroid gland, told -us that he sometimes takes before strenuous mental work, such as the -delivery of a lecture, three or four thyroid tablets at a single dose. -We must not, however, allow ourselves to be seduced to thyroid -medication by the action of thyroid on mentality, unless the condition -of our gland demands it, for the administration of such extracts in -large doses and without special diet and precautions may produce -disagreeable symptoms, a description of which we will give in a special -chapter on the treatment of old age by means of extracts from the organs -of animals. - -Footnote 90: - - Whitwell: British Med. Journal, p. 730, Feb. 1892. - -Footnote 91: - - Quoted after Oppenheim: “Lehrbuch der Nervenkrankheiten,” p. 1383, - Berlin, 1906. - -We have also frequently seen a marked improvement in the mental -faculties of adults through thyroid treatment. Thus last winter, during -a stay in Nice, we were consulted by an American lady of 69 years who -was suffering from arteriosclerosis and dizziness. Through thyroid -treatment the intelligence of this lady improved so much that it became -very noticeable to her English trained nurse, who told us that whereas -before she could do anything with this mentally torpid woman without -comment, now she first demanded to know the reason for everything before -she complied with the dietary and hygienic measures the nurse wanted her -to follow. - -That the thyroid gland affects the intellect is also proved by the very -important fact that the serum of animals whose thyroid has been -extirpated, and which is thus antagonistic to the thyroid gland, is able -to impair the intellect. Dürig[92] noticed this after using large doses -of such serum in a woman with Graves’s disease, thereby causing an -appearance of great stupidity, loss of memory, and incapability of -thinking, so that he had to suspend the treatment. These symptoms -continued for fourteen days after the treatment had been discontinued. - -Footnote 92: - - Dürig: Münchener Med. Woch., 1908, Nu. 18. - -Sleep is also one of the functions controlled by the thyroid, and as its -changes are able to promote senility, we believe it will be well to -discuss this more fully in a special chapter (XLIII). - -We cannot recall any alteration of the thyroid gland that is not -accompanied by nervous symptoms. In Graves’s disease (exaggerated -activity of the thyroid) we observe a condition of great nervousness, so -much so that, according to some authorities, Graves’s disease may be -termed a neurasthenia with tachycardia. There are many women treated for -simple hysteria who are, in fact, suffering from a partial form of -Graves’s disease with its cardinal symptom: tachycardia. In cases of -Graves’s disease we often find conditions of exaltation, even manias, -and very frequently, at the very least, great irritability. On the other -hand, in myxœdema there is, usually, a condition of melancholia, and it -is interesting in this connection, that in a number of cases of -melancholia we have found a swelling of the thyroid with a cessation of -the menstrual flow; such cases improved after thyroid treatment, -particularly when conjoined with treatment by ovarian extracts. In the -lunatic asylum of Pontiac, Michigan, some 100 cases of swelling of the -thyroid have been traced out of 600 insane inmates, as we heard on the -occasion of our visit to our friend, Dr. Edwin S. Sherril, of Detroit, -four years ago. - -As we have seen already, the thyroid stands in very close relation to -the ovaries, and, as we have often stated, the alteration of the -ovaries is very apt to produce a swelling of the thyroid, as witnessed -during menstruation, puberty, pregnancy, the puerperium, lactation, -and the climacteric. Not only may the thyroid swell in many of these -conditions, but the mental system is also changed during each of these -processes. Sometimes it may be simple irritability, but at times the -changes of the mind may develop into lunacy. Thus, in young girls, we -occasionally see in the years of puberty mental changes, such as a -tendency to wandering away from home, and even cases of lunacy, the -so-called psychoses of puberty. Similar cases of insanity are equally -frequent in pregnancy, and during the climacterium or after the -experimental climacterium—castration. Again, insanity is not -unfrequent in cases of degenerative disease of the ovaries; to such an -extent, indeed, that sometimes a gynæcologist can treat a case of -insanity in women better than a specialist in psychiatry. Not only in -women, but in men changes in the sexual organ always produce -far-reaching changes in the mind. Chronic gonorrhœa is the more to be -feared on account of its invariably involving the prostate, the -inflammation of which, in the same way as that of the testicles, is -usually followed by symptoms of neurasthenia. If we now note this and -remember that, according to Baldwin, in most cases of hysteria we may -find at the autopsy alterations in the ovaries, we shall understand -that the author of this book did not go too far when he stated, in a -communication to the Belgian Congress of Neurologists, in Brussels, in -1906, that all cases of neurasthenia and hysteria are based upon -pathological anatomical alterations, and that it is not true that, in -contra-distinction to all other diseases, these should be the only -ones without any pathological anatomical foundations. In fact, in -nearly all cases of neurasthenia or hysteria we shall find changes in -some of the ductless glands, particularly the thyroid, sexual, or -pituitary body, if we only take the trouble to search for them. The -degenerative alterations of the pituitary body are, as a rule, -followed by the symptoms of the disease called acromegaly, and this -also presents all the symptoms of a neurasthenic or hysteric -condition. - -From the foregoing we shall understand why so many people, whether male -or female—possibly the latter in greater number—who live in total sexual -abstinence, present symptoms of neurasthenia or hysteria; for it has -been shown by Rigaud and also by Mingazzini, that animals, living in -total sexual abstinence, present alterations in the epithelia of the -sexual glands (see Chapter XLVII). - -It would be simply hypocrisy and unworthy of a scientific work which -should always aspire to reveal the truth, were we to deny the fact that -many old bachelors and spinsters present a series of nervous symptoms, -especially dyspepsia and hyperchlorhydria and pains in the stomach, far -more than other persons, which we must explain by the action of impulses -coming from the sexual organs to the sympathetic and pneumogastric, the -principal nerves of the stomach and intestines, and thus producing a -hyperæsthesia of the nerves of the stomach. In such persons some kinds -of food, well digested by a normal stomach, will act as an injurious -foreign body, and be felt as such by the over-sensitive stomach nerves, -and the gastric glands will respond with a large flow of secretion and -much acid upon agencies that produce no such stimulation in a normal -stomach. - -That the sexual glands also influence the intellect is best proved by -the observation that in cases of testicular or ovarian insufficiency -intelligence is often diminished. Thus we were consulted by the parents -of a young man of eighteen years who was mentally backward; he could not -remember anything; his arms and legs were abnormally long, but his body -short, thus resembling a eunuch’s—and indeed I found his testicles were -not yet descended. His voice was that of a child, and he also exhibited -the other symptoms of testicular insufficiency described in the second -chapter of this book. - -On the other hand we may see a precocious highly developed intellect in -children with a premature sexual development. We know of a boy of six -years who tried to have sexual intercourse with a little girl of the -same age, and who at the age of four and one-half years knew all the -capitals of the world by heart. Hence the education of precociously -bright children should be especially guarded, for they can become great -men but also not rarely, if neglected, great criminals. - -As, however, in these days of scepticism we do not believe in anything -until demonstrated by experiments (often forgetting the fact that what -does for dogs or rabbits does not always do for man) which should only -assist our judgment, but not exclusively govern it, we shall have to -prove the correctness of our clinical observations on the influence of -the sexual glands—i.e., on the nervous system and mentality—by -experiment, and we believe we have sufficient facts at hand to do so. - -About a hundred years ago it was shown by Gall—who was attacked by -several authors, among them Rieger, as innovations always are, but who -was also successfully defended by the celebrated German nerve specialist -and philosopher, Moebius[93]—that castrated animals or persons have an -alteration in the back part of the skull indicating an impoverishment of -the cerebellum. And, indeed, he produces his own evidence and that of -several other authorities, Darnecy, Rousseau, etc., which gives the -history of several autopsies on castrated persons, all of whom showed an -atrophy of this structure. In cases where only one of the testicles was -destroyed, this atrophy was always present in the hemisphere of the -small brain on the opposite side. - -Footnote 93: - - Moebius: “Die Wirkungen der Castration,” Halle, 1902. - -It has been found by numerous authorities that the skull and brain of -castrated animals and persons is smaller than the normal. Gall[94] noted -this fact, and after him Vimont,[95] from experiments on animals; and, -according to the latter observer castration of both sides produces a -considerable diminution of the cerebellum. Leuret and Hoffmann[96] found -a diminution of the head in horses, sheep, and pigs after such an -operation, and that the other parts of the skeleton are always altered -is a fact recorded by a large number of authorities as stated already. - -Footnote 94: - - Gall: “Anatomie et Physiologie du Système nerveux,” T. iii., p. 108, - Paris, 1818. - -Footnote 95: - - Vimont: “Traité de Phrenologie humaine et compareè,” two vols. et - atlas, vol. ii., p. 233, Paris, 1835. - -Footnote 96: - - Hoffmann: “Ueber die Castration der Hausthiere Schneidermühls Thier - medecin,” Vorträge ii., 12. 1892. - -As we have pointed out above, any alteration of the testicles or ovaries -is followed by nervous disturbances, and, consequently, the total -removal of these glands produces far more deleterious effects, and these -will vary according to whether such persons have been castrated at an -early age or later. In these latter cases nervous disorders will be more -acutely felt, and as the celebrated French authority, Dupuytren, states, -melancholia is a common phenomenon in castrated men. According to more -recent observations in cases of enlargement of the prostate that have -been treated by castration, the patients exhibit melancholia. We may -here remark that the testicles and the prostate are in close relation, -the latter always becoming atrophied after castration. There is -experimental evidence to show that a too large amount of testicular or -ovarian secretion may produce toxic effects. Thus, Loisel, by injecting -testicular or ovarian extracts into animals, could produce toxic -symptoms in every instance. This may account for the fact mentioned -previously that persons living for a long time in complete sexual -abstinence, occasionally exhibit symptoms of disorder of the nervous -system. - -The marvelous influence of the sexual glands on the mind and character -is at once apparent if we consider the aberration from the normal of the -castrated person. The authorities who have studied the eunuchs in Egypt -and the Skopze in Russia (a religious sect who adopt castration as a -tenet), found typical characteristics in these people that distinguished -them from the normal. - -Thus, as a rule (and as stated by Moebius), the biography of remarkable -eunuchs of the old and middle ages shows that they are entirely -deficient in courage, which seems to be dependent entirely on the -possession of testicles, and the same fact may be noted also in the case -of the lower animals. Thus, an ox is a coward compared to a bull, and an -ordinary horseman prefers to ride a mare rather than a stallion. The -best means of taming certain animals is by depriving them of their -testicles at an early age. Intelligence also is much influenced, not -only by the thyroid, as already shown, but by the testicles. Thus -persons of literary or other fame, such as artists and the like, have -become impaired in their capacity after castration: Abelard, for -example. - -Moebius, in the history of the world, could find no castrates of great -intelligence. Knowledge gained by diligent labor is not referred to -here. We merely wish to express our conviction that great ideas, such as -are found in men of genius, are impossible in men devoid of their -testicles; and it appears out of the question to imagine such men as -Napoleon, Goethe, or others, as castrates. On the contrary, we are -inclined to believe that such great men had a private life that would -have rendered them unfit for the position of superintendent of an -American Sunday School. - -Courage is a specific feature that can only be found in a man who is -still in possession of healthy sexual glands; it is entirely wanting in -eunuchs. Cowardice, superstition, laziness, avarice, vanity, cruelty, -and other bad qualities are typical features in eunuchs. Our friend Sir -Hugh Adcock, formerly physician to the late Shah of Persia, told us that -his own experience with hundreds of eunuchs showed him that they all had -these bad qualities. Capacity for hard work, generosity, -kind-heartedness, and religion may be found in persons who are in the -possession of healthy, vigorous, sexual glands; but by exhaustion, after -sexual excesses, a condition may be created analogous to myxœdema after -previous Graves’s disease. This exhaustion of the sexual glands may -create a condition in which some of the features of the castrated may -appear. This is noticeable in the character of many of the dignitaries -of oriental countries who possess large harems, and also in occidental -countries in many men who lead a life of debauchery. The influence of -the pituitary is shown by changes that invariably occur in the nervous -system and mind after any alteration in it. Thus, in two millionaires -suffering from acromegaly we have observed great stinginess. We do not -intimate that this is a characteristic of millionaires, but these -gentlemen were quite the reverse before becoming afflicted with their -disease. In one case of acromegaly, for the knowledge of which we are -indebted to Dr. Dercum of Philadelphia, there was a great distrust of -anything new, even the most useful of innovations. This caused great -discontent among the gentleman’s business partners, although he himself -showed this disposition only after the symptoms of his disease were -apparent. In acromegaly there exists a hyperactivity of the pituitary; -Renon was able to produce the disease by giving large doses of pituitary -extracts, and Hochenegg obtained good results in his treatment of it by -extirpating the pituitary body. - -Extirpation of the adrenals is also followed by important alterations in -the nervous system, as was noted by Jersoni and others. Also, in -Addison’s disease, which is accompanied by a degeneration of these -glands, we notice a diminution of the intellect together with a general -mental depression. - -The influence of the ductless glands on character, and the change in the -same after alterations in those glands, may easily lead to crime, as the -two principal barriers against crime are will-power, by which we control -our passions; and sound judgment, by which we distinguish right from -wrong. It is evident that a cretinous or myxœdematous person will have -no great will-power, for this, as already shown, is dependent on the -thyroid secretion; nor do they possess intelligent sound judgment enough -to realize what is right; and, as the possible consequences of their -defective action, castrated persons, as above shown, are more attracted -to crimes due to avarice or cruelty. Those who are interested in this -question may read our lecture delivered before the Medical Jurisprudence -Society in Philadelphia,[97] in which we endeavored to prove in detail -our assertions that the origin of crime is due to nervous changes -succeeding alterations of the ductless glands. As persons of advanced -age often have a complete atrophy of the sexual glands, changes in their -character may be explained on these grounds. - -Footnote 97: - - Journal of the American Med. Association, May 10, 1907. - - ------------------------------------------------------------------------- - - - - - CHAPTER V. - - ON THE INFLUENCE OF THE SEXUAL GLANDS UPON VITALITY AND LONG LIFE. - - -WHEN we study the history of people who present a youthful appearance -late in life, and reach an extraordinary old age,—up to 120 or 140, or -even 160,—we are surprised at the unmistakable evidence of a strong -sexual activity in most of them, which is only possible by being -possessed of healthy and active sexual glands; and thus it would appear -that the possession of such glands may impart a strong vitality and the -best chances for a long life. That such is the case we will endeavor to -show by evidence of an experimental nature, and also by facts gathered -from observation of the long lives of the patriarchs. - -When the sexual glands of a person are extirpated, such castrated -people, be it man or woman, soon get old. This we can see in the case of -eunuchs who get wrinkled even in their youth, such also get fat, and -present other symptoms of premature old age; and the same is observable -in women whose ovaries have been removed. - -Matthew Paris,[98] the historian, in his description of eunuchs and the -appearance of early old age, tells us that in 1253 Frederick II, Emperor -of Germany, married Isabella, sister of the King of England, and he -presented to his wife several Moorish slaves who were eunuchs, for -servants, who looked like old masks. Pelikan[99] also mentions that the -whole community of castrated Skopze in Russia, has a withered aspect; -and in his book Merschejewski relates that their skin is withered and -wrinkled, and that they look worn out, aged, and senile. - -Footnote 98: - - Quoted after Moebius, “Die Wirkungen der Castration,” p. 43, Halle, - 1907. - -Footnote 99: - - Pelikan: “Gerichlach Med. Untersuchenger über das Skopzentham in - Russland,” Giessen, 1876. - -Besides provoking senility at an early period, castration or a -degenerated condition of the sexual glands, especially in women, is able -to produce alterations in organs, which are of great importance to the -vitality of individuals, and to a long life, such as the heart, stomach, -intestines, and liver. Experienced authorities have noted heart troubles -in dysmenorrhœa and amenorrhœa, and also neurosis of the heart with -long, lasting alterations of the female sexual glands. Professor -Kisch[100] also noted tachycardia in such conditions. Professor -Landau[101] has very often observed a degeneration of the heart after -myoma of the uterus. Lehman and Strassmann, in the Berlin Charité, have -seen such a degenerated condition of the heart in 44 per cent. of -patients with myomas of the uterus. - -Footnote 100: - - Kisch: “Das Geschlestrlehen der Frau,” second edition, Vienna, 1908. - -Footnote 101: - - Quoted after Kisch. - -It has been shown by experiments that there is a close relation between -the condition of the ovaries and the heart. Professor Hegar[102] has -demonstrated that castration, or simple tugging of the ovaries, is able -to produce a diminution of the heart beats, or even a stoppage of the -heart. Lucas Championnière has also noted the same after a tearing of -the ovaries, and Mariagalli and Negri have also noted tachycardia after -laparotomy. - -Footnote 102: - - Quoted after Kisch; as also other authors on the relation between - heart and stomach, and the ovaries. - -Very important also are the relations between the ovaries and the -digestive organs. Kretschy observed, in a case of fistula in the -stomach, that alterations of the female sexual organs regularly produced -also alterations of the digestive functions; for instance, during -menstruation there is always an increased flow of hydrochloric acid. The -same has been found by Fleischer, who noted during this period a -sluggishness in digestion, which improved after menstruation. - -Tanecki found dyspeptic troubles in cases of retroflexion of the uterus, -and Eisenheart has observed the disappearance of acute gastric troubles -after a cure of retroflexion. - -P. Muller also declares that there are intimate relations between the -sexual glands and the digestive organs. He also observed dyspeptic -troubles during menstruation; and Professor Leyden has noted neuralgia -and hyperæsthesia of the stomach in young girls after menstrual -troubles. - -Habitual chronic constipation, which is so frequent after a degenerated -condition of the sexual glands, points to the existence of close -relations between these organs and the intestines. - -Based upon clinical observations, we have advanced the theory that -alterations of the ovaries are able to produce alterations also of the -liver, and the circulation of the bile, with formation of gall-stones. -Castration also produces alterations of the thyroid: first, its -hyperactivity with increase of colloid substance, and, afterward, its -degeneration. - -Castrated animals or persons seem to offer less resistance to infection, -which may be on account of the connection, as shown by the experiments -of Metschnikoff[103] and others, that the testicles are altered in -infections, which has been shown to be equally the case with the ovaries -(Professor Cornil). The sexual glands, as the ductless glands in -general, have the duty also of protecting the body against the various -kinds of intoxication and infections, as already emphasized. - -Footnote 103: - - Metschnikoff: Loc. cit. - -From the foregoing there can be no doubt that degenerated conditions of -the sexual glands, by producing alterations in important organs, -diminish vitality and the chances of an advanced old age. - -This seems also to apply to males, for there is no evidence showing that -any eunuch has reached a very advanced age, whereas there is plenty of -evidence of persons with strong sexual glands having lived far beyond -100 years. The vitality of persons if totally castrated is, as a rule, -diminished. - -Again if we study the history of persons who attained the maximum span -of life, we find many evidences of the existence of strong sexual -impulses. Thomas Parr, who lived to nearly 153, has been accused of -having committed a sexual offense in his 102d year, for which he was -found guilty and punished. Reaching even a greater age, his sexual -appetite does not seem to have diminished, for he married, eighteen -years after, a widow, who said she could discover nothing that would -betray his great age. - -Drakenberg, a Dane, who is buried in the cathedral in Aarhus, Denmark, -lived 146 years, and reached this advanced age although he was more -often drunk than sober. When he was 111 he married a woman of 60, and -after she died he fell in love in his 130th year with a young peasant -girl; but this blooming flower of the Jutland peninsula, famous for its -fresh and healthy girls, refused her ancient wooer, who, nothing -daunted, tried his luck with several other young maidens but with no -better success; therefore he had perforce to remain a widower, and he -lived an additional sixteen years. Possibly if he had addressed widows -or elderly spinsters, he might have succeeded; but it is very -instructive that this ancient Methuselah insisted on marrying a young -girl, which certainly speaks in favor of strong sexual feelings in so -old a man, and, indeed, we may say it is an object lesson to us to -observe that these ancients were always anxious to marry again so soon -as they became widowers. That it was more than a mere formality, or bond -of platonic affection, was attested to by Thomas Parr’s wife when he was -in his 130th year. - -If many children be considered a sign of sexual activity and capacity, -these very old men distinguished themselves in this respect, as most of -them had numerous progeny. Several had a score of children after they -were 80. Peter Albrecht, who lived to be 123, married in his 85th year, -and had 7 children. Another patriarch, Gurgen Douglas, born in -Marstrand, near Gothenburg, in Sweden, who reached to 120 years and 7 -months, married in his 85th year and had 8 children, one of which was -born when he was in his 103rd year. This child was an idiot, but as it -is very interesting to note, otherwise physically well developed. - -An Italian, Baron Baravicino de Capellis, died in 1770 at Meran, a -climatic resort in the Tyrol (Austria), in his 107th year. He had 4 -wives, the first of whom he married when he was 14, and the last when he -was 84. He had 7 children, and it is an interesting fact that his wife -was pregnant when he died. - -As an English paper has reported, in 1796 there was a shoemaker, R. -Glan, living near Philadelphia, Pa., who died at 114, and never missed a -Sunday service. At his decease his third wife was but 30, and his virile -powers were normal. - -We need not be too skeptical as to the legitimacy of the children of -fathers of such advanced age for reasons we will mention later. Examples -of fathers at ages above 60 or 70 are not so exceedingly rare. A very -good example of this is that of a crowned head of one of the European -countries, married morganatically, who, in his 72nd year, was presented -by his wife with a child, and nobody who is acquainted with the powerful -constitution of this monarch and his predilection for the fair sex will -doubt his happiness as a father. He is noted for his marvelous -intellect, which, again, is so frequently met with in persons with very -active sexual glands. - -Several of these ancient patriarchs, at the autopsy, presented a -wonderfully good state of preservation of the various organs. Thomas -Parr died in his 153d year, and his autopsy was made by one of the -greatest physicians in the history of medicine—the celebrated Harvey, -the discoverer of the circulation of the blood. Harvey found every organ -in this wonderful old man in perfect condition. His death was attributed -by Harvey to over-eating, as Parr had always lived a very frugal life. -The King of England invited this astonishing personage to London in his -152d year, as he wanted to know this most interesting of his subjects; -but the rich food he received in the royal household did not prove -beneficial to him, and though his 152 years of frugal life were unable -to kill him, nine months of an opposite style of living succeeded in so -doing. - -We should not wish to omit mentioning again the important fact that, -with few exceptions, the persons who lived to such an extraordinary age -were married, and some of them three or four times, which again serves -to show us the great importance of marriage as a means to reach a good, -old age. - -We have quoted these instances of longevity from Hufeland,[104] one of -the greatest German physicians of the eighteenth century, of whose -truthfulness there can be no doubt. The great German physiologist, -Pflüger, also quoted some of the above examples of great age in his -address in celebration of the birthday of Emperor William II, at the -University of Bonn. When Parr had been found guilty of a misdemeanor in -his 102d year facts were adduced in the courts which showed that, as -Pflüger says, this “100 jährige durchaus die Eigenschaften eines -Kräftegen jugendlichen mannes besass” (the man of 100 years really had -the qualities of a powerful young man). Pflüger quotes this from -Flourens, and we were pleased to find an account of the autopsy of the -celebrated patriarch in a letter from Harvey, himself, to his nephew, -published by the Sydenham Society[105]: “The body was in such a good -condition in a man of 153 that the cartilages of the chest bones were -not yet ossified.” Harvey put it: “The cartilages were soft and -flexible,” black hair on the forearms, and the organs apparently -healthy. Probably the fact that the testes, as Harvey says, “were sound -and large,” had something to do with it. He was also an affectionate -husband, and to quote Harvey again, “His wife told me that until twelve -years ago he never ceased to embrace her frequently”; that is, when he -was 140 years old! At the autopsy of John Bayley, of Northampton, who -died 130 years old, Dr. James Keill[106] found his testes of large size. - -Footnote 104: - - Hufeland: Loc. cit. - -Footnote 105: - - The works of William Harvey, M.D., edition of the Sydenham Society, p. - 590, London, 1847. - -Footnote 106: - - Philosoph. Transactions, xxv., 1706. - -We have also knowledge of a very interesting case, that of an Irishman, -an ex-navy man, who, according to the admiralty official statistics, was -113 years old, and whose body was dissected by Professor Cunningham, -Professor of Anatomy of Edinburgh University. As Dr. Cunningham, -himself, told us, the testes were sound and healthy looking, and the -cartilages of the chest bone not yet ossified. Death was not due to old -age, but to a prostate abscess, except for which the body was in good -condition. - -Metschnikoff also mentions in his “Etudes sur la Nature Humaine” -examples of old men between 94 and 104 years, who suffered from copious -spermatorrhœa, and in whose semen he has found a great quantity of -spermatozoa. He and Dr. Weinberg observed similar conditions in old dogs -of 18 to 22 years of age, one of whom, just before his death, had shown -marked sexual tendencies.[107] Saverio Spangaro,[108] examining the -testicles of a number of old men, found many of them atrophied, but -others showed microscopically no difference to the testicles of younger -individuals; there were only slight microscopical changes. This again -proves our theory, that old age is not due to the degeneration of one, -but of several glands with internal secretion, similarly to other -diseases of these glands, like diabetes, acromegaly, etc. - -Footnote 107: - - Essais optimistes, p. 47, Paris, 1907. - -Footnote 108: - - S. Spangaro: Anatomische, Hefte, Heft lx., p. 630, Wiesbaden, 1902. - -The above facts of the preservation of the sexual glands in advanced old -age, proves also the important fact that though the actual age be there, -the symptoms of it may not be very pronounced if but the sexual glands -are in good order. Of course the condition of the other ductless glands -is of importance, for old age must be regarded as the consequence of the -degeneration of the different ductless glands, and not of one gland -alone. - -When we consider the splendid health enjoyed by most of these patriarchs -and the good condition of their organs, why should we deny the -possibility that they were disposing of at least one lively -spermatozoön, and thus we shall have no reason to doubt their happiness -as fathers. - -We must also add that the truth of the extraordinary age of these -persons has been proved, in most cases, by documents, sometimes even in -courts of law; also by the recollections of very old people who, in -their own early childhood, personally knew them. - -That people with strong sexual impulses very often reach a very advanced -old age, we can often observe. There are plenty of examples in the -history of the world. Thus, the greatest debauchery did not prevent -Louis XV becoming very old, and the Emperor Tiberius lived to be 78 -after his notorious life. However, in the same way as with alcohol and -tobacco, we would here repeat “Quod licet Jovi, non licet bovi” (or, -“what suits Peter may not suit Paul”). - -We may also refer to a few instances coming under our own observation. A -few years ago one of our confrères at Carlsbad died, 96 years of age. -His intellect was perfect, and a few months before his death we had a -consultation together about a patient who was 83, at which he gave -evidence of a wonderfully clear intelligence. In his behavior toward the -fair sex (whom he much admired) he showed a chivalry and gallantry -outvying men of half his age. Up to the last he never failed to attend a -theatrical performance when there was an operetta or a ballet. There was -nothing to prevent his attaining a greater age, but, falling in his -room, he contracted a fracture of the femur, followed by pneumonia, -which put an end to his medical practice, for this wonderful old man in -his advanced years paid his daily visits, which he only intended to -cease, as he said, when he reached 100. - -A prominent member of the aristocracy of one of the northern countries -of Europe, who is at present 90 years old, having been reproached -several years ago by his relatives for his amorous advances to the fair -sex, gave the answer, “You do not know what it means to be an old man -with the body of a young man.” This old man still rides on horseback and -still goes shooting. The fact that he looks a handsome man of 60 may be -explained on the basis of our above observation. - -In advanced old age the preservation of the sentiments toward the -opposite sex, which allows us to presume the presence, and not yet -extinction, of an internal secretion of the sexual glands, is often -found in combination with a high intellect. This is also proved by the -example of Goethe in his 83d year, for in his old age his intellect -would have been creditable to a man of 30. When he was over 81 he -astonished his audience by the uninterrupted current of his ideas, also -the extraordinary richness of his inventions.[109] Commenting on the -above, Moebius, in an interesting biography on Goethe, says: “From the -physiological standpoint the astonishment evoked by the works of this -old man is almost greater than that about his juvenile activity.” He -finished the second part of “Faust” when he was over 82. As Metschnikoff -says: “It is love that was the greatest stimulant of the genius of -Goethe,” for it is well known that Goethe was an ardent admirer of the -fair sex. When he was 74 he was passionately in love with Ulricke -Lewetzow, who was still in her teens. He danced like a youth when in her -company, and it was at this time that he wrote to his son that he had -never, up to this, felt so well in mind and body. He wanted to marry the -young girl, and the Grand Duke of Saxe-Weimar asked in Goethe’s name for -her hand; but the mother was not willing to allow a marriage between -persons of such divergence in age. So much was Goethe in love with the -young girl that his disappointment contributed to develop a serious -illness (Eckermann). Even when he was much older he again renewed his -relations with Miss Marianne Young, and was then, to a certain extent, -consoled for his disappointment over Miss Lewetzow. He preserved his -admiration for the fair sex until his death, and even in the closing day -of his life in his delirium he called out, “Look at that beautiful -woman’s head with dark curls on a black background!”[110] - -Footnote 109: - - Eckermann: Quoted after Metschnikoff. - -Footnote 110: - - Lewes: Vol. ii., p. 372; quoted from Metschnikoff. - -A similar retention of the sexual sense we see in the advanced years of -Victor Hugo, whose admiration of the opposite sex continued till his -death. Ibsen, the celebrated Norwegian dramatist, kept up a well-known -correspondence with a young lady whom he met at Marienbad a short time -before he died in advanced old age. - -Sometimes in women of extreme age instances are quoted that would seem -to indicate that in them also the activity of the sexual glands may not -have been extinct. It is stated that Ninon de l’Enclos[111] was in her -90th year still so beautiful that a young abbé fell desperately in love -with her. We know an Italian lady of 69 who is still good-looking, -presenting the appearance of 45, and she still menstruates. That she was -sexually active is shown by the fact that she has 12 children. There is -more fire in the eyes of this Italian matron than in many women of half -her age. That the possession of active sexual glands influences the -looks very much can also be proved by the pale, yellow-gray and aged -looks of even young women suffering from serious chronic diseases of the -sexual glands, and also of women who have caused these organs to -degenerate owing to sexual excesses. - -Footnote 111: - - Quoted from Professor Kisch. - -The fact that persons who have attained advanced old age in robust -health and perfect intellect often show signs of preservation of the -sexual glands, permits the inference, especially considering the -foregoing examples, that a perfect condition of these glands is an -important factor toward vitality and long life, for which reason we -devote a long chapter to the best hygiene of the sexual glands (see -Chapter XLIX). - - ------------------------------------------------------------------------- - - - - - CHAPTER VI. - - ON HEREDITY AND LONGEVITY. - - -WE occasionally witness the peculiar fact that persons who live very -moderately and eat very sparingly, and who totally abstain from alcohol, -nevertheless become old before their time, while, on the other hand, -there are those who, in spite of having been addicted all their lives to -the pleasures of a bounteous table and unstinted quantity of wine or -spirits, yet enjoy a green old age. We had an opportunity of observing -an old gentleman of 76 (some say he was really older) belonging to our -own profession, with whom we had the pleasure of traveling from Lisbon -to Paris in the same small railway compartment. This gentleman, -notwithstanding his age, was in full possession of all his mental -powers, of which he has given remarkable proofs in his recent -publications which might have well been written by a man younger by some -scores of years, and which, in fact, convey that impression. This -gentleman’s age cannot be gauged by his words, neither was it shown by -the hearty appetite with which he partook of the six courses of the -dinner, nor by the enjoyment with which he disposed of his bottle of -claret; and he smoked a large cigar afterward with such appreciation -that we began to envy the old man. We almost believe that he stood the -long-continuous journey of thirty-seven hours much better than we did, -and we were surprised at his fresh appearance the following morning -after the discomforts of a night in a small berth of the Compagnie -Internationale des Wagons-lits, half the size of the ordinary American -Pullman car berth. We must remark, however, at once, that such instances -as these are exceptional. Nature is always just, and even here we have -an illustration of the Golden Rule, for such persons inherit the health -of their fathers. - -Even character and appearance may be inherited by offspring. The height -of parents is, as a rule, though not in every case, inherited by their -children, as also are many features of their external appearance. As we -have seen in the previous chapter, the size of an individual and his -outward appearance are dependent on the internal secretions of the -ductless glands; and as these qualities are inherited, so we may presume -that the properties of the ductless glands, which produce these effects, -may also be inherited; and that this is not a vague supposition is -demonstrated, we think, in a paper we read on the subject of heredity at -the German Congress of Internal Medicine at Leipzig, in 1907, in which -we showed that the alterations of the ductless glands are inherited with -remarkable frequency. Thus Graves’s disease can frequently be inherited, -and the children descended from such parents, especially after puberty, -often have a small goiter. In such cases a slight protuberance of the -eyes can also be noticed; they are frequently very nervous, and any -sudden shock will be sufficient to induce a typical case of Graves’s -disease. Oesterreicher[112] found 9 cases of exophthalmic goiter in one -family. The frequent instances of heredity in Graves’s disease are -insisted upon by Brouwer[113] and other authors. - -Footnote 112: - - Quoted after Moebius, “Die Basedow’sche Krankheit,” second edition, - 1906. - -Footnote 113: - - Quoted after Oppenheim, “Lehrbuch des Nervenkrankheiten,” Berlin, - 1906. - -Degenerative changes of the pituitary body may also be inherited. Thus -Bonardi and Schwoner and others also showed cases of acromegaly of -hereditary origin. - -Diabetes is, as we have said, a disease of the ductless glands, and we -have especially emphasized, on previous occasions, how frequently, if -not invariably, diabetes originates through heredity. We have also shown -in a communication published in the _Practitioner_, of London, in -October, 1903, that the children of diabetic persons have an inherited -tendency to alimentary glycosuria, which occurs very frequently among -them. - -Myxœdematous persons, as a rule, have children displaying symptoms of -congenital myxœdema, and cretins have cretinous children. The very -interesting case has been published of a woman who, until the age of 40, -had two normal children. She then acquired a goiter, and the child that -was born later was a cretin with a goiter (Lanz). - -Parents suffering from diseases in which the thyroid has degenerated, -such as chronic tuberculosis, malaria, syphilis, and other cachectic -diseases, have children whose growth is slow, and who remain backward -physically and mentally. Such children easily acquire any infectious -disease. Tuberculosis, as we have shown at the International Congress on -Tuberculosis in Paris, in 1905, is remarkably frequent among them. We -can easily appreciate the fact, if we realize that the children of such -parents in whom the thyroid has degenerated through disease are born -usually with a congenital atrophy of the thyroid gland, which has been -proved by Gamier and Perrando. These children have inherited from their -forefathers the bad qualities of their thyroid, and this will also -explain why such children, when fully grown up, will not remain, as a -rule, for so long a time as youthful looking as other persons who have -inherited healthy thyroids; they early become aged-looking and, also, as -a rule, their lives are shortened owing to their tendency to contract -easily all kinds of infections. - -Evidence founded on experiments is at our disposal to prove our -assertion that irregularities of the thyroid are inherited by offspring. -Professor Lanz,[114] of Amsterdam, formerly an assistant of Professor -Kocher in Bern, has extirpated the thyroid gland of goats, and he found -that in each case the young of such animals, as compared with normal -kids of the same age, remained backward in growth. There can thus be no -doubt that the qualities of the ductless glands of the parents are -inherited by their descendants. - -Footnote 114: - - Beiträge zur klin. Chirurgie, xiv., p. 1, 1905. - -We often find diseases of the various ductless glands present among -members of the same families. We can trace, not infrequently, diabetes, -Graves’s disease, etc., and acromegaly, occurring in different members -of the same family, and this will be observed most often in the case of -diabetes and Graves’s disease. Thus I have observed in the case of two -fathers (coming from the same city in Hungary, but belonging to -different nationalities) diabetes, and their daughters had protuberant -eyes; they had a small goiter, and the typical fingers characteristic of -Graves’s disease, emaciated and pointed like those of the Madonna of -Perugino, which have been mentioned already by other authors as symptoms -of Graves’s disease. There was no tachycardia as yet in either of these -two cases which had Graves’s disease. Very probably any mental shock, as -in so many other cases, would here have caused sudden development into -Graves’s disease. - -We have already noted that in syphilis and other cachectic diseases such -as alcoholism, malaria, tuberculosis, etc., the thyroid gland becomes -degenerated (Garnier, Hertoghe, etc.), and that the fœtuses of such -parents demonstrate congenital atrophy of the thyroid (Garnier[115] and -Perrando[116]). We can thus understand the observations of Hertoghe, who -found that nearly all cases of infantile or congenital myxœdema were -born of parents suffering from the above-named diseases. Of very great -value, also, is the observation of Professor Pel.[117] He diagnosed a -case of syphilis in the father, myxœdema in the daughter and acromegaly -in the son. - -Footnote 115: - - Garnier: “Les maladies infectieuses,” Thèse de Paris, 1899. - -Footnote 116: - - Perrando: “Sulla struttura della Tiroide,” Sassari, 1900. - -Footnote 117: - - Pel: Berl. klin. Wochenschrift, 44^a, 1905. - -As shown by many observers, including ourself, the ductless glands stand -together in a very close relationship, and thus we may find that when -one member of a family shows an alteration of the ductless glands, we -may discover in the same family other members affected by alterations of -the same or other ductless glands. The case of Pel is a fine -illustration of this point; the syphilis of the father with its morbid -influence on his thyroid resulting in the hereditary transmission of a -degenerated thyroid to the daughter, and the consequent supervention of -myxœdema. The son had an altered condition of the pituitary body, and -thus developed acromegaly. The altered condition of the pituitary body -may have been secondary to the previous alteration of the thyroid -inherited congenitally, if we take into consideration the fact that, as -I showed in a communication to the International Congress of Medicine in -Madrid, in 1903, acromegaly is due to primary alterations in the thyroid -which, in the same way as is demonstrated by experiments on animals, may -lead secondarily to alterations of the pituitary closely connected with -the former gland. The qualities of the sexual glands can also be -inherited. Thus, there are cases of mothers whose menstruation began -very early, i.e., at the age of 9 or 10, and lasted until the age of 56 -to 60, and who had many children, among whom were daughters showing -similar conditions. On the other hand, we may see difficulties of -menstruation in the mother also inherited by the daughter. - -If the bad qualities of the ductless glands are inherited, it is only -logical to expect the same for the good qualities also. It stands on -this basis that we may frequently find longevity in the same family. -Longevity, as illustrated by the many facts adduced in this book from -the field of clinical and experimental observations, is closely allied -with a thorough performance of the functions of the ductless glands, -especially of the thyroid gland; if these are in good condition, and -especially if proper hygiene is also observed at the same time, -longevity will follow. The good condition of the ductless glands is -largely dependent upon a life based on hygienic principles, although -when these glands are of the best quality they may stand a good deal and -not degenerate so soon, even after excessive activity following -injudicious or fast living. - -But if a long life be dependent on a good state of the ductless glands -and if the qualities of these are inherited—which cannot be doubted -after the foregoing observations on heredity,—it must necessarily follow -that longevity is inherited too, and this is a fact which can be proved -by a large number of observations. - -If we study the history of persons who have lived over 100 years, we -shall find in nearly every case that their forefathers, or their -descendants, or other relatives of the same blood have, as a rule, also -lived to a great age. This will be illustrated by a few examples which -we will now give. - -In the year 1724 there died in Hungary in a village called Köprös, about -ten miles from Temesvar, a man, Petraz Czarten, who was 185 years of -age. When he died, his son was 95. - -We have already referred to the case of a man named Thomas Parr in our -chapter on the influence of the sexual glands upon vitality and long -life. This man died in 1635 in his 153d year, and after death his body -was dissected by the great physician Harvey. That longevity had existed -in his family was shown by the fact that one of his female descendents -died in Cork, in Ireland, at the age of 103. - -In the year 1797, in a village near Bergen, there died a man, Joseph -Surrington, in his 160th year. That he left a young widow, after having -been married several times, is not so extraordinary if we consider the -facts in the chapter in this book on the influence of the sexual glands -upon vitality and long life. When this man died his eldest son was 103 -and his youngest only 9! - -In a Finnish village near St. Petersburg there lived an old peasant -woman, Maria Willamow. She was born in 1692, and died on September 10, -1807, after having lived 115 years, 9 months, and 4 days; her brother -had already died in 1768 at the age of 108. All her relatives and -descendants were remarkable for their longevity. - -Jean Thuret was a soldier, and in spite of having been wounded in -several battles, he lived beyond the age of 104. His mother died when -118 and his uncle at 130. The high old age of many of these patriarchs -is proved by legal evidence. Thus, H. Jenkins, from Yorkshire, has -appeared before a court of justice as witness in a matter that happened -140 years ago. He was accompanied by two sons, of whom one had reached -100 and the other 102 years. Again, conclusive proof of the inheritance -of long life.[118] - -Footnote 118: - - Quoted after Professor Pel. - -To the history of these patriarchs I can add a few personal -observations. My mother’s father lived to the age of 104. He never -smoked and could read without spectacles all his life. He had eleven -children, of whom one (an aunt of mine) is 95, and I have every reason -for believing that she will continue to live yet many years in her -present condition. Another daughter is at present 85; a son is 83, and -another 78. - -We are acquainted with the history of the family of a physician in -Amsterdam, in which the great grandfather was 96. He had six sons who, -between them, totaled 600 years, one of them living to the age of 102, -some of the others to 80 and 90; and there is a daughter 79 years of -age. - -From the foregoing it seems that persons descended from long-lived -families have themselves a good chance of living to a great age; but to -do this it is essential that they should observe the rules of hygiene to -prevent the deterioration of their ductless glands. - -That the observance of good hygiene is of the greatest importance to -attain longevity can be best adduced by the fact that persons descended -from short-lived parents may also attain a green old age in robust -health, as I will show by a few examples which have come under my -personal observation. - -Sir Herman Weber, the author of a valuable work on the prolongation of -life, is descended from parents who both died at an early age. This -savant has himself followed the excellent advice he gives in his books -on long life, with what result can be best judged by his healthy and -vigorous looks. His appearance is that of a man many years his junior, -yet Sir Herman was 82 a few years ago when we were together climbing a -very steep and high hill in Carlsbad. When we arrived at the summit -nothing could restrain Sir Herman, but he insisted on also mounting a -lofty tower to see the surrounding mountains, without taking any rest -between his exertions, and this in spite of the warmth of the weather. - -On the day that we began to pen these lines we were congratulating one -of the multifarious professors of the medical faculty of Berlin on his -73d birthday. He is in perfect and robust health, and is at present -engaged on the third edition of his work, which is well known in medical -circles all over the world. He told us his father was 33 and his mother -48 when they died, and several of his brothers died before reaching old -age. However, his grandfather lived to be 90. This savant has always led -a sober and regular life. - -Sometimes chronic diseases, like syphilis, etc., do not prevent people -who come from a long-lived family from attaining to a very old age. Thus -a patient of mine, a French gentleman of 72 years, who still shows -symptoms of the tertiary form of syphilis acquired fifty-two years ago, -is still looking in splendid health, like a man of 60, and was -complaining to me about his too strong sexual feelings. Likewise, the -father of a patient of mine has reached his 96th year in spite of his -syphilis, which he acquired an age ago. - -If we now consider the environments where the longest-lived persons are -found, we shall find that those who always live in the open air, and -also moderately, rising early in the morning and leading day by day the -same regular life, have attained the longest lives. A great number of -long-lived patriarchs can be found among the peasants, or at least among -persons living in the country and out in the fresh air all day. -Undoubtedly the greatest number of long-lived people are to be found in -the British Islands, especially in Scotland. The inhabitants of Great -Britain are well known to appreciate fresh air, and on the Continent we -often see them, especially Scotchmen, going about without any overcoat -even on a cold winter’s day. - -We shall see in various chapters of this book how essentially important -is a sound hygiene to ensure long life, and we shall demonstrate in -separate chapters the great importance of fresh air and of exercise in -the open air. - -If we would inquire where are to be found the greatest number of persons -over 100 years of age, the palm must be given to Bulgaria, if what is -claimed be true, _viz._, that there are 3800 persons over that age, and -all these folk partake daily of “jogurth,” a sour milk containing three -different microbes, the most efficacious among them being the maeja -bacillus. In Germany, with its 61,000,000 of inhabitants, there are but -71 persons over 100 years old, while Bulgaria, with only 7,000,000, -claims to have 3800, and that it is due to the jogurth eaten every day. -We will deal more fully with jogurth in the chapter on the elimination -of toxic products from the intestines. - - ------------------------------------------------------------------------- - - - - - CHAPTER VII. - - ON MEANS WHICH CAN HELP US TO DETERMINE THE PROBABLE DURATION OF LIFE. - - -WE have seen in the first chapter of this book that we may find the -symptoms of old age, in quite early years, in persons whose ductless -glands (the thyroid, ovaries, testicles, liver, kidneys, pancreas, -adrenals, pituitary body) are degenerated by disease; nervous -affections; alterations of the mind: grief, sorrow, etc.; chronic -infections; numerous pregnancies, etc., or by faulty hygienics: excesses -in food, alcohol, sexual pleasures, etc. We have also seen in the third -chapter that the immunity of an individual against infections—be it by -bacterial invasion or by poisonous food or drugs, etc.—is dependent upon -the correct functionating condition of these glands. We have seen that -those in whom these glands are degenerated fall easy victims to all -manner of infections, and the previous chapter on heredity shows that -the same happens to children, the offspring of parents suffering from -alcoholism, tuberculosis, or malaria, as the children of these parents -are born with a congenital degeneration of the thyroid, and thus remain -backward in growth, both mentally and physically, and, especially, fall -easy victims to tuberculosis. Their life is generally short. While such -a sad cloud hangs over the head of persons whose glands are damaged, -either congenitally or by disease, much more favorable is the lot of -those who have inherited healthy glands and by careful living have -preserved them intact, or who, though born with ductless glands not -entirely normal, and possibly bordering on a condition of congenital -myxœdema, have, by suitable treatment and hygiene, succeeded in -improving the condition of their glands. - -We have seen that the thyroid influences powerfully the production of -those safeguards of our body against infections—the anti-bodies being, -as shown by Prof. Sajous (1903-1907), beyond a doubt products of -ductless glands—and the better the condition of the glands, the more -protective substances will be produced in order to fight down the -murderous microbes, or organic poisons, which continually threaten us -with destruction. In this fight, a person with healthy ductless glands -will always attain a longer life than one with ductless glands of -inferior quality. The better the condition of the thyroid the greater -will be the activity of those organs that are under its direct command -(e.g., the kidneys, liver, skin, and intestines), and by the increased -activity of the main emunctories of the body poisonous products will be -eliminated by means of a greater flow of urine, an abundant -perspiration, and thorough purging. Also the myriads of toxic products -that are brought from the intestine to the liver will be promptly -destroyed, or transformed into less dangerous combinations. - -Thus there can be no doubt that a person with healthy ductless glands, -especially the thyroid and testicles or ovaries, will live long -provided, of course, no other vital organ be irreparably diseased. - -The question now arises, by what means can we ascertain whether the -ductless glands are in good condition or not? We will now try to answer -this important question. - -We can diagnose a healthy condition of the ductless glands either -directly, by the examination of those glands which are available for a -digital examination, as the thyroid, sexual glands or liver, or -indirectly, by the examination of the state of those functions which are -governed by these glands; e.g., the heart’s action, the pulse, -regulation of temperature, defæcation, diuresis, digestion, activity of -the skin and its glands, condition of the nervous system, etc. - -Before entering upon the examination of these glands we must first -ascertain whether our patient comes of a long-lived stock, or, if not, -whether diseases that are particularly harmful to the ductless gland, -and are commonly hereditary, like tuberculosis and syphilis, have -occurred in the family. According to our observation boys more -frequently look like their mothers, and girls like their fathers, and -also inherit their qualities. After having ascertained the family -history, we must inquire whether the patient has had any diseases that -are specially harmful to the ductless glands: e.g., infectious -diseases—scarlet fever, diphtheria, typhoid, etc.—and also ascertain his -usual diet and habits, keeping in mind the bad effects of abundant meat -food upon the thyroid, as well as of certain stimulants like alcohol and -tobacco. As these, if of bad quality and taken in quantity for a long -time, have the most damaging influence on the ductless glands, our -prognosis of a long life will be duly influenced, and in particular -unfavorably for those who come of a short-lived stock, or who have been -weakened by previous infectious diseases. If some persons, otherwise -healthy and of good family history, can with impunity indulge till old -age in wine and tobacco, yet this is not a general rule. Individuals are -known who drank and smoked till over one hundred years of age, but such -cases are rare, and we may quote the Latin proverb: “Quod licet Jovi, -non licet bovi.” Everybody will admit that the expectation of life in -those who are moderate in the use of wine and tobacco and also, let us -insist, of tea and coffee, is much greater than in the immoderate. We -will further deal with this question in our chapters on alcohol and -tobacco. - -After having given an exhaustive history of the persons whose probable -lifetime we are trying to determine, we next proceed to the examination -of those ductless glands which are available for direct examination, and -first of all, the thyroid. - -The examination of the thyroid gland by palpation is a very difficult -undertaking and necessitates a thorough knowledge of the anatomy and -physiology of the gland. We must bear in mind the fact that, in men, we -generally find only two lobes, the lateral ones, which lie on either -side of the trachea, as the median lobe is generally undeveloped in the -male. The right lobe is usually larger than the left. In women the -median lobe is often well developed and can be distinctly seen in -enlargement of the gland, for instance, during puberty, menstruation, -pregnancy, etc., and especially when a goiter exists which, for reasons -we have mentioned previously, is more common in the female. - -When the thyroid shows a considerable swelling, as in goiter, it can be -seen and felt easily, but not always, for cases certainly exist where in -life no thyroid could be felt, and yet at the autopsy a large goiter has -been found. Thus, in a case of acromegaly a thyroid of about 130 grammes -was found by Holsti,[119] though during life nothing could be discovered -by palpation. When a large thyroid can be seen and felt, we are -justified in diagnosing a swelling of the gland; but in cases where we -neither see nor feel it, we are not always justified in stating that it -is not enlarged. - -Footnote 119: - - Holsti: Zeitschrift für klin. Medicin, p. 272, 1892. - -When palpating the thyroid we must note whether it is soft or hard. If -soft, the tissue present is probably parenchymatous in nature and so, -probably, entirely secreting tissue, while a goiter that feels hard may -denote excess of connective tissue, and thus, apparently, an inactive -gland. The presence of cystic formations raises the possibility of a -large quantity of colloid substance, either healthy or degenerate. - -Thus, inspection and palpation of the thyroid can give us, to a certain -extent, valuable information; we must, however, not rely entirely upon -the results of this external examination but, especially in cases where -no thyroid can be felt, we must add to the external examination an -inquiry into the condition of those functions which are governed by the -thyroid—we must, in fact, examine the condition of those organs whose -function is dependent upon the internal secretion of the thyroid. - -Thus, we must examine the skin and note whether it is dry or moist, and -whether the sweat glands are acting normally. A dry skin, with -diminished perspiration, denotes an inactive thyroid, especially when -excess of subcutaneous fat is present. Excess of fat, of the consistence -of bacon, is characteristic of a greater degeneration of the -thyroid—i.e., myxœdema,—and indicates a great loss of function of the -thyroid gland. Pallor of the face, with round red patches on the cheeks, -and dilated capillaries, are also characteristic signs of such a -condition in its early stages, and so are a wrinkled forehead, -especially with two perpendicular folds, and puffy eyelids. Wrinkling of -the skin of the hands, taken in conjunction with other signs, is also a -point of diagnostic value. - -The condition of the musculature can also give us some valuable -information. The thyroid and other ductless glands, as the sexual -glands, govern the tonicity of all the muscles. In children, especially -about the age of puberty, the muscles are firm and elastic, but in later -years, or even in young women, consequent upon various conditions which -are harmful to the ductless glands, such as sexual excesses or numerous -pregnancies, the muscles lose their tonicity and become lax and flabby. -This also occurs in myxœdema arising from other causes. The viscera, -deprived of their muscular support, become displaced, and in this way -arise the various forms of visceroptosis. - -Premature grayness is an indication of probable changes in the thyroid. -This is confirmed by the fact that, as a rule, such persons are also -very nervous. Premature grayness constitutes a typical symptom of -myxœdema and hypothyroidia, and as such has been described already by -Hertoghe.[120] Falling out of the hair is also a symptom of importance, -if it appears in early years, especially if it is accompanied by falling -out of the eye-brows and the hair on the back of the head. On the other -hand, Sajous found that in appropriate cases, thyroid extract promotes -the growth of hair, while adrenal extract encourages, besides, the -growth of the eye-brows. - -Footnote 120: - - Nouvelle: Iconographie de la Salpêtrière, Juillet-Aout, 1899. - -In examining the circulatory system we must bear in mind the powerful -influence of the ductless glands upon the circulation, especially that -of the adrenals, thyroid, and pituitary body. As shown by Oliver and -Schäfer, the thyroid secretion diminishes blood-pressure, whereas the -adrenal secretion increases it. Thus, these two glands are antagonistic -and it can easily be understood that if there is not sufficient thyroid -secretion to counterbalance that of the adrenals, the blood-pressure -will increase. If this lasts for some length of time, very serious -effects will follow. Atheroma and arteriosclerosis may ensue, both of -which conditions tend to shorten life. The adrenals can be stimulated to -such over-secretion by mental emotions, which act upon the sympathetic -(splanchnic) nerves. Besides mental emotion they can also be stimulated -by various poisons, such as alcohol, tobacco, or infectious diseases -(see Chapter III). We must keep these facts in mind when we examine the -circulatory system, and we must ascertain the condition of the arteries, -whether soft or hard, and of the blood-pressure. Tortuosity of the -temporal artery in young persons is also a sign of some value. The -condition of the coronary arteries is of the utmost importance. We must -also not forget the fact, that even in severe cases of arteriosclerosis -the pulse may be found soft. Everything will depend upon the examination -of the heart, and special attention must be paid to the second sound at -the aortic orifice, and to any accentuation of that sound. - -In the examination of the digestive organs we must pay special attention -to the state of the appetite. Very often with a degenerated thyroid this -may be wanting. The appetite, as shown by Pawlow, is under the influence -of the mind as we will see. With a sad melancholic disposition, as is -often found in persons with a degenerated thyroid, there is insufficient -or no secretion of gastric juice. Besides, in myxœdematous conditions -all glandular secretions are more or less checked. Thus food passes into -a stomach with insufficient gastric juice, remains there in stagnation -and causes fermentation. The stomach makes vain efforts to drive the -food into the intestine. Slowly an atonic condition of the gastric walls -arises, and later dilatation of this organ. The fermenting foodstuffs in -the stomach set up a chronic intoxication of the organism. - -Concerning the condition of the intestines we should consider the -chances of long life greater in those persons whose bowels act regularly -and who are never constipated. Such persons are able to eliminate toxic -products much better than those who are suffering from chronic -constipation. The function of the intestines is powerfully influenced by -the thyroid gland, chronic constipation being a typical symptom of all -conditions in which this gland is degenerated, whereas in the opposite -conditions, such as Graves’s disease (exophthalmic goiter), diarrhœa is -common. By giving thyroid gland we can treat successfully those -obstinate cases of constipation, which are based etiologically on such -grounds. Besides the thyroid gland, the ovaries also influence, to a -large extent, the intestines, constipation occurring, as a rule, in -diseased conditions of the female sexual organs. - -Flatulency and distention of the bowels are very frequently met with in -women with diseased thyroids or ovaries, and are due to an irritated -condition of the nerves of the intestines. - -When examining the nervous system we must inquire for headaches, -especially in the occipital region, migraines, and the previous -occurrence of neuralgia, these being very frequent symptoms in persons -with athyroidia or hypothyroidia. Most characteristic are alterations in -the mental condition. Thus, memory for recent events may be gone. There -may be apathy, with hesitation before every movement, such persons -disliking to move about. They may sit indefinitely in the same position. -As already mentioned in the chapter on the influences of the ductless -glands upon the nervous system such people are frequently somnolent. -Therefore we must inquire about the hours of sleep. Besides sleeping -long, such persons are apt to awake in the night after dreams of a -terrifying nature. Our diagnosis of a condition of athyroidia or -hypothyroidia has often been helped, by inquiring whether such persons -have seen little animals (rats or mice) creeping through the room while -sitting quiet, or before going to sleep. Such a symptom has been -described by Murray,[121] in his book on myxœdema, in the early stages -of this disease; the mind being then so much altered that even manias of -persecution and suicide may arise. - -Footnote 121: - - Murray: “Disease of the Thyroid Gland,” p. 72, London, 1901. - -Neurasthenia is a disease which, as we have tried to show, is very often -based upon changes in the ductless glands, especially the thyroid, -sexual glands, and pituitary body. The same holds good for hysteria. -Therefore the presence of such conditions will influence us in our -judgment as to the future of such persons. In cases of great -nervousness, especially when associated with mental depression, there is -less resistance to infection, for causes already mentioned (see Chapters -III and L). Great mental excitability may predispose to certain diseases -which shorten life, like diabetes, and in people in whom, owing to an -unstable nervous system, there is a frequent increase in the -blood-pressure, the possibility of apoplexy is to be feared, if such -persons are of a plethoric build. The wear and tear of life is certainly -far more felt by persons whose minds are very easily impressed and -excited by events of little importance; and, considering the great -influence of mind upon body, persons, who like a weak tree are easily -beaten down by the smallest storm, will have less chance of long life -than persons who have a better control over themselves and stronger -will-power (see “Hygienics of the Mind,” Chapter L). - -Having thus briefly described the principal functions governed by the -thyroid gland: shown how, by observing changes in these functions, we -can judge as to the healthy condition of this gland, let us now see if -any means exists by which we can ascertain the functionating condition -of the other ductless glands. - -After the thyroid the sexual glands claim our attention, as these glands -are of the utmost importance on account of their enormous influence upon -the processes of metabolism and the maintenance of life (see Chapter V). -We must first call to mind that their work is essentially under the -influence of the thyroid, changes in which invariably produce changes in -the sexual glands. Thus, in degenerated conditions of the thyroid, we -find impotency in men and sterility in women. In such conditions atrophy -of the testicles, or of the ovaries, can often be found. These clinical -observations can be confirmed by experiments. Thus Lanz[122] found -sterility common in goats whose thyroids had been extirpated. In cretins -an atrophic condition of the testicles, or of the ovaries, is present as -a rule, and such patients very frequently show lack of sexual desires. - -Footnote 122: - - Lanz: Loc. cit. - -Direct examination of the sexual glands can be more easily carried out -in men than in women. - -The presence of varicose veins is of great importance, as varicoceles -are generally accompanied by great disturbances of the nervous system, -sometimes even going as far as insanity. Suicide is not unfrequently -committed in such a condition. - -After the testicles the prostatic gland must be examined. As direct -examination of this gland is only possible by a painful examination -through the rectum, we shall have to inquire into the condition of the -functions of this gland. We must find out whether there is a flow of -prostatic liquid and semen (frequency of pollution). It must be -remembered, however, that the flow of a little semen in constipation and -sexual abstinence has no importance. - -We must specially inquire about previous attacks of gonorrhœa. Examining -the urine in two fractions, we must ascertain whether the first fraction -is as clear as the second. The presence of a few filaments tells a tale -of previous gonorrhœa, but is of no consequence for the prognosis. It -may be, however, that they possibly indicate the presence of gonococci -in the deeper lying glands of the urethra which, after sexual excesses, -can again come to the surface even after years. - -Inquiring for gonorrhœa in the past, we must find out whether the -patient was treated by local applications with instruments to the -posterior part of the urethra, this being the only radical treatment of -chronic gonorrhœa. As a rule, every chronic gonorrhœa invades the -posterior part of the urethra and, usually, inflammation of the -posterior part of the urethra involves also the prostatic gland. - -The presence of strictures and hypertrophy of the prostate, unless they -occur in connection with a gonorrhœa, are indicative of a faulty -activity of those glands which influence the formation of fatty or -connective tissue in the body, as will be shown. It may indicate changes -in the thyroid, after extirpation or degeneration of which the -connective tissue in the body is increased, to which fact is also -largely due the occurrence of prostatic hypertrophy. - -We must inquire as to the passage of urine. An interrupted stream with -pain on micturition may indicate, in elderly persons, a hypertrophy of -the prostate, especially if these pains are more frequent in cold -weather. The bladder must be examined for the presence of stone. The -presence of stone, as also of long-standing gleet and strictures that -are not cured, lessen the chances of a long life, the dangers of -cystitis, and ascending pyelonephritis, and nephritis, hanging, as the -sword of Damocles, over the heads of their unfortunate possessors. - -Gonorrhœa, if it occurs frequently and attacks the prostate, is a great -danger both to the mental stability and sexual powers. The presence of -great sexual desires, with more or less impotence, must also be taken -into consideration when we are collecting evidence to find out the -chances of long life in an individual. - -Regarding the examination of the female sexual organs and of their -functions, it cannot be the object of these lines to describe how to -conduct a thorough gynæcologic examination. We must limit ourselves to -those points by which we can ascertain the condition of those functions -which are under the control of the ovaries, with special reference to -their internal secretion. Thus, we need merely observe whether the -external sexual characteristics (e.g., breasts, hips, etc.) are well -developed, since these are under the direct influence of the internal -secretion of the ovaries. - -A chlorotic condition allows us to draw the inference that a faulty -condition of the ovaries exists (ovarian origin of chlorosis—v. -Noorden), and also of the thyroid, as this gland often shows change in -chlorosis. The extirpation of these glands is followed by a diminution -in the number of red blood-corpuscles and in the percentage of -hæmoglobin. Both of these elements of the blood can be increased by the -use of thyroid or ovarian extracts, as has been noted by several -authorities. - -The condition of menstruation can give us valuable information. The late -appearance of the first menstrual period, irregularities of -menstruation, its appearance at irregular intervals, and frequent -disappearance for months, will give us an unfavorable idea of the -ovarian activity, especially when each menstrual period is accompanied -by pain. So will sterility, as this condition is common, not only in -association with ovarian inactivity (if not due to malpositions of the -uterus or impotency of the husband), but also with thyroid deficiency. -On the other hand, too frequent pregnancies or miscarriages will also -unfavorably influence our judgment, as these agencies have, as a rule, a -deteriorating effect upon these important glands, causing their -exhaustion and, at the same time, that of the thyroid. In women with -thyroid insufficiency and general loss of muscular tone, prolapse of the -uterus may be frequent, and also metrorrhagia. As Hertoghe found, we can -stop uterine hæmorrhages in women with thyroid insufficiency by the -administration of thyroid extracts. The history of previous gonorrhœal -infection must be specially investigated, as this disease, if not -treated, which is unhappily so often the case, will always involve the -ovaries, causing their destruction and often their obliteration. -Gonorrhœa in women is far oftener overlooked than in men, as it so often -passes for a simple discharge, until by microscopical examination -gonococci are found, and the ovaries already injured. It is a sad fact -that a large majority of the cases of pelvic disease in married women -are due to infection by the husband, for an enormous number of men enter -upon marriage with gonorrhœa that is imperfectly cured, or not cured at -all. Let us hope that there will come a time when a law will be passed -obliging every man to be examined thoroughly before entering upon -marriage, especially for gonorrhœa and syphilis. Such legal precautions -would soon check the transmission of these diseases to the wife and of -syphilis to the innocent descendants. It may be that thus, to a large -extent, the propagation of some of the greatest scourges of humanity can -be checked, viz.: of tuberculosis, alcoholism, and crime[123] which, as -shown previously, flourish on the soil prepared for them by hereditary -syphilis. - -Footnote 123: - - Arnold Lorand: “Pathogeny of Crime,” Address to the Philadelphia Med. - Jurisprudence Society. Monthly Cyclopædia of Practical Medicine, 1907. - -A total lack of sexual desire in women is not normal, and may indicate -changes in the ovaries. On the other hand, there is an increase of -sexual desire at the period of augmented ovarian activity, as in the -days preceding menstruation. We have had the opportunity of hearing -praise of ovarian treatment from husbands of women with tendencies to -sexual frigidity. - -Very valuable information about the activity of the ovaries can be -gained from the examination of the breasts. It must be borne in mind -that the ovaries and the breasts stand in very close relation. Changes -in the ovaries are always followed by changes in the breasts, and it is -a very interesting fact that cases of cancer of the breast have been -cured by extirpation of the ovaries. - -Comparing the breasts of an innocent young girl between sixteen and -twenty years with those of women of the same age leading an immoral -life, or of women after many pregnancies or in advanced age, we notice -at once the great difference between the large flabby breasts and the -firm tissue of a young girl leading a moral life. According to our -observations we have described[124] cases of fatty enlargement of the -breasts, following all those agencies which are hurtful to the ovaries, -as masturbation, sexual excesses, many pregnancies, etc. On the other -hand, in degenerated conditions of the ovaries and thyroid, especially -if these conditions are congenital, we may find the breasts quite -undeveloped. - -Footnote 124: - - International Congress of Medicine, Lisbon, 1906, reported in Presse - médicale, 1907. - -After the thyroid and ovaries we will direct our attention to the -pituitary body. Direct examination of this ductless gland being out of -question, owing to its position on the base of the skull, in the _sella -turcica_, we have to judge of its vitality by indirect methods. We know -that by the alterations of this gland a condition is produced, called -acromegaly, characterized by enlargement of the toes, fingers and nose, -prominence of the lower jaw, sinking in of the temple and of the _fossa -canina_ in the cheek-bones, prominence of the occipital bone, etc. As -with all diseases of the ductless glands, besides the extreme form just -described, which constitutes the highest degree of such a degeneration, -there are also marked cases where all of the above deformities are only -slightly pronounced. We must inquire whether the features of such -persons have changed, or the nose, hands, and feet become larger. This -is best determined by comparison of old and recent photographs. - -A history of headache, especially nocturnal, of mental change, e.g., -great susceptibility or symptoms of neurasthenia, taken together with -the external appearances, may aid our diagnosis. The simultaneous -discovery of an ocular lesion (hemianopsia) will confirm our suspicions -beyond doubt. - -The pancreas, also, can only be examined by indirect evidences of its -activity. A history of frequent or occasional epigastric colic, of large -quantities of unformed shapeless stools of a yellow or yellow-gray -color, containing undigested fat, together with loss of weight, will -make us think of the possibility of disease of the pancreas. The most -exact proof of such change can only be obtained by microscopical -examination of the fæces. - -Examination of the urine for sugar can also tell us whether there is -disease of the pancreas, especially of those parts of the pancreas which -constitute a ductless gland, independently of the rest of the viscus, -namely, the islands of Langerhans.[125] - -Footnote 125: - - Langerhans: Thèse, Berlin, 1869; G. Lange. - -As Mering and Minkowski[126] first showed, every dog whose pancreas is -extirpated invariably becomes diabetic, and this diabetes is similar to -that of man. In many cases of diabetes changes in the pancreas have been -found at autopsy; and although a good number of cases without any -apparent change in the pancreas have been recorded, the cause of these -has been revealed by an American author, Dr. Opie,[127] then of the -Johns Hopkins University in Baltimore. This author has found in a few -cases of diabetes alterations in the islands of Langerhans in the -pancreas. This fact has been confirmed by a good many authors, of whom I -may mention Sobolew,[128] Weichselbaum[129] and Stengel, Sauerbeck, and -others. As is invariably the case, the statements of these authorities -have been attacked by others, as Hanseman, who have found no such -changes in the islets in diabetes. We must, however, state here, that an -apparently perfect anatomical condition of glandular structure after -death need be no proof of a perfect secretory activity during life. -Every epithelial formation, and the islands of Langerhans are of this -nature, must furnish a secretion, and this flows in every gland only -under a nervous stimulation. As Pawlow has shown, the pancreas secretes -under nervous impulse. Therefore the findings of pathological anatomy -cannot show us whether these glands have been secreting properly during -life or not, especially in a nervous disease such as diabetes. - -Footnote 126: - - Mering und Minkowski: Archiv für exper. Path. und Pharm., xxvi, 1889. - -Footnote 127: - - Opie: Journal of Experiment. Medicine, p. 827, 1901. - -Footnote 128: - - Virchow’s Archiv, clxviii, p. 1. - -Footnote 129: - - Wiener klin. Wochenschrift, 1901-1902. - -According to the experiments of Diamare and Kuliabko, the islands of -Langerhans furnish a secretion which aids in the inversion of grape -sugar. We have shown at meetings of the Biological Department of the -Hamburg Medical Society (Germany), and of the London Pathological -Society, specimens of the pancreas of diabetic persons where there were -changes only in the islands of Langerhans and none in other parts of the -pancreas while, in one case, nearly the whole of the pancreas was -destroyed by cirrhosis, but without any diabetes, for in this case the -islands of Langerhans were not changed at all. It is interesting to note -that these changes in the islands of Langerhans were also present in -mild cases of diabetes. - -Thus, the finding of sugar in the urine usually indicates the -probability of changes in the pancreas. Even small quantities of sugar, -such as appear only after starchy meals (alimentary glycosuria _ex -amylo_) may be brought into connection with changes in the pancreas; for -Wille[130] found in Hamburg from a large series of autopsies, that in a -considerable number of cases with alimentary glycosuria, there were also -changes in the pancreas. - -Footnote 130: - - Quoted after Professor Oser: Deutsche klinik., vol. v, p. 158. - -We must not forget the very important fact, that even when we find no -sugar we cannot at once exclude diabetes. There are many cases of mild -diabetes which do not show any sugar on an ordinary diet. To recognize -these cases we must give them a test meal of either about three ounces -of grape sugar two hours after a light breakfast of coffee and a roll, -or, as we have recommended in our book on the rational treatment of -diabetes,[131] we must give a test meal of much starchy food, such as -rice and cakes, and examine the urine two hours later. If then no sugar -is found, or not exceeding 0.2 per cent., diabetes may be excluded. -Persons with 0.1 per cent. to 0.3 per cent. of sugar after such a -starchy test meal may be considered as on the border line of diabetes. -Such persons show a diminished tolerance of carbohydrates, and they have -lost the power to consume all the sugar they introduce into their body. -Therefore, especially if they come of diabetic parents, they should -avoid eating much starchy food so as not to develop further this -dangerous tendency. - -Footnote 131: - - Second edition, Berline, 1909. - -Diabetes, in the majority of cases, considerably shortens the patient’s -life. Mild cases of diabetes may however live for fifteen or twenty -years, or often even longer. In predicting the chances of longevity in -diabetic subjects everything depends on the question whether diacetic -acid has been found in the urine or not. This can be easily ascertained -by putting a few drops of a solution of perchloride of iron into a test -tube with the diabetic urine. If diacetic acid is present, the liquid -will become Burgundy red in color, and the deeper this red color, the -greater is the percentage of diacetic acid present. In such cases the -chances are very bad, such patients living on an average for only one to -two years. Exceptions to this rule, however, are not infrequent, and we -know of a case of acromegaly with severe diabetes, who has passed large -quantities of diacetic acid for the last fourteen years. - -Cases of severe diabetes, with diacetic acid, can often be easily -recognized by their appearance. They are thin, the cheeks are often -flushed, and they show nearly all the signs of a myxœdematous condition, -as already described, whereas cases of mild diabetes present often -symptoms of hyperactivity of the thyroid gland, as in exophthalmic -goiter. As we have shown, diabetes is often due to an overactivity of -the thyroid gland,[132] as well as to degeneration of the pancreas, -these glands being antagonistic to one another. This is confirmed and -amplified by Sajous, who ascribes one form of diabetes to overactivity -of the adrenal system, which includes the thyroid gland. Overactivity of -the latter organ may also be followed by its exhaustion, with symptoms -of myxœdema, as is the rule in severe diabetes. - -Footnote 132: - - “Die Entstehung der Zuckerkrankheit,” Berlin, 1903, and its French - translation, Maloine, Paris, 1904. - -Patients with mild diabetes often have a fresh look and a rosy face, and -very frequently look much younger than they are. We believe that the -healthy working condition of their thyroids has something to do with -this fact. - -The pancreas is a very important organ for the maintenance of life as it -produces certain bodies (enzymes) which are of enormous importance in -the assimilation of food. One of these bodies (they are three in -number), helps the assimilation of albuminous products and is called -trypsin. It also plays an important rôle in the treatment of cancerous -growths. Besides this the pancreas produces an enzyme that helps the -assimilation of the carbohydrates (amylopsin) and another that is -indispensable for the perfect assimilation of fat (steapsin). - -As we have shown by experiments made in the laboratory of Professor -Minkowski (then in Cologne), the pancreas stands in definite relation to -the thyroid. These two glands seem to be antagonistic to one another, -for on extirpation of the pancreas of three dogs, thus rendering them -diabetic, in every case the thyroid showed a condition of hyperactivity, -whereas in one case, after previous extirpation of the thyroid, the -pancreas showed an enormous number of islands of Langerhans—(thirty-six -to forty in one field).[133] - -Footnote 133: - - Comptes-Rendus de la Société de biologie, Paris, 25 Mars, 1904. - -It was also of great interest, that each diabetic dog ceased to -eliminate sugar two days after extirpation of the thyroid. - -As with the thyroid, the pancreas has also very important relations with -the liver. Dr. Steinhaus found, in a research conducted in the -laboratory of Professor Minkowski, that in a large number of cases of -hepatic cirrhosis there were also similar changes in the pancreas. -Similar observations have also been made by Opie, Amato, Kliffel and -Lefas,[134] and others. This may be the reason that in diseases of the -liver we have had good results from the administration of pancreatic -extract. In every case we have found a better assimilation of food, and -especially a better appetite. This stomachic effect of pancreatic -extracts we have found in nearly every case and even when the patients -were not suffering from pancreatic or hepatic disease. (See also Chapter -LIV.) - -Footnote 134: - - Revue de médecine, 23, 1903. - -Still more than the pancreas is the liver indispensable for the -maintenance of life. It destroys the deadly poisons which are conveyed -to it by the portal vein for neutralization. Besides this it produces -certain bodies which help to destroy poisons arising from the -decomposition of albuminous food. (See also Chapter XIII.) - -The liver also produces certain bodies, as urea, which play a very -important part in metabolism, and it also serves as a large depot for -glycogen, the stored sugar of the body. The liver forms a large amount -of glycogen, and stores it up for the wants of the body. By a ferment, -also produced by the liver cells, the glycogen is transformed into -sugar, and in this form is given off to the body. If the liver were -extirpated the blood would contain no more sugar, as was found by -Minkowski through experiments on animals. - -Besides sugar, the liver also produces, as just mentioned, another very -important substance, and this is urea. This body is produced in the -liver from ammonia, which, as the final product of decomposition of -albuminous substances, is brought to the liver by the blood. From -carbamic acid, also, the liver forms urea. Ammonia and carbamic acid are -poisonous products which arise from the decomposition of albuminous -material, and, by transforming them into urea, the liver saves our body -from continuous intoxication. Thus we can see that in diseases of the -liver the quantity of urea falls and the elimination of ammonia -increases. A normal man eliminates about thirty to forty grammes of urea -in a day. Much smaller quantities per diem would thus indicate -diminished activity of the liver. - -Besides glycogen and urea, the liver also produces another substance, -which is indispensable to the perfect process of digestion and -assimilation. This is the bile. The bile transforms fat in the intestine -into an emulsion, and thus makes it possible for the fat-splitting -ferment of the pancreas to act upon it, and to split it up into glycerin -and fatty acids, and thus make it serviceable for the uses of the -organism. The bile augments the action of the pancreatic ferments; it -stimulates the movements of the intestine, and is a powerful antiseptic -to the contents of the intestine, as it hinders to a certain extent -their putrefaction. Another important action is that it increases the -water content of the fæces, and thus materially helps an easy evacuation -of the bowels. - -After having thus briefly passed in review the important functions of a -healthy active liver, let us now say a few words about its examination. -The liver is one of the few ductless glands which are available for -manual examination by percussion and palpation. We must ascertain if it -extends considerably below the costal margin, and by palpation we must -ascertain whether the enlarged liver is soft or hard and cirrhotic. In -the former condition we can diagnose hyperactivity of the liver, -probably due to its efforts to safeguard the body against a -long-continued intoxication, as may be the case in those who overeat, -and also in long-continued digestive troubles, especially with -dilatation of the stomach, chronic constipation, etc. Following on this -hyperactivity, as is the case with all organs, there may come an -exhaustion, more especially after long-continued intoxications. Thus in -chronic alcoholism a simple hypertrophy of the liver may go on to -cirrhosis, and later the hypertrophy may be followed by an atrophy, with -all its harmful consequences, as ascites, etc. - -On examining the liver we must not forget the sclerotics, and must note -whether, on looking upward, there is any yellow discoloration. - -While palpating the liver we must specially note whether it is tender, -and also if the gall-bladder is tender. This is a typical symptom of -chronic inflammation of the gall-bladder, or cholecystitis, which is so -frequently associated with gall-stones. We find such a tender -gall-bladder very frequently in elderly women, in whom gall-stones are -particularly common. In fact, they occur so frequently that Halck[135] -in Copenhagen, found them in 29 per cent. of 4140 autopsies on persons -above 50 years of age. However the mere presence of gall-stones does not -constitute gall-stone disease, the essential point being an inflammation -of the gall-bladder and bile-ducts. Such an inflammation of the -gall-bladder is revealed by tenderness on pressure with the examining -hand. It is a frequent symptom of all those conditions (as we have found -and communicated to the French Congress of Medicine, 1905) in which the -thyroid or sexual glands are diseased. For instance, after pregnancies, -after infectious diseases in old age, etc., it is often accompanied and -preceded by obesity, which is also a consequence of inactivity of the -thyroid and sexual glands. Frerich, many years ago, observed enlargement -of the liver and a tender gall-bladder in women at the climacteric, and -many other authors have made similar observations. Hertoghe found such -conditions common in women suffering from inactivity of the thyroid or -hypothyroidia. - -Footnote 135: - - Quoted from Hoppe-Seyler in Nothnagel’s “Practice,” p. 548, 1904. - -It has been found by experiments, made by Blumenthal and Jacobi, that -extirpation of the thyroid is followed by a dilation of the -gall-bladder, and many authors have noted the presence of biliary -constituents in the urine of animals whose thyroid has been extirpated. - -We can readily understand why women with changes in the thyroid and -sexual glands are so often attacked by gall-stone disease. In these -women there is, as a rule, atony of the intestines, with habitual -constipation. This intestinal atony is also accompanied by an atony of -the gall-ducts, and so the bile is more or less stagnant in these ducts. - -As shown by Morat and Doyon,[136] the gall-ducts contract rhythmically -every ten to twenty seconds, and the bile is thus expressed. The -periodical compression of the liver by the diaphragm at each inspiration -also helps this expression of the bile. Thus it flows under a certain -pressure through the choledochus, and it is easy to understand that the -billions of microbes which infest the intestines, will have great -difficulty in passing the narrow and tortuous passages of the bile-ducts -through which bile is circulating at great pressure. And this is of the -utmost importance, for if microbes are able to pass the common duct and -thus enter the bile-ducts, they will set up inflammation, as was shown -by several French authors: Gombault, Charcot, Gilbert, etc. - -Footnote 136: - - Traité de Physiologie. - -Inflammation of the bile-ducts plays a most important part in the origin -of gall-stone disease, for, as Naunyn and his pupils have shown, -inflammation of the bile-ducts leads to a precipitation of cholesterin, -and so to the formation of gall-stones. - -In women gall-stone disease is more frequent than in men. This depends -upon the greater frequency of diseases of the thyroid and sexual glands -in women. Changes in the sexual organs produce an irritation of the -splanchnic with checking of the peristaltic movements of the intestine -and, at the same time, relaxation of the muscular coat of the -bile-ducts. Thus there arises a deficient expression of bile, and -stagnation follows, with invariable immigration of bacilli producing -inflammation and precipitation of cholesterin and gall-stones. For the -above-mentioned reasons constipation is far more frequent in the female, -and constipation, being always accompanied by atony of the bile-ducts -with stagnation of the bile, directly exposes to the risk of gall-stone -disease. - -In men gall-stone disease may often be considered a manifestation of old -age. It appears, as a rule, after the fortieth year, and is often -brought about by previous infectious diseases. In such cases obesity -often develops first, and later gall-stone disease. For those who are -interested in this subject we would refer to our communication[137] on -the origin of gall-stone disease following changes in certain ductless -glands. Considerable, sometimes enormous, loss of weight is a very -frequent symptom of gall-stone disease, and is probably due to -pancreatic alterations. - -Footnote 137: - - Archives générales de médecine, Octobre, 1905, and Monthly Cyclopædia - of Practical Medicine, 1906. - -Gall-stone disease may be regarded as of great importance in estimating -an individual’s prospects of longevity, and at the same time as a -pathological manifestation of an inactive thyroid, or deficient sexual -glands in women. This applies equally well to the cause of renal colic, -gravel, which was found by Professor Sajous to be prevented by thyroid -preparations and a suitable diet. - -Constipation, an important predisposing cause, has been shown to be an -expression of such conditions. The truth of these assertions is proved -by experimental evidence. - -Extirpation of the thyroid provokes important changes in the liver. In -myxœdema there is a condition of hepatic cirrhosis, as shown by -Prun-Hudden, Vermehren,[138] and others. Two years after we had shown -that the thyroid and liver stand in close relation to one another, -Professor Neusser, of Vienna, brought forward the same conclusion at the -German Congress of Internal Medicine in 1906. - -Footnote 138: - - Over Myxœdemet, Kjöbenhavn, 1895. - -Another important gland that has a very close connection with the -thyroid is the kidney. A direct examination of this organ is not -possible, but we have means of readily judging of its efficiency by -observing how it performs its function. This is to eliminate waste and -poisonous products from the body by means of its secretion—the urine. -Thus from the examination of the urine we may gather all the information -necessary about the activity of the kidneys. - -In examining the urine we must first pay attention to its appearance, -the daily amount, and its specific gravity. Less than about two pints a -day of a light colored urine, with a specific gravity below 1020, -indicates a faulty action of the kidneys, and the possibility of a large -amount of toxic products being retained, instead of being eliminated. -Such a urine can often be seen in cases of thyroid insufficiency, as -this condition of the thyroid causes a diminution in the activity of the -kidneys. As we have shown in a communication to the Paris Biological -Society,[139] the thyroid and the kidneys are very closely related, -changes in the thyroid always being followed by changes in the kidneys. -Thus it was found by Albertoni and Tizzoni, by Blum and others, that -extirpation of the thyroid is followed by fibrosis of the kidneys. -Interstitial nephritis is the rule in myxœdema, and is very frequent in -all conditions with insufficiency of the thyroid. In such patients the -quantity of urine is diminished, and also its specific gravity, as well -as the quantity of urea and uric acid, which in consequence are retained -in the body. - -Footnote 139: - - Loc. cit. - -The quantity of the eliminated uric acid being diminished, its retention -in the body explains why gout is so frequent in people with thyroid -insufficiency, and why these persons so often complain of rheumatic -pains. As we have shown in our above-mentioned communication, gout is -due to a degenerative change in the thyroid and kidneys, with retention -of uric acid as a sequel. - -The presence of albumin in quantities greater than 0.5 gramme to the -liter is of grave import, and denotes important change in the kidneys. -Smaller quantities, or just a trace, may not be of great importance. -Traces of albumin occur from a great number of causes, and are often due -to the passage of toxic products through the kidney which this organ -eliminates, as one of its main functions is to eliminate toxic products -from the body. - -More serious than small quantities of albumin is the appearance of casts -and renal epithelium. These, if present, indicate a destructive process -in the kidneys. Even the occasional occurrence of hyalin casts is not -without danger, for, according to Professor Senator,[140] of Berlin, -hyalin casts are formed by degeneration of the epithelium of the -convoluted tubules, which play an important rôle in the separation of -solid products from the blood into the urine. The loss of these -structures means a hampering of the most important function of the -kidneys. Even when we find only one such cast in one or two specimens, -we must not forget that a pint of the urine may contain a very large -number, and thus every day large quantities of valuable kidney elements -are wasted and one of the most important functions in our body is -hindered. Therefore we must not pass by such a condition of things -without serious thought for the future of such persons. The length of -their lives will largely depend upon their diet, just as in cirrhosis of -the liver. If these persons are addicted to an abundant meat diet, their -chances of longevity will certainly be smaller than with milk and -vegetable food. As we have seen, the liver is constantly dealing with -poisons arising from the decomposition of albuminous food, especially -meats. The kidneys are destined to eliminate such products from the -blood and pass them out with the urine. We will treat of this subject -later in a separate chapter. - -Footnote 140: - - Die Erkrankungen der Nieren, second edition, Berlin, 1906. - -In patients with diseases of the kidneys, the condition of the skin is -of the utmost importance, as the skin is our second kidney. Therefore -patients with thyroid insufficiency have less chance of a long life if -their kidneys are in any way incapacitated. - -Besides the above-named vital organs, there are certain portions of our -anatomy which are also of importance in the determination of our chances -of life. Take, for example, the nose. In the children of parents with -degenerated thyroids there is a great tendency to adenoid vegetations. -These are, strictly speaking, not a disease of childhood alone, for -often they may be met with in adults, even in middle age. If large they -necessitate breathing through the mouth instead of through the nose, -especially at night. Such children are liable to frequent catarrhs, and -what is more serious, to pulmonary troubles. They are also liable to -suppurative otitis media and frequent attacks of tonsillitis. These -frequent attacks of tonsillitis may constitute a serious danger, as they -may induce an inflammation of the kidneys. As a rule, in such cases the -nephritis passes off in a few days, often without being recognized, the -symptoms being ascribed only to the tonsillitis. Although the acute -symptoms may have disappeared and nothing remain but a few red -blood-corpuscles in the urine and occasionally a few casts and -epithelial cells, yet under the ashes the fire may still creep on and -chronic nephritis develop. In fact, a good number of cases of chronic -nephritis whose origin is wrapped in mystery are due to such a -tonsillitis. - -The condition of the teeth must also be inspected, for people without -sufficient teeth cannot chew their food properly, and thus gastric and -intestinal catarrhs may arise. - -Just as important, if not more so, than the condition of the -above-mentioned vital organs, is the mental state. Thousands of years -ago it was a manifest truth that the mind governs the body. In judging -an individual’s chances of long life, we cannot omit the importance of -his mental character. As a rule a man with a well-balanced mind, who is -not disturbed by the smaller worries of life, has more chances of a -green old age than a man whose easily impressionable mind exposes him to -continual agitation and anxiety, and who is overwhelmed by the slightest -untoward event. A man who is a born optimist and who views everything in -a rosy light, has got far more chance than a pessimist who sees -everything in a cloud. A man who is ambitious and never satisfied is -more liable to mental and physical change than one who asks for little -and easily gets it. Being disappointed in his ambition, as so often -happens, he becomes despondent, especially if he is lacking in -will-power, which depends on the activity of the thyroid as previously -mentioned. In this condition he may not only lose his appetite and -become ill-nourished, but he is also more liable to succumb to the -incessant attacks of microbes, among which he lives, and which gain easy -access to the body in melancholic conditions. Sorrow may act in the same -harmful manner. - -The chances of a bachelor or spinster for a long life are always less -than those of a married person. Single people are more subject to -nervous change and digestive troubles, and have a greater tendency to -become despondent and melancholic. In bachelors, also, the acquisition -of contagious diseases is a continual danger, and when they get older -after their former merry lives, if merry it was, gloom invariably -follows. Married life is the best guarantee for a long life and happy -old age (see Chapter XLVIII). - -Before closing this chapter we would state that it was not our intention -to give a description of the physical examination of a patient from the -point of view of life insurance, but to indicate certain points which -must guide us in forming an opinion on a person’s chance of longevity. -All vital phenomena are under the influence of the internal secretions -of the ductless glands, which govern every organ of our bodies. -Therefore everything depends upon finding out the condition of these -glands. Any well instructed physician can make a thorough examination of -the different organs of the body for the purposes of life insurance; -therefore we did not think it necessary to describe here the examination -of the heart or lungs, etc. - -By such examination of the ductless glands we are not only able to -forecast the approximate length of life, but we are able to judge a -patient’s power to withstand disease when we are called to his bedside. -If we find the ductless glands of such a patient (especially the thyroid -and adrenals, kidneys and liver) in good working order, we can predict a -successful and rapid termination to the malady. It is easy to understand -that any one with a healthy skin, normally acting bowels, and plentiful -urine, will more readily eliminate poisonous products than a person with -a dry skin, constipation, and scanty urine. Also his tissues will be in -better condition, and in the case of wounds granulations will more -quickly form and fractures heal readily with firm callus. - -Such an examination as the above can, however, also help us, as we -readily shall understand, to foretell the chances of a person as to the -prolongation of youth and the retardation of old age. - - ------------------------------------------------------------------------- - - - - - CHAPTER VIII. - - ON THE CAUSATION OF OLD AGE. - - -WE have seen in the first chapter of this book that the symptoms of old -age may appear in quite young persons after changes in the ductless -glands, especially the thyroid, ovaries, testicles, etc. We have also -shown how these glands influence the condition of the tissues, and our -external appearance, our immunity from infections and intoxications, and -the condition of our nervous system and mind. We have also seen how -these wonderful glands influence the length of our life and our -prospects of a green old age, and thus it is evident that these glands -are in close relation with the origin of old age. It is justifiable, -therefore, to enter fully into a discussion as to whether old age is -really due to degeneration of the ductless glands, which supposition -must have occurred to anyone who has read the previous chapters of this -book. - -Sir Victor Horsley, of University College Hospital, London, was the -first to bring old age into causal relation with degeneration of the -thyroid, and after him Vermehren and Ewald of Berlin. - -In a communication we made to the Biological Society at Paris, December -4, 1907, we showed that old age is not alone due to degeneration of the -thyroid, but to changes in several ductless glands, of which the chief -are the thyroid, ovaries, testicles, adrenals, and pancreas. In a -communication to the International Medical Congress in Lisbon, in 1902, -we added to these glands the liver and kidneys, which also possess an -internal secretion. - -Let us now see if there is any evidence in support of such a statement. - -As we shall show, such proofs do exist and they are of a pathological, -anatomical, experimental, and clinical nature. To begin with, it is a -well-established fact that at a certain age the different ductless -glands show important changes, notably an increase of connective tissue, -with subsequent degeneration of the secreting tissue. - -Sir Victor Horsley[141] found that the thyroid gland, after a certain -age, shows an increase of connective tissue, with fatty degeneration of -the epithelium and shrinking (concentration) of the contents of the -follicles. Hale White[142] also, examining at autopsy seventy thyroid -glands, found an atrophic condition in old subjects, an atrophy which is -more marked the older the subject, and that these changes are already -present in the thyroids of persons fifty years old. - -Footnote 141: - - “On the Thyroid and Pituitary Bodies,” British Medical Journal, 1890, - and Proceedings of the Royal Society, 1886. - -Footnote 142: - - Hale White: Med.-Chirurg. Transactions, vol. lxxi, 182. - -The thyroid, together with the parathyroids, have been found degenerated -in old age by Erdheim.[143] Bauman found only very little iodine in the -thyroid of aged persons. - -Footnote 143: - - Beiträge zur path. Anatomie, xxxiii, p. 158, 1903. - -Let us add that, luckily, not every thyroid shows important changes -after the age of forty or fifty, although there is usually a slight -increase of connective tissue at that age. On the other hand there are -thyroids in subjects of advanced age which show no important -degenerative change. This, however, is, according to our experience at -autopsies, a very rare occurrence. The point of main importance is the -amount of colloid substance present. A thyroid with much colloid, if it -is of normal quality (which can be recognized by the way it stains with -eosin), is a thyroid of good activity. As we know, the thyroid contains -more iodine than any other part of the body. The main bulk of the iodine -in our body comes from the thyroid. It follows from the investigations -of Docent Oswald,[144] in Zurich, that the quantity of iodine in the -thyroid depends upon the amount of colloid substance. Hence a thyroid -with much colloid substance contains much iodine, and a large goiter -composed of connective tissue alone and containing no colloid, cannot -contain any iodine. - -Footnote 144: - - Oswald: Zeitschrift für physiolog. Chemie, 1899, and Virchow’s Archiv, - 169, p. 444, 1902. - -Differing with a famous French physician who said that the age of a man -depended upon his arteries, we would state that it depends upon the -quality of his thyroid. For the condition of the arteries, as we have -shown in different parts of this book (Chapters II and VI), depends very -much upon the condition of the thyroid gland, which governs the whole -circulatory system. - -The parathyroid glands, which are in relation with the thyroid, and -changes in which may produce cramps, as shown by Jeandelize,[145] -Pineles,[146] etc., also present an increase of connective tissue, with -fatty degeneration of the epithelium, in old age, as was shown by -Erdheim,[147] of the Vienna Pathological Institute. - -Footnote 145: - - L’insuffisance thyroidienne et parathyroidienne, Paris, 1904. - -Footnote 146: - - Grenzgebiete f. Med. Chirurg., 1905. - -Footnote 147: - - Erdheim: Loc. cit. - -As is well known, the ovaries also, between the ages of forty-six and -fifty, undergo important changes and involution, with consequent -cessation of the menses. There is an increase of connective tissue with -degeneration of the epithelial structure. There is also a retrograde -metamorphosis of the Graafian follicles into fibrous tissue. The -testicles have been found atrophied in old age by Professor -Langhans,[148] but there are many exceptions, as shown by S. -Spangaro.[149] - -Footnote 148: - - Langhans: “Hoden Atrophie,” Handbuch der Deutschen Chirurgie, - Stuttgart, 1887. - -Footnote 149: - - Spangaro: Anatomische Hefte, lx, 1902. - -As Sajous[150] and we[151] also have shown in our already cited -researches, that the various ductless glands are closely related, and -thus changes in the thyroid are always accompanied by changes in the -other ductless glands. This rule applies to the present case and after -senile changes in the thyroid, with increase of connective tissue, the -other ductless glands also show similar changes. These are found in the -pituitary body, the adrenals, the liver, and kidneys. We have several -times insisted upon this fact in various chapters of this book. - -Footnote 150: - - Sajous: Loc. cit. - -Footnote 151: - - Loc. cit. - -The adrenals of old people have been examined by Minervini,[152] and he -found a true cirrhosis of these glands which had included nearly the -whole gland. He also found drops of fat in the cells of the medulla. -Dellamare[153] found a hypertrophic condition of this gland in old age. - -Footnote 152: - - Minervini: Journal d’anat. et de physiol., p. 449 and p. 639, 1904. - -Footnote 153: - - Dellamare: Soc. de biologie, 17 Octobre, 1903. - -In nature every cause has a sequel. Therefore, when we see such -important changes in glands with internal secretions, there logically -must be sequels to the alterations in these important organs. And these -exist. When the thyroid is degenerated, to a greater or less extent all -those symptoms appear which are characteristic of changes in the -functions governed by the thyroid, and of which we have spoken in -previous chapters. - -Therefore, when the thyroid is degenerated, symptoms appear which are -characteristic of myxœdema. And, indeed, Sir Victor Horsley was the -first to draw attention to the fact that in old age we find all the -symptoms of myxœdema; and after him, Vermehren[154] and Ewald.[155] They -have compared the symptoms of myxœdema with those of old age, and found -the two conditions very similar. According to our own observations the -most prominent of these corresponding symptoms are:— - -Footnote 154: - - Studier over Myxœdemet, Kjöbenhavn, 1895. - -Footnote 155: - - Ewald: “Die Erkrankungen der Schilddrüse,” Nothnagel’s Handbuch, - Vienna, 1896. - -The wrinkles on the face and the drooping of the lower eyelids, in -extreme cases amounting to ectropion. Then the great number of wrinkles -on the hands of myxœdematous people, even at an early age, and the -feeling of cold in the hands and feet and their bluish color. - -With advancing age, obesity is often the first symptom, just as in -myxœdema, and, as we have said above, obesity can be caused by -degeneration of the thyroid and sexual glands. - -The hair in both conditions is very often gray, and there is atrophy of -the papillæ of the hair and of the sebaceous and sudorific glands, with -dryness and falling out of the hair. - -Constipation or irregularity of the bowels is also common. There is -often great fatigue, slow speech, and an apathetic condition in both -these states. The memory shows the same typical deficiency, events of -long ago being more easily remembered than those of quite recent date. -The character of the patient becomes egotistical and avaricious. There -is great sensibility to cold and difficulty in keeping warm. The urine -is generally below the normal quantity; often it is scanty and of low -specific gravity, with retention of solid constituents. The processes of -oxidation are diminished both in typical myxœdema and in advanced old -age. There is a diminution of the blood-corpuscles and of hæmoglobin in -both conditions. - -After the initial obesity in early myxœdema and old age, there comes as -a second stage a loss of fat, characteristic of the advanced stage of -myxœdema (the cachectic stage) and advanced old age. - -There is an increase of fatty tissue after extirpation of the thyroid -gland, and later of connective tissue, just as in myxœdema and old age. -This increase of connective tissue is typical of old age. It first -appears in the arteries, leading to atheroma, and the typical symptoms -of arteriosclerosis. In myxœdematous persons, although they may still be -young, we find atheromatous arteries and arteriosclerosis. Impotence is -common in myxœdema, especially in advanced cases, and is also found in -senility, being more marked the greater the patient’s age. - -There is no denying the fact that in old age we find, besides -degeneration of the thyroid, symptoms of degeneration in various other -tissues and functions, and the question now arises, whether these -changes in the tissues are really the sequel of previous degeneration of -the ductless glands, or whether both are only accidental and in no -causal relation We have already answered this question four years ago in -our communication to the Paris Biological Society, showing that old age -is due to degeneration of the ductless glands, and stating that these -glands govern the tissues and not _vice versa_. Still, we shall enter -here more fully upon this question, showing by experimental and clinical -evidence that the changes in the ductless glands are primary, and -followed by a degeneration of the tissues as a consequence. - -We can produce experimentally typical symptoms of old age in young -animals by extirpation of the ductless glands, more especially the -thyroid, ovaries, and testicles. - -When we extirpate the thyroid gland of an animal we get an increase of -fat in the subcutaneous tissue, or an increase of connective tissue. We -know of the case of a young bull which, two months after extirpation of -the thyroid, gained about thirty kilos in weight, due to an increase in -fat. The same thing occurred in a colt. We are indebted for our -knowledge of both these cases to Dr. Hertoghe, of Antwerp, the -well-known authority on the thyroid gland. - -After extirpation of the thyroid gland prominent writers have found a -diminution in the processes of oxidation; and by thyroid gland feeding -we can augment these processes, as was shown by Vermehren, Magnus-Levy, -Thiele, Nehring, and many others. This property of the thyroid gland is -made use of in the medicinal treatment of obesity. Since writing these -lines we have observed a loss of forty pounds in a man, a patient of -Professor Launois, of Paris, who, after this loss, felt better. We -treated him in Carlsbad for six weeks with thyroid extracts, and the -average loss was about a pound a day. True, this patient was also taking -Carlsbad water, but we have never seen so considerable a loss due to -this water alone. The diet of this patient had not been strict. This -loss of weight, then, is mainly to be ascribed to the thyroid treatment. -This treatment is dangerous, however, unless carefully regulated by a -physician. - -Thus extirpation of the thyroid is undoubtedly in causal relationship to -obesity, which, as already mentioned, is often the first symptom of old -age. But it also can produce another sign of old age, and this is the -increase of connective tissue in the various organs and tissues. That -connective tissue formation is an attribute of old age has been clearly -shown by Demange and Oettinger, who found at every autopsy on old -persons an increase of connective tissue in the walls of the -capillaries. Ord and Mahomet found exactly the same thing in the -capillaries of persons suffering from myxœdema. This has been proved -experimentally by Professor Eiselsberg,[156] of Vienna, who found -atheromatosis of the aorta and other blood-vessels in dogs whose -thyroids he had removed. - -Footnote 156: - - “Die Krankheiten der Schilddrüse,” Stuttgart, 1901. - -This increase in connective tissue has been found in various viscera -after removal of the thyroid; thus it was found by Kishi[157] in the -liver of one hundred and fifty dogs and monkeys. Rosenblatt and -Jeandelize[158] also described an interstitial hepatitis in similar -cases. - -Footnote 157: - - Virchow’s Archiv, p. 260, 1904. - -Footnote 158: - - Loc. cit. - -The same change has also been noted in the kidneys after extirpation of -the thyroid (e.g., Blum[159] found an interstitial nephritis), and in -the brain an increase of neuroglia occurs, as observed by Blum, Walter -Edmunds, and others. - -Footnote 159: - - Blum: Loc. cit. - -Increase of connective tissue in the skin is a common occurrence after -thyroid extirpation, and the name “myxœdema” is probably derived from -the fact that in some cases, as the disease advances, the connective -tissue is transformed into a mucinoid substance. The name “cachexie -pachydermatique,” as suggested by Charcot, seems to be far more -adequate. - -Formation of fat and of connective tissue is not only seen after removal -of the thyroid, but can also be observed after extirpation of the sexual -glands, the ovaries and testicles. - -As mentioned in Chapter II, Loewy and Richter,[160] of Berlin, observed -that removal of the sexual glands always produced a diminution of the -oxidation processes. - -Footnote 160: - - Archiv für Anat. u. Physiol., Supplement, 1899; and Ergebnisse der - Physiologie, ii, 1902. - -The experiments of Prof. Loewy and Prof. P. F. Richter are not -invalidated, in our opinion, by the experiments of Lüthje, who did not -find an increase in metabolism after ovarian feeding. The reason for -this may be that he was not in possession of active extracts. Anyone who -works with animal extracts knows what a great difference there is -between various organo-therapeutical preparations, some being more -efficacious than others. - -As a rule castrated animals take on fat, and this fact has for many -years been made use of by farmers. At the same time the flesh of such -animals acquires a better flavor, the pronounced flavor of the meat of -non-castrated animals being objectionable to some consumers. This -demonstrates the very instructive fact that the internal secretion of -the testicles has its effect on all parts of the body. - -Castration in man is very frequently followed by obesity and symptoms of -old age. Thus the eunuchs of eastern countries are very often fat and, -at the same time, look much older. - -The influence of the ovaries upon fat formation can also be shown by -their therapeutical action in obesity. Although not so active as thyroid -extracts, we have found that by the combined use of thyroid and ovarian -extracts, we could produce a considerable loss in weight, when, by -thyroid treatment alone, we could not obtain it. This, however, is only -in the case of women. We will treat of this subject more fully in the -chapter on ovarian treatment. - -Besides the above-mentioned experimental facts, which show that these -attributes of old age—obesity and increase of connective tissue—can be -produced by removal of the thyroid or sexual glands, we also have to -deal with facts gained by clinical observation, which show that any -cause inimical to the ductless glands, especially the thyroid and -ovaries, may bring about old age. Take, for example, infectious -diseases. They have a very damaging effect on the various ductless -glands, especially so if they are of long duration. Their influence upon -the thyroid has been clearly shown by various observers. (Roger and -Garnier, Crispino, Torri, Bayon, de Quervain, and others. See Chapter -III.) - -Not only the thyroid gland, but other ductless glands, are affected by -infectious diseases, and in the third chapter of this book we have shown -that the adrenal glands show alterations indicating hyperactivity in -infectious diseases. - -The pituitary gland is also altered in infections, as shown in the same -chapter. - -Changes in the pituitary body may also be a factor in producing -premature old age. It is a fact that all people suffering from -acromegaly appear much older than their age. In fact, one of the first -symptoms that arouses the anxiety of the relatives of such a patient is -that he looks so much older, and it is only later that they notice the -overgrowth of the nose, the hands, and feet. Since, in many people who -are getting older, the head and nose may increase in size, we may -suppose that this is the clinical expression of senile changes in the -pituitary body. There is a condition known as “acromegalie fruste,” in -which the symptoms are only slightly pronounced and which is often -unrecognized. As we have already said, all diseases of the ductless -glands may be only partially developed. This is due to the fact that -only a proportion of the thousands of follicles, of which such a gland -is composed, need be affected. - -The ovaries and testicles also show changes as an evidence of their -fight against infections, and we have mentioned the findings of -Professor Metschnikoff with regard to these glands. - -In every severe infectious disease the liver shows great change in its -parenchymatous tissue, with a subsequent increase of connective tissue. - -The increase of connective tissue in various organs, and especially in -the blood-vessels, after infectious diseases, can be regarded as an -illustration of our remarks on these same changes following -degenerations of the thyroid. It is a well recognized fact that atheroma -can be caused by various infectious diseases, and can also be -artificially produced by several infectious agents. - -The kidneys, through their rôle as eliminative organs, usually suffer, -even more than the other glands, in the course of infectious diseases. -Even a slight angina may produce an acute parenchymatous nephritis, and -the more virulent the infection, the more will the kidneys suffer. - -Not infrequently, unknown to us, important parts of the renal tissue are -lost after such infections, and a chronic nephritis may creep on -insidiously. After such loss there may be proliferation of connective -tissue, and the kidneys thus become unable to fulfill the most important -eliminative functions in the body. Owing to this incomplete elimination, -toxic substances may be retained in the body. - -From the above considerations we can see how important it is to guard -against the risk of infection. This is often impossible, considering the -billions of microbes by which we are surrounded day and night. The best -precaution is to keep those organs in good working order which safeguard -us against infections—i.e., the ductless glands. - -Even more potent than infectious diseases in producing old age are the -results of degenerative changes in the ovaries. The effects of -castration have already been mentioned. Much in the same way do those -causes act which exhaust the internal secretion of the ovaries, e.g., -many pregnancies, or sexual excesses. We must take into consideration -the fact that, as shown by many authors, the different ductless glands -are altered during pregnancy (Launois,[161] Guieysse, etc.). Many -mothers of large families look old before their time, as do also many of -those who lead a professedly immoral life. Even in young girls we can -see the consequences of such deteriorating agencies in hypertrophy of -the mammæ, developing in very short time, and also a tendency to -deposition of fat on the abdomen, which becomes pendulous in women who -have had many children. The features of women who indulge in sexual -excesses undergo a striking change even in early life. They become -coarse, bloated, less sharply defined, and the cheeks and chin become -fat and flabby. Indeed we have often been struck by the great -resemblance of such a face to that of an early stage of myxœdema, a -condition due to deficiency of thyroid secretion, which in turn, as -shown by Sajous, influences other ductless glands. The effects of -numerous pregnancies are far more marked if lactation is prolonged. - -Footnote 161: - - Launois et Mulon: “Hypophyse et femme enceinte,” Société de biologie, - p. 448, 21 mars, 1903; and Thèse à la Faculté des Sciences, 30 juin, - 1904. - -Not all women after many pregnancies, or after unduly frequent sexual -intercourse, will show symptoms of premature senility, as much depends -on heredity and also on the surroundings in which they live. Certainly -if they live in precarious circumstances, as do the poorer women of the -working classes in many European countries, especially Germany and -Austria, where these women perform hard bodily work and are badly fed, -and have much sorrow and care, they will soon appear old; and women -looking like matrons at thirty are of common occurence in the lower -classes of these countries. But this is seen also in the women of -southern Europe, although they do not work so hard. This is due to the -fact that in southern countries girls reach puberty early and are -married very young, in the East often at the age of twelve. Thus, sexual -activity begins earlier and ends much sooner. Its end, of course, means -the beginning of old age. As soon as retrograde changes commence in the -ovaries, the summer of a woman’s life is over; and, just as summer is -sometimes prolonged into autumn, so at this period of her life may she -still retain strong sexual desire. Happy the woman whose heart, as well -as her ovaries, undergoes a senile involution, for there is nothing more -terrible for a formerly beautiful woman than to see her charms wane -while her heart remains young. - -Yvette Guilbert, in her novel the “Demi-vieilles,”[162] describes in a -picturesque manner the pangs of a woman at the climacteric age. Let us -quote a few lines: “They try to remain young, hide the gradual onset of -their ugliness, and look for a chance to taste of love again. They cry -out for the past, for even while they fight against time they cannot -detain it in its course.” This description, however, does not apply only -to the majority of middle-aged women, but more especially to -professional beauties. - -Footnote 162: - - Quoted after Professor Kisch. - -It can be seen from these considerations how necessary it is for a woman -who has frequent pregnancies to observe the rules of hygiene. That these -produce excellent results we have proved. We know of a score of ladies -of the aristocratic and wealthy classes who, though having six or even -seven children, look none the worse. A certain Austrian archduchess -still remains a beautiful woman, in spite of her eight children and the -fact that she is a grandmother. Such examples may be frequent in old -families with this hereditary tendency. Though the bearing of many -children can hasten old age, yet, on the other hand some women, after -the birth of their first child, become better and fresher looking. We -can see this especially in girls of twenty or more who, having appeared -somewhat withered before marriage, begin to bloom afresh after the birth -of the first child. Increased activity of the ovaries and thyroid is the -explanation of this phenomenon. As already mentioned, the thyroid takes -an active part in ovarian changes. In a young girl of fourteen, just -previous to menstruation and puberty, we may find a swelling of the -thyroid gland. During menstruation we can often see a distinct -enlargement of the thyroid, and at the same time certain nervous -symptoms such as are usually connected with thyroid change. - -Increased activity of the thyroid during pregnancy is shown by a -swelling of the gland, often causing a regular goiter, and, at the same -time, not infrequently by the typical symptoms of exophthalmic goiter. -Lactation is also dependent upon thyroid activity. After prolonged -lactation there is an exhaustion of thyroid activity; and, on the other -hand, by giving thyroid extract we can increase the flow of milk. - -The swelling of the thyroid in the above conditions can be explained by -the greater demand for thyroid secretion, and that this hyperactivity -occurs is also shown by the observations of the early writers on -myxœdema. Morvan, Ord, and Combe found that myxœdema was frequently -caused by numerous pregnancies, especially if associated with prolonged -lactation. - -This also explains why women become prematurely old so much more -frequently than men, for their ovaries are much sooner exhausted, in -consequence of their activity being much greater than that of the male -sexual glands. There is a much greater demand not only on the female -sexual glands, but also on the female thyroid, which enlarges every -month in many women, and is greatly exhausted by each pregnancy. As -Hertoghe[163] says, with reference to this exhaustion of the thyroid by -pregnancies, “each child demands one tooth.” - -Footnote 163: - - Hertoghe: “Die Erkrankungen der Schilddrüse und der chronische - gutartige Hypothyreoidismu,” München, Lehmann, 1900. - -According to Hertoghe, pregnancies are especially apt to produce -degenerated conditions of the thyroid gland. - -Sexual excesses, on account of the concomitant nervous excitement, are -also very prejudicial to the adrenals, for just as frequent nervous -excitement in general, they produce alterations in the blood-pressure -and favor the development of arteriosclerosis. - -Sexual excesses are also very harmful to men, although their action on -the thyroid, in men, has not yet been ascertained. It is a fact, -however, that they diminish the resistance to infections, and favor the -onset of neurasthenia and arteriosclerosis. - -Changes in the thyroid also become manifest during the climacteric, and -the troublesome nervous manifestations at this period are largely due to -this fact. Later, on account of the degeneration of the thyroid and -ovaries in many of these women, there is an accumulation of fat, of a -bacon-like character, in the same situations as was described above in -women after many pregnancies and sexual excesses—_viz._, the breasts, -the hips, and the abdomen. The facial appearance of these women who -become obese after the climacteric resembles that of a typical case of -early myxœdema. In the later stages, as old age advances, just as in -myxœdema, the fat may disappear and be replaced by great thinness and -emaciation—the cachectic stage of myxœdema. This is less frequently seen -now-a-days, on account of the improvement and checking of the disease by -thyroid treatment. - -It is a very strange fact that although sexual abuses soon bring about -symptoms of old age, as do also many pregnancies, clinical observations -show that total suppression of sexual activity is also, if not still -more, a powerful factor in the production of premature senility. There -is no denying the fact that spinsters, after the age of thirty or forty, -often look older than married women with small families. See also our -chapter on the “Hygiene of the Sexual Glands” on this subject, in which -we show by experimental evidence the dangers of the total suppression of -sexual activity. - -Evidently nature will not be trifled with, and the ovaries and testicles -are made by the Almighty to serve a certain purpose, just as any other -organ. Their remaining in total idleness is no less harmful than in the -case of any other organ. We fail to see for what reason this organ alone -should be made an exception, and to deny this fact would be hypocrisy. - -Persons who live in total sexual abstinence are very often of a nervous, -neurasthenic, or even melancholic disposition. If we consider how -intimate are the relations of the sexual organs with the thyroid, we -cannot exclude the possibility of changes in this important gland under -such conditions. - -The relationship between the sexual glands and the thyroid is also -demonstrated by experimental evidence. Thus Cecca found, after -extirpation of the ovaries or testicles, that the thyroid shows an -accumulation of colloid substance; again, Jayle saw the appearance of -exophthalmic goiter in a case after castration; and, on the other hand, -Prof. Hoffmeister, of Strassburg, found a premature ripening of the -follicles in the ovaries after thyroidectomy. - -Freund constantly found goiter in cases of fibromyoma of the uterus, and -in two cases the goiter has disappeared after operation on the uterine -tumor. - -It is a well-known fact that exophthalmic goiter can be improved by -ovarian extracts, as Latzko, of Vienna, and others, have shown. - -Changes in the thyroid, as a rule, produce certain changes in the sexual -glands. Thus, in exophthalmic goiter menstruation is usually irregular -and often disappears. In myxœdema there is atrophy of the ovaries and -sterility. The above conditions in man often produce sterility. - -In partial cases of myxœdema metrorrhagia is frequent. By giving thyroid -extracts these uterine hæmorrhages may be stopped. - -After having shown that old age can be caused with more or less -certainty by degenerative changes in the sexual organs, we will now try -to show that it can also be caused by various kinds of intoxication. -Especially is this true of large quantities of alcohol continued for -many years. - -Alcohol specially influences the ductless glands. Small quantities may -at first stimulate their action, but large quantities, if taken for a -very long time, will cause degeneration. - -In the third chapter of this book we have already briefly mentioned the -bad effects of alcohol upon the ductless glands. We have seen that, as -de Quervain, Hertoghe, etc., have shown, alcohol produces very marked -degeneration of the thyroid gland. This has been proved by autopsies on -chronic drunkards. As well as on the thyroid, alcohol also acts upon the -other ductless glands. It acts, for instance, upon the adrenals. Its -action in small doses is similar to that of adrenalin. Alcohol in small -tonic doses excites the activity of the splanchnic nerves, and so may -produce an increased flow of adrenalin and a higher blood-pressure (see -Chapter XV). - -Alcohol in large doses may also have a degenerating effect on the sexual -glands. Small doses can stimulate, but large doses are decidedly -harmful. Temporary impotence may result in such cases, and chronic -impotence in inveterate drinkers. - -Though alcohol in large doses is harmful, and if taken in very large -quantities for many years can hasten old age, there is absolutely no -reason to suppose that in small doses it has any etiological relation to -senility. In fact, there are many cases on record of persons who have -taken alcohol, especially wine in limited quantity, every day, and have -lived to enjoy a healthy old age. - -One of our confrères, a surgeon of Lotharingia named Politiman, lived to -be 140. As Professor Pel, whom we quote, says, the historian explains -that this old age was due to the medicine this worthy doctor took every -day after doing his work. He had drunk his fill every night since the -age of twenty-five years. Another surgeon, Espagno, lived to be 112 with -no less moderate habits! Countess K——, who died in Nicolajew in Russia, -a few years ago, at the age of 111 years, took daily a cordial in the -form of a good drink of cognac; and about one and a half years ago the -_Daily Mail_ of London brought to public notice the case of a Mrs. -Anderson living in Springfield, near Glasgow, who, in spite of her 103 -years, was taking daily a tablespoonful of whiskey. - -A strong point against the anti-alcohol faddists is the case of -Brown,[164] an Irish peasant, who, after many years of heavy -beer-drinking, attained the age of 120. His tombstone exhibits the -following epitaph:— - -Footnote 164: - - Quoted after Professor Pflüger. - -“Here lies Brown, who became 120 only through the strong beer he was -drinking. He was constantly drunk, and in this condition so terrible, -that even death was afraid of him. When, however, one day contrary to -his habits he was sober and in a quiet mood, death got courage, seized -him, and thus at last was triumphant over this incorrigible drunkard.” -(See, further, Chapter XLI.) - -All these examples merely show what we have so often insisted upon, that -everything depends upon heredity. There are many causes that produce -premature senility. It seems, also, that when only a few of these -causes, or only one, is acting, there is a possibility of a successful -fight against it. It is a different matter when all, or several, of the -causes of old age are present. As the German proverb says: “Viele Hunde -sind des Hasen Tod” (“many dogs mean death for the hare”). - -It is a very interesting fact that seldom are all the various kinds of -immoderation united in the same person. Thus, some persons may drink and -smoke heartily and, perhaps as a result of the action of these poisons -upon the sexual glands, may be better able to combat their sexual -instincts. This will also explain the drinking habits of some old -spinsters or widows. They “drive out the Devil with Beelzebub,” as the -German proverb says. On the other hand, many total abstainers from -alcohol and tobacco are far less successful in combating their sexual -instincts, and for such persons marriage is a necessity. - -As a rule, celibatarians show symptoms of old age much sooner than -married persons. - -If among those addicted to drink there are many instances of long life, -among smokers such instances are much fewer. - -As Professor Pel says, there was only one man among many, of those over -100, who was a smoker (see Chapter XLII). - -It is also of interest that among very old people we find many with very -decided sexual tendencies. Evidently such persons must be in possession -of very active sexual glands, which indicates also a healthy thyroid -(see Chapter V). - -We may class alcohol with tea and similar beverages. A small amount -every day may be a good thing, but in large quantities they may all -become injurious and tend to shorten life. - -Tobacco, according to clinical observations (Huchard), is apt to cause -arteriosclerosis, just as alcohol in large doses; and this is also -proved by experiments—e.g., those of Isaac Adler and Hensel—which show -that atheroma of blood-vessels can be produced in animals, -experimentally, by nicotine. - -Everything points to the fact that tobacco is especially injurious to -the adrenals. We will treat of this subject more fully later on when -discussing the hygienic treatment of old age. - -Many conditions of chronic intoxication, and hence premature senility, -may be caused by faulty food, especially if taken in large quantity, for -a long time. Even fresh albuminous food of animal origin, if taken in -large quantity every day, may prove harmful. We have seen previously, in -Chapters III and IV, that meat produces by its decomposition certain -poisonous substances which should be destroyed by the ductless glands. - -Premature old age frequently occurs in people who live a sedentary life, -and at the same time consume much rich food and alcohol. This causes -obesity, and the muscles and nerves which are little used, are prone to -show degenerative changes after a certain time. At any rate the -processes of metabolism are diminished in these structures, since their -supply of fresh arterial blood is always reduced if no work or exercise -be performed. - -It is a well-known physiological fact, that nerves which are inactive -lose their excitability and degenerate. This holds good for motor -nerves, and we can also note degeneration of muscles and organs which -are not used. Thus, the nerves of an extremity, after amputation, -undergo a process of degeneration. The lower limbs of people affected -with infantile paralysis, or of persons obliged to remain in bed for a -long time, show atrophic changes. Hence we can easily see the necessity -for exercise, which increases the blood-supply to the muscles and -nerves. Work of any kind, even mental work alone, is a means of -preventing precocious senility; if manual exercise is combined with it, -it is still more efficacious. - -Plutarch, in his “De educatione puerorum,” mentions that a certain -amount of work improves the mind, but excess of work is prejudicial. - -We see the best illustration of this fact in American business men. -There are no men in any country who do such an amount of work, and at -the same time take so little recreation or exercise. They sit in their -offices till dusk, with a few minutes’ interval for a hasty meal, -consisting mainly of meat that has often been kept in cold storage for a -long time, after which business goes on again, at high pressure, until -the evening. Then, instead of walking home and taking exercise, they -take a car or carriage to their house or club, and pass the evening in -smoking and drinking, sometimes to excess. Day after day the same -killing of body and nerves goes on till these people look old long -before fifty, if, indeed, they reach that age. Arteriosclerosis, -diabetes, gout, and obesity find many victims among such men. It is sad -to think how many thousands of these splendid people, full of genius and -talent, could be saved for their native country if only they had been -taught in their youth the most elementary rules of hygienics. What joy -does money afford without health? - -Some of the most powerful agencies in producing old age are frequent -mental emotions, especially sorrow and grief. - -It is a common fact that after such emotions people soon look older. To -mention an example, there is positive evidence that young persons, after -a mental shock, have become gray in a single night, thus developing -abruptly one of the most typical symptoms of old age. - -That mental emotions, especially anger, grief, sorrow, fright, anxiety, -etc., are very harmful to glands with an internal secretion, is shown by -a series of clinical observations. Sajous has in fact termed _sensorium -commune_, i.e., the center which receives all shocks, the governing -center of the ductless glands, located in the pituitary body. - -With mental emotion there is often disturbance of a function, -interference with which is very liable to hasten the onset of old age, -and this is sleep. - -We frequently notice that persons who have not slept well for several -nights, especially if passed on a railway journey, look worn out and -older. After a good night’s rest these effects disappear and they look -fresh and younger again. - -There are other functional disturbances which are especially harmful as -they interfere with the elimination of harmful products either -introduced with the food or found in the body (e.g., uric acid). This -applies also to the bowels, perspiration, and diuresis. When these -important functions are checked, there is retention of poisonous -products and a condition of auto-intoxication. These functions are -governed by the ductless glands, especially the thyroid, as we have seen -in Chapter VI. It is easy to understand that by their interruption the -onset of old age is hastened, as these toxins will cause deterioration -and destruction of epithelium and the formation of connective tissue in -its place. Retained poisonous products play a very great etiological -rôle in the production of arteriosclerosis, which is found as a typical -symptom of old age in the large majority of aged persons. - -We thus see that all those agencies which by common consent are usually -considered the most frequent causes of old age, are also very -detrimental to the ductless glands, especially the thyroid. They produce -hyperactivity, with subsequent exhaustion, in these important glands. -The pathological and anatomical changes indicating hyperactivity give -place to those of atrophy. We have given an example of this in -discussing the changes in the thyroid in infectious diseases. The -formation of connective tissue is the final result. Thus a condition of -the thyroid arises similar to that in myxœdema, which, as we have -stated, can be produced by causes similar to those which produce old -age—i.e., infectious diseases, exhaustion of the ovaries after -pregnancies or sexual excesses, mental emotions, etc. - -The pathological and anatomical changes in the thyroid, consisting of an -increase in the connective tissue, as in myxœdema, will logically -produce clinical symptoms, and these symptoms are the same as those of -myxœdema. - -Therefore we are justified in assuming that old age will show the same -clinical symptoms as myxœdema. - -We have shown that, given changes in the thyroid gland, the other -ductless glands will be altered too; for instance, the liver and -kidneys. These glands have an important function in freeing the organism -of poisonous substances. As in old age their secreting elements are more -or less atrophied, they are unable to execute their task properly, and -these harmful products will accumulate. Now, there are important organs -which can act as corollaries to these glands. These are the intestines -and the skin. They also are under the influence of the thyroid. In -diseased conditions of the thyroid they are unable to perform their -functions regularly. The poisons will not be eliminated, and thus a -condition of auto-intoxication must arise. - -Just as after extirpation of the thyroid there is an increase of -connective tissue or fat in various organs and tissues (as Demange -found), so in old age there arises a condition of sclerosis in the -tissues and organs. - -On this account, strictures of the urethra are readily produced in old -men who have had gonorrhœa scores of years ago. The prostate gland, -owing to the abundant formation of connective tissue, will also enlarge, -although usually sclerosis of an organ is accompanied by diminution in -size. In the central nervous system, just as after extirpation of the -thyroid, there is proliferation of neuroglia. Through destruction of the -nerve cells those mental attributes arise that are deemed typical of old -age: Egotism, enmity against all new ideas, conservatism, etc., which we -described in our address on the origin of crime before the Philadelphia -Medical Jurisprudence Society, April 14, 1907.[165] The same mental -characteristics are also typical of degenerated conditions of the -thyroid and pituitary body, as we have seen in a case of acromegaly -whose history we owe to Dr. Dercum, of Philadelphia. - -Footnote 165: - - Journal of the Amer. Med. Assoc., May 17, 1907. - -To recapitulate, we may state that old age is caused by degeneration of -the ductless glands, and that there exists a condition of -auto-intoxication in old age. - -The symptoms of old age are the result of breakdown of the tissues and -organs which, owing to shrinking of the blood-vessels, are -insufficiently supplied with blood, and, owing to the disappearance of -nervous elements, are devoid of proper nervous control. - -Degeneration of the ductless glands and of the organs and tissues cannot -be simultaneous, for the latter are under the control of the former. -These glands govern the processes of metabolism and nutrition of the -tissues, and by their incessant antitoxic action protect the organism -from the numerous poisonous products, be they of exogenous origin, -introduced with air or food, or endogenous, formed as waste products -during vital processes. After degeneration of these glands the processes -of metabolism in the tissues are diminished, and there is an increase of -fibrous tissue at the expense of more highly differentiated structures. - -The fact that the changes in the tissues are secondary and take place -only after primary changes in the ductless glands, is best proved by the -circumstance that they can be produced, either experimentally by the -extirpation of certain of the ductless glands, or spontaneously by the -degeneration of these glands in disease. - -Our theory as to the causation of old age by degeneration of the -ductless glands has been confirmed by several writers, some of whom had -no knowledge of our existing work. - -Thus Campbell, in July, 1905, published a short note in the _Lancet_, -attributing old age to degeneration of the ductless glands, overlooking -our previous communication to the Paris Biological Society. - -Two years afterward Pineles, in an article published in the _Wiener -klin. Wochenschrift_, comparing the origin of diabetes, tetany, and old -age, came to the conclusion that old age was caused by the same agency -(i.e., alteration of the ductless glands) as the other conditions -mentioned. - -Sir Herman Weber, in his interesting work on the prolongation of life, -also attaches great importance to degeneration of the ductless glands as -a cause of old age. - -In his work on the same subject, Professor Metschnikoff admits, only -partially, the truth of our theory on the causation of old age. He -admits the great importance of the ductless glands in the pathology of -old age, as they serve to destroy poisons. He denies, however, the -relation of old age to a myxœdematous condition; but everyone who knows -the pathology of myxœdema will see that the arguments of Professor -Metschnikoff cannot stand, for they have no foundation. - -His arguments are that there is an œdema in myxœdema, but not -necessarily in old age; that the hair falls out in myxœdema, and that -myxœdematous women have abundant menstruation, while old women have -none; that myxœdematous persons have strongly developed muscles, and old -people, on the contrary, weak and feeble muscles. - -The truth is that there is often no œdema at all in myxœdema; that the -hair often does not fall out in myxoedema, especially in its partial -form (hypothyroidia); that myxœdematous women have, as a rule, no -menstruation (atrophy of the ovaries); and that myxœdematous people have -not a strongly developed muscular system, which is rather degenerated by -a new growth of fat, or connective tissue, or a mucinous tissue, -following the degeneration of the thyroid just as it follows its -extirpation. Professor Metschnikoff also states that certain animals -that soon become old do not develop cachexia after extirpation of the -thyroid. - -This was the belief about eighteen years ago, but now we know that they -all develop cachexia if the operation is so performed that the -parathyroids, or at least some of them, are allowed to remain untouched. -Professor Metschnikoff’s views have been greatly weakened by the far -more extensive researches of Professor Sajous which have conclusively -shown that the life process, its activity and duration, is dependent -upon the ductless glands, including the thyroid. - -It is evident from the above considerations that all hygienic errors, be -they errors of diet or any kind of excess, will bring about their own -punishment; and that premature old age, or a shortened life, will be the -result. In fact, it is mainly our own fault if we become senile at sixty -or seventy, and die before ninety or a hundred. - -It may be the privilege of a few to live until ninety, even though -worshipping immoderately at the altars of Bacchus or Venus! But these -are very few, and as we have seen, they have lived on the heritage of -their forefathers, not merely in an illustrative sense, but also in -reality, for the greater number of such persons have grown up in easy -circumstances without knowing the wear and tear of care and sorrow. - -Not only old age, but the majority of diseases, are due to our own fault -in undermining our natural immunity against infections, and subjecting -our various organs to unreasonable overwork and exertion. We do not -believe that the worst slave-driver of olden days subjected his slaves -to such treatment as we do our own organs, and especially our nerves. At -last they must rebel, and disease, with early death or premature old -age, will be the result. - -It is literally true, as the German proverb says: “Jeder ist seines -Glückes Schmied” (every man is the locksmith of his own happiness), and -as a variation on this we would say: “Every man is the guardian of his -own health.” - - ------------------------------------------------------------------------- - - - - - CHAPTER IX. - - THE RATIONAL PREVENTION OF PREMATURE OLD AGE AND THE TREATMENT OF OLD - AGE. - - - _General Remarks._ - -WE have shown in previous chapters, through facts from pathological -anatomy, experimental pathology, and clinical medicine, that old age is -a disease characterized by the abundant growth of connective tissue, -diminution of the oxidations, and a condition of auto-intoxication. - -This disease is caused by the degeneration of the glands with internal -secretion, especially the thyroid, ovaries, testicles, liver, and -kidneys. - -In the same way, and to the same extent as most other diseases, this -disease is also amenable to treatment, although a thorough cure, except -in cases beginning in very early years, is just as little possible as in -most other diseases. - -In keeping with the majority of diseases, old age is progressive, and, -in fact, is so to a far higher degree than other diseases. It is seldom -stationary; it goes on all the time. This we shall easily be brought to -understand from the fact that the more time progresses, the more food is -taken to sustain the processes of life. By the deficient action of the -glands, whose rôle is the proper assimilation of the food and the -destruction and elimination of poisonous products of the body, these -toxic substances will accumulate, day by day, especially if meat be -taken, and thus the continual poisoning will be augmented as time goes -on. Thus it must be our most important task to check the progress of a -condition in so high a degree injurious to the body. - -Let us consider the means by which we can prevent this disease, for -“prevention is better than cure,” says the English proverb. - -The preventive treatment of old age is in no less degree possible than -that of any other disease. To prevent old age rationally, we must avoid -all those harmful agencies which may be deleterious to the glands with -internal secretions, as it is the degeneration of these glands that -brings it about. These agencies, however, being exceedingly numerous, we -have mentioned in the previous chapter only those which are in the -highest degree detrimental and also the most frequent. - -By avoiding these we believe we could successfully combat old age, but -only for a certain time; and if not longer, in spite of our careful -hygiene, it would not be our fault, but that of our ancestors of many -generations ago who did not observe the rules of hygiene even as well as -we do, and left us ductless glands of inferior quality. - -Parents can only bequeath to their children ductless glands of the same -quality as they themselves possess. This undoubted fact is clearly -proved by the experimental, pathological, and anatomical results we have -mentioned in the chapter on heredity. We will illustrate this by the -following examples, which will show how often it is difficult to avoid -harmful agencies, and how much depends on having been born with healthy -ductless glands. - -A person inhales air that contains virulent bacilli and contracts -tuberculosis. Another drinks a glass of water or milk, contaminated by -water or kept in vessels that have been washed with water containing the -bacilli of Eberth, and contracts typhoid fever. Conversely, others who -have inhaled the same air and drunk much more of the same water, have -remained free from any infection. - -The cause of this is that the first mentioned have inherited defective -ductless glands from their ancestors, and probably afterward have -ill-treated these glands by an immoderate use of all those agencies that -are detrimental to them, such as alcohol, sexual excesses, much meat, -tobacco, tea and coffee in large quantities, etc., and thus could not -produce anti-bodies to counteract the infection. - -Of course, the fault does not lie entirely with such people, but that -from their birth they are the victims of the immoderation of their -ancestors; and by this fact alone are doomed to more easily succumb in -the incessant fight against the microbes, and therefore a limited -lifetime has been already meted out to them at birth. - -We have, in the chapter on heredity, quoted instances of persons coming -of short-lived families, who reached a great old age; but this was due -solely to exceedingly careful hygiene. It is not always easy to observe -these rules scrupulously, and besides often necessitates the possession -of means to carry them out and to enable us to be more exempt from the -wear and tear of life—cares and sorrow,—which shorten the lives even of -persons with healthy glands, though much more of persons who have -inherited defective ductless glands. - -It has been shown by statistics[166] that the present generation is -longer lived, and that the average of life is longer, than was the case -one hundred years ago. This is solely due to the fact that now-a-days we -know more of hygiene than our forefathers did, although the struggle for -existence and competition everywhere has certainly become more keen, -with the inevitable worry and depression of mind which it so frequently -brings about. This lengthened life is certainly due to more careful -hygiene, especially against infectious diseases. - -Footnote 166: - - Westergaard: “Die Lehre von der Mortalität u. Morbilität,” second - edition, Jena, 1901. - -The extended life of an individual depends always, first, on the -inherited qualities of the ductless glands, and, secondly, on a sound -observance of hygienic measures. - -To prevent old age coming on too soon, the first condition necessary is -the possession of healthy ductless glands, and this will depend, as just -stated, on heredity. We can exert no influence on the generations that -have passed away, and must therefore direct all our attention to the -generations that are to come. This can only be done by influencing the -laws of marriage, and particularly by prohibiting the marriage of -persons suffering from diseases that are most detrimental to the glands -with internal secretions. - -Children of people suffering from syphilis, tuberculosis, chronic -alcoholism, etc., are, as we have seen, born with congenital atrophy of -the thyroid gland, and are especially apt to acquire all infectious -diseases, such as tuberculosis, with the greatest facility. - -The Bible is literally true when it says that the sins of the fathers -are visited even unto the third generation. - -Thus we can influence the baby even before it is born; let us then -consider what we can do after its birth to prevent premature old age and -to secure for it a prolonged existence. - -The mother of the future child must carefully avoid anything that may -prove fatal to the fœtus or influence its nutrition. It is a well -demonstrated fact that different kinds of harmful products, i.e., drugs -and probably also stimulants like alcohol, coffee, etc., can be conveyed -to the fœtus. A pregnant woman must, therefore, most strictly observe -all the rules of hygiene, and especially abstain from the use of drugs -which (as for instance, iodine, the bromides, etc.) can also take effect -on the fœtus and prove detrimental; emotions must especially be avoided. - -When the child is born the best nutriment for the baby is the milk of -its mother, and if the mother be not available for this purpose, a wet -nurse must be obtained, for human milk is indispensable in the -nourishment of the baby if we desire to influence its future immunity -against infections; for this important purpose all the internal -secretions of the ductless glands go into the child through the milk -which contains them. Sajous holds that millions of infants die solely -because they are deprived of what nature provided for them, the maternal -milk, which not only nourishes them, but protects them against disease. - -The infant is practically helpless against infections, for its thyroid -contains scarcely any colloid substance, sometimes none; and it also -contains no iodine,[167] especially in children who are descended from -parents suffering from chronic cachectic diseases, such as tuberculosis, -syphilis, malaria, insanity, etc. The other glands are also not yet -sufficiently developed, as this takes place generally in the years -toward puberty. - -Footnote 167: - - Baumann: “Zeitschrift für Physiolog. Chemie,” 21, 319, 1895; 22, 1, - 1896. - -All the internal secretions will, therefore, come to the children from -the mother or wet nurse. - -The above fact also explains why infectious diseases are so very -frequent among infants, and also among children before the years of -puberty. - -The avoidance of infectious diseases is especially important for -infants, for in later life many other infections will occur preferably -in those children whose ductless glands have been weakened by previous -infection. Therefore, even with adults, when we take the history of a -case we should inquire whether, in childhood or later, the patient has -suffered from infectious diseases. The necessity of such a procedure -will be more clear after we have shown their relationship with a -weakening of the ductless glands. - -The possibility of premature old age is greater in a person who has -suffered from one or several infectious diseases in childhood than in -another who did not contract any. - -Very interesting experiments have been made on puppies fed on their -mothers’ milk, and some with raw and boiled cows’ milk, showing the -superiority of the bitches’ milk, and also of the unboiled milk. - -When human milk is not available for divers reasons, fresh cow’s milk -should be employed, using it raw, however, in order not to destroy, by -boiling, various substances of the nature of ferments. Before giving it -to the baby, the cow’s milk should be diluted with water, and milk-sugar -and cream should be added to make it more like human milk (see Chapter -on “Milk Diet”). - -Of course, when giving raw milk, we must ascertain that it comes from -cows examined specially for tuberculosis, and that the milk is of the -best quality and very fresh since it has been shown that its power to -kill bacteria—and therefore to protect the child—begins to decrease soon -after it is drawn. - -Not only for the infant in arms, but for the growing baby and child -during its first year, milk food, containing largely of milk and -cereals, will be the best diet, excluding meat entirely, since in these -tender years the ductless glands are not sufficiently developed to -destroy poisonous products that arise from the end-products of -decomposition of meat. By giving these little creatures meat we may -depreciate the efficiency of their ductless glands through unnecessary -strain in the destruction of poisons, and thus diminish their chances in -later life, of a prolongation of youth and a happy old age. For the same -reasons and even more weighty ones, alcohol, coffee, tea, etc., should -be avoided. - -It is sad to reflect that, in some countries, alcohol is given to -children, who are even far more helpless against it than adults. - -We have observed in Northern Hungary that the children of the Slovacks, -a Slav nation that inhabits certain parts of Hungary—the native land of -the writer,—are stunted in their growth. The reason for this is, that in -these parts of Hungary, where there are plenty of potatoes, but a -scarcity of other food, the peasants give brandy to their youngsters. As -we have seen in the second chapter of this book, the growth of the human -body depends on the thyroid gland. The fact that these children do not -grow shows that alcohol is deleterious to the thyroid. This question -will be considered more fully in the chapter on alcohol. The advantages -of milk food we shall also treat more fully in a separate chapter. - -To deal with old age rationally, we must begin in childhood to fight -against it, as all those agencies that tend to produce it prematurely -can at this age prove far more deleterious; and as in this world no -action is lost—whether for good or evil—we must reap the results of our -imprudence in later life. - -Unhappily at this tender age we have no reasoning powers, the glands -governing them not having been developed, and therefore our parents or -guardians must act for us. Their want must also be supplied by the -teacher, and we believe it would be productive of great good to teach -the elementary rules of hygiene in school at the same time as reading -and writing. - -The impressions we first get in childhood remain throughout life and are -never forgotten; therefore, hygiene should be learned even by small -children. The soul of a child is like plaster of Paris, that can, like -dough, be moulded into any shape we desire. It is at this early age that -we should learn of the necessity of a bath every day, of moderation in -food, the avoidance of certain stimulants, such as alcohol, and also of -tea and coffee in large quantities. - -Alcohol, coffee, and tea are especially injurious to children. The -celebrated German clinician, Strümpell, writes as follows in the -_Pædagogical Pathology_: “Among the acute as well as chronic -intoxications—which can be the cause not only of a temporary, but also -of a prolonged psychopathic condition,—intoxication by alcohol, and by -stimulants generally, plays the greatest rôle. Such abuse is especially -noxious to children, and causes an enormous number of diseases with -psychopathic results.” We ourselves believe that it is a crime to give -alcohol to children, and that it should be punishable as such. - -Dr. F. Heyn, in a statistical contribution on “Idiocy,” that appeared -recently in the _Psychiatrisch Neurologische Wochenschrift_, showed that -in 17.6 per cent. of cases of idiocy in children the above-mentioned -fault in hygiene—the use of alcohol, tea, and coffee—was the cause. -Thirteen years ago Director Trüper, in a monograph on the psychopathic -conditions of childhood, insisted on abstinence not only from alcohol, -but also from coffee, by women during pregnancy; but it should be noted -also that these agencies continue to be deleterious years after a child -is born. - -Above all else we must try to make a good man or woman of the child, as -this also is an essential safeguard against disease and premature old -age. We should endeavor to interest children while they are yet of a -school age in the fine arts, such as music, painting, and literature, as -they have a very favorable influence on the hygiene of the mind in after -years. Religious instruction also gives good results in this respect. - -When children approach puberty it is important to avoid an agency that -may prove very deleterious to certain of the glands with internal -secretions, and this is masturbation. - -We will not commit the error made by so many unscientific writers of -ascribing much greater importance to this matter than it deserves. It -certainly is not true that tabes dorsalis, dementia paralytica, or other -serious nervous diseases will result from this source; but it cannot be -denied that neurasthenia or hysteria or impotency—sexual -neurasthenia—can be promoted by the exaggeration of masturbation, if -indulged in many years. - -Masturbation is always injurious to the sexual glands, more so to the -male than to the female organs, and in addition to the thyroid, and—if -in excess—to the adrenals. It also very unfavorably influences the mind -and character. - -In youth, instruction as to the control of the sexual passions will be -of the utmost importance, even considering alone the dangers of -infections, especially of gonorrhœa, which not only endangers the future -husband, but the future wife also. We need here but mention the -well-known fact that the thorough and radical cure of syphilis may even -more readily be accomplished than that of chronic gonorrhœa. - -We have mentioned above that after gonorrhœa (every chronic gonorrhœa -involves the prostate gland) there are severe disturbances of the -nervous system, which may also influence the mind, causing hypochondria. - -To prevent all these dangers there has been formed in France a society -called “Société Française de Prophylaxie Sanitaire et Morale,” which -advocates the necessity of instructing boys and girls as to all the -dangers that threaten them and how to avoid them. - -Happy is the young man who is able to live in perfect chastity without -harm to mind or body. We will enter more fully into the consequences of -complete sexual abstinence in the chapter on sexual hygiene; but the -great majority of young men have the danger from sexual intercourse -suspended, as the sword of Damocles, over their heads, and the best way -to avoid this is by marriage. - -Marriage is, indeed, an invaluable aid in the struggle against old age; -but sometimes, although this is an exception, it may turn out to be a -double-edged sword. - -By marriage a young man acquires regular habits, and by the assistance -of a loving wife is better able to control his passions; and last, but -not least, the hygiene of the mind will also be improved. The inevitable -hardships of life are thus less felt. - -These great advantages of marriage can, however, exist only in cases -where the two halves make one whole—i.e., where the sun of happiness -shines in the marital sky. For this purpose each of these two halves -must endeavor best to please the other. The husband must, as is quite in -the nature of things, show the utmost forbearance to the wife, and never -forget that, on account of her different anatomical and physiological -constitution, the mind of the female is far more exposed to frequent -irritation as a natural consequence of the frequent alterations of the -sexual glands and thyroid in women. It would be unreasonable to blame -her for a condition for which not the woman, but her Maker, is -responsible. - -If married life is one of the best means to defer old age, on the other -hand it is positively certain that unhappy marriages are the surest -means to hasten its oncoming; but these are the exception, and, as in -everything else, the exception only proves the rule. - -A single man, or woman, is far more exposed to all the agencies we have -referred to above as being deleterious in causing old age and especially -depressed conditions of the mind, these being the consequences of total -sexual abstinence, faults of hygiene in diet, use of stimulants (alcohol -in men, coffee, tea, etc., in women), fewer precautions against disease, -and so many other agencies of less importance that there can be no doubt -that the bachelor or spinster, as a rule, will become old in earlier -years than the married person. Therefore, although himself still a -bachelor, the writer feels compelled to sing the praises of married life -as a hygienic factor favoring old age. - -The possession of children is heavenly bliss to married people, and -their pride and joy in them, and in living with youngsters, renders the -parents young, as the German proverb says. But as every good thing, if -in excess, may turn out to be harmful, _omne quod est nimium vertitur in -vitima_, so too, many pregnancies may prove very harmful in the fight -against old age, especially when the mother nurses for a long period -each of the children. In women who produce much milk this may prove -advantageous to health if not too greatly prolonged; but in women with a -meager provision of milk—as in cases of thyroid insufficiency—it may -prove disastrous by destroying the means of keeping youthful till an -advanced period. - -In married women with many pregnancies much will depend on external -circumstances of life, and it is certain that nothing will hasten the -advance of old age as many pregnancies, the mother suckling all the -children herself, in combination with deficient food, the wear and tear -of poverty, and with anxiety as to the morrow. This cruel struggle for -daily bread is what renders the women of the lower classes old before -their youth has passed. - -To prevent the deleterious consequences of too many pregnancies on -beauty, health, and wealth, in certain countries, as in France, the -habit of having one or two children has been encouraged by artificial -means. However, as is always the case when our acts disregard Nature, -great mischief may thus arise, and even in cases where death has not -followed abortions, very often such irreparable damage is caused to the -organs on which youth and beauty depend that the oncoming of old age is -still further hastened. - -The endometritis and peri- and parametritis of many years duration, -which are sometimes the result of such procedures, influence the -appearance of these persons more unfavorably than many pregnancies. - -Parents who have many children may be regarded as the happiest of -mankind. Their name is forever perpetuated through their numerous sons, -and their flesh and blood survives in their children, to quote the great -German philosopher, Schopenhauer. - -The years of the climacteric are the most troublesome in married life, -not only for the wife, who is directly affected by it, but also in -almost equal degree for the husband, who must show the greatest -forbearance to his wife at this period. The sun is setting! It is not -merely that the decline of the sexual functions produces certain changes -in the body, which are especially noticeable in the external appearance; -the influence on the mind also produces deleterious effects. Therefore -we must direct all our attention to the hygiene of the mind. In married -women with loving husbands and children the task will be much -facilitated. As we have already mentioned, this stage of human life is -most felt by professional beauties, who witness with chagrin the -vanishing of their power over the hearts of men. In many spinsters -living alone, friendless, this is also a frightful stage of life. Here -we have again an opportunity to observe the wonderful soothing effects -of religion, which offers us consolation in all our troubles. Religious -women will, therefore, much better withstand this most difficult part of -their life. Religion and philosophy, too, may be still more helpful to -overcome mental depression. - -It is interesting to note that many women, even those previously little -given to religious practices, turn over a new leaf, and to make up lost -ground, become quite pious. Such as in their youth were haughty and -proud beauties, and only went to church to exhibit their new hats and -toilette, now become meek and modest, and never miss a religious meeting -or exercise. - -Still, even after a woman has passed the climacteric, everything is not -lost if only she be a clever member of her sex. In fact, something -remains that may even place her above her much younger sisters, and that -is experience and knowledge of the world; and if, by the aid of a -skillful toilette, she is able to make the best of what good looks -remain from better days, it is probable that she will outdo many of her -sisters far below her in age. - -Even if at this time of her life, aware of the approach of old age and -its cruelties, she may be inclined to say with Longfellow, “but the -hopes of youth fall thick in the blast,” still there are, in the present -state of science, plenty of resources open to her, no less than to a -man, to put off old age for a score of years, or to mitigate its effects -when it has asserted itself with all its terrors. - -We owe our knowledge of the fact that there is a treatment for old age -to the famous French scientist, Professor Brown-Séquard, whose father -was American and who, for a time, was professor of physiology at Harvard -and later a practitioner in New York which he left to become professor -of physiology at the University of Paris. Although, before him, Claude -Bernard, a man of no less fame, had shown the existence of internal -secretions, Brown-Séquard was the first to draw practical conclusions -from this fact, and the first who gave a solid basis to the doctrine of -internal secretion. - -Brown-Séquard was the first to use the extracts of a ductless gland (the -testicle) for therapeutic purposes, although thousands of years before -him the Chinese had used different organs for purposes of healing, and -the savages of Africa ate certain portions of their enemies—the liver -and the testicles—to enhance their own courage. - -Brown-Séquard obtained surprising results by using the crushed extracts -of rabbits, guinea-pigs, and dogs, of which we will say more in the -chapter on the prevention and treatment of old age by organic extracts. - -Unhappily, as human nature is prone to attack every innovation or to -ridicule it, in spite of the great reputation of this savant, his -discoveries were skeptically received; and if the extracts of another -similar gland—the thyroid—had not yielded such marvelous results, -probably the author of the present work would never have had the -opportunity to write on the treatment of old age with organic extracts. - -It has been shown by many authorities that the thyroid gland is able—as -we have already mentioned several times in different parts of this -book—to augment the processes of oxidation, and it has also been stated -by several authorities, such as George Murray, Vermehren, Hertoghe, and -Laache, that persons treated with thyroid extracts appear much younger -after the treatment—sometimes, as Hertoghe mentions, ten to twenty years -younger. - -Now, if a person suffering from complete myxœdema can obtain such a -result by the use of thyroid extracts, should not a person suffering -only from a partial form of the same disease be able to obtain similar -results? It would be quite contrary to our physiological conceptions -that a person in a bad condition of health and in physiologically -inferior circumstances should benefit more, by exactly the same -treatment, than another person who is in a much better condition of -health. Therefore, the thyroid treatment of old age is justified. And -indeed, we ourselves have seen astonishing results from thyroid -treatment, not only in old people, but also in persons under 40. - -Thus the thyroid can be of valuable aid for the prevention of old age, -and for deferring its onset as long as possible; and for this purpose it -will be necessary to begin our treatment in women at about the age of -35, or in certain cases, such as where many pregnancies have occurred, -even before this age, and in men at some time after 40 (see also Chapter -LIII). Still, to avoid abuses in the use of this efficient drug, it -would be necessary to pass a law prohibiting its sale without a medical -prescription. - -Besides the thyroid gland, the extracts of the sexual glands can also be -used; thus, ovarian extracts for women, and testicular extracts for men. - -We have also witnessed good results with ovarian and testicular extracts -of pigs. Long before ourselves, Brown-Séquard and Professor von Poehl -and many others made very interesting observations on testicular -extract, on which we shall dwell in the chapter on the treatment with -testicular extracts. - -Besides the above extracts, those of the kidneys and of the pancreas -have also given us, and others, very good results, and they can be used -with advantage in the prevention and rational treatment of old age in -combination with the other extracts, though preferably in cases where -the functions of these organs are deficient. In old age that has already -become manifest they should always be used, as they will facilitate the -work of these very important organs, and thus prolong their vitality. In -this manner an old man will be able to employ these organic extracts of -the pig to work for the benefit of his own organs, or, at any rate, to -assist in their work. - -We have given above a sketch of the dangers that follow us from the -cradle until old age, and hasten its arrival, and shown by what means we -can avoid or diminish them in the different stages of life; we would now -like to offer a few hints that may prove useful for any of these periods -in life. - -We have shown in the previous chapters that the degeneration of certain -glands with internal secretions, especially the thyroid, liver, and -kidneys, will produce a condition of auto-intoxication, as poisonous -products will not be destroyed in the proper manner, and also not -eliminated from the body. Therefore our whole energy must be turned to -working in time against this auto-intoxication of the body. This can be -most rationally done by a careful hygiene of these different ductless -glands—into which we will enter later in separate chapters—and also by -special cultivation of the functional efficiency of those organs that -eliminate poisonous products from the body, such as the kidneys, -intestines, and the skin. - -These three organs are in close relation to each other, for when one is -threatened the others come to its assistance and aid it in the work of -elimination. Thus, when the kidneys are not functionating as they -should, the skin comes to the rescue and helps to eliminate a large part -of the remaining products by increased perspiration. Nature often does -this spontaneously before we come to her aid. - -The intestines will do their best, in like manner, to expel a part of -these products. Recognizing this co-operative action of almighty Nature, -we must also try to be of assistance by careful hygiene, and later on we -shall see what will be the best way to effect this; but let us at once -urge here that the necessity of having the bowels moved daily should be -insisted on from earliest childhood. Especially is this of the greatest -importance in the case of young girls, for with them this most necessary -rule of hygiene is so often neglected. There is no doubt that, in many -persons, fæcal matter can stagnate in the intestines for a few days -without much consequence, as the epithelium of the intestines, when in -sound condition, may prevent the entrance of poisonous products. But it -may be different when this becomes a habit; and when the epithelium is -not in perfect order,—as is often the case after prolonged constipation, -or with catarrhs of any kind, or with excreta which by their shape may -injure the epithelium mechanically,—resorption will follow. - -At any rate, it is an every day occurrence for persons who have not had -their bowels moved, even for one day, to complain of headache and other -symptoms of uneasiness, so that it is impossible to regard these as -simple reflex actions, as some are disposed to think, but rather as -symptoms of auto-intoxication. Therefore the necessity of clearing the -bowels every day should be insisted on, and again especially in the case -of the young girls, for it can easily become a bad habit once they have -begun to neglect it, and the sluggishness of the bowels, to which -females have a peculiar tendency, is thus further encouraged. - -Everything should be done to prevent habitual constipation in young -girls, for the important reason that stagnation of blood in the adjacent -organs of the pelvis is otherwise promoted, and thereby also a tendency -to subsequent diseases of the sexual organs, from which many women -suffer, at any rate much more frequently than men. - -This movement of the bowels every day can best be secured by appropriate -food, such as exercises a gently stimulating action on the walls of the -bowels. Drugs should be avoided as much as possible, for reasons we will -mention in another chapter. - -Habitual constipation, if persisting for years, can certainly facilitate -the oncoming of old age, while its appearance can be considerably -deferred by a good movement every day, owing to the prompt release from -the organism of a mass of toxic products. - -The great importance of this can be easily realized if we observe the -face of any one who has been constipated for several days. After a -thorough clearing out, the face becomes fresher and the eyes brighter. -The complexion that was previously a dirty gray becomes white and rosy -again, particularly in the case of young women. Should not this prove an -object lesson as to the vital importance of a thorough evacuation daily -as a safeguard against premature old age? - -Every physician who practices in a place where the mineral waters have -purging effects has occasion to observe that persons coming to these -spas, looking worn out and gray in the face, with pendant cheeks, and -showing all the signs of auto-intoxication from the retention of -poisonous products, always look much fresher, and, indeed, many years -younger, after the cure. We could observe the same effects in our own -case after each purge, although we do not suffer from habitual -constipation. - -There is no doubt that freedom from occupation, and particularly life in -the open air, in the woods and meadows, have a very great influence in -effecting such cures; but we may note the same effects after courses of -purging without the aid of such conditions as the above. - -The care, not only of the bowels, but of the skin, must be impressed on -every one from earliest childhood, especially the necessity of a bath -daily. Unfortunately, this is too much neglected on the Continent, and -becomes prevalent only as Anglo-Saxon customs are diffused abroad. - -By a bath with soap the pores of the skin are better opened, as the dirt -that clogs them is removed, and thus the poisonous products can be given -off through the skin more easily, and the skin thereby justifies its -name as chief assistant to the kidneys. It is, in fact, our second -kidney. When the skin comes into greater activity through the action of -the sudorific glands, a part of the solids in the urine and many harmful -matters, which otherwise would make their way through the kidneys, are -eliminated through the skin instead, in which manner the powers of the -kidneys are economized. - -It is, therefore, only natural that we should do everything to promote -these important functions, especially since we may regard the skin not -only as a second kidney, but to a certain extent also as a second lung; -for it possesses respiratory functions in addition, receiving oxygen and -giving off carbonic acid to a certain degree. - -To assist these functions in every possible way, we must allow the air -to reach the skin freely, for which purpose clothing and underwear -should be porous, in order not to impede the process of respiration and -elimination. This end will also be attained by exercise in the open air -and sunshine; in fact, by remaining out-of-doors as long as possible. -All these important features will be dealt with fully in separate -chapters. - -Before leaving the subject of the prevention and rational treatment of -old age, we will give a few hints that may be of use in any stage of -life. - -First, great moderation in the diet should be observed, as large -quantities of food may, in the long run, impair the powers of the -digestive organs, and also of several of the ductless glands, which are -concerned in the operations of digestion and assimilation—the pancreas -and liver. Sajous has shown that the secretion of the adrenals takes -actual part in the functions of all these organs. Everything that is -eaten should be thoroughly masticated and not “bolted”; digestion, in -reality, beginning in the mouth. - -Meat should not be consumed in large quantities, as it is injurious to -various glands with internal secretions, especially the thyroid and -liver, and after having been taken for a long time in large quantities -can promote arteriosclerosis (see Chapter XVI). - -The best nourishment for increasing the chances of a long life and to -defer the effects of old age, is a diet consisting of little meat, much -milk, and vegetables. We have for many weeks lived on a diet consisting -solely of milk, eggs, bread, butter, and fruits, and, we believe, have -never felt so fresh and well disposed to work as during that time and, -as friends remarked, never looked so well, either. - -A strictly vegetarian diet, without milk and eggs, is distinctly unwise -and dangerous to health, if followed for a long time. Our anatomical and -physiological construction is not adapted to such nourishment (see the -chapter on this subject). - -By many authorities wine is called “the milk of old age.” This is not -true, although it is a fact that many old people feel better after an -occasional glass of claret, when they have been in the habit of taking -it for years. - -We will deal with alcohol and its deleterious effects in a separate -chapter. Far more injurious than red wine used in moderation, are tea -and coffee used in large quantities. Unfortunately, many of those who -fanatically fight against alcohol, indulge in many cups of black coffee -or tea daily, and thus poison their nervous system. Besides containing -thein and caffein, they also aid the formation of uric acid, as they -contain bodies from which the purin substances are produced (Haig, -Hutchison, Walker Hall). - -Cocoa and chocolate may be taken in larger quantities than coffee or -tea. Cocoa with milk is, at the same time, very nutritious, as it -contains fatty substances. - -Spices should be avoided as much as possible, especially sharp, -irritating condiments, which are so freely taken, particularly in -America. - -We must not forget that the greater part of all we eat and drink must -pass through the kidneys, the fine epithelium of which is thus easily -endangered. For the same reason drugs should only be taken under medical -advice, and with great reserve, for if taken too freely they may not -only injure the kidneys and liver, but also the stomach, which first -receives them. - -Sound sleep is of the greatest importance. Most of the organs rest -during sleep; the great brain in particular being completely at rest; -but the disintoxicating glands are most active during sleep. This -function should therefore be promoted by all means, and we shall devote -a special chapter to sleep, its causation, and the treatment of -insomnia. Let us, however, at once mention that sleep can best be -encouraged by the use of a large, airy room, and going to bed early, -say, at ten to half-past, and rising at five or half-past, when sleep -has been undisturbed during the night. Seven hours’ sleep is the best; -longer sleep, if over seven and one-half or eight hours, injurious, -except for anæmic girls and women. Many people do very well with six -hours’ sleep, but less than this will prove injurious in the long run. - -It is astonishing to note the large proportion of persons living to a -very great age that were early risers; for which reason we may conclude -that “early to bed and early to rise” is a valuable factor in the -struggle against old age. - -We emphatically repeat, over and over again, the importance of fighting -against our passions and cultivating the hygiene of the mind; this must -be commenced in early childhood and continued through life; and the good -qualities of the mind, which we will call the “positive” features of the -mind, should be especially cultivated, such as kindness, -good-heartedness, friendship, love, magnanimity, hope, modesty, -liberality, generosity, frugality, and above all things, contentment -with everything. On the other hand we may describe wickedness, -unfriendliness, hatred, and jealousy as “negative” features of the mind, -which should be smothered at their very inception in the child. - -The most successful way to fight the battle of life is to cultivate -equanimity and follow the beautiful precepts of Hindu philosophy, which -teach us never to hunger after honors and riches, but to be content with -what comes in our way. It should be a lesson to us as to what to avoid -when we take note of the manner in which so many American business men -sacrifice their mind and health in an insatiable thirst for success and -riches, and after attaining them, by a real battle with life, find their -health so impaired that they reap no enjoyment from it. What is the use -of a million when all that life holds dear is lost in the struggle to -obtain it, and when, probably, our children will squander it, as do many -sons of millionaires who have worked themselves to death. Rather be a -living beggar than a dead millionaire! - -In the succeeding chapters we will enter fully into detail on all the -subjects we have touched upon in these general remarks. We will describe -the functions by which the body rids itself of toxic products, and the -means by which these functions may be improved. At the same time we -shall set forth the rational hygiene of the organs that cause the -elimination of poisons either taken through food or introduced from -without; and after having demonstrated the most effective mode of -freeing the body from such poisons, we shall mention the best kinds of -food and deal more specifically with the advantages and disadvantages of -the various kinds of food. The effects of certain agencies of great -benefit to the health, such as the open air, sunshine, exercise, etc., -will be treated in an exhaustive way. Finally, we shall show that we are -able to prevent premature old age in an effective manner, and even to -treat successfully by means of certain drugs and organic extracts the -condition of old age itself. - - ------------------------------------------------------------------------- - - - - - CHAPTER X. - - THE DESTRUCTION AND ELIMINATION OF TOXIC PRODUCTS FROM THE BODY AND - HYGIENIC MEASURES FOR THE IMPROVEMENT OF THESE FUNCTIONS. - - -THERE is not one thousandth of an inch of our body surface which does -not swarm with innumerable bacteria, and as soon as the continuity of -our skin is severed, as by a small wound, they immediately invade our -tissues and attack us. Happily we are not without means of defense. Our -organism is so well arranged that, as soon as a foreign body enters -which might become injurious, a kind of police organization comes into -action, and the leucocytes, like policemen, arrest the bacilli, and -render them harmless by eating them up. This is phagocytosis, first -described by the great French investigator, Metschnikoff. And so -marvelously arranged is our body, that there are also special -substances, the alexins (Buchner), which aid the leucocytes, and the -opsonins, which first act upon the bacteria, so as to make them more -digestible for the leucocytes. - -To make the bacilli still more sensitive to the influence of the alexins -there are the agglutinins, observed by Bordet, and by Gruber and Durham, -which immobilize the microbes, and thus aid the phagocytes and alexins -in the performance of their task. - -The leucocytes are formed in the lymphatic tissues, especially the lymph -glands and spleen. Thence they circulate through the body and offer -opposition to the microbes and other foreign bodies which they meet on -their way. The red blood-corpuscles of the adult are formed chiefly in -the bone marrow. - -The lymphatic glands play an important rôle, not only as the birthplace -of leucocytes, but also in that they are able to arrest noxious -substances, such as microbes, and keep them from entering the -circulation. That the lymphatic structures are able to protect us -against bacillary infection can be shown by the swelling of the spleen -in infectious diseases,—such as typhoid fever, malaria, etc. - -The tonsils are also of some importance for our protection against -harmful substances. They become inflamed in various infectious -diseases—such as scarlet fever, measles, acute nephritis, etc. Their -great value may best be shown by the fact that not infrequently, after -total extirpation of both tonsils, a generalized eruption has been -observed. Thus we must always seriously reflect before advising the -extirpation of these important organs, the rôle of which as sentinels is -shown by their anatomical position on either side of the entrance for -the most indispensable elements of our life: air and food. Unless -frequent inflammation, and possibly irritative nephritis, demand an -operation, it would be better not to undertake it. Even if it is done, -the glands should never be entirely removed. - -A great number of microbes enter our system through the mouth with the -air and food, but happily they are antagonized by the saliva and the -gastric juice, which are able to destroy a large number of these -obnoxious invaders. Like the ductless glands, the lymphatic glands are -closely connected with one another, and thus changes in one of these -glands are apt to be followed by changes in the others. Hence we can see -how a lymphatic structure contained in the intestine,—the appendix,—can -often become inflamed after previous inflammation of the tonsils. As is -well known, the appendix shows great similarity in its histological -structure to the tonsils, so much so that some call it an intestinal -tonsil. Several authors have drawn attention to the fact that -appendicitis has often been observed after tonsillitis, and Delcour has -written a monograph in which he attributes appendicitis, indirectly, to -thyroid degeneration,—e.g., congenital myxœdema. Adenoid vegetations are -always accompanied by chronic pharyngitis and tonsillitis, which bring -about appendicitis. And since adenoid vegetations are an expression of -thyroid deficiency, Delcour attributes appendicitis to a deficient -thyroid. We are not prepared to accept Delcour’s statement, as there are -cases of adenoid vegetations without a deficient thyroid. However, as we -have personally observed, chronic nasal catarrh and tonsillitis are very -frequent in persons subject to appendicitis. The appendix is an -important lymphoid organ and, if possible, it should be preserved. - -As I have already shown in a previous communication,[168] the lymphatic -glands stand in very close relation to the thyroid gland. In diseased -conditions of the thyroid we find, as a rule, enlarged lymphatic glands, -as in Graves’s disease, myxœdema, cretinism, acromegaly, and also in -diabetes. The thyroid seems to exert a great influence, not only upon -the lymphatic glands, but also on the blood-corpuscles. The red -blood-corpuscles are diminished after extirpation of the thyroid, as -also in myxœdema, as well as in old age. On the other hand, they can be -increased very considerably by thyroid feeding. The white -blood-corpuscles are also influenced by the thyroid, for, after -extirpation of the thyroid, their number is at first increased and later -diminished. Very important is the discovery of Mlle. Fassin[169] (in the -laboratory of the University of Liège, Belgium), who found a diminution -in the production of alexins after extirpation of the thyroid, thus -confirming what Sajous had pointed out four years earlier. According to -Sir Almroth Wright, the discoverer of opsonins, the production of these -bodies also depends upon the internal secretions. We have seen that -Sajous has shown (a fact confirmed by others since) that opsonins are -mainly composed of thyroid secretion. - -Footnote 168: - - Policlinique de Bruxelles, Avril, 1903. - -Footnote 169: - - Report in Centralblatt für Stoffwechsel, 1907. - -Thus we see that the production of antitoxins is greatly under the -influence of the thyroid, which governs the processes of phagocytosis, -and thus powerfully helps in the defense of our system. - -Besides microbes, we introduce into our body a large number of harmful -products through food and drink (stimulants). Many toxic substances are -formed by the decomposition of food, and also in the processes of -metabolism in the tissues. We are protected against these substances by -certain organs which destroy them (as the thyroid, parathyroids, and -liver), and by other organs which eliminate them (as the kidneys, the -skin, and the intestines). When these organs are all working well, we -may get rid of these products and not be affected by them; but in old -individuals it is different, as their protective and eliminative organs -have more or less degenerated. Then these substances are not destroyed -entirely, nor wholly eliminated. They are retained, and cause the -condition of auto-intoxication. - -It is very difficult to prove definitely by experiments, that there -really exists such a condition as auto-intoxication; but, practically, -its existence cannot be denied. We note after changes in the above-named -organs, when their functions are in abeyance, signs of intoxication in a -patient, which include headaches and other nervous symptoms, with a -haggard and colorless face. After a good movement of the bowels, -perspiration, and abundant diuresis, we see a great change for the -better. Thus, even if scientific experiments which are made on small -animals do not strictly confirm the existence of auto-intoxication, the -great improvement in our condition after improved elimination speaks -very strongly for its existence. Therefore, to prevent such a condition, -we must do our best to keep these organs in good working order. In the -succeeding chapters we shall consider in detail the protective and -eliminative functions of these organs, and the possibilities of their -improvement by hygienic and therapeutic measures. - - ------------------------------------------------------------------------- - - - - - CHAPTER XI. - - ON THE DESTRUCTION OF POISONOUS PRODUCTS THROUGH THE THYROID AND - PARATHYROID GLANDS. - - -THE earliest authorities on the thyroid gland, including Schiff and -others, have shown that when this gland is extirpated in a dog, as a -rule the animal develops convulsions after a few days, and subsequently -dies. It is very unusual to find a longer survival after such -operations. - -Interesting and very instructive experiments by the American specialist, -Dr. Leo Breisacher, of Detroit, Mich. (formerly assistant to Professor -Munk, of Berlin), have demonstrated that it is possible to keep animals, -operated on as above, alive for a long time if they are debarred from -meat and kept on a milk diet. - -A perfectly natural explanation of this prolonged survival, which had -never been observed until the above experiments, lies in the fact that -milk food is better adapted to animals deprived of their thyroid, and -that, as Dr. Breisacher maintained, meat acts in a poisonous manner on -the nervous system of dogs thus operated on. Thus we note that dogs in -this condition cannot live on a meat diet. The learned savant and others -noticed that dogs so fed succumbed very quickly, while at the same time -he observed that no attack of convulsions ever occurred in dogs fed on -milk, though many other authorities had noticed such symptoms in -corresponding cases. - -He also observed,—and it is a most interesting point,—that dogs which -improved on a milk diet, again got worse after meat or bouillon was -taken and died in consequence. Of great importance also is his -observation that boiled meat is not dangerous to animals thus operated -upon, which he explains as being due to the fact that the extracts of -meat having a toxic action are soluble in water. - -There can thus be no doubt, from these beautiful experiments of -Breisacher, that meat does contain substances that are poisonous, and we -may safely draw the conclusion therefrom that if we, who are in -possession of our thyroid, do not suffer from a meat diet, it is due to -the protection afforded us by this gland. If we remove this, as in the -instances given of the dogs, or if it is degenerated by disease, then -our immunity also disappears. In myxœdematous people this is -self-evident, for they are always worse after taking meat, and most of -them have an antipathy to this sort of food. Also in many cases of -severe diabetes (a myxœdematous condition), meat is very injurious, and -if taken in large quantities can contribute to the development of -acidosis.[170] - -Footnote 170: - - “Untersuchungen über die Glandula Thyroidea,” Breisacher: Archiv für - Anatomie und Physiologie, p. 504, 1890. - -The above-mentioned experiments of Breisacher have been confirmed by F. -Blum, of Frankfort. He finds also that omnivorous animals operated on as -the dogs, if fed with meat, die from tetany in a few days. But when such -animals have been kept on milk for a long time, before and after the -operation, a large proportion have survived, or, at most, passed through -a mild form of tetany, and continued well until meat was again -administered, when their condition soon became worse, and death ensued, -as in the case of the animals kept on a meat diet. Some of the dogs fed -on milk also died, but before succumbing they underwent a long cachectic -illness. In any event they lived longer than the animals fed with meat, -which rapidly died with violent symptoms. - -Dr. Blum arrived at the conclusion that the thyroid is a -disintoxicating organ (entgiftendes organ) the function of which is to -destroy poisonous products formed by the decomposition of the -albuminous food-substances.[171] - -Footnote 171: - - Virchow’s Archiv für Path. Anatomie und Physiologie und klin. Medicin, - vols. 158, 162. - -The Japanese authority, Kishi, also arrived at the same conclusion, -after having removed the thyroid gland from 150 monkeys, dogs, and other -animals. - -That the products of the decomposition of albuminoids can produce -changes in the thyroid has been proved by Galeotti and Lindemann, who -found an increase of colloid substance in the thyroid of animals after -the injection of leucin and tyrosin,—which are the products of -decomposition of albuminous substances. That meat acts in an injurious -manner on the thyroid gland, if eaten in very large quantities, has been -proved by clinical observations and by the experiments of Chalmers -Watson, into which we shall enter more fully in the chapter on the -dangers of too free a meat diet. - -The thyroid not only protects us against the poisons in meat, but also -against many others; in fact, perhaps we may say, against poisons -generally. Let us, however, specially mention those poisonous products -which have been tried experimentally. That the thyroid protects the body -against bacillary attacks has been noted by Charrin in the case of dogs, -which succumb in a very short time to all kinds of infection after the -removal of the thyroid. We have demonstrated, in Chapter III, the -protective action of the gland against such poisons as chloroform, as -mentioned in our communication to the Paris Biological Society in 1906, -where we stated that in chloroform narcosis all the characteristics of -an increased activity of the thyroid are perceived,—including symptoms -such as we see in Graves’s disease. We have also found that the thyroid -of dogs contains an increased amount of colloid substance after -chloroform narcosis, which enables us to understand why this drug is not -well borne by animals operated upon as above, as discovered by Lanz and -by Walter Edmunds; likewise, we may thereby explain why patients -suffering from Graves’s disease of long standing, in which there -generally is a transition to a myxœdematous condition, are liable to a -fatal termination after an operation with anesthesia. Cases of diabetes -(in accord with frequency of thyroid changes) also often present serious -phenomena after an operation under anesthesia, including coma and even -death. - -Alcohol also acts on the thyroid gland, there being a certain analogy -between intoxication by chloroform and by alcohol. The changes in the -thyroid after the long-continued use of alcohol are the consequences of -the frequent conditions of hyperactivity of this gland, expressive of -its antitoxic action. We have referred to the influence of alcohol on -the thyroid in other parts of this book. This gland also protects us -against injurious drugs. Hunt, of Washington, has shown from experiments -that when certain animals, such as rabbits, have been given acetonitril -and thyroid preparations at the same time, they do not become poisoned; -whereas when they have taken the former alone, they do. Jeandelize and -Perrin have also proved the protective action of the thyroid against -arsenic. - -Garnier has also found that certain drugs, such as iodine, pilocarpin, -etc., when injected into animals, produce an increase of colloid -secretion in the thyroid glands. It is, therefore, but logical to regard -this hyperactivity of the thyroid gland as an expression of its -defensive action against toxic products (see Chapter III). - -From the foregoing it is obvious what an important organ we possess in -the thyroid gland, and that by its degeneration, as in the state of -myxœdema or in the much more frequent athyroidia, we become more exposed -to all kinds of poisonous products; but what renders its degeneration a -still graver misfortune for us, is the fact that it is apt to bring -about the degeneration also of other organs which destroy and eliminate -poisonous products, viz.: the liver, kidneys, intestines, and skin. - -The liver is always altered by extirpation of the thyroid gland, -likewise as a rule in myxœdema, and even in hypothyroidia; for -congestion and other changes follow, as found by Rogowitch, Sanquirico, -and Canales, Albertoni, Tizzoni, and others. A fatty degeneration of the -liver has also been described by Sciolla. - -Laulanié has discovered, in the same way as Van der Ecke and Rosenblath, -very extensive changes in the liver after removal of the thyroid. -Jeandelize also found interstitial hepatitis after the removal of the -thyroid and parathyroids. Kishi also describes alterations in the -blood-vessels of the liver occurring in a great number of animals after -thyroidectomy. - -Hun, Prudden, Mackenzie, G. Murray, and others, found usually a -cirrhosis of the liver in myxœdematous persons. Vermehren found an -interstitial hepatitis, with thickening of the blood-vessels of the -liver, and of the bile, in myxœdema. - -It is also of great significance to note that Gley, Laulanié, and -others, constantly found biliary matters present in the urine of animals -from which the thyroid had been removed. - -After due consideration of these facts it cannot be denied that the -liver and the thyroid stand in very close relationship, and this we -maintained at the last French Congress of Medicine at Liège, where we -were glad to see that the President of the Congress, Professor Bouchard -of Paris, and later Professor Neusser of Vienna, coincided in this -opinion. - -We have also shown, as already mentioned (Chapter V), that degenerative -processes of the thyroid are able to facilitate the development of the -gall-stone complaint. The degeneration of the thyroid is not only -followed by degeneration of the liver, but also by that of the kidneys. - -It has been noted by Albertoni and Tizzoni, that animals whose thyroid -has been removed show a condition of interstitial nephritis. Blum has -found the same thing, and has observed also that this condition -frequently comes about in an astonishingly short time after the -operation, say, in 18 to 20 days. The parenchyma also presents distinct -signs of inflammation; the urinary channels lose their epithelium and -present the appearance of hollow grooves. These changes occur in all -animals, except such as die a few days after the operation, and such as -are permanently immune from the intoxication that follows the removal of -the thyroid. - -We can also observe clinically that removal or degeneration of the -thyroid are capable of producing changes in the kidneys; for after the -operation, as a rule, albumin appears in the urine. - -In myxœdema and hypothyroidia there is also very frequently albumin in -the urine, as well as hyalin or granular casts. In such cases the urine -is usually not copious; very frequently it is scanty (oliguria), and its -light color and low specific gravity show that the solids have been -retained in the body. In such cases there is often retention of uric -acid. In a communication to the Paris Biological Society (February 25, -1905) we attributed gout to changes in the kidneys giving retention of -uric acid, after primary alterations of the thyroid as the cause (see -also Chapter V). - -That the intestines also suffer changes after degeneration of the -thyroid is best established by the fact that there is obstinate -constipation in such cases,—as in myxœdema or in partial myxœdema and -hypothyroidia (old age). The functions of the skin also will be -diminished after degeneration of the thyroid, as we observe plainly in -the conditions of myxœdema and hypothyroidia. In these diseased -conditions there is an atrophy of the sudorific and sebaceous glands, so -that the skin cannot perspire; on this account a large amount of toxic -products is retained. - -We can see plainly from the above that when a person has a degenerated -thyroid a condition of auto-intoxication must necessarily follow, as -there is in consequence a degeneration also of the other organs which -destroy and eliminate poisonous materials. The liver in such a case will -not be able to fulfill its function of destroying a mass of poisonous -substances; the sluggish kidneys and bowels will not eliminate them -sufficiently, and dry skin will also contribute to their retention, -since its insensible respiration is not taking place. All these -life-shortening agencies, which may combine to cause premature old age, -can be brought back to a primary cause—the degeneration of the thyroid -gland. - -When the thyroid is removed from an animal, but the parathyroids are -allowed to remain, that animal will not then suffer convulsions, but -will only present the symptoms of cachexia typical of the operative -cases of myxœdema. - -It has been shown by Gley, Vassale, and Generali, that these very small -glandular organs, of which there are four, two internal and two external -ones, possess quite a different structure from the thyroid gland. - -It has been demonstrated by many authorities, among them Jeandelize, -that the convulsions which follow the removal of the thyroid are due to -the fact that the parathyroids have been removed completely, together -with the thyroid gland. Jeandelize was able to produce convulsions by -merely removing the parathyroids alone; he attributed tetany and -epilepsy to the changes in the parathyroids, in common with other -authorities, who have even obtained good results in epilepsy with -parathyroid treatment. - -Several authorities besides Jeandelize have attributed tetany to -alterations of the parathyroids: for instance, Pineles; and at the -German Congress of Medicine in Munich, Erdheim communicated his -observations in three cases of tetany, in each of which, at the -post-mortem, there was found hypertrophy of the parathyroids. - -Dr. Macallum, of Johns Hopkins University, has also reported the case of -a person who developed tetany in consequence of a dilatation of the -stomach, and in whom the parathyroids were found to be hypertrophied. - -We learn from the foregoing that the parathyroids protect us against -poisons that arise from the stagnation of the contents of the stomach, -and that their integrity is necessary as a safeguard against important -alterations of the nervous system. - -However, these glands, which were already described by Sandström -twenty-two years ago, have not been studied as yet to the same extent as -the thyroid, and we cannot enlarge further on this subject at the -present time. - - ------------------------------------------------------------------------- - - - - - CHAPTER XII. - - HYGIENE OF THE THYROID GLAND. - - -THE rational hygiene of the thyroid gland consists in the avoidance of -all agencies that may prove harmful to the gland, the most important of -which are infectious diseases; frequent pregnancies; sexual excesses; -intoxications by food, stimulants, or drugs; and emotions such as grief, -sorrow, etc. - -It will not be difficult to prevent some of these, but it will be nearly -impossible to avoid others, such, for instance, as infectious diseases. -There is not the least doubt, however, that at times we expose ourselves -quite unnecessarily to infections, as when we drink water that has not -been boiled or filtered, or when we take milk from uninspected dairies -for a long time; or, again, when we remain too long a time in the -confined air of assembly halls, etc., and breathe the air that has been -exhaled by thousands of others, many of them possibly with infectious -diseases of the throat and lungs. Many a case of infectious disease, -with all its dangers to life or to important organs, such as the -thyroid, may be avoided by proper circumspection. - -It is also quite unnecessary for us to expose ourselves to the dangers -arising from the decomposition of meat, which is particularly injurious, -when taken in large quantities, to the thyroid, as shown by the -experiments of Breisacher, Blum, Chalmers Watson, etc., more especially -if animal food be taken that is not quite fresh and can cause the -formation of ptomaines. According to Blum the thyroid has the special -function of destroying poisons formed in the intestines, in particular -by the decomposition of animal food. Now when too much work is thrown up -on this important gland, it is easy to understand that after a time it -will give out, and to prevent this we must avoid taking large quantities -of animal food or fish (which is meat also, a fact not realized by many -people), and when we do take it, we must first be certain that it is in -a fresh condition. To enable us to do this we are provided with special -sense-organs, and our eyes, nose, and the taste papillæ of our tongue -will inform us whether the meat, and especially the fish or crustacean, -is in a fit condition to be eaten. - -We have mentioned several times that alcohol and tobacco, taken in large -quantities or for a long time, are deleterious to the thyroid, which -fact will justify our abstinence therefrom, or the greatest moderation -in their employment; those who can do without stimulants will always be -the best off. - -Sexual excesses can also be easily avoided, and women who wish to retain -their youth will do well not to expose themselves to pregnancies year -after year after having had three or four children. It is, however, -great good fortune to have a numerous progeny, and by careful hygiene, -as plenty of instances prove, the struggle against premature old age can -be carried out successfully. In regard to this we may refer to the -chapters on the causes of old age and on sexual hygiene. Diseases of the -ovaries must be particularly avoided, as all changes in those glands -will react on the thyroid, which is closely related to them. - -Doubtless one of the most difficult tasks will be the avoidance of -strong emotions: grief and sorrow; and yet we are not helpless against -them, as will be illustrated in the chapter on the hygiene of the mind -and on the advantages of a religious belief. - -Having dwelt on the necessity of preventing injury to this important -gland, we will now show that there are certain means of enhancing its -vitality,—which effect we can obtain by improving the circulation, and -removing agencies by which this would be impaired. As Sir Herman Weber -has shown, it is possible to improve the working condition of this gland -by massage, which should be done daily and is readily carried out. - -It is easy to see that a tight collar offers difficulty to the free -circulation of the blood through this gland, and therefore it is -advisable to wear a loose, and also low, one. Strange to say, many -ladies wear such tight, high collars, not availing themselves of their -immunity from such a yoke, which men have voluntarily endured for so -long a time. It is advantageous not to button both sides of the -shirt-band to which the collar-stud is fastened, but one side only, -which is easily done when low collars are worn and is not noticeable; -the great comfort and advantage of so doing will outweigh all other -considerations. - -The vitality of the thyroid gland may be enhanced by various measures in -which thyroid secretion, or iodine—its main element,—is introduced into -the body. The easiest way to effect this is by taking foods, such as -plants and vegetables, which contain a maximum of iodine. The iodine in -the thyroid and other parts of the body is introduced therein mainly -with our food (or by drugs in the case of goiter). Another way is by -taking thyroid extracts. Since, at a certain age,—as mentioned in the -chapter on the causes of old age,—parts of the epithelium of the thyroid -are degenerated and replaced by connective tissue, thyroid extracts will -be the best means, if taken in very small doses, of supplying this -physiological need. Such doses of the extracts, freshly prepared and -from a reliable firm, can do no harm, but, on the contrary, will keep -the thyroid in good working order. As we have learned from personal -experience these very small doses can even be taken, at intervals, for a -long time, without injury to the health, and we need not await the -arrival of old age, but should use them as a preventative against it, -and in particular temporarily where there is, or has been, a great -demand for thyroid secretion, as, for instance, in convalescence after -an infectious disease, or after childbirth, especially if the flow of -milk is scanty, which is an expression of a defective thyroid; also -after sexual excesses, and in cases of mental depression, after we have -suffered grief; in fact, after any of the occurrences which we know to -be harmful to the thyroid gland, which, in such cases, has been giving -off larger amounts of its secretion. - -We must, however, caution patients against ever taking these extracts -_save under medical advice_, since otherwise dangerous results may be -and have been produced, as will be shown elsewhere. - -The diet of greatest hygienic value with regard to the thyroid will -consist of large quantities of milk, with little or no meat, but plenty -of vegetables. - -With such a diet there will result less putrefaction in the intestines, -and thus also less demand for the thyroid secretion to destroy poisonous -matters; at the same time, along with the milk and vegetables, iodine, -the main element of the thyroid secretion, will be brought into the -body, and a loss of this product from it prevented. - - ------------------------------------------------------------------------- - - - - - CHAPTER XIII. - - THE DESTRUCTION OF TOXIC PRODUCTS BY THE LIVER AND THE IMPROVEMENT OF - ITS PROTECTIVE FUNCTIONS. - - -THE liver is one of the most important of our organs. As Professor -Hemmeter, of Baltimore, says, “The liver is an organ secondary in -importance only to the heart. Living things can exist without stomachs. -They can live for forty days without eating, but mammalia can only live -a few days, sometimes not twenty-four hours, without a liver.” The -importance of the functions of the liver is illustrated in this -picturesque remark of Dr. Rovighi[172]: “Like unto Minos in Dante, the -liver tests the conscience of those that want to enter, and knows their -sins.” - -Footnote 172: - - Quoted after Professor Hemmeter. Address to Sixty-first Annual Meeting - of the Ohio State Medical Association, May 9-11, Canton, Ohio. - -We introduce into our stomach and intestines a number of poisonous -substances which, if injected into our blood, would kill us, or at -least, cause grave intoxication. Yet because they are taken by the mouth -they are harmless, and the reason for this strange phenomenon is that -they must pass through the liver, being brought to this organ from the -intestines through the portal vein, and are there destroyed. This is -illustrated in the case of the Indian snake charmers, who acquire -immunity against snake-bites after having first sucked the poisonous -fang of the snakes and absorbed the toxin via the intestine. They -thereby gradually accustom their body to this terrible poison, which, -taken in this manner, is far less harmful, since it passes through the -liver. That the liver destroys various poisons was first shown by our -esteemed friend, Prof. Paul Heger,[173] of Brussels University, who -demonstrated by experiments that nicotin added to blood soon disappeared -after it had been passed through the liver artificially. After this -remarkable discovery other authorities have found reason to state that -the liver also destroys other poisons, in particular alkaloids: -strychnine and atropine (Professor Roger[174]), hyoscyamine (Heger and -Buys[175]), quinine, morphia, curare (Lussana). According to Schiff, and -Lautenbach, alkaloids undergo a chemical change under the influence of -the liver. As Slowzoff[176] found, the liver also protects us against -poisons such as arsenic; therefore we can understand why persons -suffering from hepatic disease cannot tolerate arsenic. This should be -taken into consideration when we are treating patients with cacodylates, -or with atoxyl. - -Footnote 173: - - Thèse de Bruxelles, 1873; Journal méd. de Bruxelles, 1877; C. R. de - l’Académie des Sciences, May, 1880. - -Footnote 174: - - Thèse de Paris, 1887. - -Footnote 175: - - Quoted from Hanot, Archives Gén. de Médecine, II, 895. - -Footnote 176: - - Slowzoff: Beitr. zur chem. Physiologie u. Path., p. 281, 1901. - -It has, however, been maintained by Zagari that this antitoxic action of -the liver fails in the case of bacteria and, according to Professor -Roger, especially with bacterial toxins in old cultures. - -Yet other authors have shown that the liver probably has an antitoxic -action against bacteria and their toxins. Thus, Professor Adami, of -Montreal,[177] by experiments with a minute diplococcus similar to that -which is found in Pictou’s cattle disease, and Sir Lauder Brunton, and -Dr. Bokenham,[178] have shown that the lethal action of diphtheria toxin -is greatly diminished during the circulation of this toxin through the -liver, and also that the juice from such a liver has a slight antitoxic -power. These authors have also shown that the bile from such a liver has -a slight antitoxic action. They consider that the antitoxic power of the -liver does not depend upon the blood present in the organ, but on the -liver-tissue itself. - -Footnote 177: - - Adami: Montreal Med. Journal, p. 485, July. - -Footnote 178: - - Sir Lauder Brunton and Bokenham: The Journal of Pathology and - Bacteriology, p. 50, Nov., 1907. - -It has been shown that the liver excretes into the bile poisons which it -arrests during their circulation through the portal system. This has -been shown by Lussana in the case of curare. That poisonous substances -are excreted into the bile is shown also by the immunizing experiments -of Professor Koch against bovine plague. He employs the bile of animals -which died of plague. This contains attenuated plague bacilli, of which -Professor Koch makes use in his experiments.[179] - -Footnote 179: - - Quoted after Metschnikoff. - -Dr. Fraser[180] has shown that when increasing doses of snake-venom are -injected into an animal a condition of immunity is brought about, so -that finally fifty times the dose which would have proved fatal at -first, becomes innocuous. As Fraser found, the bile of such animals -contains an antivenine, and he made use of this bile as an antidote -against the original venom. - -Footnote 180: - - Fraser: British Med. Journal, vol. ii, p. 595, 1897. - -These experiments prove that the bile contains poisonous substances, -including pathogenic bacteria in an attenuated condition, and also that -it has antitoxic properties. Thus we may understand how it can -neutralize putrefactive products from the intestines. Not only bacteria, -but all the various kinds of poison which the liver destroys, are -eliminated by the bile; hence the importance of a free circulation of -this fluid. The liver serves as a depot for metallic substances like -iron and copper, and also for the more dangerous ones such as lead, -mercury, arsenic, or antimony. After first keeping them in storage, it -then attempts to eliminate these noxious substances. According to -Slowzoff and Bamossi, the various poisonous metals and alkaloids enter -into combinations with the proteid bodies of the liver. Animals that -have been richly fed have been found to be better protected against -these poisons because of their livers being richer in proteid contents -and glycogen. - -The liver also protects the body against the numerous toxic products -formed in the stomach and intestines during the process of digestion and -assimilation. The most important of these are the carbamins and ammonia -salts, which would be injurious to us if the liver did not protect us by -converting them into urea. - -When the liver is excluded from the circulation, as Nencky and his -pupils have done by establishing an Eck fistula, toxic symptoms arise -when the animals are given albuminous food, and these symptoms can only -be explained from the fact that the liver is unable to destroy toxic -products. The more albuminous food taken, the more marked are the -symptoms of intoxication. - -The liver aids in the transformation of the poisonous end-products of -proteid metabolism by bringing about the combination of the toxic -end-products with sulphuric acid (Baumann, Emden and Glaesner). Thus -these dangerous substances are eliminated as ethereal sulphates, which -are practically harmless. Even when these ethereal sulphates are present -in large amounts in the urine there may be no symptoms of -auto-intoxication. - -When the liver is extirpated, a condition of acidosis arises, and a -large quantity of ammonia is eliminated, which is produced in order to -neutralize the acids present. The liver protects us against acids formed -in the organism. After eating a quantity of meat, we would be menaced by -the acids formed through its decomposition, were the liver not active. - -We can prevent acidosis if we eat a considerable amount of -carbohydrates, at least 100 grammes a day as Hirschfeld has proved. It -has been shown by Waldvogel that these carbohydrates do not prevent -acidosis if they are given by a method which precludes their passage -through the portal circulation,—e.g., subcutaneously. - -As we have seen above, the liver receives an enormous amount of toxic -products from the stomach and intestine, which it transforms or -destroys. Like any other organ which is overworked, the liver may -undergo certain changes when continually subjected to a strain, and -great quantities of these toxins might be able, after a long-continued -action, to alter the liver tissue. Such a condition we may note in -gastric and intestinal diseases, especially in those cases where large -amounts of fatty acids are formed. - -Bouchard found an enlargement of the liver in 23 per cent. of all his -cases of dilatation of the stomach. - -We can understand that when fatty acids, as a result of -gastro-intestinal disease, pass for a long time through the liver, they -may destroy the delicate epithelium of this organ. Boix demonstrated -this by experiments. By feeding animals with lactic, butyric, and acetic -acids, he produced hepatic cirrhosis. - -So long as the liver is healthy it is able to withstand the constant -inflow of toxins and will transform them into less harmful compounds. -But when the liver is altered, as in cirrhosis, things are different. We -then find a diminution of urea, and an increase of ammonia. Happily such -a condition arises only when there are considerable anatomical and -histological changes in the liver. - -Salaskin and Zaleski have shown in animals that when there are serious -anatomical changes in the liver, the ammonia is increased, and the urea -is diminished. We may suppose that in old age, when the connective -tissue is more or less increased and important liver elements destroyed, -a similar decrease in the urea formation may take place just as in -chronic cirrhosis. - -That in diseases of the liver toxic products are formed and eliminated -by the urine in increased amounts, has been shown by Professors -Bouchard[181] and Roger. They found that the urine of patients suffering -from diseases of the liver is more toxic than that of normal persons. - -Footnote 181: - - Leçons sur les auto-intoxications dans les maladies. - -That the normal urine is toxic has been proved by Séglas and -Vauquelin,[182] and also by Bocci.[183] Bouchard has designated as the -urotoxic unit the quantity of urine necessary to kill an animal weighing -1 kilogramme, and as the urotoxic co-efficient the relation of the -urotoxin eliminated in twenty-four hours to the body weight of the -animal. This latter, then, indicates the quantity of urotoxins a man -eliminates in twenty-four hours. - -Footnote 182: - - Journal de Magendie, vol. ii, p. 357, 1822. - -Footnote 183: - - Centralbl. für med. Wiss. 51, 1882. - -All these calculations of Bouchard have had no great success, however, -for many authorities, as Gumprecht,[184] Heymans v. d. Bergh, etc., have -shown that the toxic effects of the injected urine may be explained in -part by the difference in osmotic pressure between the injected urine -and the blood. - -Footnote 184: - - Centralbl. für Inner. Med., 24, 1897. - -Still the fact remains that the urine of many cases of liver disease has -been found to be more toxic than the urine of other persons. - -When the liver is damaged it cannot destroy poisons in the normal -manner, as was shown by experiments. Thus, the liver cells have been -experimentally injured when it was found that such a liver was not able -to destroy strychnine as well as a normal liver. Very important findings -have been made by Roger and Gamier.[185] They have ascertained that -privation, bad nutrition, etc., can also lower the vitality of the liver -and diminish its antitoxic properties. - -Footnote 185: - - Roger et Garnier: C. R. Soc. de biol., p. 209, 1899. - - ------------------------------------------------------------------------- - - - - - CHAPTER XIV. - - THE HYGIENE OF THE LIVER. - - -WE have often observed that people suffering from diseases of the liver -feel and look much better after abstaining from meat and living on milk -and a vegetarian diet. If such a diet be beneficial in cases where the -tissues of the liver are degenerated, it appears reasonable to assume -that it will be equally efficacious when the liver has not yet been -altered by disease. We must realize that the various unwholesome matters -we eat or drink are carried to the liver to be dealt with, and that the -end-products of the decomposition of the meat, and other elements -contained in preserved meat which may not be perfectly sound, may injure -the liver-tissue, or, at any rate, throw more work on this organ than -food in the nature of vegetables or milk. - -A milk diet has the further great advantages that it assists in -destroying toxic products in the intestine, and also that it can hinder -the development of gall-stone disease (see Chapter XXXIX). - -Not only meat used in abundance, but also various kinds of spices, -condiments and stimulants may be very injurious, especially alcohol, if -taken in large quantity. Gin and brandy are the most deleterious in -their action. Wines containing little alcohol are less harmful, but acid -or strong white wines may injure the liver-tissue. - -The well-being of this organ is essentially dependent on the good -condition of various other organs with which it stands in very close -relation, in particular the intestines, for instance. It is from here -that most of the toxic products enter the liver, either by the portal -vein or through the choledochus. The intestine always contains myriads -of microbes, which may enter the liver either by the blood or the bile, -and thus provoke very important changes in the liver-tissue. Professor -Adami,[186] of Montreal, found colon bacilli in a cirrhotic liver. - -Footnote 186: - - Quoted from Quincke: “Diseases of the Liver” in Nothnagel’s - “Practice.” - -It follows, therefore, that we must maintain the intestine in the best -possible condition, and avoid constipation and stagnation of fæcal -matters, with the augmentation of toxic products. That constipation is -very deleterious to the liver can be best shown by the fact that very -often affections of the liver and bile-ducts,—and especially gall-stone -disease,—are developed in persons suffering from habitual constipation. -The best treatment for these liver affections is a purging treatment, -and it is mainly on account of their action in this manner that certain -alkaline mineral waters have attained so great a fame; in addition, due -to increased peristalsis, the circulation of the bile is enhanced. - -Proper movements of the bowel are indispensable to a sound condition of -the liver and for the prevention of hepatic disease, and we, therefore, -refer the reader to the chapter that deals in detail with the prevention -and treatment of constipation. - -Not only the intestine, but the stomach also, must be in good condition. -It has been noted by Bouchard and Hanot that chronic gastric and -intestinal troubles are apt to cause enlargement of the liver. Bouchard -has found an enlarged liver in 23 per cent. of his cases of dilatation -of the stomach. Hanot and Boit[187] have shown experimentally that the -different acids formed in the gastro-intestinal tract are able to -produce a genuine cirrhosis of the liver. Therefore acid fermentation -must be carefully avoided; and to prevent such fermentation in some -degree in the stomach and in the intestine, it is necessary to masticate -the food thoroughly, as will be shown. - -Footnote 187: - - Hanot and Boit: Congresso Med. Internat. di Roma, 1894. - -Another very important organ, the sound condition of which is of great -importance to the liver, is the pancreas. It has been found by several -authors, particularly by Steinhaus,[188] in his investigation of some 40 -cases of hepatic cirrhosis, that the pancreas is also affected in each -case of this type; and we further know that after disease of the -pancreas, as in diabetes, for example, the liver is also, as a rule, -altered. Thus these two organs are in close relationship. - -Footnote 188: - - Steinhaus: Deutsches Archiv für klin. Medicin, 1902. - -As pancreatic diseases are among the most difficult to diagnose, and -people suffering from them live and die, as do also many diabetics, -without their particular state having been recognized, so, the rational -treatment of these diseases being still imperfect, we cannot offer -advice in regard to their prevention. But, at any rate, the safest -course will be moderation in diet, especially fatty food, which exacts -the active co-operation of the pancreas. As in the case of all other -organs, long-continued overwork will exhaust this gland, and thus induce -a diseased condition. Moderation in diet will be the best policy for the -pancreas, as also for the liver; and to maintain these organs in sound -working order, meat in particular should only be taken in small -quantities, and fat also should not be partaken of in large amount. - -Milk and vegetable food, with but little meat, and that preferably as -fish, will certainly furnish the best diet to avoid diseases of the -liver. As Quincke[189] mentions, experience shows also that water in -large quantities, especially certain alkaline saline waters, can -increase the flow of the bile; and therefore, as also for other reasons -mentioned in this book in Chapters XXXIV and XLI, water should be drunk -in sufficient quantity every day. The alkaline waters referred to are -certainly superior in their action to ordinary water, especially those -kinds which at the same time cause purging. - -Footnote 189: - - Quincke: “Diseases of the Liver,” in Nothnagel’s “Practice,” 1907. - -Hot climates have a deteriorating effect on the liver. We have often -noted the great frequency of liver complaints under these conditions, -and we have never had a patient from the hot parts of Mexico who has not -had a hypertrophied liver. We are inclined to believe that it is not so -much the climate as faults in hygiene, especially in diet and in the use -of stimulants, which are the cause of such a condition in Europeans -residing in tropical climates. - -A vegetarian diet is certainly the best in tropical countries, as we -personally found during a stay in Southern Florida, Texas, and Mexico. -Just as for the kidneys, so for the liver, a bath, and particularly a -sweat-bath, is of great benefit, since by means of it toxic products may -be eliminated which would otherwise be carried to the liver. - -We have found these baths to be of great benefit in liver diseases, and -considering the amelioration of the processes of oxidation brought about -by such baths, it seems highly probable that they are capable of -improving also the working condition of a liver not as yet diseased. - -In general, it is our opinion that to prevent disease in an organ the -surest method is to use those means through which that organ, when -diseased, is found to benefit. Of course this is only meant as a general -statement; but in the children of those suffering from liver complaints -such preventive treatment is particularly indicated, as these -conditions, we have found, are most frequently inherited. We have -treated cases where three or four generations of one family had been -sufferers from the same complaint. - -Here, as always, let us follow the wise precept: “Prevention is better -than cure.” - - ------------------------------------------------------------------------- - - - - - CHAPTER XV. - - ON THE DESTRUCTION OF TOXIC PRODUCTS BY THE ADRENALS. - - -THERE is ample evidence in support of the contention that the adrenals -play an important part in the destruction of toxic products in the body. -As long ago as 1853, one of the leading authorities on the adrenals as -ductless glands, Brown-Séquard, noticed that the blood of animals -without adrenals was more toxic than that of animals the adrenals of -which had not been removed. - -Langlois and Abelous[190] confirmed the conclusions of Brown-Séquard. -They also established the fact that the blood and muscular extracts of -frogs whose adrenals had been removed, were toxic, and contained a -poison of the nature of curare. The animals died from auto-intoxication, -and these savants came to the conclusion that the adrenals were created -to neutralize or destroy poisons which are evolved during muscular work. -Frogs from which the adrenals had been removed showed also lessened -resistance to muscular fatigue. Similar results have been observed by -Langlois in the case of other animals: rabbits, dogs, guinea-pigs, etc. -Albanese[191] also found that animals operated on as above exhibited -more fatigue than those whose adrenals had been allowed to remain -intact. The recent labors of Sajous which have shown conclusively that -the adrenals furnish to the blood one of its important immunizing -constituents explain all the above observations. - -Footnote 190: - - Abelous et Langlois: Archives de physiologic norm. et path., p. 267, - vol. iii, 1892, and “Travaux de Laboratoire,” Lancet, August 20, 1898; - Société de biologie, 1892. - -Footnote 191: - - Albanese: Archiv. Ital. di Biologia, p. 338, 1892. - -The fact, observed by all these authorities, that when one of the -adrenals is removed the other becomes hypertrophied, sometimes to a -great extent, seems also to point to the conclusion that greater demands -are made on the gland that remains, the hypertrophied condition of which -appears to be due to the increased work required of it in protecting the -body from infection. - -That these organs really assist in the defense of the body against the -attacks of microbes or the introduction into it of certain toxic -products can be best demonstrated by the fact that after such infections -the adrenals are, as a rule, altered, showing that a pronounced reaction -antagonistic to these agencies has occurred. - -It has thus been proved by a succession of authors: Charrin,[192] -Langlois, Roux, Yersin, Professor Roger, and more recently by Oppenheim -and Loeper,[193] that in experimental or in spontaneous infectious -diseases the adrenals present important alterations as a result of the -reaction against infection. - -Footnote 192: - - Charrin: “Les défenses naturelles de l’organisme,” Paris, 1898; C. R. - Soc. de biologie, 1892. - -Footnote 193: - - Oppenheim et Loeper: C. R. Soc. de biol., 22 mars, 1901. - -Oppenheim and Loeper found that important changes followed upon -experimental infectious diseases; for example, after infection by the -bacilli of diphtheria or anthrax, or by the pneumococcus; also in such -infectious diseases as diphtheria, pneumonia, small-pox, typhoid fever, -etc.; and also after experimental poisonings, as with arsenic, -phosphorus, or mercury. There occurred leucocytic reaction, diffuse -diapedesis, or infectious nodules, and also a congested condition of the -adrenals, sometimes so marked that hæmorrhage took place, with complete -destruction of the parenchymatous tissue of the glands. - -Very important are the conclusions of Oppenheim,[194] that when animals -have received poisonous products, together with adrenal extracts, after -having previously lost these glands by operation, such animals show a -longer survival, sometimes even of indefinite duration, as compared with -animals without adrenals to which have been administered the same toxic -products, but without adrenal extracts. - -Footnote 194: - - Oppenheim: “Les capsules surrénales,” Thèse de Paris, 1902. - -With phosphorus and urinary poisons in particular, this author has -obtained most striking results from the injection into animals of -adrenal extracts at the same time as the poisonous substances. - -Oppenheim comes to the same conclusion as Abelous, Charrin, Langlois and -Sajous: that the adrenals play a great rôle in the destruction or -neutralization of microbic or other poisons introduced into the system. - -We are thus in possession of powerful arguments in support of the -presumption that the adrenals are antitoxic glands. The fact, found by -Langlois, that the adrenals contain less adrenalin after experimental -infectious diseases, and that established by Luksch, that after certain -experimental infectious diseases such as diphtheria, typhoid, or -tuberculosis, the extract from the adrenals no longer produces an -increased blood-pressure, do not seem to us sufficient to invalidate our -belief in the antitoxic properties of these glands; for here we are -witnessing the same occurrence as has been previously noted in reference -to the thyroid,—that the functional hyperactivity of the gland may be -followed by its exhaustion. - -Moschini, Nicholas, and Bonnamour have also found histological evidences -in the adrenals in infectious diseases indicating a hyperactivity of -these glands. - -The fact that different toxic products, such as alcohol, can produce -alterations in the adrenals, indicates also a rôle of these glands in -defending the body against toxic doses of this substance (see Chapter -III). - -It was found by Aubertin[195] and other authors that there is a -hyperplasia of the adrenals after experimental intoxication of the -guinea-pig by alcohol. Bernard and Bigart found important alterations of -the adrenals after experimental poisoning by mercury, arsenic, lead, -etc. As shown by Professor Sajous,[196] various drugs act on these -glands, and he attributes the rise of blood-pressure therefrom to the -action of such drugs on the adrenals, whose function, as is well known, -is to raise the blood-pressure. We can thus understand how if alcohol be -taken in large quantities it is able to produce atheroma and -arteriosclerosis, as are also other toxic bodies, such as nicotine. - -Footnote 195: - - Aubertin: C. E. Soc. de biologie, 22 juillet, 1902. - -Footnote 196: - - Sajous: Loc. cit. - -It is well known that arteriosclerosis is frequent in great smokers. It -has been found by several authorities, among them Borylac, that -inhalation, or mastication, of tobacco produces atheroma, and by Boverie -and Loeper[197] that similar changes have followed experiments with -tobacco or ergotin. Very important data have also been established by -Drs. Isaac Adler and Hensel, of New York,[198] who have found that -atheromatous alterations of the aorta can be produced experimentally by -powerful doses of nicotine. Such alterations were similar to those -effected by adrenalin, but were neither so constant, nor so marked. - -Footnote 197: - - Société d’Anatomie, Mai 31, 1907. - -Footnote 198: - - Deutsche Med. Wochenschrift 8, 1906. - -These experimental facts, together with observations by Dr. Sajous, -prove that the atheromatous condition brought about after using certain -drugs, such as alcohol and tobacco, can be ascribed to the adrenals. -Josué, in 1893,[199] showed that by injecting adrenal extracts (solution -1:1000) into the veins of a rabbit, atheromatous patches of the aorta -will appear after five or six weeks. The changes described by Adler and -Hensel from the effects of nicotine confirm the probability that tobacco -acts on the adrenals first, then, by their medium, on the blood-vessels -(see, also, Chapter XLIII). - -Footnote 199: - - C. R. Soc. biologie, Nov. 14, 1893. - -The above observations show that the same is also probable in the case -of alcohol, to which we may add a case of Widal and Boivin, who found in -a young woman dipsomaniac a hyperplasia of the adrenals and atheroma of -the aorta; and to complete the value of these observations we subjoin -those of a series of cases of atheroma by Joshua, in three of which a -hyperplastic condition of the adrenals was found. - -It follows logically from the foregoing effects of alcohol and tobacco, -that we must avoid large quantities of these substances if we desire to -keep in a normal condition the heart and blood-vessels, upon the perfect -state of which depends, in a great degree, our chances of a long life -and extended youthfulness. - -We will deal further with the latter points in the following chapter. - - ------------------------------------------------------------------------- - - - - - CHAPTER XVI. - - HYGIENE OF THE ADRENALS AND OF THE CIRCULATORY SYSTEM—A FEW REMARKS ON - THE CAUSE, PREVENTION, AND TREATMENT OF ARTERIOSCLEROSIS. - - -IN order to obtain the best hygienic condition of the circulatory -system, it is indispensable to avoid all that are harmful to the -adrenals. There can no longer be any doubt that these glands exercise a -controlling influence on the heart and the whole circulatory system. -They are in intimate relation with the principal nerves that regulate -the heart: the sympathetic and the vagus. Thus, for instance, emotions -that act on these nerves excite through them a hypersecretion of the -adrenals and a contraction of the small blood-vessels, with a rise in -the blood-pressure. By the hyperactivity of these glands their -secretion, in larger quantity than usual, is thrown out into the system, -producing toxic effects which result in an atheromatous condition of the -arteries. According to our present knowledge, we imagine this -atheromatosis to be due to the toxic effect of the adrenals quite -independently of the increase in the blood-pressure, for it has been -distinctly shown that even substances which diminish blood-pressure, -such as amyl nitrite, for example, are also capable of producing -atheroma. The toxic effects of adrenalin are proved by the experiments -of Amberg[200] in the laboratories of the Johns Hopkins University. - -Footnote 200: - - Amberg: Archives Internationales de Pharmakodynamie et Therapie, 1905. - -We must especially insist on the fact that high blood-pressure is not a -condition essential to arteriosclerosis. It has been shown by -Sawada,[201] Groedel,[202] and Ferranini,[203] through measuring the -blood-pressure by Riva-Rocci’s instrument, that numerous cases of -arteriosclerosis can arise without any increase at all in the -blood-pressure. According to Professor Romberg,[204] there is only high -blood-pressure in such cases of arteriosclerosis where there is a -diseased condition of the kidneys. According to this leading authority -on heart diseases, high blood-pressure is one of the earliest symptoms -of kidney complication in arteriosclerotic persons. We believe that the -high blood-pressure found in kidney diseases may be brought into -correlation with the previous statement, by the fact that in such -conditions, and especially in sclerosis of the kidneys, the adrenals, if -examined, are frequently found to be hypertrophied, as was noted by -Parkes Weber,[205] Lemaire, and in four cases of Troin and Rivet.[206] -At the last Congress of German Physicians and Naturalists in Dresden, -1907, it was proved by Schur and Wiesel, as also in their previous -communications, that the blood of patients affected with kidney diseases -contained the characteristic substance that gives the adrenalin reaction -with perchloride of iron, and produced mydriasis if dropped into a -frog’s eyes. - -Footnote 201: - - Deutsche Med. Wochenschrift, No. 12, 1907. - -Footnote 202: - - Congress für Innere Medicin, 1907. - -Footnote 203: - - Grom. Int. della Soc. Med., xxvi. - -Footnote 204: - - Lehrbuch der Krankheiten destergens und der oxlutgefüre. Stuttgart, - 1906. - -Footnote 205: - - Parkes Weber: Transact. Path. Society, London, lviii, 3. - -Footnote 206: - - Gazette des hôpitaux, Juin 14, 1906. - -It is of singular interest that all those agencies that produce a -hypersecretion of the adrenals are the same which are known to be -harmful in causing arteriosclerosis. In the front rank of such are -tobacco, alcohol, and different kinds of poison, such as lead, mercury, -etc.; also infectious diseases, especially syphilis, the important rôle -performed by which, in the production of arteriosclerosis, has been -treated of very competently by Professor Edgreen,[207] of Stockholm, and -Darier, of Paris. Arteriosclerosis can also be produced very frequently -by abundant meat food and by strong tea or coffee. There is as yet no -scientific proof to show that abundant meat food has the same -deleterious action on the adrenals as upon the thyroid, ovaries, -pituitary body, pancreas, liver, kidneys, etc., upon which we have -enlarged in previous chapters of this book; and, moreover, we have no -knowledge of any work written on this subject; but as such a diet is -very efficacious in producing a sclerotic condition of the kidneys, it -may, for these reasons alone, tend to further the development of -arteriosclerosis, considering that so often in such conditions both -kidneys and adrenals are found in a hypertrophic condition. This disease -may be produced by alcohol, tea, and coffee, by causing a great -variation in the tone of the capillaries. According to Professor Romberg -and others, it remains to be proved whether they affect the adrenals at -all; but we have already shown what their action is on the kidneys. - -Footnote 207: - - “Die Arteriosclerose,” Leipzig, 1898. - -To keep the adrenals in good condition and thus prevent -arteriosclerosis, it is necessary to avoid all the above harmful -agencies. It is true that there are some people who can enjoy these -things in large quantities with impunity and without injurious effects -until they reach a considerable age; but it is different when they all -act together. Especially deleterious are mental emotions, grief, and -sorrow, on which we have dwelt in the introduction to this chapter, and -on the effects of which we have previously remarked; they produce a -great variation in the tone and calibre of the blood-vessels. We will -therefore endeavor to treat of the prevention of a prolonged continuance -of this most disastrous agency in our chapters on the hygiene of the -mind. Emotions of a sexual character are, perhaps, more than emotions -from other sources, disastrous to the heart and blood-vessels, as shown -by the fact, which may often be observed, that persons addicted to -sexual excitations frequently die from sclerosis of the coronary -arteries. That the sexual glands are in intimate relations with the -heart, which can often be irritated in consequence of changes in these -glands, especially in women, has been already mentioned. - -We should like to add that, as the above agencies are also harmful to -the thyroid gland, the antagonist of the adrenals, its degeneration can -further the development of arteriosclerosis in the same way that -Eiselsberg produced an atheromatosis of the aorta in dogs after -extirpating the thyroid gland. According to Minnich, arteriosclerosis is -very common in people with goiter, appearing in them at a very early -age. Fries and Pineles found that alterations of the blood-vessels -occurred in goats after extirpation of their thyroid gland. - -Since arteriosclerosis is so frequent in old age it must be due to the -degeneration of the thyroid and also to the aggregation of all the -above-named harmful agencies during a prolonged period. To avoid it, and -also premature old age, it is, therefore, most essential to guard -against all agencies harmful to the thyroid and adrenals, to which we -have referred above; and this is the best basis for the rational -treatment of arteriosclerosis. It is most fortunate that Dellamare -discovered in old age a hypertrophy of the adrenals.[208] - -Footnote 208: - - “Recherches sur la senescence des glandes surrénales,” Soc. biologie, - 17 Oct., 1903. - -All this is greatly strengthened by the recent investigations of Sajous, -which show that besides its action on the blood-pressure and the heart, -the adrenal secretion actually supplies the substance which in the -lungs, takes up the oxygen from the air to sustain life in all our -tissues. It thus becomes evident that harm to our adrenals is bound to -shorten life. - -To recapitulate: There exist two chief agencies for the production of -arteriosclerosis: 1. A hyperactivity of the adrenals, causing a rise in -blood-pressure. 2. A degeneration of the thyroid gland, which, when -normal, antagonizes the first by lowering the blood-pressure. Although -from the above-mentioned facts high blood-pressure cannot be considered -as the chief cause of arteriosclerosis, still no doubt it certainly -contributes to it; for each time that there is a rise in the -blood-pressure more blood is forced through the arteries, thereby -causing them to dilate; and after a repeated number of such dilatations -the elasticity of the vessels will eventually be impaired, especially so -in the aged, where one part of the elastic fibers is already replaced by -connective tissue. As a result of the arteriosclerosis the passage of -blood through the capillaries will be impeded, and in consequence the -work of the heart will be increased; likewise the nutrition of the walls -of the vessels will be diminished. The best preventatives of -arteriosclerosis will therefore be: 1. To avoid all agencies which may -tend to cause excessive activity of the adrenals; and 2. To increase the -activity of the thyroid. - -Moderation in food is necessary above all things, for much food causes -an increase in the abdominal circulation and a larger amount of blood to -be carried through the vessels; if the food consists of much meat, then -its viscosity is augmented, as previously stated, which indicates that a -vegetable diet, with milk, and little or no meat, is the best; but too -large quantities of milk should not be taken at one time. - -Much bodily and other exercises, in excess, such as too much climbing, -should be avoided, as they promote arteriosclerosis by frequent -excitation of the splanchnics and adrenals. As Romberg observed, there -is sclerosis of the arteries in the extremities of persons who do much -physical labor, and Remlinger[209] found the same in the lower -extremities of peasant women who walked a great deal. - -Footnote 209: - - Remlinger: “Dissertation on Arteriosclérose,” Marburg, 1905. - -Not only by a diet, chiefly vegetarian, is the viscosity of the blood -diminished and the circulation facilitated as found by Determann, but -also by means of iodine administered in the shape of iodide of potassium -or iodide of sodium. This has been proved by the experiments of -Ottfried, Müller, and Inada.[210] For many years it has been well known -that iodine can greatly benefit the condition of arteriosclerotic -persons. In combination with a preparation of iodine, Professor -Senator[211] favors the use of nitrites, and Professor Huchard also -recommends nitroglycerine in the intervals between the iodide treatment. -Besides inorganic iodine, it would appear to us logical to try organic -iodine preparations, such as thyroid extracts, the principal element of -which is iodine. For the above reasons it is also necessary to take -special care of the condition of the kidneys, which can be done, as we -have shown, by hygienic and dietetic measures, already described in the -special chapters of this work. An improvement in the condition of the -kidneys, and probably also in the arteriosclerosis, may, in our -judgment, be obtained by the administration of kidney extracts, with -which we will deal more fully in the chapter on the treatment of old age -by organic extracts. - -Footnote 210: - - Preface of Romberg: Deutsche Med. Wochenschrift, No. 78, 1904. - -Footnote 211: - - “Therapie der Gegenwart,” March, 1907. - -According to Edgreen, about 25 per cent. of the cases of -arteriosclerosis is caused by alcohol. It acts by causing a constriction -of the small vessels (Traube), just as does adrenalin. - -But much more harmful in the production of arteriosclerosis is tobacco. -According to Claude Bernard, Huchard, Basch, Oser, Isaac Adler, and -Hensel, tobacco produces a constriction of the small blood-vessels. Thus -nicotin, adrenalin and alcohol have similar actions, which also -corresponds to the observations of Sir Lauder Brunton. We have had a -great many smokers among our arteriosclerotic patients; but, on the -other hand, we quote further on the cases of some great smokers who -lived to a very old age as we have seen. But this latter class is not -numerous. - -Similarly, the hygiene of the intestines is of the utmost importance, -especially as poisons generated in the intestines play a leading part in -causing arteriosclerosis, according to Huchard, Senator, and others. We -must take great care to have a daily evacuation of the bowels, and -especially to prevent flatulence, for this distention of the colon or -the stomach, by carrying the diaphragm upward, may interfere with the -expansion of the lungs and thus produce a mechanical hindrance to the -movements of the heart and a free circulation of the blood. Those with a -tendency to angina pectoris must specially avoid such dangerous courses. -Hill climbing, during which not infrequently such people suffer sudden -death, should also be avoided. More than from 1 to 1½ liters of liquids -per day should not be allowed. - - ------------------------------------------------------------------------- - - - - - CHAPTER XVII. - - THE ELIMINATION OF TOXIC PRODUCTS THROUGH THE INTESTINES AND THE - IMPROVEMENT OF THIS FUNCTION. - - -THE intestines contain billions and billions of microbes, their number -increasing downward throughout the length of the intestine. The duodenum -contains the least, and in some parts of it there are none at all. - -The presence of these bacteria is a great necessity to us, as without -their assistance we could not exist, for they take an active part in -intestinal digestion and help to form the intermediate substances, -especially from albuminous food and fat, for our nutrition. They also -assist fermentation and thus induce a better peristalsis of the -intestines, by which the contents are expressed. - -That animals cannot exist without cultures of bacteria in the intestines -is shown by the experiment of Schottelius, who demonstrated that young -chickens could not thrive on a sterilized nutrition, and Nuttall and -Thierfelder had great trouble in keeping their guinea-pigs alive when -feeding them for a time on sterilized milk. - -All those bacteria which are found in the intestines are, we may say, -innocuous; they assist digestion and do no harm. But among such are -often virulent bacilli against which, under normal circumstances, we are -well guarded, as the epithelium of the intestines is so wonderfully -arranged that so long as it is in a healthy condition it does not admit -the passage of these microbes; but in the aged, or in those exhausted by -debauchery or previous disease, or when there is an inflamed condition -of the intestines, stagnation of hard masses of fæces for a very long -time cause mechanical lesions of the epithelium when, conditions now -having changed, nothing will prevent these microbes from entering the -walls of the intestines and either cause disease, like typhoid or -tuberculosis, or from passing through and entering into the blood. - -Besides these dangerous bacteria many other harmful substances pass from -the stomach down into the intestines, whence they are taken up by the -portal vein and brought to the liver. When the latter is in good -condition so much the better for us, but when they arrive in too large -quantities, or when the liver is more or less degenerated, as in old -people, drunkards, gourmands, etc., then trouble arises. - -When the number of bacteria in the intestines is much greater than -usual, certain dangers arise from such a condition, as thereby the -immigration of bacilli into the bile-duct is facilitated causing -inflammation of the gall-ducts and gall-bladder, and subsequently -gall-stone disease. Further consequences of such a condition may be the -closure of the bile-duct, and then no bile can reach the intestines. The -presence of bile, however, is very important, for, according to current -opinion, this exerts an influence on the checking of putrefaction in the -intestines. Bile is a natural antiseptic of great efficacy, and has also -a stimulating effect on the nerves of the intestines, promoting their -peristaltic movements. - -It would, therefore, greatly interfere with the useful work of those -organisms normally present if we permitted the formation of enormous -quantities of bacteria, especially of such as are harmful to us; so we -must endeavor to eliminate them and not give them the opportunity to -turn against us, and we must do all in our power to keep the peristalsis -of the bowels in good working order so as to prevent any stagnation of -their contents, as such a stagnation, in addition to favoring the growth -of bacteria, also facilitates the development of auto-intoxication. Even -if it is true that most of the end-products of proteid food in our -intestines, like indol and skatol, are not able to produce severe -poisoning if injected into other animals; still there is no doubt that -in medical practice not infrequently cases are observed where the -retention of all these products together results in very grave -conditions. Thus Ewald[212] has published the case of a woman who, for -about a month, retained the contents of the bowels and in consequence -presented a serious condition of intoxication; after eliminating a large -quantity of fæces—pitch dark—she recovered and the symptoms of -intoxication disappeared. Senator also published a very interesting case -of auto-intoxication with hydrothionuria. - -Footnote 212: - - Ewald: “Die auto-intoxication,” Berl. klin. Wochenschr., No. 7-8, - 1900. - -We often have occasion to note cases of persons having no bowel action -for two to three days, who then complain of headache, loss of appetite, -and various nervous symptoms, neurasthenia, etc., all of which may, -perhaps, be regarded as of reflex origin; but when we see in such people -a yellow or yellowish-gray complexion which, after a good purge, resumes -its clear condition, clinically, we regard it as auto-intoxication. - -Even if, as already mentioned, most of the elements of albuminous -catabolism are not toxic if injected into animals, still, occasionally, -toxic products can be formed, such as cholin and neurin, which come from -the former. These elements arise from decomposition of the lecithin, -which, of our various foodstuffs, is contained in the greatest quantity -in eggs; and these substances can provoke serious nervous symptoms. In -such cases there is, of course, a stagnation of long duration of the -bowels, but such a condition as the latter can arise without a stricture -or obstruction, although these are the most frequent causes. Another -toxic product is the pepto-toxin of Brieger. - -Stagnation takes place in sluggish bowels. As a general rule, fæcal -movement is caused by peristalsis of the intestines, which consists of -circular contractions of the bowel by which the contents are propelled -toward the end of the same; besides these movements there are also -pendular or vermicular contractions of certain parts of the intestines; -all these movements also assist the admixture of the chyme with the -juices of the intestines. All these contractions are caused by impulses -from the nerves which lie in the walls of the intestines, the plexus -myentericus; they can also be provoked by impulses coming from the -central nervous system. - -The nerve ganglia that lie in the walls of the intestines can be -influenced mechanically by the contents of the intestines, when such are -bulky, and also when they are fermenting; therefore, the bacteria, by -promoting fermentation, also aid in peristalsis. The bulky condition of -the bowel contents can be best induced by food of the vegetable kingdom -through its cellulose contents, of which tissue the cells of plants or -fruits are largely formed. When these irritating agents act on the nerve -filaments in the intestines, the bowel will contract and expel its -contents. - -But when food contains no irritating substances and is easily -assimilated without forming _residues_, or when the innervation by the -vagus is sluggish and the peristaltic movements are slow, the contents -of the intestines can remain longer, especially in the haustra of the -intestines. It may be that the bowels move every day, but that does not -prove that everything in the intestines has been expelled therefrom, for -some amount of fæces can yet remain in the haustra of the intestine even -for many days; so that in such cases there is still a constipation of -one part of the bowels. We have observed, personally, and on patients, -that, after a good opening of the bowels, when a purge is given—for -instance, directly after a meal—a short time afterward there has been -another copious discharge that had evidently remained behind. Thus, no -doubt a retention of fæces, and sometimes a condition analogous to -auto-intoxication, can be caused in people who have the bowels opened -every day, although not to the extent of those having obstruction or -habitual constipation. - -To avoid such a condition a good purge should be taken at regular -intervals, say once a week, even by persons who have a movement daily, -in order to eliminate matter which may have remained. It will not be -necessary, naturally, to use a too powerful purgative, but one adapted -to the necessity of the case; taking, as a rule, such a purge as will -act a little better than the ordinary bowel movement, and graduated -according to the strength of the person so using it. - -Before closing this chapter we must also briefly insist upon the -importance of the fact, that the secretions of the intestine and of its -glandular annexes have also an anti-bacterial and antitoxic action. Very -important is the rôle of the bile for the disinfection of the intestine, -as it contains two acids, the glycocholic and taurocholic, which possess -highly anti-fermentative properties. As already mentioned, the bile also -assists in the assimilation of fat, and also exercises a stimulating -action on the peristalsis of the intestines. - - ------------------------------------------------------------------------- - - - - - CHAPTER XVIII. - - ON THE PREVENTION AND TREATMENT OF HABITUAL CONSTIPATION. - - -WE all know from physiology that the expulsion of fœcal matter from the -intestines takes place in such a manner that the contents therein act as -a kind of _extraneous_ body with stimulating action upon the walls of -the intestines and the plexus myentericus contained in the same. -Consequently there follows a contraction of the walls of the intestines, -and their contents are expelled. All nerves, the plexus myentericus -included, are under the control of the central nervous system, which -creates motor impulses through the medium of the pneumogastric (vagus), -or may cause a check to the peristaltic movements through the -intervention of the splanchnic nerves. - -Thus, as we see, different agencies influencing the central nervous -system, like strong emotions, shock, etc., may cause an irritation of -the pneumogastric, the motor nerve of the intestines, and thus occasion -a movement of the bowels. Different toxic products may act also upon the -pneumogastric; strong motor action of the intestine with diarrhœa may -also be caused by the abundant secretion of the thyroid gland, as in -Graves’s disease, where an excess of toxic matters of the thyroid gland -are secreted. - -In the same way we can also produce diarrhœa if we give thyroid extracts -in too abundant quantity; but giving the same in more moderate doses -will effect an improvement in the peristaltic movements. - -That the thyroid gland has a controlling influence on the innervation of -the intestine is evident from the fact that, when the thyroid is -degenerated, the bowels are very sluggish. Under such conditions we -often find very stubborn constipation; but when we administer to such -persons thyroid extracts for a given time, we note a considerable -improvement of the bowels, which can even go to the extent, if too -excessive doses be given, of causing diarrhœa as already mentioned. - -In addition to the thyroid gland, there are other ductless glands which -seem to influence the peristaltic movements by acting on the splanchnic -nerves, and these are the sexual glands. In women they are frequently -altered. Dysmenorrhœa, amenorrhœa, and other troubles are frequent, and -constipation is a typical symptom of such conditions. This may also -serve to explain why women are more often constipated than men. - -But the alteration of the sexual glands can also cause constipation in -men, if we may draw the inference from the great frequency of -constipation in diseases of the prostate gland, which to some extent may -be in relation with the subject with which we are now dealing. - -In order to avoid constipation we must therefore observe a careful -hygiene of the thyroid, and also of the sexual glands, following the -advice we offer in special Chapters XVIII and XLVIII. - -Besides constipation, as above, from the central nervous system, the -same may be caused through the lack of a stimulation which may come from -the intestinal contents. As we have already seen, the peristaltic -movements of the intestine and the expulsion of fæcal matter take place -through the stimulation of the nerves in the intestinal walls by the -intestinal contents, which act either mechanically or by the irritation -which their fermentation causes. - -To prevent constipation we must take such nourishment as will act in a -stimulating way, either mechanically, owing to its bulk, or by the -fermentation it causes. In order to have good bowel movements we must -create them, and this is best done, not by a diet of meat and finely -ground cereals, which are absorbed with scarcely any residue to effect -the purpose, but by one of vegetables and fruit, which contain cellulose -in the largest quantity, this substance forming the framework of the -structure in which the cells are imbedded; it constitutes the wall of -the cells. This cellulose provides us with the best residue from food, -which, if present in large quantities, will exercise a mechanically -stimulating action on the intestinal walls. - -Vegetables are thus a valuable aid in the prevention of constipation, -and of these the following are the best: spinach, carrots, green beans, -and boiled lettuce, taking into consideration their action as laxative -food. Cabbage also acts well as a bulky food. - -Graham bread and brown bread in general, and in particular a special -kind, called “cellulose” bread, are also very good agents with which to -prevent and to treat habitual constipation. Some breads, as various -kinds made from bran, are so coarse that, to a certain extent, they may -be considered as setting up a kind of internal massage of the -intestines. - -Not only vegetables, but fruits, by reason of the fruit sugar and acids -they contain, may also prove laxative if taken in given quantities. -Fruits may be taken stewed, as a compote, or baked, as for instance, -apples; they may also be taken _au naturel_ if the condition of the -stomach permits. Of compotes the most laxative are plums, prunelles -(sour figs), and apples; also pineapples, cherries, and various berries, -all of which may also be partaken of in the form of a mush or purée, to -great advantage; also fruit juices and fruit wines, if free from -alcohol. - -Of fresh fruits, grapes and, according to our observation, pineapples -also undoubtedly have the best laxative quality, as also have green -figs, which can be taken regularly as a preventive against constipation. -Figs when dried, especially the so-called Olympia figs from Smyrna, or -the California variety, are also most beneficial, their laxative -properties to a certain extent being probably due to the seeds which -they contain, which serve as a means for intestinal massage. - -Orange and grape-fruit, taken on an empty stomach in the morning, may -also have a laxative effect, due probably to the quantity of fruit acids -they contain. - -We sometimes hear patients complain of constipation after partaking of -milk. According to our experience, this is more often the case when -boiled milk, heated above 60° C., is taken. On the other hand, we -believe that when uncooked milk is taken it may act as a laxative in -many persons, due to the action of milk-sugar and acid. Acidulated milk -may have this property in a greater degree, as also may buttermilk, and -especially whey; all of these are, on the whole, good laxatives. - -The diet of those suffering from habitual constipation should be as -follows: In the morning, on rising, take a glass of cold water and an -orange. For breakfast, one or two oranges or several slices of fresh -pineapple, or, in countries where one is so fortunate as to obtain such -delicious and wholesome fruit, a grape-fruit; after that one or two soft -boiled eggs, cereals, Graham or brown bread, or one of the kinds of -coarse breads rich in cellulose, and fresh butter thickly spread on the -bread (if the stomach is good). Then follow with orange marmalade or -purée of prunes, ending with some grapes. Honey (another excellent -laxative) may also be added. Two glasses of milk or more, for those who -can stand it; in fact, as much as they desire. For dinner, the following -is recommended: Roast or boiled meat, two sorts of green vegetables (by -preference spinach), French beans, carrots, boiled lettuce, one course -of stewed compote of fruit, and finish with dessert of grapes, figs -(dried or green), or preserved plums (California or Bordeaux). For -drink, mineral waters, such as the various light American kind, either -mixed with wine or alone. Alkaline waters, such as Biliner, Vichy, etc., -if taken very cold, may also contribute to the laxative action. For -supper, something akin to breakfast. As we shall point out in the -chapter on the hygiene of food, we recommend meat only once a day. - -We are confident, from experience gained with our own patients, that -people who follow such a regimen will have an easy bowel movement daily, -and will thus avoid those dangers which are connected with the habitual -use of laxative drugs. - -For those who, in spite of such a course of diet, have sluggish bowels, -we recommend massage and electricity, and also certain hydrotherapeutic -procedures. The method of carrying out such must be obtained from the -special hand-books written for that purpose; but we would merely mention -here that massage should preferably be performed by one belonging to the -medical profession, or, at any rate, by one trained in the Swedish -system. - -Electricity may be applied by either galvanic or faradic current, both -of which give excellent results. - -Hydrotherapeutics must not be overdone or harm may result. We find that -a compress of lukewarm water (Pressnitz compress) worn round the abdomen -and back through the night, produces good results in many cases, if the -diet is, at the same time, appropriate. - -For those who only suffer occasionally from constipation, as, for -instance, after a railway journey, it is an easy and always efficacious -method (if there is no inveterate constipation) to take a suppository of -glycerine and introduce it into the rectum. After only ten to fifteen -minutes interval there may be a copious evacuation. - -In persons where the dietetic and above-mentioned mechanical remedies -have not proved effective, irrigation of the rectum and intestines -should be employed. We would not, however, advise the constant use of -this method, as torpidity of the intestine might result if practiced -daily (see chapter on the hygiene of the intestines). - -In cases where there is a more serious degree of constipation a little -soap, or olive or castor oil, should be added to the water, together -with a little soda to assist the formation of an emulsion. - -Enemata possess the advantage of having nothing to do with the stomach, -and thus this important organ can be spared much irritation which, -unfortunately, cannot be avoided when other purging remedies, such as -drugs, are given, all of which must pass through the stomach when taken -by the mouth. If we find it necessary to resort to laxative drugs by the -mouth we must first try such drugs as are least irritating to the -stomach and intestines, and foremost among these is rhubarb, which can -be taken in the form of a compote as well as a drug. To this it is well -to add magnesia and bicarbonate of soda. We should, if possible, -administer only the mildest purgatives, and, therefore, if rhubarb is -not effective, we may give cascara sagrada, or the pulp of tamarind, -which is, moreover, pleasant to take; but the action is not so -pronounced as in the case of cascara sagrada (rhamnus purshiana). - -Before resorting to drugs, however, we think it would be better to try -the natural mineral waters, and only when these fail should we fall back -on drugs. - -There are two kinds of mineral waters, each varying in its action: 1. -The milder acting water, of a laxative nature. 2. Stronger water, with -drastic action. Of the former we will mention those which are employed -for several weeks continuously for a regular cure: Germany: Kissingen; -Austria: Carlsbad; Marienbad. As the author of this book is himself a -practicing physician at one of these springs, he thinks it more becoming -to pass over in silence which of these waters is preferable. Each of -them, as also many others not mentioned for want of space, have their -undoubted merits. A teaspoonful of Sprudel salt, taken in a glass of -lukewarm water in the morning on an empty stomach, will give excellent -results; but it should not be taken every day for any length of time, as -otherwise, as with all other drugs if taken continuously, it may deaden -the excitability of the nerves of the intestines, and success depends -upon keeping these nerves in such a condition that they may respond, -upon a light stimulation, with a contraction of the intestinal walls and -expulsion of the fæcal matter. - -Of the strong mineral waters with drastic action, there are several -excellent springs in America, some of them surpassing many of the -European mineral waters. In Europe there are in Hungary: Hunyadi-Janos, -Ferencz-Jozsefforrás, etc.; Spain: Rubinat, Villacabra-Loeches, etc.; -and elsewhere a number of such springs. As all are natural remedies they -should be used in preference to drugs when the intestine does not -respond to mild laxatives and a strong whip is needed. In my opinion -they are less fitted for every day treatment, though well adapted for a -thorough cleaning out of the intestine to get rid of stagnant matter -(see Chapter XIX). - -These strong, drastic, natural waters act by causing a transudation into -the intestine, creating a condition somewhat similar to a catarrh, but -in a more benign way. - -Briefly, the best and most rational treatment of sluggish bowels is by -stimulating the intestine by means of an appropriate diet which, at the -same time, tends to ward off old age. - - ------------------------------------------------------------------------- - - - - - CHAPTER XIX. - - HYGIENE OF THE INTESTINES. - - -AS the means by which we are able to keep the intestines in good working -order are of the same efficacy also for the stomach, all that is -necessary to mention in this chapter about the intestines will apply -equally to the hygiene of the stomach. The same applies also to the -pancreas, so that it is unnecessary to treat of its hygiene separately. -It is also our intention in this book to mention only the hygiene of -those organs which are able to rid the body of toxic products, as it is -mainly by their degeneration that premature old age is brought about. - -There is scarcely a serious disorder of the stomach without an attendant -alteration of the intestinal functions. All the different agencies that -are dangerous to the stomach will also prove dangerous to the -intestines. We have mentioned several of these in the chapter on food -and the hygiene of eating, where we have pointed out that defective -mastication is very deleterious. Food introduced into the stomach passes -into the intestines, and if it reaches these insufficiently masticated -it will present great difficulties for the penetration of the intestinal -ferments. Not only will it not be well digested, but as the different -ferments cannot well penetrate these compact masses they will putrefy, -thus considerably increasing the natural fermentation, in consequence of -which a great amount of toxic products and a considerable irritation of -the intestinal mucous membrane will result, which may subsequently cause -disease. By thoroughly masticating everything we eat, we are not only -safeguarding the condition of the stomach, but also that of the -intestine. - -The integrity of the functions of the intestines is of supreme -importance, for it is here that absorption and assimilation of most of -our food occurs. If our intestines are not in perfect order we shall -soon waste and dwindle away, even within a short period, and sometimes -very rapidly. Thus if we wish to retain our strength we must treat the -intestine with the greatest care. This is especially the case in old -age, for then an atrophy of the glandular mechanism of the digestive -tract, stomach, and intestines, takes place. Thus old people will not be -able to assimilate nourishment to the same extent as younger ones; they -will lose a portion of its nutritive value, and it will become more and -more difficult for them to completely digest their food. To such people, -therefore, it will be necessary to give food in a form that is easily -absorbed, preferably in liquid form; it would also be desirable to give -them their albuminous food in a predigested and soluble form. In -Germany, especially, are used a considerable number of so-called -“Nährpräparate,” a nutritive preparation which contains albumin in the -form of albumose, which naturally can be assimilated easier; there are -also carbohydrate preparations in which the starch is transformed into -dextrin or maltose. There is a legion of such preparations, but it would -lead us too far to enlarge on them by a longer description. They are -produced from proteids, many of them from fish, or from blood, or from -eggs; also from milk; while others consist of finely ground preparations -of wheat, oatmeal, barley, rice, arrowroot, sago, tapioca, buckwheat, -Indian corn, etc. As aged persons have greater difficulty in -assimilating in their intestines and stomach food in its natural state, -the use of the best of these predigested preparations would certainly be -advisable in order to insure a healthy condition of the intestines and a -prolongation of life. The last mentioned carbohydrate preparations -possess also the great advantage of preventing an excessive putrefaction -of the intestinal contents with its harmful consequences, which tendency -is always greater with albuminous food, starchy foods in large quantity -tending, as already stated, to produce acid fermentation in the -intestines by which many products of albuminous digestion can be -destroyed. Against these poisons formed in the intestinal tract we -possess a natural defense in certain ductless glands, the thyroid and -liver, which are degenerated in old people; therefore carbohydrate is -the best for them. - -The prevention of intestinal putrefaction is, however, equally important -in younger people. As Combe proves, we can avoid this by the use of -certain kinds of food, especially carbohydrates and fruit, and by other -substances producing lactic acid, which is, indeed, the best -disinfectant for the intestines. The great benefit of various kinds of -sour milk generally has been pointed out by Metschnikoff and his -disciples. Among the causes of old age this savant attributes an -important rôle to the processes of putrefaction in the intestines, and -to avoid this he recommends the use of a certain kind of sour milk -produced by fermentation by a number of microbes, including the -Bulgarian _Bacillus maya_. - -That certain kinds of food exercise poisonous effects when introduced -into the intestines is a matter of common observation. Thus, in not a -few cases, fever, accompanied by cutaneous eruption, may be witnessed -after partaking of strawberries or oysters, and especially after eating -meats (notably sausages) which are in a state of decomposition. Severe -cases of poisoning, even resulting in death, have occurred; and in -Germany there have been, from time to time, regular epidemics after -partaking of sausages in the above condition. - -Of course everyone partaking of such poisonous food will not become -poisoned as this is prevented by the action of such glands as the -thyroid and liver, whose function it is to preserve us from such -effects. People in possession of healthy sensory organs,—eyes, nose, and -tongue,—will be enabled to tell whether meat is in a fit condition to be -eaten or not; but frequently we cannot discover by our senses a state of -decomposition when such is not in an advanced stage, and if such food is -taken regularly and in large quantities the great number of microbes we -thus introduce into the intestines will poison us slowly but surely. - -Such poisonous microbes thrive and multiply very well in the alkaline -contents of the intestines, but the growth of such dangerous bacteria -can be greatly hindered by the introduction therein of acid substances, -especially lactic acid. It has been observed by several authorities, -such as Grundzach,[213] Schmitz,[214] and Singer,[215] that lactic acid -decreases intestinal putrefaction, and also the conjugated ether -sulphates in the urine. - -Footnote 213: - - Grundzach: Zeitschrift für klin. Medicine, p. 79, 1893. - -Footnote 214: - - Schmitz: Zeitschrift für Physiologische Chemie, vol. xix, 1897. - -Footnote 215: - - Singer: Therapeutische Monatshafte, p. 441, 1901. - -Professor Metschnikoff, of the Pasteur Institute in Paris, deserves -great credit for having insisted on the importance of introducing -certain microbes into the intestines for the purpose of transforming the -sugar of their carbohydrate contents into lactic acid, and thus causing -the disinfection of the intestines by destroying the noxious germs and -hindering their development. For this purpose the so-called Bulgarian -bacillus can best be employed, as it is able to transform the cultures -of pathologic microbes in the intestines into a beneficient growth that -is quite harmless. - -This Bulgarian bacillus is well known because of its action in producing -the sour milk “yoghurt” of the Bulgarian population, to the use of -which, according to Metschnikoff, is due the very large number of -centenarians to be found in that country. - -The action of the lactic bacilli has been proved by the experiments of -Dr. Herter, of New York,[216] who discovered that by the introduction of -large quantities of these bacilli into animals their intestinal -putrefaction was diminished. - -Footnote 216: - - Herter: Brit. Med. Jour., p. 1898, Dec. 25, 1897. - -Dr. Michel Cohendy[217] has performed similar experiments on himself. -After taking for twenty-five days his usual diet and subsequently noting -the degree of his intestinal putrefaction, he took pure cultures of a -lactic bacillus, extracted from “yoghurt.” For more than two months he -continued to take large quantities of these bacilli (280 to 350 grammes -a day). Not only during the course of the experiment did the urine -exhibit evidences of a diminution of intestinal putrefaction, but this -continued for seven weeks afterward, and he arrived at the conclusion -that the lactic acid fermentation due to this bacillus was able to -hinder the putrefying action of the microbes developed from the meat he -had taken during his experiments. He, therefore, comes to the conclusion -that it is unnecessary to discontinue meat food for the suppression of -intestinal intoxication if lactic bacilli be taken therewith. - -Footnote 217: - - Cohendy: C. R. de la Société de Biologie, Mars 17, 1906. - -Dr. Pochon, assistant to Professor Combe, of Lausanne, continued upon -himself the experiments of Dr. Cohendy. For several weeks he took sour -milk (lait caillé) which was prepared from cultures of pure lactic -microbes, and he found positive proofs of the checking of intestinal -putrefaction thereby.[218] In those, therefore, who are able to procure -and use a pure preparation of lactic bacilli, intestinal putrefaction -will be greatly diminished. But even when we cannot obtain these -preparations we can follow a diet that will tend to develop lactic acid -fermentation. This can be brought about by taking carbohydrates in large -quantities, especially those which are very rich in sugar, at the same -time taking milk, particularly sour milk. - -Footnote 218: - - Combe: “L’Auto-intoxication intestinale,” Paris, 1906. - -It is an absolute fact that in those who are addicted to a diet of -carbohydrates, intestinal putrefaction is diminished, owing to the -formation of lactic acid from the fermentation of the milk-sugar which -is contained in such carbohydrates. - -Intestinal putrefaction is enhanced by the alkaline contents of the -intestines; it can, therefore, be checked by various agencies that -diminish the alkalinity of the intestine, such, for instance, as by -lactic acid, just referred to. Fatty and acetic acids also effect this; -likewise fatty food, which promotes the formation of fatty acids. Cheese -may produce fatty and also lactic acids; wherefore it is of value to -combat putrefaction in the intestines. Of the further benefits of cheese -as an article of food, we make mention in the chapter on the hygiene of -food; we also state there that it is unsuitable in those cases in which -the intestines are not in thorough order. - -Great care should be exercised in the quality of the food. The freshness -of various foods is of the greatest importance to the intestines, since -the main function of the stomach is principally a mechanical one, -serving to reduce the food into a convenient form and carry it to the -intestines, ready to be there prepared, through the influence of the -intestinal juices, into a condition fit for absorption and assimilation. -During this process the food is being reduced to its simpler elements, -and the more noxious substances are being freed to commence their -baneful activity. These substances first of all create an inflamed -condition of the intestines; then, being absorbed into the blood, they -cause a general intoxication. Fortunately they are not frequently -absorbed, and thus their injurious effect is limited to the intestine. -Among other such injurious foods we may mention fish and oysters, -sausages and meats that are in a state of decomposition; fruit that is -unripe or unsound; and canned food in which certain drugs are used as -preservatives, such being poisonous in varying degree, examples being -salicylic boracic, and sulphuric acids, etc., and at times even the -terrible poison, verdigris. Fresh food should always be preferred to -canned food, or to food preserved in other forms for too long a period -(see also chapter on the hygiene of food). - -The stomach, and intestines also, can frequently suffer damage from ice -cold drinks, especially if taken habitually and in large quantities. As -already mentioned in the chapter on the hygiene of the kidneys, we -should never forget that every sort of food or drink must pass a series -of delicate epithelia of our noblest organs, which can be injured by -sharp and poisonous substances with which they come in contact. - -More injurious is the action of various kinds of noxious food, -especially if putrid, which remain for a long time in the intestines, -thus creating a chemical laboratory constantly preparing poisons. Even -the residue of less harmful foods, especially albuminous, even if of -good quality, when taken into the body, can become deleterious if it -remains too long in the intestines. It will, therefore, be a part of the -highest wisdom to exercise care in having these highly important organs, -on which all our nutrition depends, in thoroughly good working order by -keeping them clean and by removing stagnant material. We have already -designated the best way to effect this in a previous chapter, and we -desire here to say a few words on the abuse of, and great dangers -arising from, remedies constantly prescribed for constipation. - -We have insisted in the foregoing pages on the necessity of a daily -bowel movement, and have stated that appropriate food is the best way to -attain this. Food that leaves no residue, like meat or finely ground -cereals, is incapable of producing a stool. Hence, as Schmidt has -pointed out, constipation is often caused by the food being too -completely absorbed. Strassberger, by analyzing and counting the number -of bacteria in the stools, found that certain cases of constipation were -caused by a diminished fermentation in the bowels. Lohrisch has found -that in persons whose intestines possess a marked power for absorption -there does not remain in them a residue sufficient for the action of the -bacteria, and thus there will not be a sufficient fermentation to act as -a stimulant to the intestinal walls to cause them to expel their -contents. Uncooked cold milk (especially buttermilk, whey, sour milk, -“yoghurt,” kefir, etc.), and dishes containing vegetables and fruit, -grapes, puree of prunes, marmalade of oranges, and brown bread (Graham, -Pumpernikel, etc.) should produce a movement of the bowels every day in -a normal man or woman. There are, however, many exceptions to this, -especially in the case of women, caused either by previous errors in -diet, or by negligence in answering at once the demands of the bowels -for an immediate evacuation, and also, very often, by an abuse of -purgatives. All this is, of course, aggravated in those in whom the -innervation of the bowels, which is controlled by the splanchnic nerves -and the vagus, is altered by the degenerative condition of certain -glands which influence these nerves: the sexual organs and the thyroid. - -These alterations are far more common in women, as frequently mentioned -before, as their sexual glands and thyroid are so often irritated by -physiological and pathological processes peculiar to her sex, and which -so frequently recur during the life of a woman. It is a fact that most -of the diseases of the female sexual mechanism are followed by -alterations in the intestines, due, in part, to their close proximity to -the pelvic organs, but, in a greater degree, to the intimate relation of -these regions to the nerves that control the intestines. The same is -true to a lesser degree in man, so that after troubles with the -prostate, or after chronic gonorrhœa, a regulation of the bowels is an -important matter, constipation being usually very obstinate in such -cases. - -In addition to this sluggishness of the bowels in females, owing to -anatomical and physiological causes, there may be associated faults -arising from a bad habit. Instead of paying special regard to the innate -tendency toward constipation and endeavoring to have a movement every -day, many women, especially young girls, neglect this by even resisting -the demand of the intestine to be evacuated, and deferring this most -important function to the following day, or even later. Such a course -necessarily lowers the vitality of the intestinal nerves and muscles. As -soon as such a nervous impulse is felt, we must promptly act on it; -should we not do so a greater nervous and muscular effort must follow, -and, if even then we neglect to obey the call of Nature, after several -such useless efforts the nerves and muscles of the intestines will -relax, particularly if such a foolish practice be often repeated, for it -is quite natural that such an intestine will not respond to the -stimulation by the pressure of its contents upon the nerves, and its -muscles will not contract to expel the fæcal contents, as in normal -people. - -Unless, therefore, from force of circumstances, it is impossible, we -must at once respond to the first admonition of the intestines, and not -exhaust the vitality of its nerves and muscles by exposing them to -unnecessary efforts at our own expense. Some people are so impressed -with the importance of immediately answering such a call that they will -forego the most urgent business on that account. I know an authentic -case of a member in the profession—a great surgeon—who, a few years ago, -was urgently summoned to a member of the highest nobility who had met -with a hunting accident. Unfortunately for the patient the call came at -just such a moment as we have been speaking of; true to his principles, -he did not arrive immediately, but only after having fulfilled the -execution of this important part of the hygiene of his intestines, and -the patient lost his life. - -Happily such an instance is of the rarest occurrence in our profession, -for we always ignore our own chance for a long life in favor of our -patient’s, which is fully proved by the fact that, of all professions, -the physician’s life is the shortest. - -Corsets as worn by women contribute to develop in them ptosed -bowels—gastroptosis and enteroptosis—which can easily arise after -pregnancy; the strength of the intestinal muscles becomes still more -diminished and constipation is the consequence. - -It is not to be wondered at if women, and men also, in cases where the -diet alone does not bring about an ordinary movement, should resort to -drugs, several of which we have mentioned previously. At first, even the -mildest drugs will act; but, unfortunately, after a time the intestine -becomes accustomed to them and they cease to act. Stronger drugs are -then resorted to, such as often contain aloes, which, besides injuring -the stomach, act in a very irritating way on the intestines; these -respond by a very strong action, causing copious stools accompanied by -colicky pains. But it is in the nature of things, as we have observed -holds true in any organ, that overstimulation of any function is -followed by its exhaustion; thus the nerves and muscles of the intestine -get over irritated and relax if obliged to overact. After a copious -evacuation caused by strong drugs we, therefore, find a still more -obstinate constipation than before. Stronger and stronger drugs are then -used until there is a complete breakdown and ruin of the intestinal -innervation and muscular action. We must, therefore, commence first with -a suitable diet, then use mild drugs if necessary, with massage and -electricity, as already described. - -Intestinal enemata are also beneficial, but if a large amount of liquid -be used the muscular walls get too greatly dilated and may lose their -elasticity and vitality, particularly if strong drugs be used in such -enemas. - -Many women suffer from habitual constipation by reason of their drinking -but little water, especially if the food they take contains little -fluid; the fæcal masses become solid and coagulated, and thus their -passage in the intestine toward the anal exit becomes more difficult, -whereas by a sufficient quantity of liquid, such as water, this movement -will be much facilitated; and that this is an important consideration is -quite evident in the case of women who have a tendency to lethargic -bowels. Such a thickening of the fæcal masses occurs particularly in -certain parts of the intestines, such as the cæcum, the ascending colon, -and the sigmoid flexure. In these parts the fæcal matters often become -detached, accumulate, and easily get condensed. They may remain there -sometimes for longer periods, which can easily be proved by experiments, -giving bismuth by mouth and then examining the abdomen by means of the -Roentgen rays. - -It thus happens that people, under the impression that a good daily -stool has produced a clean bowel, still have a residue, and this can -instantly be seen by removing the same by purging drugs. We, therefore, -recommend the weekly use of a reliable purgative, such as bitter water, -thus cleaning the bowels of all residue, which frequently remains in -deep haustra of the intestines, as in Barlow’s disease. - -The stagnation of fæces around the cæcum may also facilitate the -development of appendicitis, this being frequently due to neglect of the -hygiene of the intestines. It is also one of the commonest diseases, as -we will show in the succeeding chapter. - - ------------------------------------------------------------------------- - - - - - CHAPTER XX. - - HYGIENE OF THE INTESTINES—A FEW REMARKS ON THE CAUSE AND PREVENTION OF - APPENDICITIS. - - -APPENDICITIS, in these days, is one of the most frequent causes of an -unexpected death. As this work is designed to set forth the means by -which we may prolong life, it is desirable not to miss the opportunity -of offering a few remarks, in connection with the chapters on the -preservation of the intestinal functions, upon the cause and prevention -of an intestinal disease by which particularly young and promising lives -are frequently cut off. - -In the previous chapters we saw that the cæcum was one of the places of -selection for the stagnation of the fæcal contents in the intestinal -canal. As the pressure of such fæcal matter in the cæcum and colon is -greatest toward the appendix the contents may go more easily into than -away from the appendix, and particularly so when, from a long rest in -the cæcum, they are thickened. The return of fæcal matter from the -appendix is often hindered by a spindle-shaped thickening at the -junction of the appendix with the cæcum, which presents the appearance -of a narrow bridge. - -This thickening of the mouth of the appendix is the consequence of the -very close contact of the psoas muscle, upon which, in many people, the -appendix lies, so to speak resting upon it. This has been shown by -Offerhaus[219] (a surgeon in the Hague Hospital) to be the case in 62 -per cent. of normal men. - -Footnote 219: - - Offerhaus: Proefschrift, “Eine mechanische oorzaak voorhet ontstaan - van Appendicitis,” Leiden, 1901. - -In certain movements, such as running or cycling, the psoas is -continually pressing against the appendix, and it is natural that such -continuous pressure against this organ will in time leave a permanent -mark, which is, indeed, seen in many cases of appendicitis. After a -certain time a circumscribed segmentation will be visible on the parts -of the appendix which are in contact with the psoas, and later this -becomes so marked that a circular kinking results, establishing the -narrow bridge to which we have already referred. - -It is logical that the thicker the appendix, the more pronounced will be -the marks produced by the pressure of the psoas. The average size of the -appendix, even in the adult, is that of a somewhat slender worm, from -which is derived the name “vermiform appendix.” But when there is -stagnation of the fæcal contents in the appendix, and especially when -the thickened fæcal matters are of such hard consistency that a hard -stony concrement, such as the coprolith is formed, then the appendix -sometimes assumes quite a comparatively large size. We saw the case of a -girl of 16, operated on by Dr. Offerhaus at the Hague (details of which -case were published by him), in whom the appendix was of the size, in -circumference, of a large thumb. - -In such large appendices the marks of the psoas will, of course, be more -pronounced, and frequently the narrow bridge referred to will develop. -This is caused by the appendix being further attached to the intestines -where, owing to the narrow connecting bridge, it is unable to evacuate -itself, and so grows larger and larger, the mischief thus constantly -increasing. - -It is also evident that the nutrition of an organ whose blood-supply is -mechanically interfered with, as in the case of the appendix by its -close contact with the psoas, as described above, must necessarily be a -precarious one; and it is a pathological fact that an organ which is -badly supplied with blood is also more liable to disease, because the -insufficient supply of blood causes a diminution in the number of -phagocytes thereby weakening the defense of the organ against infection, -as explained in Chapters III and X. Consequently the microbes easily -prevail, particularly in a portion of the body like the intestines, -where they normally exist in such great numbers. - -By the foregoing we have not only shown the cause, but also the -principles for a rational prevention, of appendicitis. As we have seen, -the starting point of all mischief is the close proximity of the psoas -to the appendix, and the occasional cause is constipation, with -stagnation of the fæcal contents. The best preventive against -appendicitis consists in avoiding both causes, which, however, is only -possible in the latter case by adopting all those measures we have -mentioned in the chapter on the treatment of constipation. - -The first cause, the close contact of the psoas with the appendix, can -certainly not be prevented; but what we can do is to avoid all movements -by which the psoas is unduly pressed against the appendix. This can be -done by avoiding those exercises in which the psoas is brought into -frequent contraction and then pressed forcibly against the appendix: for -instance, running, cycling, etc. The young lady, already referred to, -with the large stone in the appendix, indulged freely in such sports. -The habit of sitting with one leg crossed over the other should also be -avoided. - -We must now, however, determine who those persons are in whom such a -condition exists. They are those who frequently complain of pains in the -appendicular region, usually after quick walking or running, and -especially after cycling, and at times even without these; but in this -latter class the pain is milder. In order to make an exact diagnosis -whether such pains are caused by pressure of the psoas upon the -appendix, we must tell the patient to lift the right leg high and we -then press with the right hand against the thigh. If there is a latent -form of appendicitis due to the above-named anatomical relations, then -the patient will experience pain when we press with the left hand upon -McBurney’s point. By this means appendicitis can be diagnosed while it -is still in an early stage, and the life of many may be saved before it -is too late, and we know only too well how rapidly this treacherous -disease can lead to a premature death. - -Having made the diagnosis in the above-mentioned way, we should prohibit -all active movements, especially running, cycling, etc., and take -special care to have a daily bowel movement by the use of a suitable -diet and those other means previously mentioned. - -Pain in the appendicular region may be of a very pronounced character, -and yet there may be no appendicitis, for it may be caused by -inspissated fæces. The presence of stagnating fæcal matter often induces -the formation of gas, and by the distention so caused the intestinal -nerves are irritated and thus pain occasioned. - -We can distinguish between appendicitis and pains following colics, -caused by flatulency, by giving carminatives, such as the decoction of -different carminative herbs called Aqua Carminativa Regia, which is much -used in Germany and Austria, where it is an official preparation of the -Pharmacopœia Austrica and Germanica. A few tablespoonfuls of this -decoction will produce free passage of gas, after which, in the case of -flatulent colic, the pain will disappear, especially if we add a -purgative and clear the intestines. Of course, in appendicitis the pain -will not disappear after the use of carminatives. - -Besides the foregoing very frequent causes of appendicitis there are a -few others to deal with, all of which here is out of the question; our -intention is to confine ourselves to mentioning some of the more -frequent causes and not to deal exhaustively with the subject, which can -be found in the various hand-books on surgery. Yet we should like to -mention one cause that is not infrequent, and this deals with the -relation between the tonsils and the appendix. If we examine these -organs histologically, we shall find that both are of the same lymphoid -tissue, and, indeed, some writers go so far as to term the appendix the -tonsil of the intestine. - -Now we can often observe that when one of the lymphoid structures is -changed, the others may follow; and this shows that just as the ductless -glands are in close relation to one another, so also the ductless glands -and the lymphoid structures stand in close mutual connection, as we have -mentioned in previous works, emphasizing the fact that the tonsils are -often much enlarged in myxœdema, Graves’s disease, acromegaly, diabetes, -etc. - -In addition to these intimate relations there are also other causes -arising from the tonsils that affect the appendix. Such is the case when -the tonsils are inflamed and infectious matter arising therefrom reaches -the intestines. The cause of appendicitis from such a source has been -confirmed by the bacteriological examinations of Professors Lanz and -Tavel. Indeed, clinically, we can often see that appendicitis has been, -in quite a number of cases, the result of previous tonsillitis, this in -turn often being caused by the secretion from the inflamed posterior -part of the nose coming in contact with the tonsils, as has been -previously stated. - -Very frequently such a condition exists in conjunction with adenoid -vegetations, and this explains the error into which Delcour has fallen -in his book on the relation of adenoid vegetations to appendicitis, in -which he attributes the immediate cause of the latter to a state induced -by an insufficiency of the thyroid gland. We can often observe that -adenoid vegetations can exist with a good thyroid and _vice versâ_, -although we cannot deny the fact that in children with thyroid -insufficiency adenoid vegetations are frequent. - -It is very probable that the first mentioned causes of appendicitis and -the last named often go together, the one assisting and developing the -other. The unfavorable anatomical position and constipation, together, -offer a very favorable soil in which, through bacterial co-operation -after tonsillitis, influenza, or other infectious diseases, this much -dreaded disease can develop. - -By a slight operation life is often saved. The pity is that such aid is -often invoked too late. - - ------------------------------------------------------------------------- - - - - - CHAPTER XXI. - - ON THE ELIMINATION OF TOXIC PRODUCTS THROUGH THE KIDNEYS. - - -IN the course of this work we have frequently insisted on the fact that -we are being continually poisoned during the processes of life, either -by poisons coming from without into our body through food or drink, or -by toxic substances being formed in our body through defective -metabolism. We have a series of glands with internal secretions which -have properties antagonistic to these poisons, the most important of -such glands being the thyroid, parathyroid glands, adrenals and the -liver, which act by destroying these injurious products. - -The following can now happen: Either these toxic products may be -produced in such enormous quantities that even the increased functions -of these glands will be insufficient to overcome them, or the glands may -not be in a condition of complete integrity. In either of these cases -the bulk of these poisons will be carried to the eliminating organs to -be dealt with, viz.: the skin, the intestines, and the kidneys. - -As we shall see, the skin alone is not able to eliminate more than a -certain portion of these products, even by the additional assistance of -perspiration. In addition to the skin the intestines may also assist the -work of the kidneys, by expelling principally the poisons from the -digestive organs. But only a small portion of the poison circulating in -the blood will be eliminated in this way, especially if there is a lazy -action of these organs. Thus the great bulk of all these products is -carried to the kidneys, which are, indeed, our most important organs for -the elimination of toxic products from the blood. - -It is furthermore important to consider the kidneys because they are -also glands with internal secretion. This is evident from the fact that -uræmia is a condition which is dependent upon the absence of such a -secretion.[220] It is not caused only by the retention of urine and the -urea contained therein, for cases have been noted where there has been -no urine for as long a time as seven days, and yet there was no uræmia, -whereas uræmia rapidly develops at times in spite of an abundant flow of -urine and elimination of urea. Thus, logically, uræmia must be ascribed -to another factor, which can only be the absence of an internal -secretion from the kidneys, which may otherwise perfectly perform their -work. Another convincing proof of this statement is the fact that we are -able to treat with great effect, as we have personally observed, -diseased kidneys with extracts from the kidneys of pigs. We will -demonstrate the action of this in a separate chapter. - -Footnote 220: - - Senator: Loc. cit., and others. - -That the kidneys are glands with internal secretion has been proved -already by Brown-Séquard,[221] Meyer,[222] and other authors, among whom -we will mention as two of the last authorities on this question, -Professor Senator and Professor Hermann Strauss. - -Footnote 221: - - Brown-Séquard: Archives de physiologie norm. et path., p. 778, 1893. - -Footnote 222: - - Meyer: _Ibid._, p. 179, 1894. - -The kidneys, being glands with internal secretion, must then stand in -close relation to the other ductless glands, according to the law -established by us in our previous works. As already mentioned, we have -shown in a communication to the Paris Biological Society, February 25, -1907, that these glands have an intimate relation to the thyroid gland, -and _vice versâ_. Thus, alterations of the thyroid always produce -changes in the condition of the kidneys. These alterations in the -kidneys may, however, not necessarily be based on the intimate relations -between thyroid and kidneys as ductless glands, but may be produced by -the fact that, when the thyroid is degenerated and cannot destroy toxic -products, these poisonous matters will be thrown on the kidneys (the -skin and intestines not being of assistance under such conditions) and -eliminated by them. Naturally the passage of such poisonous products -through the kidneys is liable to produce changes in them, and -albuminuria and hyaline or granular casts may show themselves in -consequence. - -The same may also happen after changes in the liver. When this important -organ is not able to destroy poisons they are carried in increased -quantities to the kidneys, whence their passage will produce albuminuria -and hyaline and granular casts, as has been especially described by such -French authorities as Huchard, Teissier of Lyons, Molière and Gouget, -etc., as occurring in diseases of both liver and gall-ducts. - -The appearance of albuminuria, and even of hyaline casts, must be taken -as a proof of an abnormal condition of the kidneys, and this -notwithstanding numerous authorities who are inclined to regard such an -occurrence in a more lenient way. We hold, with Professor Senator, that -the permanent presence of such elements in the urine is the proof of the -fact that the kidneys are not in a normal condition. Even the -orthostatic albuminuria of quite healthy persons, which, as its name -implies, only occurs when such persons have been standing for a time in -an upright position, has been considered by Senator as an expression of -the existence of certain changes in the kidneys. According to Senator, -the hyaline casts also are not such an innocuous symptom as certain -authorities claim, but they are formed from the degeneration of the -convoluted tubules. This is the most important element of the kidneys, -for the greater part of the solids and toxins are excreted by its cells -from the blood, and besides this function these epithelial cells also -have an internal secretion. The appearance, therefore, of hyaline casts -(which, as Senator found, could be proved under the microscope as having -been formed through degeneration of the epithelial cells) must be -considered as evidence of the loss of the secreting portion of the -kidneys and of the destruction of their most important elements, and can -be found regularly in all the toxic processes that take place in the -body, showing that the poisonous products of these processes have passed -through the kidneys and been eliminated. - -Thus we find albuminuria and casts, and even signs of a serious -inflammation of the kidneys, in different infectious diseases, and even -after tonsillitis; also after other toxic conditions caused by the -secretion of toxic products in the body from certain ductless glands, -such as the sexual glands during puberty and the thyroid gland in -Graves’s disease. Likewise in certain diseases where waste products of -metabolism cause uric acid to be formed in large quantities, as also in -diabetes, where a quantity of other toxic products, besides uric acid, -are produced. - -From the foregoing it is only natural to expect that different toxic -products which are introduced into the organism from without, either in -the food or in the drink, or which result from the decomposition of meat -and alcohol and other stimulants, will also, for the most part, be -eliminated by the kidneys, especially with a dilatory performance of the -other disintoxicating organs. When passing in large quantities, or -sometimes even in smaller numbers, they may be able to irritate the fine -epithelia of the tabula epithelia and also those of the glomeruli, and -produce casts (hyaline ones especially) and albuminuria. After large -quantities of alcohol such a condition can even become permanent if the -other toxin-secreting organs are sluggish. - -In his experiments on animals Penzoldt has produced albuminuria by means -of English mustard, pepper, and particularly radishes, and still more so -after black tea. Gunzburg noted this also in a boy of 13, and Roth in a -child of 3½, in both cases after the use of black tea. - -Albuminuria and casts can frequently be observed after the -administration of drugs in degrees varying according to the toxicity of -the drugs. We have published a case in which even epithelial cells of -the kidneys, single and in casts, as well as blood-casts in quantities, -have been found after an administration of chloride of potassium. Luttje -found casts in 33 cases out of 207, and in 92 of these albuminuria, -after the administration of salicylates, and he issues a warning against -their continual usage. That the same occurrence has also been observed -after the use of other poisonous drugs such as mercury, chloroform, -etc., will only appear to us as natural. - -The skin and intestines, which co-operate continually with the kidneys, -are able to do a part of the work of the latter by eliminating poisons -which otherwise would have been carried to the kidneys, injuring the -delicate structures by which they are secreted and through which they -pass. As will be found in the chapter on the functions of the skin, this -tissue is able to eliminate (especially when its functions are -increased, as in cases of perspiration) a part of the harmful products, -among them being some of the nitrogenous end-products of metabolism, and -also common salt. But when the skin is unclean and its pores are clogged -by dirt and the products of perspiration, and when it is diseased, as in -skin diseases, or when it is burnt extensively and the sudorific glands -destroyed, then these poisonous products are directed to the kidneys, -whose secreting structure will naturally be injured by their passage. - -The same may also happen after an obstruction or hindrance to the -intestinal functions. When the passage of fæcal matter is retarded for a -long time, a re-absorption of toxic matters can take place by the blood, -necessitating their elimination by the kidneys, with harmful -consequences to these important organs. This has been proved by -experiments made by Wallerstein, who mechanically closed the anus of -rabbits and dogs. After but twenty-four hours he found albuminuria and -different kinds of casts in the rabbits’, and casts only in the dogs’ -urine. It is very important evidence in favor of our supposition that -the convoluted tubules of the kidneys play the most important part in -the excretion of harmful products from the blood, that Wallerstein -found, after four days, that the greatest change had occurred in the -convoluted tubules of the kidneys in these animals. The epithelial cells -of these tubules were greatly degenerated and in a state of coagulation -necrosis. - -Similarly English[223] has found albuminuria and casts in cases of -strangulated hernia in men, in consequence of the stagnation of the -contents of the intestines and the re-absorption of toxic matters. -Similar results may also occur according to Leichtenstein, Senator, -Jaffé, etc., in cases of intussusception, incarceration, and similar -pathological conditions. - -Footnote 223: - - Oesterr. Med. Jahrbuch, No. 2, 1884. - -Thus we can all easily understand how the stagnation of the intestinal -contents, as, for instance, in chronic habitual constipation, may also -be injurious to the kidneys; and, indeed, Kobler and Huler have -described albuminuria as a consequence of constipation. Not only is the -elimination of excrementitious substances checked, but there is -re-absorption of poisonous products from the intestinal contents which -the kidneys must excrete. - -That poisonous products coming from the intestinal tube are apt to -produce even serious changes in the kidneys has been proved by Heller -and Fishel after catarrhs of the stomach and intestines. At the same -time we will also mention that in cases of intestinal auto-intoxication -we can also observe a diminution in the quantity of urine, as noted by -several authors, of whom we specially mention Boas and Hemmeter.[224] - -Footnote 224: - - Hemmeter: Loc. cit. - -From the foregoing there can be no doubt that most of the toxic products -in the blood are eliminated by the kidneys. This is also the manner in -which the nitrogenous end-products of metabolism leave the body. The -kidneys act as a kind of filter for these products. When the kidneys, -however, are changed or degenerated by the formation of connective -tissue and loss of the elements of excretion, as in old age, then these -products will be retained in a greater or smaller number, and a -condition of auto-intoxication follows, to which we have previously -ascribed a great rôle in the pathology of old age. Logically, if we wish -to prevent old age coming on too soon, or a diminution of our chances -for a long life, we must do our best to prevent such a diseased -condition. - - ------------------------------------------------------------------------- - - - - - CHAPTER XXII. - - HYGIENE OF THE KIDNEYS, AND THE PREVENTION OF RENAL DISEASE. - - -THE most rational hygiene of the kidneys for the prevention of kidney -diseases consists in the avoidance of all those causes which are -injurious to the kidneys, and which we have mentioned in the previous -chapter. A great part of the poisonous products that are eliminated by -the kidneys are introduced with the food and beverages, and it is -important for us to bear in mind the fact that what we eat or drink must -pass through our kidneys, and that the structure of these organs is -delicate; that the most important secreting parts are composed of fine -epithelium which can easily be desquamated by the passage of irritating -products. Thus we note the appearance of hyaline casts after different -kinds of spices and stimulating liquors, especially if taken in large -quantities. - -There are many members of the profession who attach no importance to the -occasional appearance of a hyaline cast. But, considering the finding of -Professor Senator[225] that such casts are formed by degeneration of the -tubular epithelium, we cannot take such a lenient view; for even if we -find only one cast in two or three microscopic specimens, we must -realize how many thousands of these there may be in a liter of urine. -Thus every day thousands of these casts, and in a year enormous -quantities, may be lost. But as each cast means the loss of important -secreting elements, there can be no doubt that, after a certain time, we -shall have lost an important part of these most important organs, whose -place is taken by connective tissue. Thus the development of -interstitial nephritis can be hastened by faults in our alimentary -régime. In cases where meat is taken abundantly it is most probable that -the continual excretion from the blood of nitrogenous end-products of -metabolism means a serious overwork for the kidneys and grave damage to -their epithelium. And still more so if, owing to a diminished activity -of the liver due to senile degeneration, toxic products of a higher -toxicity than urea, and even uric acid, are passed. - -Footnote 225: - - Senator: Loc. cit. - -We have observed the great frequency of albuminuria and casts in the -urine of persons who were addicted for many years to a plentiful meat -diet. According to Dr. James Tyson,[226] who has been for many years -making accurate observations on diseases of the kidneys, and who has -published a standard work on them, interstitial nephritis can be -produced after the prolonged ingestion of much meat. If we wish to keep -our kidneys in the best condition, a lacto-vegetarian diet with only -little meat, once a day, is the most suitable. Still more than meat, -bouillon and meat gravies should be avoided, since they contain -irritating meat extracts. - -Footnote 226: - - Tyson: A treatise on “Bright’s Disease and Diabetes,” second edition, - London, 1904. - -Milk diet in abundance is not only indicated in liver disease, but also -in chronic kidney troubles. But when there are coexisting changes in the -circulatory system, milk should not be given in large quantities, but in -smaller amounts. Milk has also the great advantage of being a strongly -diuretic substance, especially in its acidulated forms (yogurth or -kefyr, or simple sour milk); and at the same time it irritates the -kidneys very little, since it contains only a minute amount of common -salt. - -According to Bunge, we take decidedly too much salt every day, and in -this way we injure our kidneys considerably. Achard,[227] Strauss,[228] -Vidal and Javal,[229] and simultaneously H. Strauss, have found that -diseased kidneys (especially in acute or chronic parenchymatous -inflammations) are unable to eliminate sodium chloride properly, and its -retention leads to œdema. According to these authorities, œdema is -caused by a retention of water and sodium chloride, the retention of the -latter playing the primary rôle, whereas according to Alexander Koranyi, -Richter, Kovesi, and Roth-Schulz, the retention of the water is the -primary factor. - -Footnote 227: - - Achard: Presse méd., 1901. - -Footnote 228: - - Strauss: “Die chronischen nierenentzundungen,” Berlin, 1902. - -Footnote 229: - - Vidal et Javal: Soc. Méd. des Hôpitaux, Juil. 31, 1903. - -For these reasons salt should only be taken in very small quantities. -Alcohol should also be avoided, except in small quantities, as being -very injurious to the kidneys; and considering that chronic nephritis -may be caused by the immoderate use of alcohol, Bunge thinks that the -chronic nephritis following large quantities of alcohol may be -attributed to the fact that, according to the researches of Keller,[230] -made in Bunge’s laboratory, the alcohol habit leads to an immoderate use -of salt with its deleterious effects upon the kidneys. - -Footnote 230: - - Keller: Zeitschrift für Physiol. Chemie, vol. xiii, p. 130 and 134, - 1889. - -According to Bunge, rice gives very little work to the kidneys, as in -twenty-four hours only 2 grammes of alkaline salts are eliminated. On -the other hand, potatoes cause a very great elimination of salt by the -kidneys. Bunge thinks that rice would be a good food for patients with -renal disease. - -Not only alcohol, but other stimulants, like tea, can be of harm to the -kidneys if taken in large quantities, as we have mentioned in the -preceding chapter when speaking of black tea. - -We do not think, however, that the daily use of black tea, in moderate -quantities, would have unfavorable effects on the kidneys. Its relation -to the production of uric acid should, however, be remembered (see -chapter on other stimulants: coffee, tea, tobacco, etc.). - -For reasons already mentioned, irritating spices and adulterated sauces -should be very carefully avoided; also all kinds of food which contain -pungent ingredients. We have no doubt that by their use life is often -shortened. The passage of such poisonous substances for years through -our kidneys must injure their delicate structure and hasten the -development of the senile kidneys, with interstitial nephritis. - -It is advisable to drink plenty of water, especially when much meat, or -the above-mentioned sauces, are eaten. By this means we can flush out of -our kidneys the end-products of proteid food, and also other toxic -substances. For the same reason it is well to use certain mineral waters -with diuretic properties. They should, however, not be taken at the same -moment as substances irritating to the kidneys are taken, or the kidneys -may be so injured that acute hæmorrhagic nephritis may ensue. We[231] -have published such a case, where even small quantities of chloride of -potassium taken on an empty stomach, together with Wildungen waters, -which have very diuretic properties, provoked a condition of acute -nephritis, with great quantities of blood clots, epithelial and granular -casts, many epithelial cells, and red and white blood-corpuscles in the -urine. - -Footnote 231: - - Journal méd. de Bruxelles, 1903. - -When taking various drugs, we must always remember that they must pass -through our kidneys. The drug habit, especially when irritating drugs -are taken, can have a ruinous effect on these vital organs and surely -diminish our prospects for a long life. Day by day many of the -epithelial cells will be desquamated, slowly but surely, and -inflammatory conditions of the kidneys will eventually appear. There is -nothing in this world without a cause, and if a chronic parenchymatous -or interstitial nephritis suddenly appear, it must have a pre-existing -cause. It is the result of our continual neglect and abuse of these most -important organs. As Prof. Friedlich Müller said a few years ago, the -kidneys never forget the wrong they once have suffered. Indeed, most of -the evil that befalls us in this world is our own fault, for doing -things we should not do and omitting those we should. - -A frequent source of renal diseases is infectious diseases with the -passage of toxic products through the kidneys. This source of kidney -disease is often overlooked, the symptoms of acute nephritis being -mistaken for or confused with those of the infectious disease. Acute -nephritis after tonsillitis is often not diagnosed unless the symptoms -are very marked. In such cases occasional casts and epithelial cells, -with red and white blood-corpuscles, may remain for a long time in the -urine, sometimes permanently, and thus slowly and insidiously chronic -nephritis develops. - -Tonsillitis is often caused by the dropping upon the tonsils of mucous -secretion from a post-nasal catarrh. This is commonly so in chronic -rhinitis caused by adenoid vegetations. The best prevention of renal -diseases in these cases is operation on the vegetations and treatment of -the rhinitis, rather than removal of the tonsils, which probably play a -great rôle in the defense of the organism against infections. This is -shown by the fact that they are inflamed in the early stages of many -infectious diseases. - -The greatest care must be given to the condition of the skin and -intestines, if we wish to keep our kidneys in good order and prevent -their deterioration. We must try to eliminate through the skin and -intestines as many as possible of the toxic substances which otherwise -would make their way to the kidneys and increase their work, and perhaps -injure their epithelium. In this way we can save our kidneys for their -time of need. - -Therefore, the skin and intestines should be kept in good working order. -We must do all we can to maintain the function of the skin, and in -several chapters of this book we have considered this question. We will -only mention briefly that the invisible perspiration of the skin should -be encouraged as much as possible. Damp and cold weather are apt to -suppress it. In such weather our skin also gives off too much warmth, -therefore we should be warmly clad, wool, especially for old persons, -being best. Still more important is this when the kidneys are already -damaged. For such persons a warn climate is advisable. By increasing the -perspiration to sweating, products which are harmful to the kidneys may -be eliminated. Hence such procedures will take work off the kidneys and -rid them of injurious substances. The sweating should be done -frequently, at least once a week, if we want to keep our kidneys in good -condition. For fuller particulars on the hygiene of the skin, and also -of the intestines, we refer to the chapters relative to these questions. - - ------------------------------------------------------------------------- - - - - - CHAPTER XXIII. - - ON THE ELIMINATION OF TOXIC PRODUCTS THROUGH THE SKIN. - - -THERE are some two and a half million small glandular formations—the -sudorific glands—on the whole surface of the body in the subcutaneous -tissue of the skin, from which issues a secretory tube somewhat of the -nature of a corkscrew to the external surface of the skin. - -These glands are richly provided with blood-vessels, and a comparison -may be drawn, to a certain extent, between the glomerules of the kidneys -and these small glandular formations. The first receive certain -substances from the blood and give it off through the tubules which -carry away the urine, and the latter take both fluid and solid -substances from the blood and eliminate it in the form of sweat through -the excreting channels of the sudorific glands. - -Gas can also be eliminated through the skin—carbonic acid—though in -infinitely smaller quantity than by the lungs, for while the latter -eliminate from 800 to 1200 grammes of carbonic acid, it has been shown -by the experiments of Aubert[232] that a human being eliminates through -the skin a maximum of 6.3 grammes and a minimum of 2.3 grammes in -twenty-four hours, which is certainly a very small quantity. Besides -carbonic acid the skin probably also eliminates other organic -combinations in the form of gas, though it would be very difficult to -analyze them by exact experiments. Pettenkoffer was able to demonstrate -from experiments, that, if many persons are in a confined place, it is -not carbonic acid alone that causes the very disagreeable sensation of -the foul air, but that it is a consequence of the accumulation of -harmful products of perspiration through the skin, the particular nature -of which has not been determined as yet. - -Footnote 232: - - Aubert: Pflüger Archiv, vol. vi, p. 539, 1872. - -On this account it is permissible to speak of a respiration through the -skin, although it has not yet been demonstrated by exact methods that -the skin is really absorbing small quantities of oxygen; and it is even -now not yet beyond doubt whether the small amount of carbonic acid may -not be ascribed, perhaps, to the decomposition of the excretions from -the skin, and of the epidermis that is shed, as stated by Prof. -Bunge.[233] - -Footnote 233: - - Professor Bunge: Lehrbuch der Physiologie des Menschen, Leipzig, 1905. - -But if it is not possible to prove the certainty of respiration through -the skin to a degree that would satisfy the postulates of exact science, -on the other hand the observations of ancient savants, whose chemical -knowledge and powers of observation were not inferior to those of their -present successors, in spite of a deficient education in chemistry, all -point to its existence, and we shall have to take it into account. - -As a rule the various products of skin perspiration cannot be seen, as -they are eliminated in the form of vapor. This evaporation takes place -in this invisible form, however, only when it is not checked or when it -is not produced in excessive quantity. But when such evaporation is -hindered by clothing that is impermeable to such products, such as -rubber clothes or fur, or when it is too abundant, then it will be -eliminated in the form of water through the pores, and will appear in -drops. The human body loses from 1 to 1½ liters of this moisture, that -is to say, sweat, in a day. - -Such checking of evaporation produces a very disagreeable feeling, a -fact that indicates the existence of skin respiration; as does also the -circumstance that persons clothed in a way that permits of the -circulation of air to the skin and the elimination of the products of -perspiration, and who also use other means for maintaining a good -hygiene of the skin, such as a bath, are always in better health than -those who neglect these points. - -That the retention of various harmful products normally eliminated -through the skin is extremely injurious to health is best shown by the -fact that animals whose skin is varnished all over invariably succumb to -intoxication. Especially is this true in amphibia, who, as -Spallanzani[234] found, can live longer after the removal of the lungs -than after varnishing the whole skin. The cause of this is that in -amphibia the respiration by the skin is more important than that through -the lungs. - -Footnote 234: - - Memorabilien traduits par Levebier, p. 77, Genève, 1863. - -But even if, in higher animals, there is far more respiration through -the lungs than through the skin, the varnishing over of the skin on the -entire body can produce death in certain mammalia. This has also been -observed to have occurred in man. The day before the solemn entry into -Rome of Pope Leo XIII, a little boy was painted over his entire body -with gold leaf so as to represent an angel; but he suddenly died before -the procession began. We cannot, however, conceal the fact that the -death of higher animals, according to some authorities, is not due to -the retention of the products of perspiration, but rather to an -increased loss of warmth of the body, especially as these animals have -always been shaved prior to being varnished. - -Still, for reasons we shall give later, we believe that this cannot -alter our views on the harmfulness of checking respiration through the -skin. The injurious action of this is also shown by the fact that -persons whose skin is burnt to a large extent, die, as a rule, by -intoxication. Certain opinions have been advanced which ascribe such a -death to a change in the constitution of the blood after extensive -burns. I am inclined to think that death may be due to the fact that the -skin respiration is, in such a case, more suppressed, as the body is -enveloped in bandages which, like sticking plaster, do not admit of air -circulation; and also because there is no elimination. At the same time -the other parts of the body are covered by the clothing instead of the -same being removed. If, however, after such burns the body be kept quite -naked and the air thus permitted a free circulation on all sides, then -even after the most extensive burns death will not follow, as we have -seen in several cases so treated by Dr. Sneve in St. Paul, Minn., whose -wards we inspected some years ago. Why should the changes in the blood -not induce death in these patients in the same way as it does in -patients swathed in bandages? Logically, this cannot be the reason for -death, but in all probability it is the suppression of the skin -respiration. But if death after extensive burns is due to this cause, -then the same may be given as the cause of death after varnishing the -body. The substances which are eliminated from the body through -perspiration are urea, uric acid (in small quantities only), common -salt, creatin, acetic acid, lactic acid, and a number of fatty acids. -Although exact science does not demonstrate that poisonous matters are -eliminated through perspiration, still some very noted men, like Ortner -and Goldscheider, are convinced of it. Arloing contends that the -perspiration of even a healthy man is toxic, whereas Queirolo admits -this to be so only in the case of sick persons. - -We shall also be able to realize the great importance of the skin as an -eliminating organ for toxic products after a little consideration on the -origin of skin diseases, which we believe are due to two principal -causes: Firstly, the invasion of microbes into the skin after a -diminution of its resistance, which, in turn, is dependent upon the -condition of its nutrition by the blood. This is the external cause. -Secondly, by the elimination of toxic products which are formed in the -body and then pass through the skin. These may have originally been -introduced from the outside, either by food or by drugs, or they may -have been produced in the body through products arising from certain -glands, such as the thyroid, sexual glands, etc. The waste products of -metabolism, such as uric acid, may also be included in this category. -This is the internal cause of skin diseases. Both of these causes may -stand in relationship; thus the existence of the second may favor the -development of the first. - -For the subject now under consideration the second cause is more -important, and we will say a few words on the matter as showing the -importance of the skin as an eliminating organ for toxic products. - -We may frequently see persons who are affected by eruptions on the skin -after eating certain kinds of food, as oysters or strawberries; and -especially after eating oysters which have not been absolutely fresh. In -our own case, and in many others which we have observed, an eruption of -acne on the face has followed the eating of cheese. A similar state of -things may result from taking certain drugs; thus, after bromine or -iodine very often acne may be observed on the face. This interesting -fact we have experienced personally and have noted in patients who have -taken thyroid tablets in certain quantities, which also contain iodine. - -If we examine acne eruptions we find in them certain microbes, such as -the bacillus of Unna, etc. In gout, which is caused by the retention of -uric acid, skin diseases are very frequent. - -Sufferers from Graves’s disease, in which there is, as has been so often -mentioned, a hyperactivity of the thyroid gland, have very frequently -cutaneous eruptions, including acne, and often also a very irritating -pruritus. Also in diabetes, in which thyroid hyperactivity plays a -prominent rôle, it is not so much the sugar as the factor I have -referred to, which is the cause of the great frequency of skin diseases. -Here also a number of toxic products are eliminated through the skin. - -In women, during menstruation, we often see cutaneous eruptions, as acne -or hives. The former is often very distressing in boys and girls in the -years of puberty, and it is quite impossible to deny that this may be a -symptom of a hyperactivity of the sexual glands. Thus, we often observe -acne in persons who are masturbating, or who for a long time live in -complete sexual abstinence, so that in certain places the laity term -these “pimples of chastity.” Here, again, married life is the best cure -for this disease, as it is for so many others. - -It is very interesting to note during the question we are now discussing -that persons suffering from psoriasis feel relief from their affection -when they have had a good opening of the bowels, or when they perspire -freely; hence in hot summer weather they suffer less inconvenience than -in the winter; also by following a certain diet this disease may be -favorably influenced; that is to say, such persons have fewer psoriatic -patches when the toxic products are eliminated by the intestines or -kidneys. When there is a hyperactivity of the skin function, as in -perspiration, the toxic products are eliminated in the vapor or moisture -of the perspiration, but during a diminution of this function they form -the psoriatic patches. - -When the skin function is increased, as in sweating, a number of -products that are otherwise eliminated through the urine pass through -the skin, which may eliminate a considerable part of the solid waste -products, and particularly a very important chemical product—common -salt. When the kidney is diseased the elimination of common salt and -other substances may become difficult, and thus still more injure the -kidneys; these products, and especially the common salt, will be -retained. Then comes the skin to the assistance of the kidneys. Not an -inconsiderable part of these substances may then pass through the skin -when it is in a condition of increased activity, in the form of sweat. -Thus the kidneys and skin work in harmony; they are companions, and may -be graphically called “Kidney and Co.,” the skin being the second -partner. The skin is thus one of our most important organs, and in the -following chapter we will deal with its hygiene. - - ------------------------------------------------------------------------- - - - - - CHAPTER XXIV. - - THE HYGIENE OF THE SKIN—AIR BATHS. - - -IN another part of this work we have attributed to the kidneys a very -important part in the causes of premature old age, as their degeneration -is one of the most striking causes of auto-intoxication, the immediate -cause of old age. The more injurious the products passing through the -kidneys, the quicker will these noble organs be degenerated and the -sooner will they decay. - -It will thus be the wisest policy in the prevention of premature old age -and in the interests of a long life, to lighten the work of the kidneys, -and avoid their being overstrained by throwing a part of the work on -their partner—the skin. This organ, as stated at the close of the -preceding chapter, is, in a certain measure, a co-partner with the -kidneys. When, through cold weather, for instance, the functions of the -skin are diminished, a greater flow of liquid will pass through the -kidneys in the form of urine; but when the weather is hot and there is -perspiration, to a certain extent, less liquid will be secreted and -excreted by the kidneys: that is, they will work less. By perspiration, -also, more common salt will pass through the skin, and consequently less -through the kidneys. - -It follows logically from these considerations that if we are anxious to -preserve the vitality of the kidneys and also free the blood from -noxious elements, we must pay special attention to a good action of the -skin, and this is only possible by a rational hygiene. - -The sudorific glands are abundantly provided with small blood-vessels, -which bring a large quantity of warm blood to them, from which they -absorb watery and solid parts, and, in all probability, gaseous -substances also, and pass them through their tortuous excretory channels -to the surface of the skin. The mouths of these channels are the pores, -and it is of fundamental importance that they remain open; for if closed -these waste products cannot pass out and must remain in the body, while -in addition no air can pass into the pores, and so no exchange of -materials can take place. - -These pores can easily be clogged; for example, by the -scales—cuticle—which we shed every day, mostly from the superficial -layers of the skin, and also by the oily secretion of the sebaceous -glands. The fat that these glands secrete is intended by Nature to serve -as a protection against liquids, like water, and against the -perspiration from the skin. In some persons this fat is secreted in too -large quantities and may then, especially with its products of -decomposition, clog the pores. In the same way the products of -perspiration, and also foreign materials, such as dust, may close the -pores. It will, therefore, be necessary to remove all these substances -which are preventing the proper aëration of the skin and the elimination -of harmful matters by it. It is also not impossible, when the products -of decomposition of the sweat remain long in close contact with the -skin, that some of those injurious elements may be re-absorbed. - -The best method of getting rid of these harmful substances is by bathing -every day. But water alone, except it be very hot, and the bath of long -duration (and in this case it presents some inconvenience and may be -injurious also to health if taken daily), is not able to remove the oily -and fatty products of the skin. Therefore it is best to use soap in -addition to water, and to rub energetically with it the entire skin -surface of the body. - -Besides removing, by a bath, the injurious products that clog the pores, -we must take particular care to allow air to penetrate to the pores as -freely as possible, thus permitting a free issue to the body exhalations -and facilitating respiration by the skin. - -We should not, therefore, exclude the air by thick, non-porous clothing, -such as furs; nor should we use underwear that fits too closely to the -body. To permit of a thorough aëration of the skin it would be -advantageous to remain exposed naked to the air once or twice during -each twenty-four hours, and each time for at least five to ten minutes. -When the weather is warm and we bathe in the sea or a river, we combine -the advantages of a water and air bath. But in places where there is no -sea, lake, or river in which to bathe, we could, if living in the -country, enclose some spot for such an air bath which, in sunny weather, -would also become a sun bath at the same time. On the grass of a -clearing in a wood, or in a garden, such an air bath could best be -taken. In summer, if the air is not too warm, and if we are in the sun, -we may remain longer than ten minutes in such an air bath. - -If we are not able to procure a place in which such a bath can be taken -quite naked without being seen, the next best thing is to clothe oneself -in amply large white pajamas, or, for women, in a very wide white mantle -or costume of the empire style, and thus attired to take a walk in the -garden or ground of one’s property. - -In cities many can take such an air bath in one room every day when they -can spare ten minutes, the best time being before dressing and after -undressing. But also during the day, especially in summer, we should -spare a few moments to take such a bath. In winter the room must, of -course, be warmed for the purpose. In combination with the bath, -breathing exercises can also be performed to great advantage in the way -described in the chapter on the advantage of open air. In order to avoid -catching cold in such an air bath it is advisable to rub the entire skin -surface of the body. This causes much blood to be brought to the skin; -thus more blood is conveyed to the sudorific glands which are thereby -enabled to absorb a larger quantity of harmful matters from it, while at -the same time more air can be taken in by the pores. While rubbing—which -is best done by a brush—we can also move about, and while standing also -beat the periphery of the body with a thick rough towel in the same way -as in Finland they do with brushwood after hot baths. It is not painful -and is very effective in producing a hyperæmia of the surface of the -skin. When the skin is thus better nourished with blood it also offers -more resistance to germs that may cause diseases of the skin, and such -better nutrition and its improved hygienic condition is a safeguard -against catching cold. - -Such an occurrence is more likely to occur in persons who neglect a -thorough cleansing of the body daily by baths and who go warmly clad; in -such cases the muscles which contract the pores are less active, and -because of this more body heat is lost and catching cold more easily -takes place. When we feel warm more blood circulates through the skin, -and when afterward cold air reaches us the pores, in a normal person, -contract quickly and the blood is retained in the interior of the body. -Thus we are prevented from giving off too much warmth from the body and -catching cold. Persons who have been trained since their early childhood -to cold water and cold air show a great facility for reaction against -cold. When cold air reaches the skin, which on account of warm -surroundings has become warm, filled with blood, red, and moist, the -skin will contract and become pale, the easy conduction of warmth will -be checked, and the heat retained in the body. Thus such persons will -not so easily catch cold as others whose skin is not kept in good -hygienic condition. - -Many people have already shortened their existence by catching colds. -Pneumonia, pleurisy, nephritis, and many other dangerous ailments have -arisen from such a cause and led to premature death. A good hygiene of -the skin not only serves to eliminate toxic products from the body and -keep our kidneys in good order, but also prevents the tendency to -catching cold, which is so often the cause of an early death. We must, -therefore, do our best by a careful rational attention to the hygiene of -the skin, and for this purpose we will deal further with the subject in -two chapters on the hygiene of the skin by bathing and by rational -clothing. - - ------------------------------------------------------------------------- - - - - - CHAPTER XXV. - - ON RATIONAL CLOTHING. - - -THE chief object of rational clothing is to obtain porosity. All -underwear as well as outer coverings must be made out of some porous -substance which will in no way check the perspiration from the body or -the evaporation of such perspiration, and which will at the same time -allow of a free passage of air to all parts of the body. - -First, we will discuss the question as to the nature of the underwear -which is most appropriate for keeping ourselves in a healthy condition. - -Wool is the most suitable material for warmth for underclothing, as it -is a bad conductor of heat and can therefore best retain the natural -heat of the body. It follows, therefore, that this is the best for aged -persons to use. - -In old age, especially when very advanced, less natural heat is produced -in the body. On account of the degenerative changes of the small -capillaries the surface of the body is not so well provided with the -heating element, which is the blood. At the same time, on account of the -loss in elasticity of the musculature, the skin of an aged person -contracts less readily from cold than does the skin of younger people; -thus, while on the one hand less warmth is produced, on the other hand -more warmth may be given off, a due consideration of which leads to the -logical conclusion that all aged persons had best wear woolen -underclothing. - -Woolen underwear, though the best to retain the warmth of the body, has, -on the other hand, very serious drawbacks. Wool possesses the great -advantage of easily absorbing the perspiration of the body; it can, in -fact, absorb about 40 per cent. of the moisture, by weight, without -becoming so saturated as to be noticeable; but at the same time it gives -off this moisture again very slowly, necessitating the changing at once -of such damp covering. - -The greatest drawback to wool, however, is that it soon loses its -porosity after it has been washed, for then it shrinks and its meshes -contract, and in consequence the material is no longer porous; while in -this condition it does not freely give off the moisture, but retains it, -the aëration of the skin is seriously hindered, and the products of -perspiration are not gotten rid of. - -Everybody knows what a disagreeable feeling is produced by keeping on -such underwear after it has become dampened by perspiration, and this is -due to the prevention of the dissemination of the exhalations from the -body. Such disadvantages to the wearer of woolen underclothing may -possibly be discounted by making such underwear with large meshes; but -even in this case it is not easy to prevent the loss of porosity after -washing. It is therefore advisable to wear a large meshed linen garment -next the skin under the woolen underclothing; there will thus be a -cushion of air between the skin and the woolen garment; and linen also -has a great affinity for absorbing moisture and rapidly giving it off -again. - -All kinds of underwear, whether of wool or other material, should be -loose about the body. It is a great mistake to have it too tight. There -should always be a considerable layer of air between the clothing and -the skin. This layer is warmed by the blood at the surface of the body, -and as air is a bad conductor of heat, even in the case of underwear not -so thick as wool, if such clothing is worn somewhat loosely about the -body and is porous, we shall not feel cold. The porosity of the tissue -permits the entrance of air, and such tissues, with air in their pores, -are abstracting a minimum of heat from the body, though such pores in -the tissue allow for the free passage and exit of the harmful -exhalations and evaporations from the body. - -From the foregoing it follows that socks which do not fit too tightly -but fairly loosely, and which are made of porous material, such as good -wool, will also be the warmest. It is quite unnecessary to adopt heavy -double socks which fill up all the space in the shoes; as a matter of -fact in such a case we may have colder feet than if we wore light porous -good woolen socks that do not fit too tightly. - -Linen possesses the great advantage that it easily absorbs moisture and -easily gives it off again, but as it is not such a bad conductor of heat -as wool, and freely gives off heat, it may most advantageously be -utilized in warm weather, and also in winter if worn under the other -woolen garments. - -Linen is superior to wool in so far as the matter of cleaning it is -concerned, as it can be washed much more thoroughly than wool, which -easily retains dust and dirt. Linen is one of the most porous substances -for underwear. - -Ramie is a material made from a tropical plant, the _Bæhmeria Nivea_, -and has lately come much into use. It readily absorbs the moisture from -the skin and does not retain it as long as does wool, but rapidly gives -it off again. It also does not abstract warmth so much as linen, and -next to wool is the warmest material for underwear. The drawbacks to it, -however, are that it is too heavy and does not last long. Silk underwear -also retains the warmth, and also very easily absorbs moisture; but it -is too expensive for ordinary use, and can readily be spoilt by -indifferent washing, unless the most expensive quality is used. - -Of all the various materials for use as underwear possibly cotton has -the greatest average advantages. It gives off the moisture it has -absorbed from the skin, although not quite so efficaciously as does -linen. According to James Paton it absorbs moisture equally well as -linen; but Pettenkoffer is of a different opinion, as in his view cotton -does not absorb the moisture from the skin as readily as does linen. - -The greatest advantage, however, of cotton over all other kinds of -material (except perhaps ramie) for underwear is its porosity. It is -about the most porous material there is, especially if in the course of -manufacture the maker takes particular care in selecting the very best -cotton; it does not shrink like wool, and therefore does not lose its -porosity in the same way when washed. - -When cotton is so manufactured as to present the greatest possible -porosity, it has also the great advantage of being almost as warm as -wool, which is due to the fact that air can enter freely everywhere and -remain in the interstices of the material. It has already been mentioned -that air is a bad conductor of heat, so that cotton underwear of good -quality retains the warmth of the body and at the same time allows a -free exit for the exhalations of the skin. If, therefore, cotton be -prepared from the best possible material, and manufactured in such a -manner as to obtain the greatest amount of porosity, i.e., when it is -loosely woven, it can compete successfully with wool as material for -warm underwear; it is, therefore, quite an erroneous view to hold, as so -many do, that cotton is very different in this respect from wool; -everything depends upon the _quality_ and the manner in which it is -manufactured. - -According to the researches of Sir William Thompson[235] there is -practically no difference between wool, cotton, and linen in regard to -their capacity as conductors of heat. Nevertheless we ourselves still -believe that in winter weather, or when there are cold northern winds, -wool is best, especially for the aged. This same holds good also for -those younger persons who catch cold easily. - -Footnote 235: - - Sir William Thompson, in “Heat,” Encyclopædia Britannica. - -In order to keep warm in winter it is, however, necessary that the -cotton material should be of a certain thickness, besides being of the -best quality and of the best make. As already mentioned it is of the -utmost importance that the underwear should not fit too closely around -the body, but that there should always be a layer of warm air between -the skin and the garment. Instead of the present custom of wearing -close-fitting trousers it would be much more beneficial to adopt the -very large loose linen trousers that are worn in certain countries, such -as Hungary. When once accustomed to such, and especially in the case of -the younger generation, they can readily be worn also in winter time. -Then, possibly, porous cotton can take the place of linen, although many -people may feel just as warm in porous linen underwear; or we could -possibly follow the example of an English gentleman who told me he never -wore any underdrawers at all. - -In many European countries women, especially of the lower classes, wear -no undergarments on their legs at all. In healthy women such a custom -may be of great advantage, as it permits of the free passage of air and -the elimination of the perspiration from the skin, being in effect a -continuous free-air bath for the lower parts of the body. - -It is not so necessary to keep the lower extremities, except the feet, -warm (provided that the feet are made warm by the constant motion of -their muscles), as we do not need to be so well protected there as on -the upper parts of the body; we also feel the cold less in these parts, -which we can all appreciate if we are in the habit of walking much and -not sitting about all day. - -Before putting on clean underwear we must be careful to ascertain that -it has been thoroughly aired and is quite dry, for it happens in more -cases than one knows of that the linen arrives from the laundry quite -damp, although apparently it appears and feels dry. After having caught -cold each time I changed my linen, after having perspired, I had the -idea to put my vest over an electric lamp, and was surprised to see a -cloud of moisture arise from it. As moisture readily absorbs the warmth -of the body, we can therefore easily lose too much warmth and thus catch -cold. Before putting on clean linen it is also advisable to rub the body -with a brush (or rough towel) until the skin glows, and the linen itself -should of course be put into a hot-air cupboard or be aired before a -stove or fire, by which means many colds will be prevented; and these -precautions are particularly necessary in all cases after free -perspiration, in which latter case also a bath is very desirable before -putting on our clean linen. It is of primary importance to change -underwear every day, so as not to leave the products of perspiration on -the skin for several days (see chapters on the hygiene of the skin and -kidneys through perspiration). - -We will now offer a few remarks on the subject of white linen. We should -not wear starched linen shirts, as they are less permeable to the air. -In lieu of these, porous linen shirts are advisable, or any other kind -of soft and porous material, without a starched front. The use of -starched shirts should be confined to dinner parties and social -functions. - -The most absurd part of our linen outfit is unquestionably that -instrument of torture we wear as a yoke around our neck, preventing a -free circulation through our most important arteries and throttling one -of our most important organs—the thyroid gland. This we know as the -“starched collar,” without which we must not appear in decent society. -It is in any or all of its present shapes an unhealthy article of -clothing, but especially so when, from foolishness, it is worn standing -high up to the chin, keeping away the air from the neck and hindering -free circulation. Its bad effects upon the thyroid have already been -referred to in the chapter on the hygiene of the thyroid gland. It would -be more reasonable to wear a low collar, turned down, and of soft linen, -as worn by our forefathers. Women may have this privilege, but, sad to -say, they do not avail themselves of it, but instead, in many instances, -cover their necks, and even more than their neck, by impermeable -materials. Yet the neck is one of the parts of the human frame where -many sudorific glands are situated and where we perspire freely. These -parts especially should not be enclosed by clothing; neither should the -armpits and the toes of the feet, for here the sudorific glands of the -body are very numerous. Yet we wear the most impermeable materials, such -as leather, and often indeed thick leather, and _horribile dictu!_ even -rubbers, very often, on these important organs. - -The outer garments should also be made, after careful consideration, to -afford the greatest amount of porosity. It would be the height of -hygienic triumph to wear clothes made to allow of the free inlet of -wholesome sunlight. Gray garments are, therefore, the best, and next to -this blue should be greatly preferred to dark colors. - -The overcoat should never be too heavy nor too warm; as a general rule, -we should never wear clothes warmer than the temperature at the time -requires, always being guided by the thermometer and not by the -calendar. It is much better to be clad too lightly than too warmly, for -we thus avoid perspiring and thereby catching cold; or, in other words, -if clad simply lightly the likelihood of our taking cold is less than -when we are too warmly clothed, for then we also perspire less freely. -It may be that we shall more readily feel cold, but, fortunately, the -sensation of feeling cold does not imply catching cold. In fact, when -lightly clad we feel much more inclined to take brisk exercise. Then we -feel warm, and, as we shall show in the chapter on exercise, more blood -is sent to the periphery of the body and the general nutrition of the -skin is increased. Naturally, when we are lightly clad we do not sit -about without moving, but we endeavor to create a reaction in the skin -by brisk exercise. Englishmen, and especially Scotchmen, rarely wear an -overcoat, never sleep in a warmed room, and rarely ever catch cold, -which is certainly much more prevalent in countries with overheated -houses, as in America, and where the people are more accustomed to ride -in the street cars (also heated) than to walk. - -Catching cold is best obviated by hardening the body against the -influence of cold, and this is best done by a continual aëration of the -skin, and by means of cold baths, commenced in a judicious manner. We -should become accustomed to permit the entrance of air as frequently as -possible to the whole surface of the body, which we can do by remaining -stark naked in our room for only a few moments several times a day, as -already advocated in the chapter on the hygiene of the skin. But still -more important is free access to the air, even though cold, if we desire -to be immune against colds. Most people who do catch cold contract it -first in the head, especially after being in a state of perspiration. - -The frontal and temporal parts of the head are very well provided with -sudorific glands, and it is therefore most unreasonable to prevent free -air access by a warm covering. It is also unnecessary, because Nature -has already provided these parts with a natural covering, viz.: the -hair, which, with the skull, is intended for the adequate protection of -our most delicate organ, the special construction of which places us -above all other animal creation. - -That young men with abundance of hair should wear heavy head coverings -is extremely unreasonable. It would be a far more healthy custom to go -without a hat, and thus preserve for a much longer period this natural -ornament to the head. At the same time we would perspire less in the -head and thus be less liable to take cold. By continuing this practice, -as is customary among the boys of a certain English school (The Blue -Coat School), the scalp of the head will become so much hardened against -climatic influences that we should be able to go out with uncovered head -even in cold weather. As, however, not all our neighbors and -acquaintance are keenly interested in the postulates of health and long -life they may laugh at first, but afterward they will themselves be -converted by the advantages of such a custom and will follow our -example. - -Those whose scalp has become bald or only scantily covered with hair, by -excluding from the same too much air or by reason of disease, may not so -readily stand the effect of the cold, and for such a head gear may be -necessary, in which case the preference should be given to soft and very -light felt hats, and not to those made of hard material, which prevent -the circulation of the blood through the scalp and thus kill the roots -of the hair. - -Those who are slaves to the prejudices of their short-sighted brethren -may wear their hat when in their company or in the streets, but by all -means take it off at other times, and especially when in the woods or in -the fields. - -It is a singular anomaly that the English, who in many questions of -hygiene, as by conducting their sports in the open air, stand at the -head of all nations, yet obstinately stick to their tall hats and long -black coats in the warmest summer weather, sacrificing health and -comfort to social prejudices. How long will Bacon’s nation persist in -such a custom?[236] - -Footnote 236: - - Latterly city men wear straw hats in summer and also the coachmen and - servants of the upper class. - -Other parts of the body richly provided with sudorific glands are the -feet. This must logically make it obligatory for all who wish strictly -to follow the rules of health and long life not to prevent the free -access of air by impermeable rubbers or heavy high boots. Leather, of -course, is not a porous material, like certain kinds of cloth, and -hinders the free passage of air and the evaporation from the surface of -the feet. The most suitable footwear, and that best adapted to the -demands of rational hygiene, would be sandals, similar to those worn by -the Greeks and the Romans. Such, however, could only, in present days, -be worn in villages, at the seaside, or in the country generally, if we -do not want to be criticized as queer or eccentric by our neighbors, who -have less knowledge of the hygienic methods of living. - -It might be possible to make footwear in such a manner as to overcome -this feeling as to wearing them—of the nature of sandals, or part -sandals and part shoes—such as slippers or “pumps.” At any rate it is -advisable never to wear other footgear than half-shoes, and the author -of this work wears such even in winter time without inconvenience and -without feeling cold. The best half-shoes for summer wear would be those -made of canvas with leather soles. It goes without saying that one has -to get accustomed to this habit of wearing low shoes, by beginning in -warm weather and continuing uninterruptedly to the winter, and even -throughout that season, unless very severe weather prevails, when -gaiters should be worn above them. - -If porous woolen socks of the best quality are worn in conjunction with -the half-shoes cold is not felt, especially if we do not remain still -but walk about briskly, which will practically convince us of the -necessity of walking and running for exercise. - -Rubbers are unquestionably unhealthy things to wear, and to many will -cause a disagreeable sensation owing to the hindrance to foot -perspiration. - -It is advisable to take off our shoes, as the Mohammedan does, as often -as possible during the day; for instance, while working or reading, and -at any time when we are in private, and only put them on again when -visitors are present. Everybody appreciates what an agreeable sensation -it is to take off one’s shoes and have a good airing of the feet, -especially after a long walk, in which latter case a foot-bath is also a -capital thing which will certainly increase our comfort, especially if -we have been wearing sandals or half-shoes and we have been wandering -about the country exposed to dust. - -We have referred more fully to the use of the foot-bath in another -chapter. In the same way as with our footwear, we should reform our ways -by removing the yoke which cruel fashion obliges us to wear round our -necks—the high, stiff collar. How long shall we continue to put up with -these continuous impediments to our health? Top hats! tight collars! -tight boots with a pointed toe! and a fur coat over our dark clothes! -How can the sun and air penetrate such idiotic harness, and how can the -poisonous exhalations of the body find their way into the fresh air when -they are retarded by very heavy and warm woolen underwear? We must again -repeat that we catch cold much more easily when we are clad too warmly -than too lightly. The more freely we perspire in our clothes the more -easily we catch cold. We found this from personal experience. We were at -one time always catching cold, in consequence of too sedulously wrapping -ourself in woolen garments and heavy clothing. But since we have taken -to wearing linen or cotton underwear and light clothes, with half-shoes, -carrying our hat in the hand, and the overcoat rather on the arm than on -the body, we now rarely ever catch cold. - -All of our garments should be loosely fitting, and in this respect the -American fashion for men’s clothing is superior to the European fashion -of tightly fitting garments. Also the present style of long, narrow -trousers is not only unæsthetic but also unhealthy and unsuitable for -quick movements. Let us go back to the knee-breeches of forefathers, who -were thereby made much more pleasing to the eyes—at least, those of -normal build were. - -A sufficient aëration of the body is necessary not only by day, but by -night. In fact, it is more necessary at night, for as mentioned in the -chapter on sleep, the ridding of the body from toxic products is -performed more actively during the night. It will logically follow from -this consideration that heavy feather beds and, in fact, all kinds of -heavy coverlets are not beneficial to health, as they are apt to -suppress the exhalations of the body and to prevent the access of air to -the body. For the same reasons it is also imprudent to go to bed in -underwear, and particularly if woolen. I would even go so far as to -dispense with the use of the night-shirt, a garment which was quite -unknown to our ancestors until a few hundred years ago. By going to bed -quite nude, in a large bed, with ample bed clothes of a porous material -wrapped not too tightly about the body, we have thus a kind of air bath -in bed and feel more refreshed in the morning, especially after having -slept in a room where the air can enter freely. In cold weather in -winter a double woolen coverlet can be used. - -It may be that in carrying out strictly the rules of a rational hygiene -of clothing as laid down above, many people may have to revolutionize -their old habits of an unhealthy and life-shortening way of living. But -the real question is: Do we want to live long and retain as long as -possible our youth that is passing away only too quickly in any case, or -do we want to descend into an early grave before our time? Those who -desire the first alternative and who wish to enjoy their lives up to the -very last may follow my advice; then they will soon be rewarded by -fresher looks and increased vital power. - - ------------------------------------------------------------------------- - - - - - CHAPTER XXVI. - - IMPROVED HYGIENE OF THE SKIN AND KIDNEYS THROUGH BATHING—FOOT-BATHS. - - -EVERY day we are getting rid of the superficial layers of the skin, -which process can become so intense in some people that the skin looks -as though it were covered with flour dust; and in some persons with dry -skin such apparel as stockings sometimes gets full of this. These minute -scales, which get necrotised in the upper parts of the skin, are apt to -clog the pores, which can also become closed by particles of dust, or by -products of the sebaceous glands and by perspiratory residues. As the -free entrance of air to the pores is an essential condition for skin -respiration, and as the elimination of harmful products is only possible -when the pores remain open, we must get rid of the foreign matters which -clog them, for which purpose we take a bath. But water alone, even if it -be hot, is not able to effect a thorough cleansing of the skin on -account of the oily substance which is secreted by the sebaceous glands; -so, to obtain the fullest cleansing effects, we add the use of soap and -a brush, as already mentioned before. We must rub the soap well in, and -then rub it off energetically, if we desire to benefit by a fully -hygienic bath. - -As we are daily getting rid of the above-mentioned skin scales, so it -behooves us to take a daily bath. It is not necessary to stay in the -bath more than ten to twelve minutes, or at the most fifteen. For the -reasons above mentioned the effect of bathing is a rational hygiene of -the skin. - -By the action of the water, soap, and brush friction the skin receives -more blood, which is, at the same time, a great advantage to the -internal organs, as the blood drawn away from them facilitates the -circulation through them should they be congested. When more blood -reaches the skin the muscles that contract the pores are also better -nourished, and they then react better to certain agencies—cold, for -instance. They quickly contract the pores, so that the blood will be -kept back in the interior of the body and a cooling off of the periphery -of the body, with its dangerous consequences from catching cold, may -thus be avoided. - -A daily bath can also be advantageous for those who perspire too freely. -After a bath, and this is one of its greatest advantages, the insensible -perspiration is much increased, and more water leaves the body through -the pores than before, and when a bath has been too hot, a very free -perspiration may ensue. But usually with people with a too free -perspiration, this tendency would be diminished, as it can often be -noted that those who daily take a lukewarm bath perspire less than -others on warm summer days. - -Besides exciting the functions of the skin baths are also an excellent -means for diminishing a possible overwork of the kidneys, and thus -keeping them in good condition. It is possible to eliminate, through -bathing, such products by the skin which otherwise would have to be -eliminated through the kidneys. - -It has recently been shown by experiments conducted by Strasser and -Blumenkranz[237] that baths taken for a long time and at a temperature -of 34-35°C., are able to create an increased elimination, not only of a -considerable quantity of water, but of common salt also, and of the -products of decomposition of nitrogenous matter. - -Footnote 237: - - Strasser und Blumenkranz: “Die Wirkung indifferenter und - schweisstresbender Bader bei Nephritis,” Med. klin., Beichfte Hefte 6, - 1907. - -These authorities come to the conclusion that through bathing there can -be brought about a true increase not only of the water-secreting -activity of the kidneys, but also of their ability to eliminate -nitrogenous end-products and salt. They found an increase of diuresis to -double the usual amount and an increased elimination of from 50 to 100 -per cent. of nitrogen, and from 100 to 200 per cent. of salt. According -to Liebermeister, Loewy, Rubner, and others, the processes of oxidation -can be increased by cold baths from 50 or 100 to 200 per cent., and by -hot baths, according to Winternitz and Rubner, 50 to 100 per cent. -Rubner also asserts that the processes of oxidation can be wonderfully -increased by cold douches. - -There can thus be no doubt that baths are able to influence the -conditions of the kidneys in a very favorable way, and that their -vitality may be augmented by the daily use of the bath. - -The drawback to the bath is that so many people easily catch cold -afterward; to prevent which, such persons should not wet the head, and -especially the back part of it, as otherwise catching cold is easily -effected; and it is also of importance that the bath-room should not be -left while the skin is hot. The best way is to allow cold water -gradually to enter the bath, getting out directly there is the least -sensation of cold. The rule should be not to leave the bath when the -skin is hot and red and the pores wide open, without letting cold water -contract them by taking a short douche, and on getting out of the bath -the skin should be quickly dried by energetic friction with a rough -towel until the skin becomes quite scarlet. Not sufficiently drying the -skin will cool it rapidly, and even intensely, owing to the evaporation -of the water from the periphery, and surely cause a severe cold. - -To prevent the habit of catching cold the best way is to accustom the -skin to the action of cold water. Rubbing the skin with a cold wet towel -until the skin glows, especially the chest and extremities, is a good -way to effect this, beginning in warm summer weather and continuing -through the winter, but not _vice versa_. Decidedly the best -preventative to catching cold is to get the skin accustomed to fresh air -and cold water. - -To prevent catching cold after a bath a reaction of the skin is -necessary, and this is best attained by a rough towel, as before -mentioned, and by rubbing the body with a hard brush. Massage is an -excellent addition to bathing, as by this means the circulation through -the skin and muscles is much increased, thereby increasing the oxidation -of the body. By kneading the muscles waste products are brought into the -lymphatics (see, also, chapters on exercise). - -It is only logical that we must pay special attention to cleanliness in -those parts that have the greatest number of sudorific glands, such as -for example the axillæ and the toes of the feet. Circumstances often, as -when on a journey, do not allow of the luxury of a complete bath, and in -such cases we must be content to wash the body with water and soap, and -to rub down with a rough towel and brush, paying particular attention to -the axillæ and feet. These may also be bathed in alcohol and water, ½ to -⅓ of the latter, and also with vinegar and water; the feet can best be -cleansed in a foot-bath. - -From ancient times, especially in the East, such foot-baths have been -largely used, probably for the reason that sandals were worn, which -allowed dust and dirt to accumulate on the feet; people whose feet -perspire freely should always use a foot-bath daily; and, because the -feet are a part of the body which are the worst aërated from being -covered with impermeable leather, while they are, at the same time, the -best provided with sudorific glands, a daily foot-bath is advised for -all. - -When the feet perspire freely, hot water must be used; but after using -such we must immediately use cold water so that the opened pores will -close again. Pouring cold water into the bath or over the feet will -effect this, but it must be done quickly. - -Foot-baths are excellent things for those who suffer from cold feet, and -what at first sight seems paradoxical, a cold foot-bath in particular, -which acts by enlivening the circulation in the feet; the bathing -should, however, only last about a couple of minutes. Cold baths for the -feet also act very beneficially in cases of headache, and especially in -insomnia. They act upon the distribution of blood in the brain; the -blood-vessels are thereby first distended and afterward they contract, -which, lasting for a certain time, induces sleep; for, as mentioned in -the chapter on sleep, the brain must be free from blood if sleep is to -result. In hot summer weather it is quite delightful to sit on the banks -of a river and allow our feet to dangle in the water, and we always feel -refreshed after it; walking with bare feet is also very pleasant and -healthy in summer time. - -The action of a foot-bath is much increased by the addition of salt or -mustard, and with the latter is an excellent preventative against a -hyperæmic condition of the brain, such as apoplexy, as thereby we favor -a decreased congestion of this noble organ. - -Cold foot-baths should not be used by very old people, as they distend -the brain-vessels which, as a rule, are altered in such people and may -more easily rupture; if taken, a wet, cold towel should be wound round -the head. - -Cold baths generally are often beneficial in the case of certain nervous -troubles, such as neurasthenia and hysteria; only they must never be too -cold nor too prolonged, as otherwise the effects may be very depressing. -A short cold friction of the body every morning on rising is of great -advantage in the preservation of health. In kidney trouble we must, -however, be careful, as often an increase of albuminuria has been -observed after them. Sea baths are especially refreshing, owing to the -sodium content of the salt water. Our own observations teach us that a -bath had best be taken by first using water of the highest temperature -that can be borne (about 42 degrees C.). Those who can stand it might -continue to add hot water until the skin is quite red. Abundant -perspiration will then appear on the head, face, and neck. After having -perspired freely, we should then allow cold water to enter until the -bath has become cool. It usually takes some time to cool the water off -thus gradually, but after such a bath there is a feeling of great -exhilaration, especially after warm sea baths taken in this manner. We -consider that hot baths of long duration—say 30 to 45 minutes—are -especially useful in cases of kidney disease, or as a preventive of -such. We could take them twice a week as a means of eliminating the -toxic products of metabolism, but _it is an essential condition that the -heart and blood-vessels be in good condition_. The Japanese are in the -habit of taking such hot baths at an enormously high temperature, and -they feel the better for it. - -Bathing generally is favorable not only to the kidneys, but to all the -organs, as the processes of oxidation are thereby promoted, and our -prospects for long youth and long life are bettered. - - ------------------------------------------------------------------------- - - - - - CHAPTER XXVII. - - HYGIENE OF THE SKIN AND KIDNEYS BY MEANS OF PERSPIRATION. - - -UNDER normal conditions we daily lose a certain amount of water and also -of gaseous and solid products, among them many harmful ones, through the -invisible and insensible perspiration of the skin. That such a process -does actually take place is proved by our personal observation and by -the disagreeable feeling produced in cold and damp weather by the -checking of such perspiration. We can even be seriously affected if by -disease or by extensive burns a large portion of the skin be destroyed, -thus abolishing this insensible perspiration. - -The invisible and insensible perspiration can become visible and -sensible when either its evaporation into the air is checked, as in the -case of tight-fitting clothing, such as a rubber overcoat, or when the -temperature of the medium around the body is raised. Both conditions can -be fulfilled by fur clothing, for which reason its use as wearing -apparel is to be deprecated. - -When in a state of perspiration we should take special care that the -passage of the perspiratory products into the air shall not be impeded -by any means. Fur garments are not so unsuitable for old people in whom -the perspiratory functions of the skin are much diminished. We have, in -this connection, observed an old lady of 76 sitting at the dinner table, -close to an overheated fireplace, and wearing a large fur collarette, in -which she felt quite comfortable. As frequently mentioned in this book, -in old age there is a degeneration of the thyroid gland to a greater or -lesser degree, and consequently a lowering of the temperature of the -body and a diminution of the functions of the skin, which is dry and -rarely perspires. - -When the temperature of the medium which surrounds the body is raised to -a high degree, the capillaries of the skin are widened and more blood -circulates through them; thus also more blood is conveyed to the -sudorific glands, and naturally more water is then excreted by them, and -at the same time also more of the solid and harmful products. According -to Camerer, the sweat contains in each 100 grammes 50.6 g. ashes, 10 g. -fat, and 10 g. nitrogenous matters, of which 30 per cent. is urea and 75 -per cent. is ammonia. Uric acid was also found in the sweat of healthy -people, but Magnus-Levy found it missing in gouty patients. By frequent -sweating procedures the hygienic conditions of the skin can be promoted, -and especially so in individuals whose skin is generally dry and -inactive. In those who perspire much too freely, however, after several -procedures of this kind the overactivity of the sudorific glands can be -diminished. After very free perspiration the condition of the skin will -be improved, and then we will note the disappearance of certain skin -diseases, such as psoriasis in hot summer weather. - -Habitual excessive perspiration can, however, impair the skin through -the elimination of harmful products, although the skin is, to a certain -extent, protected by the greasy matters secreted through the sebaceous -glands. Likewise we can also note the loss of hair in persons perspiring -very much about the head and more particularly in those parts where the -sudorific glands are situated, such as the forehead and temples. This is -most frequently observed in those who have dry hair, in whom accordingly -there is a diminution of the functions of the sebaceous glands. In -persons who wear fur caps and whose head is always covered, we most -frequently find bald heads, especially if they have a tendency to -perspiring about the head. For this reason it is also more reasonable -never to wear hats if we desire to retain as long as possible the -natural ornament of the head. - -We can cause abundant perspiration by all the various means by which the -temperature of the body is raised. In such cases more blood comes to the -periphery of the body, and thus also to the sudorific glands. The -essential factor is the widening of the capillaries, and this can be -produced not only by agencies influencing the body from without, such as -hot air or a vapor bath, but also by agencies from within the body which -act on the vasomotor centers and thereby cause a widening of the -capillaries, such as certain drugs like salicylates, and also organic -preparations like thyroid extracts; mental emotion will also cause such -an occurrence. Salicylates are excellent drugs for producing abundant -perspiration, and are also less dangerous than pilocarpine. After the -use of the former and very free perspiration, we notice an improvement -in the symptoms of gout, for reasons we will give later. - -Of the different baths which are used to induce perspiration we award -the preference to electric light baths, where we obtain a double -advantage, for we can unite the advantages of perspiration with those of -the influence of light upon the body. We are able to prepare such a bath -so that the chemically active rays (see chapter on the advantages of -sunshine) are obtained. Not only is a very abundant perspiration -produced (indeed sometimes about a liter of sweat can be removed from -the body in from twenty to twenty-two minutes), but also the processes -of oxidation can be augmented. As a consequence we often note a great -diminution of fat in persons with a superabundant accumulation of this -substance. When in such baths blue light is used and the blue rays are -acting in overwhelming quantity, the condition of the nervous system can -be influenced in a very favorable way, and especially can excited -conditions be calmed. It is also probable that by such sweating -procedures toxic products, which are deleterious to the nervous system, -can be removed. Perspiration can also be caused by bodily movement -through exercise. In such cases, as proved by physiological experiments, -impulses are sent to the vasomotor centers, which result in a widening -of the capillaries through the excitation of such centers. Thus sweating -is created by fast walking, running, and frequently also by horseback -riding, and by various kinds of sports, such as cycling. In all these -cases it is essential, however, to change the clothes and underwear -which we have worn when perspiring, and to take a bath; for the -possibility is not to be denied that a part of the toxic products which -adhere to the skin after such sweating exercises may be re-absorbed, -although we are not in a position to give exact experiments to prove -such a supposition. - -Taking a bath and using soap and brush, and creating a friction until -there is a red reaction of the skin, may then prevent the danger of -catching cold, but after such a bath it is most important not to leave -with a hot, red skin and opened pores, but to cause their contraction by -a quick cold douche, continued at intervals until the skin is cooled and -the pores thereby contracted. An energetic friction of the skin must -follow before leaving the bathing place. - -After such a bath we shall experience a sensation of great comfort, and -shall feel much lighter and fresher. Such baths should be taken -frequently, at least once a week, and if we are very desirous of keeping -a youthful appearance for a long time, even more frequently. In stout -people, however, it is necessary for such baths that the muscles of the -heart be not degenerated; and also that there should be no serious -affection of the heart valves or of the blood-vessels, if baths of a -very high temperature and lasting a considerable time are indulged in. - -In cases of chronic intoxication and such like diseases of metabolism, -such as gout, and in cases of old age, perspiration induced by very hot -baths, providing the circulatory system is in good condition, should be -tried and given often if the results prove satisfactory, as we thus -obtain the benefit of the bath and also of the perspiration. - -The sweat baths should not exceed 15 to 20 minutes in duration unless -they are well borne, when a few more minutes may be added. In old people -cold douches should not be resorted to, but directly after the bath they -should be put to bed, which should have been previously warmed by -hot-water bottles. In persons where the processes of oxidation are -diminished and the skin very inactive, as is the case with many aged -people, such baths give very excellent results. - -Sweating improves the functions of the kidneys in a much greater degree -than those of the skin. By insensible perspiration water is eliminated, -together with certain harmful solid products which otherwise would make -their way through the kidneys; this occurs much more so when the -perspiration is greatly increased by sweating processes. In such cases -about a liter of water can pass through the skin daily, and in addition -a considerable part of the nitrogenous end-products of metabolism and of -common salt. It has been discovered by Professor Hermann Strauss[238] -that in a liter of sweat, under favorable circumstances, fully six -grammes of common salt can be removed from the body. Leube once found -2.31 grammes of chlorides in 800 grammes of sweat. - -Footnote 238: - - Deutsche Med. Wochenschrift, p. 34, 1904. - -Of nitrogenous bodies, according to Strauss, about 2 grammes can be -removed through the skin daily, and according to Professor von -Noorden[239] only 1 gramme. Leube discovered, about thirty years ago, -that the amount of nitrogen in the urine was 2 grammes less on such days -as sweating processes had been used than was usual on other occasions. -Kovesi and Roth-Schulz found 29 grammes of nitrogen and 29 grammes of -common salt in the sweat of patients suffering from Bright’s disease. -Strasser and Blumenkranz found, after electric light baths, a -considerable increase in the elimination of common salt up to 18 -grammes, 4 grammes more than had been ingested. Nitrogenous bodies have -also been eliminated in larger quantities than have been introduced, as -has also more water. This has been proved in experiments on the effects -of bathing, in which people with diseased kidneys have been used as the -subjects. In these cases the elimination of common salt and nitrogenous -products is certainly greater than in normal individuals. Still there -can be no doubt that with such, by perspiration and bathing, an -increased elimination of these products can be obtained. - -Footnote 239: - - v. Noorden: Pathologie des Stoffwechsel, vol. i, 1906. - -The experiments of Roth-Schulz and Kovesi are most interesting. These -authorities discovered, and before them H. Strauss, that the sudorific -glands of nephritic patients when in increased activity can secrete a -liquid that is more concentrated than the blood. Thus a compensatory -action can be obtained. They hold that, through sweating, from 10 to 20 -per cent. of the solids in the urine can be eliminated through the skin. - -It is also most important that they discovered a reduction in the -molecular concentration of the blood, which, as we know, is increased in -nephritic conditions. The frequency of sweating processes for persons -suffering from affections of the kidneys is all the more indicated -because such persons, generally, have a pale and very dry skin, the -temperature of which is, as a rule, diminished. - -To this great amelioration of the kidney functions by perspiration is -also due the fact that gouty patients are much relieved after frequent -sweatings. As already mentioned we attribute gout to an alteration of -the tissues of the kidneys, by which uric acid is retained. By diverting -the end-products of the nitrogenous bodies to the skin and relieving the -kidneys of a part of this strain, we may also improve their condition -and thereby the gouty element. At the same time, in consequence of these -procedures, the excretion of urine has much increased; and this has been -going on for several days, not only after the bath, but after the -sweating. By such an increased diuresis the condition of gout can also -be much improved, as everything that improves the kidneys improves that. - -From the observations of Haig, the elimination of uric acid is rendered -more difficult by reason of the presence of common salt; the increased -elimination, therefore, through the skin must necessarily be more -advantageous in the case of gouty people. - -There can be no doubt that sweating processes are of great benefit, not -only to the kidneys, but also to the other organs, such as the liver. - -We also generally observe perspiration in all processes of infection or -intoxication, and it may therefore be regarded as a probable species of -self-defense of the human body against the attacks of microbes or other -toxic products, for it would seem that by this means nature desires -spontaneously to get rid of the various toxic matters. Indeed, when we -treat fever with salicylates we are assisting nature to this end, for we -thus create perspiration. As already mentioned in Chapter III, persons -with a dry skin, who perspire but rarely, have less protection from -infectious diseases than others. Thus everything supports the theory -that the various toxic products, including those from microbes, are -eliminated by perspiration. Many years ago we tried to find microbes in -the sweat of typhoid fever patients in the St. Pierre Hospital in -Brussels, but as has been found in the bacteriological laboratory of the -Institute Solvay, the cultures that formed were due to a pollution of -the perspiratory products with foreign microbes. The efforts of other -authorities have also failed up to now to discover, by exact research, -the presence of microbes in sweat, as expressive of their elimination -through sweating. But, even if not supported by exact evidence, we feel -inclined to believe that by perspiration in abundance a number of toxins -of bacterial origin can be eliminated from the blood, because in -feverish ailments, after great perspiration, as in the case of -pneumonia, a great improvement takes place in the condition of the -patient. In former times bleeding gave similar results, perhaps in a -greater degree; but in the present day sweating has superseded this. - -To the hygiene of the skin through bathing we would wish to add, before -concluding this chapter, that carbonic acid baths may also give good -results, as they cause a better circulation of the blood through the -skin, which gets red. Such baths are also excellent preventatives -against arteriosclerosis. - - ------------------------------------------------------------------------- - - - - - CHAPTER XXVIII. - - ON EXERCISE, SWEDISH GYMNASTICS—MASSAGE—SPORT, AND WALKING AND RUNNING - EXERCISE. - - -ALL kinds of exercise have one essential point to them—they produce a -contraction of the muscles. As Ludwig and his disciples have shown, -contraction of the muscles produces an increased supply of blood in -them; more arterial blood being brought to the muscles, more oxygen and -heat is generated through them, which results in a general increase of -the process of oxidation. - -When muscles are undergoing contraction impulses are conveyed to the -splanchnic nerves, which are the regulators of the vasomotor system. -Through the irritation of these nerves, the blood-vessels of the -internal organs supplied by the splanchnics contract, and more blood is -despatched to the periphery of the body. The capillaries of the skin -will be dilated, and more blood will also be brought to the sudorific -glands; these also excrete more water, which takes the form of sweat. -Thus, by exercise that causes some exertion, abundant perspiration -follows, by which means we can obtain the advantages we have mentioned -in the chapter on the hygiene of the skin and kidneys; and it is for -this reason also that we place this chapter on exercise immediately -after the above-named one. - -The essential point in these exercises is that a great part of the -circulating blood will be brought to the periphery of the body, and thus -the congestion of the internal organs will be prevented or relieved. -Among these organs the kidneys will be benefited, but only in a -preventive sense, for in inflammatory conditions of the kidneys, -especially in the parenchymatous forms, all kinds of exercise should be -avoided. Besides the kidneys and other organs, the heart also may -benefit by exercise if such be taken in moderation. The greatest -benefit, especially for those with a diseased heart, will follow -exercises carried out in the form of Swedish gymnastics. - -The originator of the Swedish gymnastic movements was Peter Ling, who -gained great credit for himself and his country by the invention of this -system, which has prolonged the life of many persons suffering from -chronic ailments. In the Royal Central Institute for Gymnastics in -Stockholm, and also in private schools in that city, many experts have -been trained in these methods, and from thence they have spread all over -the world, many coming to the United States, where Dr. S. Weir Mitchell -introduced these salutary systems, and also massage. - -Massage was known thousands of years before Ling’s time, notably in -India, Java, and other countries of the Malayan race. Even the great -Harvey knew the effects of massage, for he quotes the case of a man who, -in consequence of an insult which he could not avenge, became so -overcome with passion and rage that he fell into a strange -disorder—suffering from extreme compression and pain in the heart and -chest, from which he only eventually received some relief when his chest -was pummeled by a powerful man—just as a baker kneads dough.[240] - -Footnote 240: - - Quoted after Sir Lauder Brunton, Harveyan Oration. - -The essential thing in massage is the kneading of the muscles. We thus -artificially increase the flow of the blood in them through the local -irritation of the skin and the mechanical diffusion of the blood in the -direction of the muscle. We thus produce artificial hyperæmia, not -unlike the effects of a mustard plaster, and, in the same way as the -plaster, we are also drawing blood from the congested organs, and -especially from the engorged heart; thus we obtain a better distribution -of the blood throughout the body and facilitate the action of the heart. - -It has been shown by the experiments of Sir Lauder Brunton and -Tunnicliffe that kneading the muscles increases circulation through them -in the same manner as massage. They found that during such kneading the -amount of venous blood which issued from them was sometimes diminished -and sometimes increased; that just after the kneading was over the flow -diminished (apparently from the blood accumulating in the muscles), and -this diminution was again succeeded by a greatly increased flow. The -clinical results are precisely what one would expect from increased -circulation in the muscles, and cases apparently hopeless sometimes -recover most wonderfully under this treatment. - -By means of massage the functions of the heart can thus be facilitated, -for massage mechanically diminishes the resistance of small capillaries -to the oncoming blood-waves sent from the heart. It mechanically -quickens the circulation of the blood through the capillaries by -dilating them in a way similar to exercise (see, also, Chapter XVIII). - -By certain massage movements applied to the exterior region of the -heart—such as vibratory massage—this organ can also be favorably -influenced; and by kneading, friction, and massage together applied to -the periphery of the body, and by passive movements of the extremities, -many cases of heart disease have been treated with good results, and -premature death prevented. Still more thorough is the effect of such -treatment if carbonic acid baths are used in connection with the above, -as at Nauheim, for such baths stimulate the skin, which becomes better -provided with blood. We have referred to the effect of such baths in a -previous chapter on the hygiene of the skin and kidneys by means of -bathing. - -The Nauheim treatment affords good results in mild cases of -arteriosclerosis, dilatation of the heart, and various other forms of -heart disease. - -Massage is also an excellent thing in chronic diseases of metabolism, as -it helps the resorption of waste products and augments the processes of -oxidation; in cases of gout, obesity, and also diabetes, it can -therefore give very good results. - -In the case also of healthy people who can afford to be massaged daily, -vital functions can be rendered more active and youthfulness prolonged; -and for those who do not possess facilities for being massaged by -others, they can perform it themselves by friction, rubbing the body at -rising and just before going to bed. - -The Swedish movements can also be performed not only by free gymnastics, -but also by the use of mechanical apparatus, such as that invented by -Dr. Zander of Stockholm. These movements, combined with massage, also -give good results in many of the above-mentioned ailments, but it would -lead us too far to enlarge upon them here. - -Much more strenuous for the body than Swedish movements and massage are -the exercises of sports, a complete description of which would exceed -the limits of the present work; but whether it be football, tennis, -golf, athletics, or cycling, the great object in all is to easily create -perspiration, by which the benefits described in the chapter on hygiene -of the skin and kidneys are obtained. It goes without saying, that a -diseased state of the kidneys excludes all kinds of violent exercise -which require a severe bodily movement. By means of sport the processes -of oxidation are also rendered more active, and thus obesity can be -prevented and cured, and at the same time the waste products are more -thoroughly consumed. Neurasthenic conditions, insomnia, etc., may be -improved if the sport adopted does not lead to too great fatigue; -otherwise they may be made worse. Taking into consideration, however, -the conditions of the circulatory mechanism, sport is a two-edged sword. -If undertaken in moderation all sport can improve our physical -condition; but it may prove disastrous if reason be not exercised and it -is indulged in to excess. By the strong muscular exertions referred to -an irritation of the splanchnic nerves takes place, resulting in a high -blood-pressure; more blood will pass with greater vigor through the -arteries and capillaries, which, consequently, become dilated. If this -occurs too frequently they will, as is only natural, lose their -elasticity, in which case degeneration of the arteries and development -of arteriosclerosis may follow. - -When a succession of severe muscular exertions takes place an -accumulation of blood occurs in the right side of the heart, and, as the -right ventricle cannot empty itself, shortness of breath, and even -death, may result. The left ventricle then becomes dilated, and such -dilatation of the heart not infrequently persists for a long time, even -in persons who have been in good health before undertaking severe -exercises. If, therefore, the normally healthy may suffer from an -irrational indulgence in sport, how much more fatal must be the results -to those with heart or kidney complaints, and with degenerative -conditions of the blood-vessels? - -To persons of advanced age sport may be very pernicious, for here the -elasticity of the arteries is wanting; they are more rigid, and -consequently cannot so readily dilate. Overexertion in such cases may -lead to the gravest results. - -As those engaged in sport lose a large quantity of fluid, they soon feel -thirsty, and so may be inclined to make up the deficiency of water in -the blood by partaking of alcoholic beverages, such as beer, whisky, or -wine; and if such are taken in large quantities, necessarily further -dilatation of the heart and blood-vessels will result, as is usual from -the frequent use of large quantities of liquids, not taking into account -the mischief caused to the various organs by the alcohol. As a general -form of exercise sport in moderation can be beneficial to the heart. -Naunyn has shown that blood-pressure falls from continuous exercise, and -Masey has also demonstrated this on galloping horses. The best form of -exercise is walking or moderate climbing. Moritz has shown that after -exercise the volume of the heart is diminished, and the rate of the -pulse increased. - -There are certain sports which do not require great bodily exertion, and -these are, in consequence, less harmful to the heart. Take, for example, -horseback riding, which produces a more or less accentuated rhythmic -shaking movement of the body. In a particular style of riding called -“the English trot,” the body rises and falls at regular intervals, which -causes—as we noted in our own person—free perspiration; the circulation, -especially in the abdominal organs and lower extremities, is also -promoted. We consider riding to be one of the most beneficial kinds of -exercise. We frequently note the healthy appearance of horseback riders -(except jockeys, who are underfed in their training). A well-known -member of the medical faculty in Berlin, a world-renowned specialist, -was a great horseman. He took part in the last Medical Congress in -Dresden, coming on horseback through the pouring rain from Berlin. -Possibly his good health was due to the vigorous exercise of which he -was so fond. By a strange irony of fate, this enthusiastic admirer of -riding died in consequence of an accident caused by his automobile a -short time ago. - -In certain kinds of sport, such as riding and cycling, the greater -possibility of accidents is a drawback, and in nervous individuals -serious traumatic neurosis, and often diabetes, may sometimes develop, -particularly in those cases where such people are descended from -diabetic parents. We published a case of this kind some years ago. For -such people this kind of exercise should be prohibited, especially in -those descended from diabetic parents. Cycling has the additional -drawback, according to Zunz, that from it fatigue is not so soon felt, -and thus overindulgence may more easily occur. - -Less injurious than sport, and much easier to be performed, is walking -exercise. As walking on the level does not necessitate great exertion, -unless performed rapidly, it can give good results if continued for a -considerable distance. It is desirable to walk as much as possible, and -never to use a street car or a carriage unless pressed for time; by this -means health may be greatly improved. In walking especially the muscles -of the lower extremities are contracted, and at the same time the -circulation is improved, the more so, of course, in the lower -extremities, but also in other parts of the body; and this is still more -the case when we walk briskly. For those possessing a good circulatory -mechanism, it is always advisable to walk briskly, thus indulging in a -healthy and practical and muscular exercise; and for such, also, running -for a few minutes several times daily is excellent, as perspiration can -thus be created, whereby harmful products are eliminated from the body. -This latter exercise is more suited to those living in the country, or -if in cities, to those who have a garden or large yard. - -It is advisable not to run too fast, as such would cause severe exertion -with bad effects upon the heart; but if undertaken at all it should only -be for a minute or so. Running at a moderate speed, breathing deeply and -rhythmically at the same time, and with rhythmical, rather short steps, -can be kept up even for eight to ten minutes without any particular harm -to the circulatory system. Personally we used to do this, and often, -when the thermometer stood below zero, without hat or overcoat, -finishing thoroughly warm and comfortable. Standing still after running, -when so attired, might lead to catching cold, but running out of the -house and back again without stopping causes no such risk, even in a -strong wind, as we have personally proven. Such running may best be done -three times a day, before breakfast, dinner, and supper, as this running -in and out of the garden is the best of appetizers, and is far more -beneficial than drugs for those men and women who sit about all day and -complain of want of appetite. Such running practice is only good for -those who have sound blood-vessels, heart and kidneys. Deep regular -breathing while exercising is also indispensable. - -Walking up a hill will naturally require greater exertion than walking -on the level, and may be more beneficial to the health than sports -conducted to a similar degree. At first the blood-pressure will -increase, but it will afterward decrease. Deeper respirations will have -to be taken, so that a larger supply of oxygen will be brought to the -lungs and tissues. - -Climbing high mountains should be strictly forbidden persons suffering -from disease of the heart and arteriosclerosis, for the greater exertion -then required has often caused death in persons so afflicted. To prevent -the bad circulatory effects of climbing it is necessary to breathe -deeply and regularly, and this, indeed, should not be overlooked in all -forms of exercises; even masseurs are unable to work properly unless -they take deep regular breathing. - -In mild cases of heart trouble, and even in more serious cases if -applied judiciously, Oertel’s treatment of each day slowly walking up a -steeper and steeper hill will give good results, giving good training -for the heart-muscle. But this treatment should only be carried out -under the direction of a competent specialist. - -The great advantage of the various kinds of sport and of walking, -climbing, and running exercise is that several other agencies can be -combined with them that are very important in the treatment and -prevention of the effects of old age. These are fresh air and sunshine. -We think that the combination of the three agencies—exercise, fresh air, -and sunshine—is the best and most necessary means for the preservation -of youthfulness and for the prolongation of life. - - ------------------------------------------------------------------------- - - - - - CHAPTER XXIX. - - A FEW REMARKS ON COLD FEET—THEIR CAUSE AND TREATMENT. - - -IT is intentional that we present this chapter immediately after those -on the improvement of the functions of the skin and on exercise, as -these are the principal means by which, as a general rule, we are able -to prevent cold feet. - -These are, for the most part, occasioned by an insufficient supply of -arterial blood to the extremities. This can be caused either by a -hindrance to the circulation—as for example in the case of irrational -use of articles of clothing—or through the want of muscular contraction -by exercise. In old people, especially, cold feet can be occasioned by -the degenerative alterations of the blood-vessels, in consequence of -which less arterial blood reaches the feet. If to this anatomical cause -there are other factors added, then naturally the sensation of cold feet -will much more easily result. We must bear in mind that the feet, like -the nose also, are the most distant parts of the body from the center of -the circulatory system—the heart, so that naturally in these parts, -through the less effective warmth of the arterial blood in old people, -and even in younger anæmic women, the sensation of cold will easily -arise. - -Cold feet through irrational clothing can be caused by using garters or -thick footwear with tight shoes, owing to the circulation of the blood -being thus impeded in the lower extremities. It is of no use to wear the -thickest woolen socks or stockings as a protection against cold feet, -which should serve to retain the natural warmth of the feet, and then to -prevent this warmth being given off, this latter resulting in the -sensation of cold feet. But how can this thick footwear retain the heat, -the generation of which it prevents by mechanically compressing the -blood-vessels and thus rendering the influx of warm blood impossible? - -It is also useless to wear thick socks if there be no layer of air -between them and the skin, which layer is the best means of retaining -warmth, as mentioned in the chapter on the hygiene of the skin in -connection with rational clothing. Neither the footwear nor the shoes -must, therefore, be close fitting. Many people wear such tight-fitting -socks or stockings, and boots or shoes, that the pattern of the socks is -impressed on the feet, in which case of course it need cause no surprise -if they complain of cold feet in spite of the thickness of their socks -or stockings. - -As already mentioned in the chapter on hygienic clothing, it would be -preferable to wear thin wool of the best quality and low half-shoes; -when so clad we will not suffer from cold feet if we take exercise. The -writer of this book wears such even in winter, in which season he puts -on gaiters only when the temperature is below 20° F. On some very cold -days he might feel cold in them, but then only in the morning, for after -a brisk walk, or better, after a smart run (see previous chapter) the -cold sensation disappears for the rest of the day. - -Exercise is, as a rule, the best preventative against, and the best -method of treatment for, cold feet, as it is through the muscular -contraction produced by walking or running that heat is generated, as -explained in the previous chapter on exercise. - -Rubbing and massage of the feet will produce results similar to those -obtained by exercise, and are still more effective if supplemented by -walking. - -When we sit still our body will naturally cool off. It is therefore a -good plan to make circular or other movements with the feet and not -allow them to remain still if we feel cold in them. - -While residing as a guest with an elderly lady, the head of an -aristocratic Dutch family, I observed her putting her feet on a silver -warming utensil, in which her footman constantly burnt a little oil -lamp, in order to keep her feet warm. I told her she could easily -dispense with this if she would make up her mind to take exercise on -foot instead of driving in her luxurious carriage, and not confine -herself to merely walking from one room to another. - -Defective circulation of the blood to the feet can not only result in -cold feet, but also in very serious ailments, and even in a shortening -of the ordinary span of life. Thus, in consequence of a deficient influx -of arterial blood and the stagnation of the venous circulation, -especially in old people with sclerotic changes of the blood-vessels, a -very trying and long-continued ulceration of the feet may result. By -bringing more arterial blood to the feet and causing hyperæmia, -according to Bier, we can cure this condition. - -Still more serious consequences may be brought about by defective -circulation in the feet, and especially in the toes, in the form of -senile gangrene, which is far more frequently found in diabetic persons, -and sometimes even before the commencement of old age. In cases of -arteriosclerosis, where cold feet are the consequence of defective -blood-supply owing to arterial degeneration, iodides together with -thyroid extracts will be found successful. They produce a dilation of -the blood-vessels, diminish the viscosity of the blood, and thus produce -the sensation of heat. The method of application will be found in the -chapter on the treatment of old age by organic extracts. - -As the promotion of a hygienic condition is an excellent preventative -against cold feet and also excellent for their treatment we repeat again -that a foot-bath should be used daily in such cases, and not only warm, -but also cold water should be used therein. Cold water acts as already -mentioned as a stimulant when applied as a foot-bath; but it should only -be used for a very short time, after which energetic rubbing of the feet -will produce active circulation and the feeling of warmth in them. We -recommend for cold feet to rub them with a cold wet towel, then to pour -over them a little eau de cologne or alcohol, and again rub them till -they begin to become red; we must next move the toes forward and -backward twenty or thirty times with our hand. We will then feel in the -feet a sensation of agreeable warmth. - - ------------------------------------------------------------------------- - - - - - CHAPTER XXX. - - ON THE BENEFITS OF SUNLIGHT. - - -IT is a matter of everyday observation that when we leave plants in a -room, where no sunshine can penetrate, they lose their color and soon -show quantities of parasites. Similar changes occur in persons who live -in dark rooms and seldom come into the sunlight. They become pale, and -are liable to all kinds of bacillary infections, especially -tuberculosis. An Italian proverb says, very justly, “Dove no viene il -sole viene il medico”—“Where comes no sun, the physician is coming,” and -a German proverb again says, “Auf die schattige seite der strasse kommt -der Leichenwagen doppelt so oft, als auf die sonnige,” which means in -English, “The funeral coach turns twice as often on the shady side of -the street as on the sunny side,” which saying, like most proverbs, -contains much truth. - -We often notice that on days when there is no sunshine especially when -at the same time it is cold and damp, we feel depressed in mind. In such -an atmosphere there is a diminution of the respiratory and transpiratory -functions of the skin, and, in consequence, a retention of toxic -products. On the other hand, on sunny and dry days these functions are -facilitated, and there is less work to be thrown upon the kidneys. Such -a rest does good to an organ that is almost constantly at work, and is a -wise economy for the days of old age. It is astonishing how sunshine can -influence our mental condition. We feel better able to work, and also to -take outdoor exercise, on sunny days. Particularly in old age is -sunshine precious, and we see our old house dog and our cat lying in the -sunshine and taking a sun bath. In the same way, instinct tells old -people that the sun is good for them, and thus they eagerly watch for it -to shine, and like to sit in it, especially on cold days. - -It has been shown by exact researches that the sun’s rays can kill -bacteria, and statistics have shown that in sunny weather there are -fewer infectious diseases, like influenza, than in dull weather. In -sunshine there are two elements which possess antitoxic and healing -properties: light and warmth. Its light is made use of in the treatment -of certain infectious diseases, like lupus (Finsen treatment). Both -these properties can be used to great advantage in the sunbath -treatment. Lying in the sun for a certain length of time causes a -dilatation of the blood-vessels and, later on, abundant perspiration. - -The ancient Romans made use of the therapeutic action of sunshine, and -many of them took sun baths on the roofs of their houses. There were -also public sun-baths, much visited by the population. The ancient -physicians recognized the value of sunshine in the treatment of various -ailments. According to Hippocrates, the sun-bath augments transpiration -and makes us more resistant against disease, giving us more strength. -Celsus also advised its use in nervous diseases. - -Certain people have undertaken scientific experiments on animals to -prove the great effects of light. Moleschott, the great physiologist, -found that the embryos of frogs gave off far more carbonic acid under -the influence of light than when they were in the dark. The stronger the -light the more carbonic acid was given off. Edwards found that such -embryos could not develop at all in the dark. - -Very important was the discovery of Arloing,[241] and also of -Duclaux,[242] that the growth of bacteria when exposed to the sun is -checked, and that later on they will even be killed. This is mainly due -to the action of blue and ultra-violet rays. - -Footnote 241: - - Arloing: C. R. de l’Academie des Sciences, p. 378 et 511, Paris, 1885. - -Footnote 242: - - Duclaux: Revue Scient., 1887. - -The chemical action of sunlight is exercised by the blue and -ultra-violet rays (Finsen), and the heat comes mainly from the red rays. -From our point of view, however, the chemical rays play the more -important part. - -When we sit in the sun for a long time and get an inflamed skin, this is -due mainly to the chemical rays. This fact was established by Charcot on -the basis of clinical observations. Charcot’s work has been confirmed by -the researches of Widmark, and especially by the exact experiments of -the famous Danish physician, Niels Finsen,[243] in 1906. The latter -showed that when strong light killed bacteria, this was due to the -action of the chemical rays alone, and, specifically, to the -ultra-violet rays. He also showed that these are the rays which produce -dilatation of the blood-vessels and an inflammatory condition of the -skin. - -Footnote 243: - - Finsen: “Om anvendelsen af concentrerede chemiske Lysstraaler,” - Kjöbenhavn, 1896. - -To the red cheeks of those people who pass much time in the open air and -sun, we can compare, as a contrast, the pale faces with a greenish hue -of those who live in the dark, like polar explorers. If strong light -dilates the blood-vessels, and sends much blood to the periphery of the -body, thus promoting the insensible perspiration and metabolism, on the -other hand, in the long night of the arctic regions there is contraction -of the blood-vessels, and the blood is kept back in the interior of the -body, with the retention of excretory products. It has been shown by -Oerum,[244] through experiments on animals, that the quantity of their -blood and its percentage of hæmoglobin is dependent upon the light. They -are reduced in the darkness and increased in the light. Through a light -bath the quantity of blood was increased 25 per cent. within four hours. -Finsen[245] has also found, through examination of twenty-nine persons, -that there is less hæmoglobin in the blood in winter than in summer, due -to the lack of sunlight in winter. Grawitz and Graffenberger have seen a -diminution of the hæmoglobin, as also of the quantity of the whole -blood, in animals which were kept in the dark. Marti found that the red -blood corpuscles are diminished in such animals, but become augmented -when they are again exposed for a time to the sunshine. - -Footnote 244: - - Oerum: Pflüger’s Archiv. f. d. g. Physiologie, vol. cxiv. - -Footnote 245: - - Hospitalstidende, p. 1209 and 1239, 1894. - -We should aim to get our share of direct sunlight in the open air, for, -as Finsen has shown, the valuable chemical rays of the sun are excluded -by glass; and, after all, it is not warmth alone we seek, but also the -chemical and anti-bacterial action of the sunlight, together with its -effects upon the blood-vessels and nervous system. - -To absorb as much of the active rays as possible, it is best to wear -light or light blue or light gray clothing, which allows the sun’s rays -to pass, whereas dark cloth does not, as found by Boubnoff and Lenkey. -The rays of the sun are always valuable, but their action varies with -the altitude. Thus, the higher the altitude and the rarer the -atmosphere, the more efficacious will be the action of the sun’s rays. -In lower altitudes the rays have to pass through dense strata of air -filled with vapors of carbonic acid and dust, and thus much of their -strength is lost. As Prof. Mohn[246] says in his book on “Meteorology”: -“The rays of the sun in transit meet always denser and denser air, which -contains large quantities of vapor, carbonic acid, and dust. A part of -their strength is absorbed by the substances contained in the air, and -these, as well as the air, are heated. Hereby some of the power of the -sunshine gets lost, as the rays of the sun are reflected off these -substances. Furthermore, they pass through clouds. Hence the rays of the -sun lose more and more of their strength before they reach the earth.” - -Footnote 246: - - Mohn: Quoted after Holm, Norsh Magazin. Laege, W. 6, 1906. - -It is also an important fact that the higher the altitude, the more -numerous are the chemical rays of the sun which have the greatest -heating properties. In high localities sunshine contains much more of -the blue and ultra-violet rays, whose wonderful action upon the red -blood-corpuscles has been shown by the experiments of Niels Finsen.[247] -Not only on the blood, but also on the nerves, they exercise a tonic -action. As Niels Finsen has shown, it is due to these blue and violet -rays that insects regain their vitality as soon as the sun shines. As -Dr. Holm says, it is probably due to these rays that the quantity of red -blood-corpuscles and of hæmoglobin is increased at altitudes of 500 or -600 meters above the sea level, as found by Viault[248] and Mintz.[249] - -Footnote 247: - - Meddelelser fra Finsen’s “Chemiske Lysinstitut,” Kjöbenhavn, 1899. - -Footnote 248: - - Viault: C. R. Acad. Sciences, p. 917, 1890 and p. 295, 1891. - -Footnote 249: - - Mintz: C. R. Acad. Sciences, p. 298, 1891. - -As a logical consequence of the above, we must try to enjoy sunshine on -mountains, or on the terraces of high buildings, as there can be no -doubt but that sunshine is more beneficial in such places. In high -altitudes sunshine is far more warming than lower down, probably due to -the fact that the sun’s rays pass fewer strata with vapor and foreign -substances, and thus less of their warmth is absorbed. Thus we can -explain the observations that, by exposure for a certain time to the -rays of the sun on the top of high mountains in mid-winter, erythematous -or eczematous eruptions were produced. At such great heights the air is -usually very dry, and so there is less loss of heat from the body. -Therefore we can sit comfortably in the sun at such heights without an -overcoat, even in winter, whereas several hundred meters lower down we -should feel cold even with an overcoat on, especially in a coast -climate. - -Let us be grateful for every ray of sunshine and take advantage of it. -Some ladies avoid the sun, but it would be wiser to seek it and, if -possible, to expose our whole bodies to its rays. Let us remove all the -curtains from the rooms in which we sleep or sit, especially from our -work room. In the train let us sit on the sunny side, and not draw the -curtain unless we are reading; in short, let us seek the sun wherever it -shines. We shall soon observe how much better we feel after a long -sojourn in the sun. We have often been surprised at the appearance of -patients whom we have sent for a holiday to the Riviera in Egypt or to -other sunny places. Thus we have often seen pale patients come back -rosy-cheeked and flourishing, and in our own case we have observed the -same thing after staying in California, Arizona, Mexico, and Florida for -several weeks. There is no denying that, as a rule, those who spend much -time in the sun look better and healthier than those who live in dark -rooms or offices. It must be understood that we are talking about -sunshine at a moderate temperature. But even a somewhat higher -temperature, with sunshine, can do no harm, especially to persons -suffering from chronic kidney trouble. In old age, as in other -conditions of athyroidia, we often find chronic interstitial nephritis -and sluggish kidney functions. Therefore we should relieve the kidneys -of any overwork and make the skin do more, which can be accomplished by -warm sunshine. Old people, if their means allow it, should never be left -to pass a winter in cold climates, but should be sent to warm sunny -climates like the Riviera, Egypt, or California or Florida in America. -They require as much sunshine as possible. Americans may use with great -profit the climatological charts of Dr. Charles Denison, of Denver, -Colo., which show with great exactness those parts of America where the -greatest number of sunny days occur. - -Against old age sunlight should be regarded as an excellent protection. -It safeguards our kidney functions by promoting skin activity, and it -aids the processes of metabolism. It is best used in combination with -exercise, like riding or some form of sport, and a daily sun bath. It is -our belief that, by such means, both youth and life may be prolonged. - -The wonderful effects of sunshine are illustrated by an interesting -experiment of Benjamin Franklin. According to Hufeland[250] this savant -had received wine from Madeira which he was putting into bottles on his -Pennsylvania estate. In this wine he found a few flies, which were -apparently dead. The sharp-minded savant put these flies in the July sun -of the hot Pennsylvania climate, and before long the life that had been -so long interrupted appeared again. The flies became lively and soon -flew away. They thus showed the same reaction to the beneficent effects -of sunshine as the insects in the above-mentioned experiment of Niels -Finsen. The fly is a most objectionable animal, but it possesses one -good trait that reconciles me to its existence; and that is that it is -so fond of the sunlight that it may thereby serve as an example to those -foolish people who do their best to avoid it. - -Footnote 250: - - Hufeland: “Makrobiotik,” p. 129. - - ------------------------------------------------------------------------- - - - - - CHAPTER XXXI. - - ON THE ADVANTAGES OF AN OPEN AIR LIFE AND OF BREATHING EXERCISES. - - -WHEN we note the faces of persons who, by reason of their occupations, -pass their lives in the open air, such as peasants, gardeners, etc., we -usually find them healthy and fresh-looking, and looking more youthful -than their actual age. This is especially so in the case of their wives -and daughters, who are more exempt from certain injurious habits, such -as smoking, and are less addicted to other harmful agencies, like -alcohol. Their fresh rosy faces speak in eloquent terms of the benefits -of fresh country air. - -On the other hand we see that others, whose daily avocations compel them -to stay all day in a close atmosphere, very frequently look pale and -sickly. Among such persons, as observation shows, infectious diseases -are frequent, and especially tuberculosis. This disease most frequently -develops in persons who pass all their time in close places, especially -when they are poorly fed at the same time. We can trace this plainly in -the working classes in certain European countries where, in Vienna, for -instance, until the past several years, about 70 per cent. of the total -mortality was due to tuberculosis. - -If we now take such tuberculous persons and place them in a hospital or -sanatorium and subject them to the open air treatment, compelling them -to pass all their time exposed to the fresh air, both day and night, we -soon witness a marvelous change. Their appearance is improved, and also -their appetite; and after a time in most of the cases there will be an -increase in bodily weight. We thus see that the open air produces -wonderful effects in such persons, who, as a rule, have been immured in -close places, they shattering their health. - -We have thus witnessed the clinical demonstration of the fact that fresh -air is able to improve our health. Fresh air contains much oxygen, and -this is a most indispensable substance, for without it we cannot live. -The red corpuscles in the blood which, loaded with carbonic acid, the -veins convey to the lungs, eagerly absorb the oxygen from the air that -we inhale and then convey it to the tissues to satisfy their -requirements for this precious substance. - -By absorbing oxygen the elimination of carbonic acid is at the same time -facilitated. The greater the number of red blood corpuscles that comes -to the surface of the lungs the greater will be the volume of oxygen -which is taken into the system, and afterwards the larger will be the -volume of carbonic acid gas expelled. Thus in the lungs there takes -place a distintoxication of the organisms, and, according to certain -authorities, the cells of the lungs are co-operating in this process in -a manner analogous to the internal secretion by the cells of other -glandular structures. - -The more fresh air, i.e., the more oxygen we get into our lungs, the -more we can contribute to the processes of oxidation in the tissues. -When the processes of circulation and of breathing are checked, and when -insufficient oxygen is absorbed, we soon see a very important change for -the worse in the condition of such persons, as exemplified by cases of -heart and lung trouble. - -Given the great importance of oxygen, we must try by every means to get -as much of it into our lungs as possible; we shall get more of it from -air that is not stagnating, but always in circulation. When we are in a -closed room, after a certain time we absorb all the oxygen in it, -particularly when there are several persons present who are sharing with -us the oxygen in the air. - -Staying for a long time in air so vitiated that it contains but little -oxygen and much carbonic acid and many microbes exhaled by the others, -we are liable to reap the disadvantages we have set forth in the chapter -on the dangers of a close room. According to Pettenkofer, the -exhalations from the persons present in a close room are much more -noxious than the carbonic acid gas. We, therefore, open the window and -door in order to create a current of fresh air, and so allow the oxygen -to be renewed. In this we but imitate nature, which sends a wind to -purify the close atmosphere on warm summer days. This is natural -ventilation. - -If we want to preserve our youth for a long time and attain an old age, -we must take all available means to avoid such air contaminated by -billions of microbes and vitiated by the exhalation of so many human -beings and animals, who also absorb much of the oxygen. To this is added -the smoke from the numerous manufactories, houses, and plants, and the -dust and exhalations from many noxious substances of various kinds. As, -however, fortunately, all this vitiated air is generally found in the -lower strata, always endeavor to find a lodging in the more elevated -portions of the city, and on the highest floor possible if staying in an -apartment house or in a hotel. If possible our houses should be built on -the outskirts of the city, and preferably near a park, or wood, or at -least a meadow where there is a free circulation of pure air. - -In our rooms, and especially in the sleeping room, the window, or at any -rate the transom, should always stand open, and if possible also during -the night. But when obliged to sleep in a room with a closed window to -avoid the noise of the street traffic, the first thing to do in the -morning, directly one gets up, is to open the window and let in the -fresh air, and do not close the window again until night-time. When we -are well covered we need not be afraid of catching cold. As a rule only -those take cold who keep in a warm room and live at enmity with fresh -air. Fresh air, as a matter of fact, never does any harm to its friends; -it is only dangerous to its enemies. As Captain Svaerdrup, a member of -Nansen’s expedition to the North Pole, told us, he and his comrades -never suffered from colds as long as they were in the polar regions. -They first caught them when they approached Christiania. - -When standing at the window inhale the fresh air deeply several times -and retain it as long as possible before exhaling it. - -Indeed we could preserve our health much more effectively if we imitated -the Indian and slept in the open air. It is a fact that many Indians -possess great immunity to all kinds of fatigue, enjoy very robust -health, and reach a green old age. This is undoubtedly due to the fact -that they pass the whole of their life in the open air. When tuberculous -people are kept under the free-air treatment we are, after all, only -following the example of the red man. Nobody who is accustomed to live -in a close room with heavy curtains at an average temperature of 75° to -80° from October to May, can imagine the pleasures of a wooden hut or -tent for day and night use. When Dr. Pottenger, of the Monrovia -Sanatorium, near Los Angeles, California, showed me around his little -wooden cottages in which his patients lived, I simply envied them. I -cannot imagine a more healthy dwelling-place than a tent in summer and a -wooden hut in winter, with a stove in it for the cold weather; and if we -cannot raise the heat over 75°, so much the better. - -The son of a family in England, who are great friends of mine, has -formed a resolution not to sleep any longer in the comfortable family -mansion, but in a tent in the meadows of his property during both winter -and summer. His family and friends regarded this as an eccentricity, -against which they warned him; but still he got on very well in his -tent, and looks fresher and healthier than ever before. We are always -put down as eccentric if we have the courage to resist the foolish -prejudices of our surroundings. For my part I prefer to live to be 100, -and to attain this I do not object to be considered “eccentric.” - -Anyone who is anxious to live long and preserve his youth should -endeavor to spend as much time as possible in the open air. After the -day’s work is finished we should always get out into the air, preferably -in a park or wood adjacent to our home, where there is more oxygen -contained in the air. We should follow the example of those English -people who leave town on Saturday and remain in the country until -Monday, leaving behind them the cares of business. There is probably no -nation which likes exercise in the open air so much as the English, -Scotch, and Irish, and among them is to be found the greatest longevity. -An agreeable way to get plenty of fresh air is by automobiling, and for -those whose means can afford it long journeys by automobile may -constitute an excellent fresh air cure, as they tend to improve the -appetite, produce sleep, and relieve neurasthenic conditions in general. -But automobiling can only be considered as a hygienic means for -longevity when the speed does not exceed twenty to twenty-five miles an -hour. - -When in the country we should always prefer mountains, and the higher -they are the purer is the air and the more oxygen does it contain, as a -rule. At the same time very much depends also on the presence of -forests, especially of pines and fir trees. High mountains with such -arborization generally have pure fresh air full of oxygen, and there is -no drug in pharmacy that can equal this in its beneficial effects. It is -a fact, established by leading physiologists, that persons living on -mountains have more red blood-corpuscles than those living in the -plains. When patients are sent to spots so elevated in the air as -mountains with forests, we find them, as a rule, looking healthy and -fresh when they return from their holiday in the fresh air. - -As found by A. and Y. Loewy and Luntz,[251] mountain air improves the -processes of oxidation and increases the number and depth of the -respirations. All this, however, according to these savants, is the -result of the exciting action of the sunshine. It speaks volumes for the -health-giving properties of mountain air that the inhabitants of such -spots, especially in Scotland, Switzerland, and Norway, have such fresh -rosy cheeks. These we notice more particularly among the females, -especially in young girls who are freer from the agencies harmful to -good health, such as alcohol, sexual excesses, etc. In Norway almost all -the young girls have fresh red cheeks, for which, indeed, they are -noted, due to the delightful air on its mountains and forests, with -which the whole land is almost covered. - -Footnote 251: - - Quoted after Landois: “Lehrbuch der Physiologie des Menschen,” Berlin, - Wien, 1905, eleventh edition, p. 235. - -I had the opportunity of proving for myself, after spending a certain -time in a resort on the top of a mountain in Norway, the delightful -purity and invigorating quality of the air, which was due to the large -amount of oxygen. As a confrère expressed it, there was champagne in the -air! It was not soiled here by any manufacturing plant, the curse of so -many places with fine air. Norway, one of the most extensive countries -in Europe, has at the same time a very small population, only about two -millions, and very few factories, so that the air is not polluted either -by a dense population or by the smoke of manufactories. Scotland, with -its highlands, has also a similar air, and the color of the Scotch -lassies is not far behind their Norwegian sisters. This can be admitted -as a scientific argument for the relations of health in the country. - -But Americans need not travel so far. There is as good a climate and -wonderfully fresh air in the Rocky Mountains, and also in other highly -elevated places, of which America can boast many more than Europe. But -whether there or in Europe it would be necessary to give up all -occupations for a few months, or at least for several weeks after every -six months. This time we should pass in those elevated places where we -can climb every day; climbing presents an excellent opportunity to get -much fresh air into our lungs, as we are then obliged to take much -deeper inspirations, thereby obtaining more oxygen from the pure air of -the mountains. As we shall show in the next chapter, exercise combined -with fresh air is of the greatest importance to our health and chances -for a long life and a green old age. - -But in order to get plenty of air it is not indispensable to go to -forests or mountains or to the seaside; we can also get it at home, -although not with the same amount of oxygen. To absorb much air we must -breathe deeply and keep in the inspired air, and endeavor to get it into -all parts of the lungs. In ordinary life we forget this and we get just -as much air into us with our superficial breathing as is necessary to -keep us alive and to feel no harm from our want of air. Most people -breathe only superficially, and only inspire deeper when mounting the -staircase, unless, indeed, they adopt the less healthy habit of reaching -the first floor by the elevator. But as it is of apparent benefit to us -to get as much air into our lungs as possible, we improve this state of -affairs by breathing exercises. The great importance of these breathing -exercises for the prolongation of human life has been especially -insisted on by Sir Herman Weber.[252] But before him, Hamel and Harry -Campbell[253] had already demonstrated the great therapeutic results of -respiratory exercises. Sir Herman Weber recommends commencing with -moderately deep inspirations and expirations, continued during from -three to five minutes once or twice a day, and then gradually increasing -to ten minutes or a quarter of an hour. The depth of each inspiration -and expiration, and the duration of holding the breath, are to be -increased only gradually. Sir Herman Weber advises inspiring in an erect -position, with raised arms and closed mouth, bending the body forward -during expiration so that the fingers touch the ground or the toes. - -Footnote 252: - - Loc. cit. - -Footnote 253: - - Dr. Harry Campbell on “Respiratory Exercise in the Treatment of - Disease,” London, 1907. - -According to this authority, besides the influence on the circulation, -the respiratory movements keep up the nutrition and efficiency of the -lungs, and also maintain the elasticity of the chest walls, which are -apt to become stiff in old age and thus interfere with the free action -of the lungs and pleura. - -These respiratory exercises can also be performed in a sitting or -horizontal position. - -According to Sir Lauder Brunton, the deep respiratory movements act as a -kind of massage to the lungs, thoracic walls, pericardium, and heart. - -Sir Herman Weber mentions that he has seen persons who get out of -breath, even after short walks and climbs, and who for this reason -abstained from such, and consequently suffered in health and spirits, -become, by means of these movements, active walkers and climbers, -gaining improvement in every function of the body, and outliving by many -years their brothers and sisters who had not practiced them. He also -specially recommends these breathing exercises to literary workers, -statesmen, professional men, and others who get no time to take the -usual methods of exercise. - -In certain heart troubles—for example, dilatation of the heart—these -movements are contraindicated. - -It is natural that if we practice these exercises in the fresh air of -the forests or mountains their salutary action will be still more -pronounced. But if we are too indolent to perform the regular breathing -exercises, whose beneficial effect upon the heart’s nutrition and action -is so great, it will suffice for us to take deep inspirations and -expirations while walking. We must get into the habit of doing this -every day, and thus prolong our life. - -As a general rule we only breathe with one part of our lungs, sadly -neglecting the other, by which the aëration of the blood will not be so -thorough. Independently even of the breathing exercises, it would be -very advantageous to our health if we gently took a long breath, which -should be so prolonged that we feel our stomach distended. The air will -thus reach the deeper portions of our lungs. This will also be the best -practice while singing; indeed, the latter would be the very best of -ways in which to obtain a good and thorough aëration of the lungs. We -have heard of cases where people without a voice have taken singing -lessons, for the simple reason that they were descended from families in -which tuberculosis was hereditary. - -This latter disease is one of the most frequent causes of a shortened -existence, and it is, therefore, our duty to point out here the great -advantages not only of a generous diet, consisting of a certain amount -of underdone fresh meat, uncooked milk of healthy cows or goats, and -many eggs, sausages and puddings made of the blood of pigs (see Chapter -XXXIX), but also of regular deep breathing, thereby permitting of the -entry of oxygen to all parts of the lungs. - -We always recommend breathing through the nose, as doing so through the -mouth dries up the mucous membranes, especially if throughout the night, -during sleep, the mouth is kept open. This bad habit permits of the -entrance of cold air which, not being warmed by passing through the -nasal passages, may be injurious to the lungs. The Indians are fully -cognizant of this fact, for in some tribes the mother binds up the mouth -of her child and thus compels it to breathe through the nose. - -In the foregoing we have shown the great advantages of abundant fresh -air. We have referred to the fresh appearance of country people, -especially of those who live on mountains, as also to the improved -condition of tuberculous persons after having been exposed to as much -fresh air as possible. I ask, therefore, why, if people suffering from -this disease derive so much benefit from fresh air, should not we, who -are still healthy, be also benefited by it? Let us therefore remain in -the open air as much as possible, and never prevent its close approach -to us; for it gives health, long youth, and a good old age. - - ------------------------------------------------------------------------- - - - - - CHAPTER XXXII. - - ON THE DANGERS OF LIVING IN CONFINED AND ILL VENTILATED QUARTERS. - - -Persons in the enjoyment of complete health and vigor are frequently -very sensitive to recognize the different agencies deleterious to their -health. In the same way as animals they possess a certain instinct in -this respect. In fact it is by this faculty alone that they can enjoy a -normal and robust health, as they are thus enabled to avoid all kinds of -dangers to their health, the integrity of their healthy mind also giving -them the necessary will-power for this purpose. - -Against all sorts of dangers to their health such persons, as a rule, -are prompt to act; thus, when they come into a close room the air will -soon become offensive to them, and they will either leave or ask for the -opening of a window or of a ventilator, closed through folly. On the -other hand sickly persons, or people who do not otherwise enjoy perfect -health or well-balanced minds, will remain in such a vicious air and -contract all the dangers consequent to it, shortening their prospects -for a healthy youth and long life. - -That living in the vitiated air of a close room is deleterious to health -is proved by a simple observation of the faces of those stopping for a -long time, or habitually doing so by reason of their professions, in -close localities. They will present a pale, gray sickly appearance, and -it is a fact that they very rapidly acquire all sorts of infections; -especially is tuberculosis very prevalent in such cases. We observe -precisely the same thing in the case of plants which, if kept in a close -room, especially where little light reaches them, soon lose their color -and are destroyed by parasites; and exactly the same happens in the case -of man. Prisoners, unfortunate work-people, living and laboring in large -numbers in small and close quarters, waiters and similar employees, are -those in whom tuberculosis is most frequently found. In respect to -workmen, this may be more truly the case in Europe, where they live -under more miserable conditions, than in America, where their position -is possibly the most enviable of all wage earners. - -Close air, just as much as stagnant water, promotes the growth of -dangerous microbes, and the chances of infection are greatly enhanced -where a number of people are gathered together in such places. Many of -them may be suffering from infectious diseases of the respiratory -organs; they exhale, and also eject by coughing or sneezing, an enormous -number of microbes, which mingle with the air and multiply at their -leisure in such close atmospheres; and this is especially so when they -are assisted in their growth by the great heat prevalent in such places, -particularly in winter time. Bacteriological examinations made of the -air of such localities have shown an enormous number of dangerous -microbes. We need, therefore, not be surprised when persons, and -especially children whose resistance is diminished, often contract -tonsillitis, diphtheria, bronchitis, or pneumonia, etc., after having -passed an evening in such a place, the air being hot, and particularly -if, at the same time, the temperature outside was very low. - -Living in a close room will soon tell on the general health, and this is -easily visible in the appearance of such persons. Their pale faces form -a striking contrast to the fresh rosy cheeks of those who habitually -live in the fresh air. Those who have to pass their lives in offices are -to be pitied, although, to a large extent, it is their own fault; they -deprive themselves of the benefit of fresh air, which, after office -hours, they would have ample opportunity to obtain if they would not -persist in spending their leisure time in a club or other close place, -instead of taking a brisk walk and exercise in the fresh air. No wonder -that such people easily acquire dyspepsia and stomach troubles! Exercise -in the open air is most valuable for promoting an appetite, and persons -sitting constantly in close places often lack this; thus their gastric -juice, which is indispensable to a thorough digestion (see chapter on -hygiene of eating—how to obtain an appetite) fails, and eating without -this juice their food will not be well digested and will create stomach -troubles, which are extremely frequent in such office workers, but rarer -in the case of peasants, coachmen, and other fortunate individuals whose -occupation keeps them in the fresh open air. There is an increased -amount of carbonic acid in the air of all localities where many persons -are present. According to Pettenkofer, even in our living-rooms the -carbonic acid content of the air is increased above the normal; and -still more is this so in lecture-halls (3.2 per cent., against a normal -content of 0.5 per cent.), in public houses (4.9 per cent.), and most of -all in school rooms (7.2 per cent.). - -We should, therefore, always keep a window open and never close the -ventilator. Fresh air is the thing we are most in need of to carry on -the oxidizing processes in our body. Exclude this and you exclude -health. We must also remove from the rooms all those things which can -absorb the air or hinder its entrance. There should never be flowers, -and particularly no potted plants, in a living room, as they require air -like ourselves; while to sleep in a room with plants is very deleterious -(see chapter on sleep). - -Curtains should all be removed, especially those of a heavy nature and -dark color, which would prevent the entrance of the beneficial sunshine. -Every room should be provided with openings for ventilation, and the -transoms used in America are especially useful when they are open, and -not used only to let the electric light into the sleeping room during -the night, thus disturbing sleep. As a close room tends to shorten life -it should be the policy of the government authorities never to allow the -use of any newly built house, especially of public buildings, unless it -contains openings for ventilation, the closing of which should be very -severely punished by law. - -If, during the day, it is necessary to have fresh air in every room, -there is still greater necessity for this during the night, as we -require more air during sleep than while awake; and, therefore, we -should never sleep in a room that is entirely closed, but always leave -the window (the upper part by preference) or the ventilator open. - -We can easily convince ourselves how injurious it is to sleep in a close -room by leaving our room in the morning, taking a walk in the fresh air, -and then re-entering our sleeping chambers that have remained closed as -we left them, and we shall at once realize the unhealthy condition of -the air in such a room, filled as it is with carbonic acid that has been -exhaled during the night, and also loaded with the other deleterious -toxic substances cast off by our lungs and skin. We shall then certainly -make up our minds not to inhale during the next night the same air -again, but to allow it to escape by the open window and thus permit the -entrance of fresh air into our lungs, whose need for air is much -increased during sleep in order to replace the large volume of carbonic -acid exhaled. - -As a consequence of passing the night in such a close room, we feel, on -the following morning, very heavy, and often have a headache; we also -often have no appetite for breakfast after such a night, unless we first -take a walk in the fresh morning air. - -The danger of the close room should be brought home to all, even -children, through instruction in hygiene in the public schools; and even -from their very youngest days this should be instilled into the minds of -youth, together with the contra-advantages of fresh air. By these means -they will be accustomed to the fresh air and its beneficial effects, as -much as they will learn to detest the horrors of the air exhaled by -other people, which is the source of so many infections. Every one who -wishes to enjoy life during youth, and live to a good old age, should -abominate a close room and never, if he can possibly help it, pass an -hour in such an atmosphere. - - ------------------------------------------------------------------------- - - - - - CHAPTER XXXIII. - - HYGIENE OF ARTIFICIAL HEATING—THE DANGERS OF HEAT BY STEAM AND A FEW - HINTS ABOUT THEIR PREVENTION. - - -OLD people are particularly sensitive to cold, and they therefore need a -warm room when the temperature falls in the autumn. In old age, -especially in its advanced stage, the processes of oxidation are -diminished, and thus less natural warmth is produced; but, as we give -off more heat in cold weather, it is only natural that they will feel -the cold then much more than younger individuals. - -The rooms, therefore, in which old people live must be kept very warm, -in the same manner as we do with infants, especially for those who come -of parents with degenerated thyroids. Thus we see again how old age and -infancy present many parallel features. - -But, if a very warm room be compulsory for aged folks, no such necessity -exists in the case of the young or middle aged, and it is abusing their -health if they remain long in rooms heated above 75° to 85°, or -sometimes 90°, where, at the same time, every window is sedulously -closed on all sides, so that no fresh air can find entrance. Such -overheated rooms we usually find in northern climates, and the air in -such cases is frequently hotter in the house in winter than we find it -in the open on a comfortably warm summer day, when, being in the open, -the heat can certainly be better borne than in a close room. - -In America many things are better than in Europe; but this certainly -does not apply to the method of heating used in the majority of the -houses, hotels, and office buildings, all of which are mostly -overheated, and that by steam heat, and very frequently with defective -ventilation, if there be any at all. The worst part of it is that a -uniform heat is maintained, whether it be a warm or a cold day; thus, -the air temperature was 55° F. on October 15, 1906, when I was in New -York, and in one of the most fashionable hotels the temperature was 75° -F. In Houston, Texas, there was a heat wave in February, 1907, with -disagreeable hot weather, yet 70° F. of steam-generated heat was -maintained in the hotels, which made life unbearable for those who, like -the author of this book, are so fond of fresh air. - -As we are endeavoring in this work to give hints how to reach a ripe old -age and prevent diseases which may dissipate our hopes in that -direction, it is our duty to protest and to point out the dangers of -such irrational heating. - -It seems to me, however, that in some northern countries in Europe -things are not much better, especially since steam heat is becoming more -and more used, as in Norway, even in the private houses. In some of -these countries—Russia, for instance—cotton is put around the window -panes to exclude the air, and also to absorb the moisture condensed on -the inside of the double windows. - -In many European countries, however, fireplaces and stoves are common. -The most rational method of heating, though not the most economical, is -the open fireplace in England, whence the most ventilation is obtained; -for the essence of the problem is to obtain warmth and fresh air at the -same time. English, Scotch, and Irish are most sensitive to an -overheated room, and they are probably the most healthy inhabitants of -Europe, too. While a guest, some years ago, of friends in Derbyshire, I -well remember that, directly the temperature rose above 65, the windows -were thrown open. - -Americans in Europe often complain that they are not warmed at the -fireplace, which only keeps the face and not the body warm. This, -however, will only apply to those who only feel comfortable at a -temperature of 75° F., which is distinctly unhealthy; for the open -English grate can very easily produce the standard temperature of 15° R. -(about 18° C.), which should not be exceeded if we want to have a -healthy warmed atmosphere in our rooms. Of course such fireplaces can -produce a much higher temperature, but even then the air is never so -offensive as that of rooms heated by steam. - -It would seem, at first thought, that women can withstand cold much -better than men, considering how much lighter is their dress and how -much more it exposes them to cold air. We sometimes see young girls of -the poorer class in such light clothing in mid-winter, standing in the -streets and talking with their friends, that we men shiver at the mere -idea of such clothing. Yet it is women who most need a warm room, -probably because their dress is much the same indoors in mid-winter as -in mid-summer. They, however, when out-of-doors wear heavy furs which -entirely check the respiration of their skin; and their light clothes, -when indoors, do not afford much opportunity for their skin respiration, -for then there is usually no fresh air in the house, but an oppressive -heat, all air ventilators being sedulously closed. It is strange how -people try, by every means, to destroy their health! - -In warm weather we give off less warmth and do not require so much food -in order to produce warmth, as the natural temperature also requires -less of us; in summer, therefore, we need less nourishment. - -Circumstances, also, become much more equalized in the artificial summer -of the overheated room. Whereas people taking a brisk walk in a cold and -bracing atmosphere return with rosy cheeks and a roaring appetite, the -unfortunates who persist in passing the day in overheated, especially -steam-heated places with a confined atmosphere will not feel a natural -hunger, will eat without a healthy appetite, and will have insufficient -gastric juice (see chapter on appetite), exposing themselves to -digestive troubles in consequence. Their need for food will be less, and -a bad condition of health will follow. - -Another and most imminent danger of overheated rooms is the facility -with which we are apt to take cold by walking from a room kept at summer -heat to the outside cold of winter. We all know how we catch cold, as a -rule, but we never know how it may end. Sometimes a simple cold is -followed by sore throat, but often also by catarrh of the bronchi, and -even of the lungs. In persons addicted to alcohol a fatal pneumonia from -such a cause is common; but, in any event, there is a great failing of -the general health for a long time, all of which may have originated -from an overheated room which has made us more sensitive to the effects -of cold. - -When we keep ourselves cool we are less liable to catch cold, as is well -known; for then our body is not first heated up and then cooled off -rapidly. This has been shown by experiments on animals. It is certain -that people accustomed to a temperature of 15° R. have much less -tendency to take cold than those living in rooms at 75° to 90° F. Such a -temperature is also a breeding place for billions of dangerous microbes, -which certainly prosper better at such a warm temperature. - -Still more dangerous are the consequences from the overheating of -railway compartments, as then it is still less impossible to avoid rapid -changes of temperature. When there are many persons in overheated -places, and the exhaled air from all of them contains an enormous -quantity of virulent bacilli, the danger of infection is still greater; -especially so when there is steam-generated heat, with its injurious -effects on the mucous membranes, whose resistance to bacillary invasion -is thus lowered. - -Steam heat is the most injurious of all heat, as it dries up the mucous -membranes and renders them thereby more liable to infection. We have -often noticed in persons with large tonsils inflammation of these -glands, which commenced every time that such persons inhaled -steam-generated heat for several hours. Such frequent tonsillitis will -also undermine the health, especially if we consider that not -infrequently an acute glomerulo-nephritis may ensue (and often does -follow, in an insidious way, without even being diagnosed). There have -also been plenty of cases of appendicitis in which the tonsillitis has -been in prior etiological relation to its development. - -We have observed persons who, in consequence of such frequent -tonsillitis due to steam heat, have run down in health, lost their -appetite, and presented a pale, gray and miserable appearance, whereas -before they were rosy-cheeked and vigorous. In others, continued -pharyngitis, bronchitis, and sometimes asthma, may be observed. - -In order to mitigate these dangers of steam heat we must place basins -filled with hot water in the localities where the steam heat is -produced. Such basins can be readily placed behind and attached to the -radiators; but they must be of large dimensions and must be kept -properly filled. - -Steam heat is most dangerous when there is insufficient ventilation; -there should, therefore, be behind the radiators, and also in the -opposite wall at a certain height, an opening for ventilation. It is, of -course, understood that such ventilators are to be always kept open and -not, as is unhappily so often the case, closed. It is of the utmost -importance that the radiators be thoroughly dusted every day, as this -heated dust is most injurious to health. This is a rule that should be -especially observed in railway cars. - -Fireplaces and stoves, which allow of a renovation of the air in a room, -are superior to the steam heat. In a room with an open fireplace or a -good stove the air is renewed, for a current of air is created which -removes from the room microbes and dust. Thus the air is purified. But -it is quite different with steam heat, which does not remove bad air -from the room. Fancy, now, a steam-heated hall, with many people in it, -which is overheated at the same time, and you will understand the -frequency of tonsillitis and bad colds after staying in such a -hall—which we would feel inclined to spell in a different way, to show -better its real nature. - -Hot-water heating is superior to steam heating. - -Everyone who desires to preserve youth for a long time and attain a good -old age, should avoid living continually in places overheated by steam, -without proper ventilation, as this is one of the surest means of -shortening life. - - ------------------------------------------------------------------------- - - - - - CHAPTER XXXIV. - - FOOD HYGIENE—GENERAL REMARKS. - - -THE leading principle in the use of food is that we should eat to live, -but not live to eat. It is certain that more people die from eating too -much than too little. It is wonderful to consider how little food -animals, or human beings, can exist upon for a long time and remain in -good health; and it is certain that the foundations of many diseases are -laid by excessive eating. It must be borne in mind that the elaboration -and assimilation of a large quantity of food requires the activity, or -even hyperactivity, of several of our most important organs, upon the -condition of which our length of life depends. And here we may repeat -the statement that has been made so often in the course of this book, -that overactivity of an organ may be followed by its exhaustion. By -laying too great a burden upon an organ, and continually overworking it -without giving it any rest for recuperation, we are burning the candle -at both ends, and rapidly exhausting the vitality of such important -organs as the liver, kidneys, pancreas, stomach, and intestines, not -forgetting those important glands, the thyroid and parathyroid, which -take a great share in the destruction of poisonous products formed in -our bodies from the end-products of food. - -We have just mentioned that with very little food animals, or human -beings, can live for a long time. But prolonged underfeeding may be -quite as dangerous as overfeeding. In starvation the resistance against -infectious diseases, and especially tuberculosis, is diminished. This -disease, the most common of all maladies, is found most often in -underfed people, especially if they live in confined localities with -little air and no sunshine. Moderation in food, as in everything else, -is the only way to attain a happy old age. - -The Romans had a very appropriate proverb which ran: “Omne quod est -nimium, vertitur in vitium,” “Everything in excess becomes a vice.” - -Much depends upon the quality of the food we take, for some foods are of -very little nutritive value; and even of the most nutritive food, some -parts may pass out as waste products, because those organs which -elaborate and assimilate food may be partially, or wholly, changed by -disease, and so unable to fulfill the work for which they are destined. - -Therefore, given a moderate amount of food, the condition of the body -and the maintenance of strength will depend mainly upon the nutritive -value of that food. An exact method of estimating the nutritive value of -food has been shown by Frankland, Stohmann, Danilewsky, and Rubner. - -The best method of calculating the nutritive value of any food consists -in estimating how many calories it produces in the body during -combustion. One calorie is the amount of heat necessary to raise the -temperature of one gramme of water one degree Centigrade. Comparing our -system to an oven in which food represents the fuel: Just as oxygen is -necessary for combustion in the oven, so we could not carry out the -processes of combustion in our system without a plentiful supply of -oxygen through our lungs and skin. Also, just as gases produced in a -furnace must have free exit, so the carbonic acid, formed in our tissues -in the processes of combustion, must be eliminated by the lungs and -skin, otherwise auto-intoxication will occur. The above-named -authorities have reckoned exactly how many calories the various kinds of -food produce in our body. - -All articles of diet can be classified into three principal groups: -proteids, carbohydrates, and fats. According to the above-named -authorities one gramme[254] of proteid produces 4.1 calories; one gramme -of carbohydrates, 4.1 calories; but one gramme of fat produces more than -twice as many, i.e., 9.3 calories. - -Footnote 254: - - As well known, one gramme is the equivalent of 15 grains. - -In order to maintain life without waste or without exposing ourselves to -disease, it is necessary to use all three kinds of food; for although -many animals, or human beings, can live for a certain time on only one -variety of food, most of them would die if this were persisted in for a -long time. The total exclusion of proteids especially would produce, -after a certain time, a considerable wasting of the body tissues and -certain death. According to Voith, it is necessary to take about 100 -grammes of albumin a day if we want to avoid waste of body tissue. -Proteid food cannot be replaced by either of the other two groups of -food. - -There are a series of facts which show that the estimate given by Voith -is perhaps too high. Horace Fletcher has shown by experiments on -himself, controlled by Professor Chittenden, that he could live in -splendid health with food not containing more than 45 grammes albumin, -and of 1600 calories heat value, in twenty-four hours, with a body -weight of 186 pounds. - -As shown by Professor Noorden,[255] in Vienna, a man must take 30 to 34 -calories for each kilo (2⅕ pounds) of his bodyweight when he is doing no -work, and 34 to 40 calories with light, and 40 to 60 calories with -harder work. Accordingly a man weighing 70 kilos would require to take -food equivalent to about 2800 calories for light work, and about 3500 to -4000 calories for heavy work. But Fletcher got along well on 1600 -calories with a body weight of 186 pounds. However, he lost some weight, -36 pounds, but became healthier and stronger than he was previously. -Later on he still further reduced his diet and lived on 38 grammes of -albumin and 1581 calories, continuing in perfect health. - -Footnote 255: - - v. Noorden: “Die Zuckerkrankheit,” fourth edition; and “Pathologie des - Stoffwechsels,” fourth edition, vol. i. - -By a series of experiments on a number of healthy American soldiers, -continued for a long time, Chittenden[256] and Horace Fletcher[257] -found that these men could do very hard work with an average of only 55 -grammes albumin and 2700 calories; and, what is more interesting, their -muscular power was doubled. - -Footnote 256: - - Chittenden: “Physiological Economy of Nutrition,” New York, 1904, and - “The Nutrition of Man,” London, 1907. - -Footnote 257: - - H. Fletcher: “The A, B-Z of Nutrition,” New York, 1904. - -The same result was obtained by Professor Chittenden by experiments on -seven of the finest athletes among the 2300 students of Yale University. -He found the strength of these students increased as much as 48 per -cent. One of them won the championship in gymnastics, open to all -American universities, during the course of these experiments. -Rechenberg found that the weavers of Zittau in Germany required 65 -grammes of proteids a day. - -Very interesting are the observations of Professor Baelz, of Tokio, made -on the Japanese coolies, who drew the jinrickshaw containing Professor -Baelz, who then weighed 160 pounds. These coolies took carbohydrates, -mainly rice, with a proteid content of only 60 to 80 grammes. They were -able to do their work exceedingly well on this meager diet. One day -Professor Baelz gave them a little meat which they took for three days, -and then refused it, saying they would take it after their journey was -done. Baelz made the interesting observation that these men were able to -go about 60 miles, drawing a man of 108 pounds, whereas Baelz, who -followed riding in a carriage, had to change his horse six times and -only beat them by half an hour. - -The author of this book has observed that while taking 1½ liters of milk -a day, 2 eggs, 40 grammes of butter, 3 rolls, 3 oranges, a pound of -cherries, a cup of coffee with milk, and one tart, he was able to live -very well for about two months without any loss in weight. The milk was -of excellent quality, containing about 700 calories to the liter, and -about 34 grammes albumin; thus he was taking about 70 grammes albumin -and about 2300 calories a day, with a bodyweight of 155 pounds, and -leading a very active life and he felt better than ever before. - -Still we would not like to generalize and say that 55 or 60 grammes -albumin in the day would be a suitable amount for every individual. -Here, as everywhere, individuality and many other circumstances must be -considered. What is good for one may not answer in the same way for -another. The Japanese have constitutions different to the Europeans, for -which reason we cannot apply to Europeans facts which hold good for -Asiatics. Moreover, not everyone’s digestive organs are capable of -utilizing ingested food to the same degree. The quality of the food is -also of great importance, and likewise its digestibility. Therefore the -question is very complex, and, for these and other reasons, the -discussion of which would lead us too far, we cannot recommend a diet -containing such a small amount of albumin for general use. - -Everybody likes to judge from his own experience, and so the author is -inclined to the belief that, when milk is taken in large quantities, in -addition to fats and carbohydrates, it is possible to get along with a -smaller amount of albumin, and of calories in general. Milk, in healthy -stomachs and intestines, is very easily absorbed, and the food leaves -less residue than most other kinds of food. Then, again, milk contains -in a wonderful combination all the three main groups of food. So we -believe that when milk is taken as the main article of diet we can get -along with a smaller number of calories, without any prejudice to our -health. - -According to Rubner[258] the following number of calories are indicated -daily:— - - Albu- Carbo- - min Fat hydrates Calories - - For an adult of 50 kilos (doing light work) 90 37 262 2102 - - For an adult of 70 kilos (doing light work) 123 46 317 2631 - - For an adult of 50 kilos (doing heavy work) 96 44 404 2472 - - For an adult of 70 kilos (doing heavy work) 118 56 500 3094 - - 91 45 322 2111 - -Footnote 258: - - Rubner: “Physiologic der Nahrung und der Ernährungtherapie,” Leipzig, - 1897. - -Albuminous food serves, according to the prevalent opinion, to build up -our body tissues, carbohydrates to produce the energy that is necessary -for muscular work, and the fats to produce heat. - -Accordingly, persons who are growing will need more albumin in order to -produce body tissues; and albuminous food will be indicated for those -who have had much loss of tissue, as in convalescence after wasting -disease. By albuminous food the waste of body tissues can best be -replaced. Also after different kinds of excesses where tissue is wasted -(e.g., after sexual excesses) albuminous food will be indicated. - -Such a food is also necessary for women during pregnancies, and -especially during lactation. - -In any of these conditions the minimum of albuminous food, taken daily, -should certainly be 100 grammes. But other persons can often manage with -less without any wasting of the body proteids, so long as carbohydrates -and fats are taken simultaneously in sufficient quantities. - -Besides the three principal groups of food there are certain other kinds -which are almost as indispensable, e.g., mineral matter and water, -without which no animal or man could live, and vegetable acids and -cellulose. - -The most important mineral matters are lime salts, mainly in the form of -phosphates. They are present in greatest amounts in cows’ milk. Common -salt is a most important element of food, for which animals and men -often risk their life. As Bunge shows, where vegetables that contain -much potassium are taken, then common salt must be taken as well. He has -shown by experiment upon himself, that when potassium salts are taken a -great quantity of sodium chloride is eliminated from the body. The -reason is, that when a potassium salt is taken, e.g., carbonate of -potassium, and this, in the blood, meets with chloride of sodium, then -chloride of potassium and carbonate of sodium are formed. But the -kidney’s duty is to see that the composition of the blood is maintained, -and that foreign substances, or the surplus of a normal substance like -carbonate of sodium, are eliminated. Hence the carbonate of sodium and -the chloride of potassium are together eliminated, and thus our blood -loses two important elements: chlorine and sodium. Thus, when potassium -is taken, the body loses sodium chloride, and then more of this -substance is required. - -A diet of potatoes necessitates much salt, as they are rich in -potassium; on the other hand, rice contains only minimal quantities of -potash. Potatoes contain 42 grammes of potassium in 100 grammes; rice -only 1 gramme. Thus rice as food would require only the smallest amount -of salt. - -At the same time Bunge points out the great dangers to the kidneys of a -diet from which quantities of an alkali salt are formed and circulate -through these organs. We can draw a practical conclusion of great value -from Bunge’s observations, and not use much salt in our food, nor too -large quantities of vegetables containing much potassium, if we want to -save our kidneys from harm. That salt is deleterious to the kidneys, -especially when previously damaged, is shown by the works of Achard and -Loeper,[259] Strauss,[260] Vidal and Javal,[261] and others. We have -enlarged upon this in our chapters on the functions of the kidneys and -their hygiene. - -Footnote 259: - - Achard and Loeper: C. R. Soc. biologie, 23 Mars, 1901. - -Footnote 260: - - Strauss: Die chronischen Nierenentzundungen, Berlin, 1902. - -Footnote 261: - - Vidal et Javal: Soc. Méd. des Hôpitaux, 26 J., 1903; Vidal: “Le regime - dechlorusé,” Liége Congrès de Méd., 1905. - -A mineral of great importance is iron, which is contained in pig’s blood -to the largest extent, and in certain vegetables and fruit in -considerable quantities. Vegetables and fruit are also rich in vegetable -acids, and also contain a large amount of cellulose, which plays an -important rôle in the normal evacuation of the bowels, being the most -natural stimulus for this purpose. - -Condiments are also indispensable in a certain quantity with our food, -for without them the food would have no taste and would not stimulate -appetite, which is of great importance for digestion. On the other hand, -too much of these condiments would irritate vital organs, like the -stomach, intestines, liver, kidneys, etc. Therefore they should only be -used in moderation, and the more potent ones, like mustard and pepper, -should be avoided, or only taken in minimal quantities. Vinegar would -not be so bad if it did not so often contain sulphuric acid. Certain -sharp sauces which are much used are veritable poisons to the kidneys. -This is true of soup that contains them, and even strong bouillon, when -it is taken every day in large quantities, may be injurious to the -kidneys and affect unfavorably the blood pressure since it contains many -meat extracts. To minimize the dangers of all these kinds of harmful -materials, and also of the end-products of nitrogenous food when passing -through the kidneys, it is best and healthiest to drink large quantities -of water, hard water being most desirable, according to Roese, because -of its richness in lime salts. It is advisable to drink this after -meals; but if water is not taken in too large quantities it may be -perfectly harmless to take it during meals. It helps the appetite in -many persons, and encourages the absorption of the food. If taken in too -large quantities it may dilute the gastric juice, although in such a -case the glands of the stomach strive to keep up the standard acidity, -and secrete more acid in consequence. As shown previously, a certain -degree of fluidity of the intestinal contents is indispensable for the -healthy action of the bowels. For all these reasons we recommend a -moderate amount of good fresh water daily. Happily, most of our -foodstuffs, especially green vegetables and fruit, contain water in -large quantities. - -Under the name stimulants we include various kinds of food accessories. -The most important of these are alcoholic drinks. It has been shown by -physiologic experiments that when alcohol is taken in moderate -quantities it is harmless, and at the same time may be of value as a -nutrient foodstuff. It is evident from the result of the experiments of -Atwater and Benedict that alcohol has a nutritive value, and that as a -kind of fuel it can largely replace carbohydrates and fats. In such -quantities it also stimulates digestion and other functions, e.g., those -of the heart and nervous system. Such small quantities of alcohol are -contained in beer and wine. According to Rubner, 100 parts of beer -contain:— - - - Alcohol Albumin Extracts - - Bavarian 3.45 0.61 5.3 - beer - - Pilsner 3.46 0.4 5.0 - - -English and American beers, however, are much stronger in alcohol; thus -Scotch ale contains 8.50 per cent. of alcohol; London porter, 6.90 per -cent.; lager beer, 3.90 per cent. - -Beer is also of nutritive value on account of its sugar and dextrine, -which are in considerable amount, especially in dark beers; it also -contains an appreciable amount of albumin. On the other hand, beer has -the disadvantage of forming uric acid in considerable quantities, as -shown by Walker Hall and Haig. Beer also conduces to obesity. There can, -however, be no harm in taking a small amount of light beer every day. - -Wine contains proteid substances, carbohydrates, and salts. In some -kinds of wine, like port, sherry, Tokayer, Malaga, and Madeira, there -are large quantities of sugar. The alcohol contents of the different -kinds of wine are given by Rubner as follows:— - - - per - cent. - - Tyrolean wines 8.3 - - French red wine 9.4 - - Rhine wines 11.1 - - Palatial (Pfalz) 11.5 - wines - - Mosel 12.1 - - -Thus, Tyrolean wines are the lightest, French wines come next, but Mosel -wines are the strongest, in spite of the popular belief that they -contain only little alcohol. - -Wines contain more acids than beer (0.41 per cent. to 0.69 per cent., -according to Rubner), whereas beer has only 0.1 per cent. As wine -contains vegetable acids, just as do vegetables and fruit, they may be -of a certain dietetic value on this account. - -We do not think it harmful if old people drink, every day, a few glasses -of good French claret, although we are not prepared to indorse the -dictum of Hufeland that wine is the milk of the old. Much greater -precaution must be taken in the enjoyment of spirits: brandy (cognac), -whiskey, and rum. These beverages contains 50 to 60 per cent. of -alcohol. Still we do not think that small amounts of whiskey, if taken -occasionally and in measured quantities, can be dangerous. Care must be -taken to get whiskey of good quality. There can be no doubt, however, -that when large quantities are taken, as in dipsomania, old age is -brought on sooner. It is claimed that after taking whiskey less uric -acid is eliminated than after taking the other alcoholic beverages, as -beer or some kinds of wine. - -Coffee, tea, and cocoa also belong to the class of stimulants, and we -will treat of them in a special chapter, as also of tobacco. - -Great moderation must be observed in the amount of food we take daily. -Too rich food would induce not only diseases of the digestive organs, -but also disorders of metabolism, like obesity, gout, or diabetes, and -thus shorten life. Arteriosclerosis is also promoted by such a diet. - -The more food also the more exercise should be taken, and the more we -work the more food should we take. - -Aged persons should take less proteid food and more carbohydrates. -Proteid food is better suited to young persons who are growing. Besides -carbohydrates, milk is also especially indicated for old persons, as are -also certain amounts of fat, butter, etc. - -The amount of food should also depend upon the climate; thus, in winter -more fat should be taken, for fat produces heat. Inhabitants of northern -climes eat much fat, and in Scandinavia more butter is taken than in -southern countries. In hot summer weather little proteid food is -required, and carbohydrates, vegetables, and fruit are more suitable. - -Much depends on the preparation of food. In the process of cooking the -food should be brought into the most advantageous form for absorption -and assimilation. Therefore much depends upon the way in which the food -is cooked, and the great importance of this fact is shown by the -establishing of courses in cooking in Berlin under the direction of -Prof. H. Strauss. - -In the choice of food attention must be paid to its digestibility. A -robust man, who works hard and takes much exercise, can digest easily -the most indigestible vegetable food, whereas a man occupied with -scientific work and sitting down all day will have a greater difficulty -in digesting it. Aged persons, whose digestive glands are atrophied, are -unable to digest food which presents great difficulties to the action of -their juices. Therefore raw milk, whipped eggs, tripe, lamb, rice, sago, -tapioca, barley, and soft boiled eggs, are the most digestible foods for -them. Of the vegetables, rice is among the easiest to digest, and it -will also soonest disappear from the stomach. There are special -preparations made from various kinds of cereals, finely ground, and -containing the most nourishing elements, and these may be advisable for -aged persons. There are also albuminous foodstuffs in which the albumin -is changed into the form of peptones. However, it has been shown by -Professor Ewald that they contain very little peptone, but mainly -albumose, its precursor. Others of these foodstuffs have the starch -transformed into dextrin or maltose. There can be no doubt that aged -persons will thrive and prosper on the best of these preparations, which -also have the advantage that they can be taken in conjunction with milk. -Another point in their favor is that they require little mastication. - -We add here a table after Professor Ewald, of Berlin, on the -digestibility of the various kinds of food:— - - - TABLE INDICATING THE DIGESTIBILITY OF DIFFERENT KINDS OF FOOD. - - The following food leaves the stomach in 1 to 2 hours:— - - 100 to 200 gr. of pure water. - 220 gr. aërated water. - 200 gr. tea. - 200 gr. coffee. - 200 gr. beer. - 200 gr. light wine. - 100 to 200 gr. milk. - 200 gr. bouillon. - 100 gr. eggs (soft boiled). - - - A longer time, 2 to 3 hours, is required for the digestion of the - following food:— - - 200 gr. coffee with cream. - 200 gr. cocoa with milk. - 300 to 500 gr. water. - 300 to 500 gr. beer. - 300 to 500 gr. milk. - 100 gr. raw eggs, hard boiled eggs, or omelette. - 250 gr. sweetbread, boiled. - 200 gr. dried cod, boiled. - 150 gr. asparagus, boiled. - 150 gr. potatoes, boiled. - 150 gr. potatoes, mashed. - 150 gr. cherries, a compôte. - 150 gr. cherries, raw. - 70 gr. white bread, new or stale, dry or with tea. - 72 gr. fresh oysters, boiled. - 200 gr. carp, boiled. - 200 gr. pike, boiled. - 200 gr. haddock. - 70 gr. biscuit, fresh or stale, dry or with tea. - 50 gr. Albert biscuits. - - - A still longer time, 3 to 4 hours, is required by:— - - 230 gr. young chickens, boiled. - 230 gr. partridges. - 220 to 260 gr. pigeons. - 195 gr. pigeon, roast or broiled. - 250 gr. beef, boiled. - 160 gr. ham, raw or boiled. - 100 gr. roast veal, hot or cold. - 100 gr. beefsteak, roasted. - 100 gr. sirloin of beef. - 200 gr. salmon, boiled. - 72 gr. caviar, salted. - 150 gr. dark bread. - 150 gr. brown bread. - 150 gr. white bread. - 100 to 150 gr. Albert biscuits. - 150 gr. potatoes. - 150 gr. kohlrabs, boiled. - 150 gr. carrots. - 150 gr. spinach. - 150 gr. cucumber salads. - 50 gr. apples. - - - The following food demands the longest time for its digestion:— - - 210 gr. pigeons, roasted. - 250 gr. filet of beef, roasted. - 250 gr. beef steak, roasted. - 250 gr. tongue, smoked. - 200 gr. hare, roasted. - 240 gr. partridges, roasted. - 250 gr. goose, roasted. - 250 gr. duck, roasted. - 200 gr. herring, salad. - 150 gr. lentils, mashed. - 200 gr. peas, mashed. - 150 gr. green beans, boiled. - - -The digestibility of these various kinds of food is calculated for the -normal stomach. By following the above table we can make the best choice -of easily digestible food. Especially for aged persons we should choose -such, and at the same time we should mince them, or give them in the -form of porridge, which is still better. We must do this because aged -persons do not possess, as a rule, good teeth, if any, and thus cannot -fulfill the demands of mastication, which we will treat of later on in a -separate chapter. - -The food should not be too hot nor too cold, as, if it is, the stomach, -and even intestines may be damaged; on the other hand, as a rule, warm -food disappears sooner from the stomach; but there are many exceptions -to this rule. - -The keynote in the hygiene of food is moderation. We should never eat -more than necessary to satisfy hunger. Most people know when they have -had enough; and as a rule animals never eat more than enough to satisfy -them, and then they will refuse more food. But with the intelligent -human being it is different, and there are not a few who eat more than -they require, and thus dig their graves with their teeth. Moderation is -all important; it is, indeed, the cause of longevity of those persons -who live about 100 years. - -We know the story of Cornaro, who became ill at 40 through immoderate -living. He recovered his health by reducing his food to the necessary -amount only, and then lived, happy and healthy, to 100 years. Mr. Horace -Fletcher,[262] and many other persons, have recovered their health -through moderation in food, after having come to the brink of death -through immoderation. Such examples we may often see, and they are -eloquent advocates of moderation in diet. - -Footnote 262: - - Loc. cit. - -We will show later that we can only digest food that we eat with relish; -therefore never let us be persuaded to partake of food, or compel -ourselves to eat, when we are not hungry. Therefore, at least six hours -should pass between dinner and supper, and five hours between breakfast -and dinner. It is more healthy, and especially conducive to healthy -sleep, to have dinner at 12 or 1, and supper at 6 or 7. Meat should only -be taken once a day, at dinner, and in the evening much less should be -eaten than at noon. Meat should never be taken for breakfast. We would -recommend the following diet:— - - - BREAKFAST. - -Grape fruit or oranges, 2 eggs (soft boiled), cereals, stewed fruit, -white or brown bread, fresh butter, a teaspoonful of marmalade or other -kind of jam, fresh cherries, or fresh strawberries, or other fruit in -season, especially grapes, half to one pint of milk. - - - DINNER. - -Soup, fish or meat, vegetables, stewed fruit, fresh fruit, white or -brown bread. - - - SUPPER. - -Like breakfast: one pint of milk, or half a pint of sour milk, kefir, or -koumiss. Also, if liked, sour milk during the day. - -In the above diet list we have a variety of foods, which variety is of -great importance. - -It is very advantageous, according to our observation, to append to this -diet some milk, carbohydrates, fat, green vegetables, and fruit, with -the exclusion of meat. This we may do, especially if the weather is warm -in spring, summer, or early autumn; but in winter the above diet with -meat should be taken. It would be an excellent thing to take these two -diets in alternating periods. Much will depend upon the tastes of each -person, and the special indications which we give later on in their -respective chapters. - -When no meat is eaten, then at least 1½ to 2 liters of rich milk should -be taken, and some cream cheese. - -After these general remarks on food we will treat of the merits and -drawbacks of the various kinds of food. - - ------------------------------------------------------------------------- - - - - - CHAPTER XXXV. - - ON PROTEID FOOD, ANIMAL FOOD, MEAT, FISH, EGGS, MILK, ETC. - - -MEAT is the commonest animal food, is the most nutritious, and most -closely resembles in its composition our own bodily tissues. Because the -albumin of meat is much better absorbed than any other kind of albumin, -such food can replace wasted body elements in a shorter time than can -any other kind of nutriment. - -Even the albumin of milk leaves more residue than that of meat. From -this latter, therefore, is derived the most benefit during the period of -bodily growth, or in the other conditions above mentioned; but it will -not be so efficacious in those whose growth is already finished, or -whose body tissues are wasted by disease or by other demands on them. - -Meat contains very valuable nutritive elements, such as large quantities -of proteids and fat, but very little carbohydrates; also various -important salts, such as chlorides, phosphates, and carbonate of -potassium. Meat also contains iron, the largest amount being found in -the blood of pigs. We can estimate the nutritive value of different -kinds of meat from the following table; according to Professor -Rubner,[263] each 100 parts contain:— - - - ────────────┬──────────┬──────┬────────── - Food. │ Albumin. │ Fat. │Calories. - ────────────┼──────────┼──────┼────────── - Lean beef │ 20.6 │ 1.5 │ 98 - Fat beef │ 16.9 │ 27.2 │ 327 - Fat pork │ 14.5 │ 37.3 │ 406 - Lean pork │ 19.9 │ 6.8 │ 145 - Lean veal │ 19.8 │ 0.8 │ 89 - Fat veal │ 18.9 │ 7.4 │ 146 - Fat chicken │ 18.5 │ 9.3 │ 162 - Hare │ 23.3 │ 1.1 │ 106 - Herring │ 10.1 │ 7.1 │ 107 - Bacon │ │ 95.3 │ 886 - ────────────┴──────────┴──────┴────────── - - -Footnote 263: - - Rubner: “Physiologie der Nahrung und der Ernährungtherapie,” Leipzig, - 1897. - -In addition to the above nutritive elements there are also a series of -extractive substances to which is due the pleasant taste of the meat. -When such food is boiled these substances and salts pass into the water, -and such meat loses in flavor, though not in its nutritive qualities, -for the water i.e., the soup is not nutrimental at all. Meat, if -prepared for the table directly after the animal is killed, would not be -palatable; and it is, therefore, necessary for it be kept for a given -time before it is eaten. Dr. Wiley, of Washington, considers that meat -improves if kept not exceeding fourteen days in cold storage, after -which time it begins to lose its best qualities. - -When meat is chilled it does not lose its pleasant taste; but when it is -frozen the case is very different, for then it loses its beneficial -juices, which escape into the surrounding ice. In such meats, therefore, -the extractives which give the pleasant flavor are wanting. Refrigerated -meat generally arrives in Europe in excellent condition from America. - -Before animals are slaughtered to be used for food a rigorous -examination by veterinarians must be made, in order to avoid poisoning -from meat in a condition of putrefaction, or from diseased animals. Some -animals, such as pigs, very often suffer from acute inflammatory -diseases caused by catching cold while on long journeys prior to being -slaughtered. Fortunately, in the early stages of such illness there is -little danger, for it can be avoided by thorough bleeding. The Jewish -method of bleeding an animal is thus particularly to be recommended, for -by this means poisonous products can leave the animals’ bodies in large -quantities. Meat retaining all the natural blood decomposes very -rapidly, especially in hot climates, and we must not forget that such -poisonous substances, as ptomaines, in meat, are not destroyed by the -process of cooking. - -The greatest danger from poisoning lies in oysters, which are otherwise -a most digestible food. This is owing to the frequent presence of sewage -contamination in the waters where they are bred, thereby causing -veritable epidemics of typhoid fever. Just as in fish foods, oysters and -mussels, sausages in the meat foods are the most frequent cause of -poisoning when they are not quite fresh and thoroughly sound, and from -such a cause epidemics from poisoning are frequent in Germany. Sausages -are a very nutritious food, as they contain a large amount of fat; their -greater value when made from the blood of pigs, on account of its -richness in iron, will be specially dealt with in another chapter. - -Fish contain somewhat less albumin and much more water than meat, but -some of them are rich in fat, such as the eel. We show in the following -table the nutritive values in each 100 parts of some of the most -frequently eaten fish:— - - - ────────────┬──────────┬──────┬────────── - │ Albumin. │ Fat. │Calories. - ────────────┼──────────┼──────┼────────── - Herring │ 10.1 │ 7.1 │ 107 - (Rubner) │ │ │ - Haddock │ 17.1 │ 0.3 │ 73 - (Rubner) │ │ │ - Salmon │ 16.10 │ 5.50 │ 110 - (Pavy) │ │ │ - Eel (Rubner)│ 17.8 │ 28.4 │ 317 - White fish │ 18.10 │ 2.90 │ 102 - (Pavy) │ │ │ - ────────────┴──────────┴──────┴────────── - - -Fish contain as a rule very little extractive substances compared with -meat, and are therefore less tasteful; but still the fatter fish have an -agreeable flavor, and are pleasant to the taste. As a general rule, they -are more digestible than meat, and also have less of other disadvantages -than meat food, on which we will dwell more fully in another chapter. - -On the other hand, it is more important than with meat that fish should -be absolutely fresh, which would be best attained by keeping them alive -in water until just before being required for the table. Boiled fish is -the most digestible, fried less so, and pickled or smoked the least. - -The most perfect animal food is milk, as it contains all the three -principal elements of nourishment, and in normal digestive organs is -easily resorbed. As in the case of meat diet, we will deal more fully -with this most important and wholesome food in a special chapter. We -will content ourselves with mentioning here that milk not only contains -the three principal elements of food, but also most of the equally -important organic and inorganic minerals, without which life would be -impossible. It contains very important organic phosphorized combinations -in the shape of lecithin and nuclein; and of the inorganic salts, lime -exists in milk in a much greater degree than in any other food. Besides -the albumin, carbohydrates, and fat which it contains, milk comes under -the category of foods which are richest in mineral salts, especially -lime, of which cows’ milk contains 1510 milligrammes in every 100 -grammes of desiccated substance, according to Bunge. In iron only is -cows’ milk very poor, and therefore when milk forms the main part of our -daily nourishment it will be necessary to partake of iron at the same -time, which we can best do by eating sausage and puddings made from -pigs’ blood (see Chapter XXXVIII). - -According to Professor Rubner milk and the various products of milk -contain the three main elements of food, in each 100 parts, as follows:— - - - ────────────┬──────────┬──────┬──────────┬────────── - │ Albumin. │ Fat. │ Carbo- │Calories. - │ │ │hydrates. │ - ────────────┼──────────┼──────┼──────────┼────────── - Cows’ milk │ 3.4 │ 3.6 │ 4.8 │ 67 - Cream │ 3.7 │ 25.7 │ 3.5 │ 268 - Buttermilk │ 3.8 │ 1.2 │ 4.6 │ 41 - Whey │ 0.8 │ 0.2 │ 3.4 │ 24 - Butter │ 0.9 │ 83.1 │ 0.5 │ 404 - Cream cheese│ 27.2 │ 30.4 │ 2.5 │ 779 - ────────────┴──────────┴──────┴──────────┴────────── - - -According to Bunge the following is the composition of cows’ milk, human -milk, and the milk of some animals which rank nearest to human milk; -each 100 parts contain:— - - - ────────────┬──────────┬────────┬──────────┬──────── - │ Casein. │Albumin.│ Fat. │ Sugar. - ────────────┼──────────┼──────┬─┴────────┬─┴──────── - │ │ │ { 3.1 } │ { 5.9 } - Woman │ 1.2 │ 0.5 │ { 3.3 } │ { to } - │ │ │ { 3.8 } │ { 6.5 } - Cow │ 3.0 │ 0.5 │ 3.7 │ 4.9 - Horse │ 1.2 │ 0.8 │ 1.2 │ 5.7 - Ass │ 0.7 │ 1.6 │ 1.6 │ 6.0 - Goat │ 2.4 │ 0.8 │ 4.3 │ 3.6 - ────────────┴──────────┴──────┴──────────┴────────── - - -The milks nearest to human milk in composition are those of the horse, -ass, and goat. It is a very interesting fact that goats’ milk contains -ten times as much iron and nearly seven times as much lime as human -milk, and also ten times as much iron and eight times as much lime as -cows’ milk. On account of its nearer similitude to human milk than the -cows’ milk, and also because of its being richer in valuable minerals, -we will later on, in the chapter on the advantages of milk food, -advocate its use in preference to cows’ milk. We will also show at the -same time that milk must not be boiled, for by so doing very valuable -ferments contained in the milk will be destroyed. Woman’s milk is richer -in these ferments. According to Beauchamp, Bouchut, and Moro, there is a -diastatic ferment in breast milk, but not in cows’ milk. Manfur and -Gillet found a saponifying ferment in mothers’ milk which is less active -in that of cows. Luzatti and Bianchini found a starch-separating ferment -in woman’s milk which is absent in cows’ and goats’ milk. According to -Spolverini, cows’ milk has the same ferments as has human milk, except -the amylolytic ferment, and also a salol splitting element that has been -discovered by Nobecourt and Merklen in the milk of woman. - -Butter is a milk product in daily use, and is one of the foods most used -in our diet; and as it is consumed in connection with carbohydrates, we -will refer to it later, when discussing the question of carbohydrates -generally; but we may mention here that butter must be taken only in a -fresh condition, and it should not contain a greater proportion of salt -than 2.5 grains per ounce, for reasons we have so often insisted upon in -our general remarks on food when referring to common salt, and also in -the chapter on the hygiene of the kidneys. When butter is in a rancid -condition it produces acid fermentation in the stomach, and also -disorders of the intestinal functions. - -Cheese is a milk product very rich in fat, consisting of the coagulated -casein of the milk fats and salts. American, Canadian, and English -cheese are manufactured from pure milk, while the majority of cheeses of -other manufacture are made from skimmed milk. A very nutritive cheese is -made in Norway from the pure milk of goats; this has a very pleasant -taste and is very easy to digest. By moderately pressing fresh curds -cream cheese is made; and we are of the opinion that in this form it is -more hygienic than old cheese, and we therefore give the preference to -cream cheese, or to cheese made from pure milk that is not old or sour. -Cheese is a very valuable article of nourishment on account of the large -amount of albumin and fat that it contains. Gervais and other sorts of -cream cheese have a very high percentage of fat. - -Dr. Haig[264] recommends cheese as a valuable article of food in the -dietetic treatment of uric acid diathesis. It has also the great -advantage of being able to check intestinal putrefaction, owing to its -milk and fatty acid contents. - -Footnote 264: - - Haig: Loc. cit. - -On the other hand, sometimes very old cheese may cause intestinal -putrefaction, with symptoms of intoxication, and serious catarrh of the -intestines. Professor Vaughan, of Ann Arbor, found toxic ptomaine bodies -in cheese and old and stale milk. - -Many people are unable to digest cheese well; others develop skin -eruptions or acne after eating it; but, for those who can take it, it is -very valuable as an article of diet when a lacto-vegetarian regimen is -followed, as suggested in our general remarks on diet. - -In addition to milk and meat, the next most important animal food is -eggs, which are very rich in a most soluble animal albumin, and also in -a substance which plays an important part in the structure of the -nervous system—lecithin. According to König[265] chicken’s eggs have, in -their natural watery condition, 13 per cent. of albumin and 0.3 per -cent. of fat; and 89 per cent. of albumin and 2 per cent. of fat in the -dried substance of the white part; whereas the yolk, in the natural -watery state, contains 16 per cent. of albumin and 32 per cent. of fat, -while, if dried, 33 per cent. of albumin and 65 per cent. of fat. Eggs -also contain much lime. - -Footnote 265: - - T. König: “Chemie der menschlichen Nahrungs und Genussmittel,” second - edition, Berlin, 1882. - -Eggs with milk, carbohydrates, and fat together constitute a food which, -in our opinion, is the most perfect, and one which will enable us to -live a longer life in perfect health, even with a complete exclusion of -meat; though if we take in addition a little of this latter at dinner we -may increase considerably in weight, notwithstanding bodily exercise, as -the author found from personal experience and from observations on a -series of patients. Therefore, we again repeat that the above appears to -be the most beneficial diet to follow if we wish to obey the dictates of -health and enjoy a prosperous long life. - - ------------------------------------------------------------------------- - - - - - CHAPTER XXXVI. - - ON CARBOHYDRATES AND FATS, AND THE GREAT ADVANTAGES OF VEGETABLES AND - FRUIT. - - -SPEAKING generally, by the title “carbohydrates” is principally meant -vegetable food, in the same way that by “albuminous” animal food is -mainly designated. Still there are vegetables which contain more albumin -in their natural watery condition than meat; thus peas contain 23 per -cent. of albumin, whereas lean beef has barely 21 per cent., and fat -beef only 17 per cent. But one thing must especially be considered, and -that is the fact that a considerable portion of peas (about 28 per -cent.) is not absorbed, as Rubner has shown, whereas nearly the whole -albumin contents of lean beef is. - -Most albumin is found in leguminous vegetables, such as peas, beans, and -lentils; and these are also rich in carbohydrates, as will be seen from -the following table of percentages by Rubner, in which reference is also -made to the nutritive value of our most important fresh vegetable -foods:— - - - ─────────────────┬─────────┬──────┬──────────┬─────────┬───────── - Food. │Albumin. │ Fat. │ Carbo- │ Cellu- │Calories. - │ │ │hydrates. │ lose. │ - ─────────────────┼─────────┼──────┼──────────┼─────────┼───────── - Flour of peas │ 25.7 │ 1.8 │ 57.2 │ 1.3 │ 362 - Flour of beans │ 23.2 │ 2.1 │ 58.9 │ 1.8 │ 363 - Flour of lentils │ 25.7 │ 1.9 │ 56.8 │ 2.1 │ 364 - Flour of rice │ 6.9 │ 0.5 │ 77.6 │ 0.1 │ 351 - Flour of Indian │ 14.0 │ 3.8 │ 67.6 │ 3.1 │ 382 - corn │ │ │ │ │ - Flour of wheat │ 10.2 │ 0.9 │ 74.7 │ 0.3 │ 357 - Flour of rye │ 10.9 │ 4.8 │ 70.5 │ 1.2 │ 383 - Wheat bread │ 6.8 │ 0.8 │ 57.4 │ 0.4 │ 252 - Rye bread │ 6.0 │ 0.5 │ 47.8 │ 0.3 │ 226 - Potatoes │ 2.1 │ 0.1 │ 21.0 │ 0.7 │ 98 - Carrots │ 1.0 │ 0.2 │ 4.4 │ 1.4 │ 50 - ─────────────────┴─────────┴──────┴──────────┴─────────┴───────── - - -From the above we see that peas, beans, and lentils have the most -nutritive properties, for they contain not only much albumin but also -much carbohydrates, and also more fat (except in the case of ground -Indian corn and rye), than the other above-mentioned vegetables. - -Thus we shall not be surprised to learn that we can thrive very well for -a long time by using such exclusively for food, as has been proved by -the experiments of Rubner and Woroschiloff. The drawback to this kind of -food is that it requires the stomach and intestinal juices to perform -much more work, for reasons already mentioned; and, in consequence, less -of it is utilized; and, after a certain time, the development of stomach -and intestinal troubles is facilitated. - -Another drawback attending vegetables is that they contain purin bodies -and form uric acid, indeed in considerable quantities, especially peas -and beans, as Walker Hall[266] discovered from experiments conducted in -the Caroline Institution at Stockholm. Of the various kinds of cereal -foods rice forms the least uric acid, and also, as already mentioned, -contains the least salt, for both of which reasons it is the best food -for the kidneys. It is, at the same time, a very valuable nutritive -food, as it contains a very large quantity of carbohydrates, viz.: 77.6 -per cent., and almost the least cellulose of all foodstuffs, as shown in -the table above; but it is very poor in fat, and has also but a small -amount of albumin. As it contains so little proteid and fat its adoption -by people with vegetarian proclivities necessitates the simultaneous use -of leguminous vegetables and of fats. It has the advantage over -leguminous vegetables in that its starch components are extremely -digestible. Thus it is the most valuable vegetable food, in spite of its -being poor in mineral matters. - -Footnote 266: - - Walker Hall: Berliner klin. Wochenschrift, p. 868, 1903. - -Granted the enormous value of rice as a foodstuff, we must express our -surprise that it enters in so small a degree into our daily diet. In -Europe, and in other parts of the world where persons of European -descent reside, as also in America, the potato takes the same place as -rice does in Asiatic countries, though the former is much less rich in -nutritive qualities, as we will show later on. - -Rice must be a most excellent food, for the natives of Asiatic -countries, who live almost exclusively on this, offer us examples of -great tenacity, and of resistance against bodily fatigue. Take the -Japanese for example. Their coolies, as shown already, are able to do -enormous muscular work on rice and fish food, and in athletics, such as -jiujitsiu, they present a great example of muscular strength, though it -cannot be denied that it is more their dexterity and knack than their -superiority in mere strength that leads them to victory. That by means -of rice diet, as by carbohydrates, great muscular energy can be -obtained, is a well-known physiological fact. - -The starchy portion is converted, through the digestive ferments in the -saliva, pancreatic, and intestinal juices, into dextrin and grape sugar; -absorbed through the intestines, it is deposited in the form of glycogen -in the liver, the muscles also absorbing a large part of this glycogen. -Through work this glycogen is exhausted. Thus work is performed mainly -at the expense of the carbohydrates, which are the prime generators of -muscular energy. We have also seen that the above-mentioned Japanese -coolies perform their incredible muscular efforts largely on such food -only. Still, a part of the muscular energy of the body can also be -provided by the proteids and fats. - -Carbohydrate foods, and especially those that are poor in fatty -contents, such as rice, and especially potatoes, which are the most -deficient of all (having but 0.1 per cent. of fat), necessitate the -simultaneous use also of fat; for this kind of exclusively carbohydrate -diet would invariably lead to starvation unless there was a plentiful -supply of fat with it; and the best and most agreeable form to introduce -fat into the body is by means of butter. - -Butter is very nutritious, as it contains, according to Rubner, 83.1 per -cent. of fat, 0.9 per cent. of albumin, and 0.5 per cent. of -carbohydrates. One hundred grammes of butter contain, according to -Rubner, 779 calories. In addition to the above, butter also contains -salts, and from 8 to 12 per cent. of water. A diet rich in carbohydrates -could not be well assimilated without butter; but, at the same time, the -abundant use of the latter also necessitates the use of carbohydrates, -which are the best vehicle for butter; therefore, when in diabetes we -prescribe much butter or other fats, we make it a rule, also, to give -some kind of food that contains some amount of carbohydrates, such as -brown bread or green vegetables, or sometimes, in mild cases, also -boiled potatoes. - -Potatoes, when new and watery, contain 16 per cent. of carbohydrates; -when they are old, 22 per cent. In many European countries they form a -most important article of diet. Though, as shown in the foregoing table, -they contain only 2 per cent. of proteids, they contain also important -salts, such as a certain amount of citric acid and citrates of -potassium, sodium, and lime. Thus potatoes, by means of these salts, are -also an alkaline food, and if consumed in very large quantities, the -acidity of the urine can become much diminished. These salts are burned -in the body, and the potassium is then transformed into a carbonate -salt. Mossé recommends potatoes in large quantities as a preventive of -diabetes. - -Thus, after food which is rich in such vegetables as potatoes, or after -fruit with much fruit acids, the urine can become less acid; but after -food that abounds in proteids the urine becomes acid. This happens after -eating much meat, or leguminous vegetables rich in proteids. Such a very -acid urine is often passed by diabetics; therefore in their diet a -certain amount of fruits, rich in salts but poor in sugar, may give good -results. - -The most rational diet is that which combines all the principal items of -nourishment—in the greatest proportion proteids, as from such the body -is built up and waste tissues replaced; next in proportion -carbohydrates, from which, as already shown, we obtain muscular energy; -and to a smaller extent than the two preceding must be taken fat, which -serves to produce heat in the body. Besides these three important -constituents there is a further class of valuable substances -indispensable for our well-being, and these are the mineral matters. -From experiments made by Lunin[267] in Bunge’s laboratory, and by -Förster,[268] it has been shown that animals cannot live if fed on food -that is devoid of mineral matters; and the latter savant has further -shown that animals can live longer without any food at all than with -food that has no salt whatever. We need these salts for different -purposes, such as building up the skeleton; and the condition of the -teeth depends also on the richness of our bodies in lime, and in order -to obtain this it is indispensable to introduce food that contains a -maximum of it. This is of special importance in the nutrition of -children. - -Footnote 267: - - Lunin: Diss Dorpat, 1880. Zeitschrift für Physiolog. Chemie, vol. v. - March 1, 1881; quoted after Bunge. - -Footnote 268: - - Förster: Zeitschrift für Biologie, vol. ix, p. 247, 1873; quoted after - Bunge. - -We give below a table by Bunge showing the amount of lime contained in -many of our common articles of diet; 100 grammes of dried substance -yields milligrammes of lime:— - - - Cows’ milk 1510 - - Human milk 243 - - Strawberries 483 - - Figs 400 - - Yolk of eggs 380 - - Prunes 160 - - Peas 137 - - Dates 108 - - White of egg 130 - - Potatoes 100 - - Pears 95 - - Malaga 60 - grapes - - Graham bread 77 - - But beef, 24 - only - - -Probably no cell growth can take place without lime, and even if grown -animals are fed on a diet containing no lime they soon become weak and -will certainly die at some time from it; therefore not only children, -but adults also, must obtain a sufficient quantity of this, and milk or -water that contains lime is certainly the best means by which to get it. -Very interesting are the observations of Roese,[269] showing that in -parts of Germany where water poor in lime is drunk less people are fit -for military service and the teeth of the population generally are in -bad condition. Lime is indispensable for our body, for it has a -favorable influence upon the work of the heart, the secretion of stomach -juice, and the movements of the intestines; it increases the quantity of -the urine; and, as Lehmann, Posner, and v. Noorden have shown, the -carbonate of lime dissolves uric acid. - -Footnote 269: - - Roese, “Erdsalzarmuth und Entartung,” Berlin, 1908. - -Another most important mineral salt is iron, this being an essential -element of the hæmoglobin of the blood. This latter is the red coloring -matter of the blood, and consists of the combination of an albuminous -body-globulin with a ferruginous body, the hæmatin. According to -Bunge,[270] a man weighing 70 kilos has in his blood 3.2 grains of iron, -and according to Schmidt from 2.4 to 2.7 grains. - -Footnote 270: - - Bunge: Loc. cit. - -Bunge maintains that organic iron is more readily absorbed than -inorganic iron, and that the best way to obtain sufficient iron in the -body will be to choose a food that is rich in iron - -We present below a table by Bunge, showing the various articles of food -that contain the greatest percentage of iron; 100 grammes dried -substance contain milligrammes of iron:— - - - Pig’s blood 226 - - Spinach 33 to 39 - - Asparagus 20 - - Yolk of eggs 10 to 24 - - Beef 17 - - Cabbage, green 17 - leaves - - Apples 13 - - Red cherries 10 - - Almonds 9.5 - - Lentils 9.5 - - Strawberries 8.6 to - 9.3 - - Carrots 8.6 - - White beans 6.2 to - 6.6 - - Black cherries 7.2 - - Peas 6.2 to - 6.6 - - Potatoes 6.4 - - Huckleberries 5.7 - - Grapes 5.6 - - Wheat 5.5 - - Rye 4.9 - - Barley 4.5 - - Raspberries 3.9 - - Figs 3.7 - - Human milk 2.3 to - 3.1 - - Cows’ milk 2.3 - - Dates 2.1 - - Pears 2.0 - - But rice, only 1.0 to - 2.0 - - -We thus see that certain kinds of fruits and vegetables are noticeably -very rich, not only in lime, but also in iron; such are strawberries, -Malaga or California grapes, peas, potatoes, etc. - -If not rich in lime, yet, on the other hand, rich in iron, are certain -vegetables and fruits, such as spinach, asparagus, the outer leaves of -cabbages, lentils, almonds, apples, cherries, etc. - -As it is very probable that organic iron is more easily assimilated than -inorganic, it would be advisable in those cases which require a better -nutrition of the blood and an increase of its contents in iron, to give -plentifully the above-named vegetables and fruits. - -The fruits mentioned as being rich in iron, such as apples and cherries, -or in iron and lime, such as strawberries and grapes, can not only -increase the amount of iron in the blood, but increase its alkalinity; -and at any rate if they cannot increase it they can at least preserve -it; and not in the blood only, but also in the other fluids of the body, -this being effected through the acids contained in such vegetables, such -as citric, tartaric, malic, acetic, and oxalic acids, which are either -in a free state or in combination with alkalies, as alkaline salts. -After the combustion of the acids in the body they appear as carbonates, -thus increasing the alkalinity of the blood and other fluids. - -Of the above acids, grape-fruit contains mostly citric acid, as also do -oranges, lemons, gooseberries, etc.; apples and peas contain malic acid, -and grape juice, tartaric acid. - -There can be no doubt that the above-named fruits and vegetables—and let -us not omit the important potato—are able to do us good service in the -prevention and treatment of the condition of acid intoxication that we -find in severe forms of diabetes or in serious disorders of the liver; -but also in uric acid diathesis they can render valuable assistance. - -For a long time past through various kinds of fruit, especially berries, -various cases of gout have been successfully treated. Strawberries, -cherries, and apples especially have been recommended in such -conditions, and the value of such a prescription has been confirmed by -the experiments of J. Weiss,[271] made in Bunge’s laboratory. We also -used grapes in large quantities, besides the above-named fruits. - -Footnote 271: - - J. Weiss: Zeitschrift für Physiolog. Chemie, vol. xxv, p. 303, 1898; - vol. xxvii, p. 216. - -In case of gravel, also, where the concrements consist of uric acid, the -administering of such fruit can give beneficial results. - -Besides mineral salts and vegetable acids, fruits and vegetables contain -a third important substance, which is cellulose, the framework of their -cell tissues. Although this is very difficult to digest, still there can -be no doubt, from the experiments made on animals and also on man by -Weiske,[272] that cellulose is also a nourishing food, for he proved on -himself and another person that from 46 per cent. to 65 per cent. of the -cellulose can be digested. - -Footnote 272: - - Weiske: Zeitschrift für Biologie, vol. vi, p. 456. - -The chief advantage, however, of cellulose does not lie in its -nourishing properties, which are not great, but in the fact that it acts -as the best natural stimulus to the peristaltic movements of the -intestines. Thus food that contains such a residue (which is contained -most largely in vegetables and fruit) is also the best to use if we -desire to keep the intestines open and to observe the most important -precept of their hygiene. This hygienic condition can also be much -advanced by vegetables of the cereal kind, which, as shown in the -chapter on hygiene of the intestines, may act as a disinfectant of the -same through the milk acid that is formed therefrom in the intestines. - -Vegetables and fruit have thus very great advantages, and even in winter -our daily diet should consist plentifully of them, as grape-fruit, -oranges, etc., can be obtained at that time of the year. But when -vegetables and fruit are exclusively used as a diet they present certain -dangers, as we point out in the next chapter on the advantages and -disadvantages of a vegetarian diet. - - ------------------------------------------------------------------------- - - - - - CHAPTER XXXVII. - - ON THE ADVANTAGES AND DISADVANTAGES OF A VEGETARIAN DIET. - - -OWING to certain peculiarities in our anatomical construction we are not -intended by Nature to be vegetarians. This is amply demonstrated when we -consider the formation of our teeth. These are neither the teeth of -carnivorous nor of herbivorous animals. We have, in fact, teeth similar -to those found among omnivorous animals, such as the dog and pig, while -our whole metabolism, the transformation and assimilation of food in our -bodies, presents great similarity to that of the dog. - -The construction of our intestines is further evidence that Nature did -not intend us to be numbered among the herbivorous animals, which are -required to have an enormously long intestine to store up and assimilate -the very large quantity of herbs or vegetables which are necessary to -satisfy their wants. We should have to possess an intestine many times -longer than we are provided with in order to be able to exist on -vegetables alone; and even with such an intestine it would be very -difficult for us to live comfortably for a long period on a purely -vegetarian diet. It is, however, certainly possible to exist on such a -diet for a certain time; and it may be of direct advantage for those -persons who have overtaxed their digestive organs by large quantities of -meat food, as it will afford the said organs a well merited rest. In -order to live for a long period without risk on a vegetarian diet, it is -necessary to add certain products of animal sources, such as milk and -eggs. We know from personal experience that with a vegetarian diet -supplemented by cereals, especially rice, milk, butter, and eggs, it is -possible to exist very comfortably for a long time, and to thrive on it, -for we have frequently witnessed a considerable increase in the weight -of the body. This experience we have also gained and confirmed by -personal test. - -A vegetarian diet, when supplemented by milk and butter, can be indulged -in for a considerable time, and advantage may be gained therefrom. In -many cases of nervous diseases it is of excellent value, especially in -neurasthenia and hysteria, Graves’s disease, myxœdema, etc., when meat -food is deleterious, for reasons we have often given. With such a diet -we can also avoid all the dangers which threaten us from the formation -of uric acid. We must, however, avoid taking in large quantities of such -vegetables as beans, peas, etc., which, according to Walker Hall, -contain purin bodies, the mother substances of uric acid. - -Rice is the vegetable which will form the least uric acid, and it is at -the same time one of the most nourishing of vegetarian foods, as it -contains 77 per cent. of carbohydrates. - -Thus with vegetarian diet we can avoid, in great probability, those -diseases which arise from an excessive formation of uric acid. As -Professor Dettweiler,[273] of Freiburg, demonstrated at the German -Congress of Medicine in 1907, the viscosity of blood is greatly -diminished by a vegetarian diet. As gout is a disease which is due, in -all probability, to a retention of uric acid (after preliminary changes -in the thyroid and kidneys, as we have pointed out in a communication to -the Paris Biological Society, February 25, 1907), a long extended -vegetarian diet can unquestionably be of a great benefit for the -prevention and treatment of this disease. It is, however, necessary that -such a diet should be prescribed for a very long time (for several -months at least) if we desire to reap the full benefit from it. - -Footnote 273: - - Dettweiler: German Congress of Internal Medicine, 1905. - -To prevent the development of diabetes, also, especially in cases of -children of diabetic parents, a vegetarian diet can be of great use. In -the chapter on the deleterious action of excessive meat food, we refer -in detail to the fact that diabetes is most often found in persons -addicted to much meat food, especially if carbohydrates are taken in -large quantities at the same time. Obesity is seldom found in persons -who live on a vegetarian diet. Carbohydrates can be taken in large -quantities without producing obesity, if only meat is not taken at the -same time in more than a limited amount. - -Arteriosclerosis is very seldom found in persons who have been addicted -for many years to vegetarianism. Not only is this due to the fact that a -vegetarian diet is the least deleterious to the circulatory system, but -as we have mentioned above, the viscosity of the blood is also -diminished; but with a vegetarian diet, coupled with milk, there is much -less intestinal putrefaction, if any, than with a meat diet. It is well -known that the production of arterial sclerosis can be facilitated by -the products of intestinal putrefaction. - -As Brissaud and Siccard have shown, the injection of adrenalin and uric -acid at the same time into animals produces atheromatosis in each case. -We also know, from clinical observation generally, that arteriosclerosis -is of greater frequency among gouty people, and the frequency of -diabetes among such can be attributed to arteriosclerotic changes in the -pancreas (endarteritis obliterans, Flexner). - -Marcel Labbé has shown at the French Congress of Internal Medicine in -Paris, 1907, that a diet of cereals, milk, butter, and sugar diminishes -the quantity of uric acid, while the addition of nucleo-albumins -augments it. - -Vegetarian diet is of great service to the intestines, their torpidity -being thereby greatly overcome; and if milk be taken at the same time -intestinal putrefaction is checked and the tendency to catarrh improved. -Such a diet is also of great value to other important organs: the -thyroid, liver, and kidneys; as in cases where such are in a diseased -condition, the chances of recovery or for a more prolonged life are much -enhanced, because such a diet is least harmful to these organs. - -But the greatest advantages of a vegetarian diet are seen in the -prevention of the ravages of old age by this means. By the use of such a -diet we can, to a certain extent, check the degeneration of those organs -which play the most important pathological roll in the development of -old age, and which have already been mentioned several times, viz.: the -thyroid, liver, and kidneys (see the hygiene of these organs). The -degeneration of these may produce the retention of toxic products and a -condition of auto-intoxication; but by a vegetarian diet, coupled with -milk, these troubles may be more easily avoided. - -A vegetarian diet, with milk and a few eggs daily, is the best -nourishment for old people; the greater the age the more of the latter -should be taken. In fact, persons advanced in age will do well to eat -very little meat, for reasons which are fully given in the chapter on -the dangers of a too abundant meat diet. - -We have thus seen that a vegetarian diet can give the best results, not -only in the prevention and cure of many diseases, but also in the -preservation of health in old age. It is a fact that we often see -persons who follow such a diet looking much fresher and more youthful -than those who partake of much meat, especially when they have passed -the seventies. - -But if milk and vegetarian diet, with a few eggs daily, can be taken for -many years and yield good results, it is quite a different case with -those people who are in the habit of living only on vegetables to the -exclusion of any article of animal food; such are vegetarian fanatics, -and if they keep up this deleterious habit for a lengthened period, they -must inevitably suffer for it. - -Even if we do not admit the pretensions of certain authors, who declare -that the albumin of the vegetable is less nourishing than the albumin of -animals, still it is impossible for us to introduce into our bodies the -quantity of vegetables which would contain the number of calories -necessary in order that we should not suffer from a deficiency of them, -and at the same time would allow for waste. To satisfy the requirements -of our bodies we would have to eat enormous quantities of vegetables and -thus overload the stomach and intestines, with the result that even the -strongest stomach would undoubtedly give way after a certain time, and -dyspepsia, especially sour stomach, and eventually atony, and in many -cases even dilatation, of the stomach would follow; and abnormal -fermentation would readily take place in the intestines after a certain -time. Consider, also, what large amounts of enzymes, how much saliva, -hydrochloric acid, bile, etc., must be produced in order to insure a -good digestion and assimilation of the food, though it is of course true -that the ferments, at least, can readily act in a very small degree upon -large quantities of food. Vegetarian diet has also the drawback that, -for reasons already mentioned, more salt must be taken when we partake -of it. - -There are many people who develop hyperchlorhydria after a vegetarian -diet, and we frequently had to have our patients abandon such a diet -when they got acid stomachs; and they only recovered from these ill -effects after animal food had been given in certain quantities. It is -certain that the present capacity of the stomach and intestines, and -their present anatomical and histological structure, also, is not -sufficient or adequate for the continued use of a vegetarian diet, the -greatest danger of which lies, however, in the threatening -_under_-nutrition, and in consequence the imminent danger of bacterial -infection. - -It is a positive pathological fact that under-nutrition (or defective -nutrition) through lack of the necessary amount of proteids in the diet -exposes one more to infection by bacilli. This is plainly to be seen -every day, especially in regard to tuberculosis; and as the best -preventive to this we strongly recommend plenty of nutrition, especially -rare meat and milk. We have personal knowledge of several cases of -tuberculosis arising from a purely vegetarian diet (see, also, Chapter -III). The findings of Grawitz[274] indicate that an insufficient proteid -diet predisposes also to anæmia. The importance of this fact is -emphasized by Sajous who has shown (1903) that defective nutrition -weakens the activity of the pituitary, thyroid and adrenals, the -products or secretions of which take an active part in the destruction -of bacteria and their toxins. - -Footnote 274: - - Grawitz: “Klinische Pathologie des Blutes.” third edition, 1906. - -In our chapter on the destruction of toxic products by the liver, we -referred to evidence gained from actual experiments, that -under-nutrition predisposes to infection. We have referred to Roger and -Garnier, who have proved that the liver loses its antitoxic properties -in cases of under-nutrition, and it is probable that the other antitoxic -organs exhibit a similar condition. - -There are two primary conditions on which infection depends: 1. The -invasion of the microbes. The greater their number and virulence the -more easily will infection take place. 2. The diminution of our normal -resistance against infection, which, as we have seen in the third -chapter, can be caused by different factors, among which is -under-nutrition. - -In any case we are surrounded by countless millions of microbes every -day, which are only too anxiously awaiting a favorable moment to attack -us; and should we be so foolish as to encourage their attacks by -adopting fads in our nourishment? - -The greatest danger of a strictly vegetarian diet is for those persons -whose parents suffered from chronic cachectic diseases, such as -tuberculosis, chronic alcoholism, etc., in whose cases the perils of -infection are much more menacing. Should such expose themselves still -more by insufficient nourishment, such a course can be called by no -other name than culpable negligence, leading to suicide. It is the -object of this book to demonstrate the best way to reach a ripe old age -and to avoid disease; it is, therefore, my duty to emphasize the dangers -of a sole vegetarian diet, especially for weak people. - -As the processes of oxidation are, as a rule, diminished in old age, -especially in its advanced stage, such persons can exist on less food -and need not introduce so many calories into their system; and as they -also take less exercise, so they require less nourishment. Consequently, -they can live better on a vegetarian diet than can the young and robust. -Even then, however, it may be prejudicial to their health to live solely -on vegetables, and it will be necessary to supplement this with milk and -a few eggs daily. For young people such a diet, continued for a -prolonged period, will present evils, and it would therefore be -advisable not to continue such nourishment longer than four or six -weeks, and then add meat once a day to the former diet of vegetables. -This is mixed vegetarian diet, and should be interposed in the ordinary -diet routine at intervals and at times of necessity. Thus when symptoms -of over-nutrition may present themselves a purely vegetarian regimen may -be followed, but not for longer than three or four weeks; but for those -having a weak constitution and great tendency to infection, a purely -vegetarian diet is not indicated, even for so short a time as a week. - -Judging from my own personal experience, I do not think it possible for -persons who confine themselves solely to a vegetable diet to prosper and -look well, especially if they exist on such insufficient food for -several months, and still less so if they continue such a course for a -longer time. We know that all the people of our acquaintance who existed -for a long time on such a diet, presented a pale, haggard and miserable -appearance, so that we could not but pity them. We, personally, tried to -follow their example, but after a short experience hunger forced us to -abandon the idea. Even long and careful mastication did not satisfy our -craving for food, so that we had to add milk, cheese, and eggs. We -admit, however, that for those of an unhealthy constitution, requiring -less food, and especially for those who are in the habit of -overeating,[275] there may be found some satisfaction in such a system -of under-nutrition; but even they have no right to call it a healthy -method of nourishment. We have found, that as a whole, women can stand -more easily, and also for a longer time, a vegetarian diet. - -Footnote 275: - - As an illustration we may mention the amusing story of the rich - Dutchman, who, while en route to an Austrian watering place for the - treatment of his obesity, was arrested in Germany for some imprudent - utterances termed “lèse majesté,” and after having been kept in prison - for four months on a largely vegetarian diet came home as a slender - man cured of his corpulency. - -Those who point out by historical facts that man was destined to -vegetarian diet may not be right, for it is certain that many thousands -of years ago man was a fruit eater, when he also lived in trees. When he -began to reside on terra firma, compelled to so do by the scarcity of -fruit in consequence of the increase of humanity, he turned hunter and -meat eater. When we visit ethnographical museums, we find that from 10 -to 5000 years before Christ man fashioned spear heads and knives from -flint, with which he killed animals, upon the meat of which he -subsisted; and at such times he lived chiefly on meat and fish, only -later becoming agriculturist and omnivorous in diet. - -Many believers in a sole vegetarian diet like to point to animals as an -example, for these, they maintain, prosper on, and are contented with -herbs. Let us follow up this statement and see what we find to be the -case in the animal world. - -We maintain that the truth of the matter is that there are few animals -of the nobler kind to be found among those existing on herbs. We find -the monarchs of the animals among the carnivorous class, and if we take -them as our example, the courage and valor of the lion will appeal to us -far more forcibly than the cowardice and helplessness of the sheep. - -Energy gained by the addition of a certain amount of animal food does -not exclude the nobler qualities peculiar to the human brain, freed from -fads and fanaticism, and it is a valuable factor in combating the -numerous vicissitudes of life. - - ------------------------------------------------------------------------- - - - - - CHAPTER XXXVIII. - -ON THE DANGERS OF A TOO ABUNDANT MEAT DIET—A FEW HINTS ON THE DIETETICS - OF MEAT. - - -MOST of us have experienced a feeling of heaviness after a dinner -consisting of rich meat, and not infrequently there is also a sensation -of drowsiness after it, which is not easy to overcome. The first may be -due to the difficulty of digestion; but we may not experience this after -taking even twice as much carbohydrate and green vegetable food. We -know, from the observations on food already referred to, that meat is -far more digestible, unless it contains much connective tissue and -sinewy matter, than the majority of cereals and green vegetables, and -especially fruit; and yet after a dinner of the latter we will not feel -so heavy as after a meal in which we have taken a smaller amount of -food, but of which the greater part was meat. - -This feeling of heaviness can, therefore, not be attributed to -difficulty of digestion, and as there is, at the same time, a greater -disinclination to work and a feeling of sleepiness after a meal with -much meat than after one of vegetables alone, or of milk and vegetables, -meat must, undoubtedly, have a more deleterious effect upon the central -nervous system than have other kinds of food. - -That this mere clinical observation is not fallacious is also shown by -the fact that after eating much meat nervous disorders are far more -frequent; and we find many more instances of neurasthenia and hysteria -among eaters of much meat than among vegetarians; and in the treatment -of many nervous disorders far better results are obtained after -excluding meat from the diet. - -It is noticeable in a marked degree in Graves’s disease, and also in -myxœdema, that patients suffering from them will not improve with meat, -and after partaking of it their symptoms are aggravated. This is only -natural, as these diseases are caused by changes in the thyroid gland, -to which we have referred in Chapter II, where we have also shown that -this gland undergoes changes through an overabundance of meat. We have -there mentioned the very interesting experiments of Leo Breisacher, of -Detroit, and of Blum, of Frankfort, and others. But we would wish to -remark here that it has been demonstrated by the experiments of Chalmers -Watson, of Edinburgh, that when certain animals, such as fowls, eat much -meat to the exclusion of all other kinds of food, they present great -enlargement of the follicles of the thyroid gland, and that rats, kept -on the same diet, exhibit even a degeneration of the gland, which can -even go to the extent of presenting the clinical picture of Graves’s -disease. Not only the thyroid, but the other ductless glands also, have -been found altered after an exclusive meat diet. Forsyth[276] found also -an enlargement of the follicles of the pituitary body in birds of prey, -and Houssaye[277] found that chickens lost their fertility after such a -diet, which affected their ovaries. - -Footnote 276: - - Forsyth: Lancet, 1907. - -Footnote 277: - - Houssaye: C. R. Académie des Sciences, p. 934, 1903. - -There are numerous clinical and anatomo-pathological evidences to show -that the other ductless glands also—that is, the glands with internal -secretion, such as the liver, kidneys, and even also the pancreas—are -altered by an abundance of meat food if long continued. - -We have already dwelt on the fact that the liver has the function of -destroying the harmful products that are formed by the decomposition of -meat food. Thus the more meat we eat the more work is thrown on the -liver, which may first become hyperæmic, but, through the continuation -of the harmful agency more deleterious conditions may develop. Every -physician can observe daily, as we have, that when patients suffering -from disorders of the liver take meat, they gradually get worse, but -when they give up meat they soon get better. If, therefore, we desire to -retain our vitality for a long time, it is best for us not to take too -much meat. - -In the same way the kidneys can also be kept in good condition if too -much meat be not taken. These eliminate the end-products of meat food, -and the more of such products that pass through the kidneys, the more of -them are taken from the blood and excreted by means of the fine -epithelia of the kidney tubules, and thus the more is the work done by -these organs; and we have mentioned that any overwork of an organ may be -followed by its exhaustion. As a consequence of eating meat sometimes -very harmful products pass through the kidneys, especially in the case -of preserved, strongly seasoned, or spiced meat, for such preserved food -may contain disease germs, ptomaine bodies, mineral poisons, etc. But -even the passage of normal end-products of meaty food—for example, if -urea be continually passed for years in large quantities—can produce -serious alterations. Many authorities, such as Dr. James Tyson, of -Philadelphia, who is well known by his works on the kidneys, attribute -to the very frequent taking of such food many cases of interstitial -nephritis; and nearly all such authorities, including Senator, of -Berlin, prohibit the use of meat in most of the disorders of the -kidneys. But we have already referred to the danger of such a diet to -the liver and kidneys, and it is only because of the importance of the -subject that we have again referred to the matter. - -There is some clinical evidence in favor of the opinion that the -pancreas may also be altered by an abundant meat diet. We know that when -this organ is diseased we may discover a quantity of unabsorbed meat -fibers in the fæces, indicating that the pancreas has failed to fulfill -its task of assisting in the digestion of meat by the production of its -ferment—the trypsin. Meat, when taken in large quantities, can thus -cause the pancreas considerable overwork, which, in the long run, as is -well-known, may cause trouble, as is shown by the fact learned from -observation, that diabetes develops generally in meat eaters. Even in -dogs an abundant meat diet can produce spontaneous diabetes, a fact we -have already published. Diabetes may not only be due to the changes in -the pancreas, but also as we have shown[278] to those in the thyroid -gland, consequent upon such nourishment. - -Footnote 278: - - Lorand: “Die rationelle Behandlung der Zuckerkrankheit,” second - edition, Berlin, 1909. - -It is a very important fact that much meat can become most injurious to -diabetic patients, and, as v. Noorden[279] observed, even slight cases -of diabetes can be transformed into severe ones in consequence of such a -diet; thus, in our opinion, in all severe cases of this disease meat -should be prohibited. - -Footnote 279: - - v. Noorden: Deutscher Naturforscher Congress, 1902. - -Not only can diabetes, especially if of an hereditary nature, be -increased by abundant meat food, but gout also, as is well known, may be -caused thereby, and, existing, may be made worse. Such diet not only -provokes the elimination of sugar, but of uric acid as well, which -latter is a cause of gout. - -Many authorities, especially Walker Hall and Haig, have demonstrated -that even small quantities of meat can produce uric acid, especially -when such meat contains a large quantity of nuclein bodies from which -uric acid can be formed, such as the glandular organs, especially -kidneys, liver, sweetbreads, shortbread, etc. - -Meat food in abundance is also deleterious to other organs, as, for -instance, to the intestines, which, receiving a food so easily digested -and absorbed, lack the natural stimulus for good peristaltic movements, -which can best be produced by a cellulose food like vegetables and -fruit. - -The greatest danger to the circulatory apparatus lies in meat, for, as -already mentioned, the viscosity of the blood is thereby increased, as -discovered by Determann,[280] and thus its circulation through the -blood-vessels impaired. It is a well-established fact that -arteriosclerosis can very often be observed in persons who have been -largely addicted to a meat diet for a long time. Apoplexy also is more -frequent among such. - -Footnote 280: - - Congress für Innere Medicin, 1904. - -These conditions can, however, be improved if the meat be suppressed and -replaced by a vegetarian diet. - -It would lead us beyond the limits of this book if we attempted to point -out in an exhaustive manner various other dangerous consequences of a -too abundant meat diet. All we desire is to discuss the question -whether, in view of the various dangers to which a meat diet may lead, -to which we have referred, we should or should not give up meat. - -We think we should be guilty of fanatical prejudice if, because of the -above accounts of the dangerous consequences ensuing on an unlimited -_abuse_ of meat, we should discard meat entirely, even in small -quantities. Such a course is, indeed, strongly advocated by Haig,[281] -but we cannot follow him so far. - -Footnote 281: - - Haig: “Uric Acid in the Causation of Disease,” sixth edition, London, - 1904. - -It is quite true that even a moderate amount of meat may create uric -acid, but there is not one hour out of the twenty-four that we do not -produce a small amount of uric acid in our system, even if we exclude -food of every description, such being the uric acid produced -endogenously through the decomposition of the nuclein-containing -albuminous bodies in the system, and which it is hardly possible to -avoid; and if our kidneys be in good condition they will easily -eliminate this small amount. - -Should we therefore prohibit a person of 50 or 60, who has been in the -habit of eating meat every day of his life since childhood, and who is -in quite a normal state of health, from taking a moderate amount of meat -once a day, and thus knock him out of all his old habits? We do not -think this would be a wise proceeding on the part of any physician of -wide clinical experience and of unprejudiced mind, as everyone must have -observed that such a radical change in the habits of a lifetime may lead -to consequences unfavorable to the general health. No! We desire to be -temperate ourselves and to preach moderation. We must bear in mind that -it is the _im_moderate use of meat that is to be condemned, and not its -use in small quantities. We may, therefore, allow a moderate amount of -meat, once a day, well cooked to destroy, if possible, certain harmful -matters which can be rendered innocuous by sufficient cooking; and, by -preference, we recommend boiled meat, as such food has all the -nourishing properties of roast meat but less extractive substances, -which might, perhaps, irritate the kidneys. Fresh meat should be taken -in preference to canned food, as in the latter at times there is present -certain additional matter, such as preservative salts, boracic acid, -etc. - -White meat is always preferable to red, although it is the pretension of -Offer and Rosenquist that in their action both kinds of meat are -similar; still, for clinical reasons, we agree with Professor -Senator[282] who, from his experience, considers white meat better for -the kidneys. The correctness of this opinion has been proved recently by -the researches of Max Adler.[283] We have seen the sugar disappear from -the urine of our diabetic patients when they were placed upon a diet -poor in extractive substances, such as fish (except salmon and carp), -veal, etc., and vegetables poor in carbohydrates; indeed, after such a -diet they were able to tolerate quantities of carbohydrates without -eliminating sugar. It is also of importance to remember that meats -containing many extractive substances, or broths made from such meats, -are capable of greatly increasing the blood-pressure; for this reason -red meats should be forbidden to the aged. The meat of animals that have -been hunted and subjected to great exhaustion before death should not be -used, or used only with very great moderation. Meat strongly seasoned -and spiced, or pickled, should also not be eaten. Sausages should also -be omitted from the diet. We must also remember that fish is also a meat -food, although on account of the greater amount of water it contains and -its more tender structure, and especially because of its smaller content -of extractive substances (except salmon, carp, etc.), it is preferable -to meat proper; yet if taken in large quantities, especially such fish -as salmon, it is quite as harmful as meat. At any rate fish, except the -red-fleshed kind, should always be preferred to ordinary meat. - -Footnote 282: - - Senator: “Die Erkrankungen der Nieren,” Nothnagel’s Handbuch. - -Footnote 283: - - Adler: Berliner klin. Wochenschrift, 1908. - -It is best not to give meat to little children nor to persons in -advanced years—above 70, or earlier than this if they are decrepit. As -found by Baumann,[284] Charrin,[285] Lafayette Mendel,[286] and others, -the thyroid of infants contains no iodine; after the first year there is -some, but even then very little. Baumann and Jollin[287] also found that -the thyroid of old people contained only little iodine, which, as this -is the main element of the thyroid gland, gives to such persons less -chance of destroying toxic products; and by reason of this no meat -should be given either to little children or to persons of advanced age. - -Footnote 284: - - Baumann and Ross: Zeitschrift für Phys. Chemie, 21-319, 1895; 22-1, - 1896. - -Footnote 285: - - Charrin et Bouriet: C. R. Soc. biologie, c-2-339. - -Footnote 286: - - L. Mendel: Journal of American Medical Assn., 3-2-’85. - -Footnote 287: - - Jollin: Nord. Med. Arch., 1897, Test number. - -We must also remember, as already mentioned, that proteid food is needed -to build up the body, and this is not necessary in senility. All -authorities agree that aged people require very little proteid in their -food, and Prof. Magnus-Levy[288] accepts this opinion. There is, -consequently, no necessity to force them to take meat, neither is it -rational to permit its use, for they are more defenseless against the -harmful products formed by the decomposition of meat than are younger -people, for their thyroids and parathyroids, liver and kidneys, are -degenerated. Thus they would be able neither to destroy such products -nor to eliminate them from the body. Exception may be made in the case -of the aged who are in robust health and enjoying a green old age, for -in such we may expect to find more active ductless glands, and they will -therefore be better able to resist the dangers of meat food. - -Footnote 288: - - Magnus-Levy: v. Noorden, “Pathologie der Stoffwechsels,” i, 472. - -There are certain precautionary measures that, perhaps, can mitigate -such dangers; thus, by the daily use of water in proportion to the -amount of meat the end-products of the meat can be washed away. We -should also with much meat eat also much fruit and vegetables. Abundant -meat diet produces acids in the system; but, as mentioned in Chapter X, -by means of green vegetables we can raise the alkalinity of the blood. -Whether much or little meat be taken, sour milk, kefir, yogurth, or even -ordinary milk and cheese should be taken also. We have not mentioned -here another danger from meat diet, which is the putrefaction that may -arise in the intestines, but on which we have enlarged in Chapter XIX. -By means of sour or ordinary milk, or cheese, the putrefaction can be -avoided, through the lactic acid formed. - -With a meat diet, especially when taken in large quantities, it is -obvious that a good cleansing of the bowels will be all the more -necessary, and this is best obtained by the addition to such a diet of -fruit, vegetables, and sour milk. - -By precautions such as these the harm from a too abundant meat diet may -be reduced or at least limited; but for those who are desirous of -attaining an advanced old age, the greatest moderation in the matter of -meat consumption is strongly recommended. - -When we study the nature of the diet enjoyed by persons who have lived -to and over 100, we find, indeed, exceedingly few who are great meat -eaters; very many are persons who eat no meat at all; and in many cases, -also, the original meat diet was subsequently abandoned in advanced age. -According to the report of the Collective Investigation Committee of the -British Medical Association, the 55 centenarians whose cases they -examined were, for the most part, small meat eaters.[289] - -Footnote 289: - - Quoted after Humphrey. - - ------------------------------------------------------------------------- - - - - - CHAPTER XXXIX. - -ON THE GREAT ADVANTAGES OF MUCH MILK IN THE DIET FOR THE PREVENTION AND - TREATMENT OF OLD AGE. - - -WE have often observed that patients taking large quantities of milk -daily, together with eggs and vegetables, and little meat, soon begin to -look better, and sometimes even younger. We have also observed upon -ourselves the great advantage of such a diet in comparison with other -diets. - -It is not surprising that persons using large quantities of milk daily -look fresher and younger if we consider that when we take much fresh raw -milk we are also taking extracts of various ductless glands, and -especially of the thyroid. - -It has been shown by Bang,[290] Mossé,[291] and others, that the -internal secretion of the thyroid passes into the milk. There are, -indeed, several facts which prove that thyroid secretion is contained in -the milk. As we know, the iodine in our body comes mainly from the -thyroid, which, of all organs, is the richest in iodine. Now there can -be no doubt that iodine enters the milk, for when we give iodine to the -mother it can pass, by way of the milk, into the infant. As the thyroid -of the infant, or of puppies, contains very little or no colloid -substance, upon which, as shown by R. Hutchison and Oswald, the quantity -of iodine depends, they must receive the iodine from the maternal milk. -Mario Flamini (Revue mensuelle des maladies de l’enfance, 20, 97-120), -by injecting iodipin into a goat, obtained milk containing as much as -0.12 gramme iodine to the liter. Another very important fact is that -children suffering from congenital myxœdema never show any symptom of -this condition so long as they are taking their mothers’ milk; but as -soon as they are weaned symptoms of myxœdema appear, which we must -logically ascribe to want of thyroid secretion. - -Footnote 290: - - Bang: “Ueber die Aurscheidungs des Jodothyrius durch die Milch,” Berl. - klin. Wochenschrift, Dec. 27, 1897. - -Footnote 291: - - C. R. de l’Académie de Medicine, 1898. - -Another fact, upon which we would like to insist, is that when we -extirpate the thyroid gland of goats or other animals, their milk -contains (as shown by Professor Lanz in the case of goats) a substance -which acts upon the thyroid gland, diminishing its activity. Logically, -we think, we may conclude that the milk of goats with intact thyroids -must contain a substance antagonistic to the substance contained in the -milk of thyroidless goats. Such a substance is the thyroid secretion. - -Besides thyroid secretion the milk also contains important nutritive -substances, like albumin, milk-sugar, and fat; also lecithin, etc., -certain ferments, and mineral matters, as lime, magnesia, iron, etc. -(see, also, chapter on animal food). The valuable ferments which -facilitate the digestion of the milk are, however, only contained in raw -milk, and to a less extent in milk which is heated above 75° C. Behring -has shown that even this temperature, if maintained as long as thirty -minutes, is apt to deteriorate the milk. Pasteurized milk that is never -heated above 70° C., and is cooled immediately afterward, contains a -considerable amount of these important ferments. But if milk is heated -to higher temperatures, as happens in boiling, the ferments are killed. -It is of the greatest significance that raw milk has also the property -to kill microbes to a certain extent. Thus Walter Hesse found in 1894 -that the microbes of cholera died in raw milk. In experiments he has -made recently with Hemp,[292] it was shown that raw milk of certain -kinds of cattle had also the property to kill the bacilli of typhoid -fever. But it is of the utmost importance to remember that these -bactericidal properties of raw milk are destroyed if the milk is heated -to 60° C. (140° F.). These authors have found that refrigerated milk, -even if it is cooled down from 70° C., does not lose its bactericidal -properties. - -Footnote 292: - - Hemp: Verhandlungen des Congresses Deutscher Naturforscher und Aertze, - Dresden, vol. i, p. 112, 1907. - -There is a wonderful difference in the effects of boiled and raw milk. -Animals, or children, never thrive so well on boiled as on raw milk. -Professor Behring, of Marburg,[293] has shown that animals fed on milk -heated to a high temperature never thrive well. Calves have been reared -in Marburg, or on Bohemian or Hungarian farms, on boiled milk, and -others on raw milk. Experiments with hundreds of such calves have shown -that boiled milk is not a suitable food for them. - -Footnote 293: - - Behring: Beiträge zür experimentellen Therapie, 8 fl, 1906. - -In children, also, we can see the bad effects of using boiled milk. It -has been shown by many authors that Barlow’s disease and rickets may be -due to drinking overheated milk, especially when such milk is not fresh. -Behring has now shown by experiments that when calves are fed on boiled -milk they acquire rickety deformities of the bones and scorbutic -conditions. The majority of the calves died from exhausting diarrhœas, -just as do infants in large cities. - -Thus it is evident that we should always use raw milk, and only when -there is doubt as to the origin of the milk should we heat it, and then -not above 60° to 70° C. (140 F.), so as not to destroy all its valuable -properties. Considering the enormous importance of this question for the -public welfare, it would be advisable to put all establishments for the -supply of milk under the control of physicians or veterinary surgeons. -As the welfare of many children depends upon the condition of the cow -that is giving them its milk, cows should be kept with great care and -regarded as a kind of wet nurse. Just as prisoners, or men who work all -day in close and badly ventilated rooms, are apt to develop -tuberculosis; so, also, are cows if they are kept in dark stables with -no fresh air. Therefore cows should be let out to pasture on the meadows -every day, and kept there at night if the weather permits. The milk is -also improved in quality if the cow gets some food rich in proteids in -addition to her grain and hay. Every cow should be tested by tuberculin -injections, and if this is positive the animal should be destroyed. The -milking of the cows should be done with scrupulous cleanliness. The -udders and surrounding parts should be washed, and the milkers -themselves should be dressed in clean white clothes, and their hands -should be clean, preferably by washing them with some antiseptic liquid. -Unless the cow is tubercular or otherwise sick, its milk never contains -any harmful substances. As soon as it is obtained the milk should be put -into an ice chest, as this is the best way to preserve it, and air -should be excluded. It has been shown that milk cooled off to -16° C. -does not lose its good qualities, and can be kept in fresh condition for -many days. - -By undergoing acid fermentation milk does not lose its valuable -properties. Important substances like lecithin, iron, lime, native -albumin, and valuable ferments are contained in such milk. Whey and -buttermilk are also milk foods of the highest value. - -Besides its contents of internal secretions, valuable ferments, and -mineral matters, milk must also be considered as an ideal form of -nourishment owing to the fact that it contains all the necessary -elements of human food. It is the most nourishing of all foods since it -contains albumin, fat, and carbohydrates, the three main elements of -human food, in large quantity. Good cows’ milk contains about 35 grammes -of albumin, 40 grains of milk-sugar, and 35 to 40 grammes of fat to the -liter. Thus if a person takes 2 liters of milk a day, or even less, 3 to -4 eggs, a little butter and several rolls, he can live comfortably -without meat. We have made an experiment on ourselves by taking 1½ -liters of milk, 4 eggs, 2 rolls, and 20 grammes butter a day as our only -food, and after two weeks of such a diet, with a bodyweight of 68 kilos, -we felt very well, and even lost no weight at the end of the trial. We -have found in our own case, and in many patients, that with one plate of -meat at dinner, together with vegetables and the above diet, with -cheese, it is possible to live prosperously for months and to increase -considerably in weight. The rosy cheeks of persons living on such a diet -are the best proof of its efficiency. - -Those who do not like milk in large quantity may add a little cocoa, or -a little weak coffee to it. For those whose stomachs cannot tolerate -pure milk, a milk obtained by fermentation—kefir—is indicated. This can -be prepared by fermenting cows’ milk with grains of kefir. It should not -be fermented, for most purposes, for longer than one-half a day. By -virtue of the carbonic acid which it contains it has a soothing action -upon the walls of the stomach, and also promotes a better flow of -gastric juice. Thus it is more easily digested than ordinary milk, whose -valuable properties, however, it retains. - -Milk is also of value when taken in large quantity, since it checks the -formation of bacterial and toxic products in the intestine, which, as we -know, is enormously rich in such products, especially after having eaten -animal food, like meat. milk-sugar and lactic acid are very powerful -antiseptic substances probably the best natural intestinal antiseptics -of which we know. This fact is made use of by Metschnikoff in the -production of his lactobacilline, by which, through the formation of -milk acid, the multiplication of the intestinal bacilli can be checked, -and thus, according to Metschnikoff, old age prevented to some extent -(see, also, Chapters XIX and XX). - -It is a very interesting fact that in countries where much of a certain -kind of acid milk is used (e.g., Bulgarian “yogurth,” prepared with the -aid of the Maya bacillus), there are many persons who live to be more -than 100 (see Chapters VI and XIX). Some of the long-lived patriarchs -whom we mention in this book, as Parr, who has lived to be over 152 -years old, lived mainly on a milk diet. - -In addition to the above-mentioned properties of milk, this food has -also the great advantage of throwing the minimum amount of work upon -those organs whose duties are concerned with the assimilation of food -and the elimination of its waste products. We have already mentioned -that animals whose thyroids have been extirpated can only survive if -they are put on a milk diet. (Breisacher,[294] Blum.[295]) This shows -that when the thyroid is extirpated or, what is the same thing, entirely -degenerated, only milk food can be tolerated, for the poisons of other -food, like meat, are normally destroyed to a great extent by the thyroid -gland. - -Footnote 294: - - Breisacher: Loc. cit. - -Footnote 295: - - Blum: Loc. cit. - -In old age there is greater or less degeneration of the thyroid gland. -Just as is the case with infants, whose thyroids are not yet developed, -so also old people, as a general rule, are more helpless against poisons -formed by the decomposition of meat. For such persons evidently, just as -for infants, milk food is the best. - -Here, again, we see the similarity that exists between infancy and -senility, and we realize the truth of the saying that in senility we -return to childhood. That milk is the best food to keep the thyroid in -good working order has been proved by the experimental researches of -Fordyce.[296] - -Footnote 296: - - Fordyce: British Med. Journal, vol. x, p. 619, 1902. - -In our opinion one of the greatest advantages of milk as a food is that -it exacts for its assimilation so little work from some of our most -overworked and most important organs, like the stomach, liver, and -kidneys. - -It is certainly a boon to an overworked stomach, which is otherwise -normal, when we prescribe a diet of raw milk, which, for many persons, -is more digestible than most other foods. It is a fundamental principle -in the treatment of old age to give a rest to those organs of the body -which are the most active. Such a rest will certainly do good to the -stomach, especially in the case of heavy eaters, and will improve its -vitality. The same maxim holds good for the liver and kidneys. - -There is no food which, with the same nutritive content, contains so few -harmful toxic products as milk. Imagine the difference between the liver -or thyroid of a heavy meat eater, and those of one who has long taken -mainly milk. The experiments of Chalmers Watson[297] and of Forsyth[298] -speak volumes on this point. - -Footnote 297: - - Chalmers Watson: Loc. cit. - -Footnote 298: - - Forsyth: Loc. cit. - -Since milk food contains scarcely any products harmful to the liver, -even when taken in large quantities, and considering at the same time, -the antiseptic action of milk food upon the bacilli in the intestines, -it is easy to understand that with such a diet little work is thrown -upon the liver, and its tissues are not damaged. We have been surprised -to see how well patients with liver or gall-stone trouble looked after a -diet of milk and vegetables for several weeks. The importance of such a -diet upon the condition of the bile passages is shown by the well-known -fact that inflammation of the bile-ducts and gall-bladder can be caused -by the immigration of bacilli from the intestine. It follows that with a -lessened amount of intestinal bacilli, the bile passages will not be so -liable to infection, and by a milk diet, especially one of sour milk, -kefir, koumiss, etc., we can limit, to a large extent, the number of -bacteria in our intestines. Therefore such a diet would be calculated to -prevent disorders of the gall-ducts and bladder and gall-stone disease, -which are so often found in elderly persons. - -Milk is a food which contains scarcely any extractives. In consequence -it is an ideal food for the kidneys, through which it passes without -causing the least injury to these vital organs, which cannot be said of -meat with its numerous extractive substances. Milk contains very little -salt, which qualifies it as a most excellent food for the kidneys. Milk -diet has rightly been given since the early days of medicine in kidney -troubles. Since in old age there is an increase of connective tissue in -the kidneys, with impairment of their eliminative capacity, on this -account also milk diet is the most suitable for old persons. - -In order to derive the greatest possible benefit from this most -excellent food, it would be necessary to take human milk, as thus we -introduce into our system the internal secretions of human ductless -glands and human ferments. Such good fortune can, however, only fall to -the lot of infants, and, we are sorry to say, not to all of them. -Therefore we are obliged to use the milk of those animals which is next -best to human milk—for example, asses’ milk. This, however, cannot be -obtained easily; two pints of it would cost, in some places, about a -dollar. The next best substitute is goats’ milk, which also contains ten -times as much iron as cows’ milk. It is a great puzzle to us why the -milk of this animal, which is richer in fat and albumin than cows’ milk, -is not more used. Perhaps the main objection is the occasionally -disagreeable smell, which, however, can be avoided by keeping the goat -very clean. The goat is rarely subject to tuberculosis, which also is a -strong argument for the use of its milk. - -There can be no doubt that, for those who can stand it in large -quantities, milk is an excellent aid in the fight against old age and in -its treatment. As most constituents of the blood enter the milk, perhaps -it is not too daring to say that drinking milk is, in a measure, -drinking blood. Evidently blood contains all the internal secretions of -the ductless glands as well as most valuable ferments; hence the -rational prevention and treatment of old age would consist in drinking -blood. There is, however, no general tendency to such bloodthirsty -methods at the present time, but, maybe, it will be used in the future. -But if we cannot drink blood let us drink milk, the most valuable food -there is. - - ------------------------------------------------------------------------- - - - - - CHAPTER XL. - - ON BLOOD AS AN ARTICLE OF FOOD CONTAINING IRON AND ANIMAL - EXTRACTS—SAUSAGES AND BLOOD PUDDINGS. - - -IRON is a most important element of our blood, the lack of which, as in -chlorosis and various anæmic conditions, may produce very serious -symptoms. To replace this deficiency iron is introduced into our system, -and this can be done in two ways: either by the natural way, i.e., by -food which contains iron, or artificially, by means of drugs which -contain iron. It is the opinion of Bunge that iron, given in drugs, -especially as inorganic iron, is not so readily absorbed and assimilated -as organic iron, i.e., iron as it occurs in various articles of food, -and especially in the blood. - -Therefore an effort has been made with more or less success by -manufacturing chemists to make preparations of iron obtained from the -blood, and Professor Bunge[299] has experimented on animals by using -iron containing nuclein, separated from the yolk of eggs; and in -Professor Kossel’s laboratory such a preparation has been made from the -eggs of the carp. It was found that these preparations were perfectly -absorbed and assimilated. - -Footnote 299: - - Bunge: Lehrbuch der Physiologie, Berlin, 1907. - -Professor Bunge, and also his pupils Abderhalden and Haüsermann, found -that all animals which received food containing but little iron, became -anæmic, e.g., young rabbits fed only on milk, which, as above mentioned, -is very poor in iron. Later food was given that contained iron (as green -vegetables, cabbage, herbs, etc.; or meat, yolks of eggs, and fruit), -and soon afterward the iron contents of their blood was found to be -increased. Even if we are not anæmic or chlorotic, it is necessary to -take a certain amount of iron, preferably organic iron, into our -systems. - -Anæmia of slight degree is very frequent in women, especially after -degeneration of the ovaries, as after the menopause. As we have already -mentioned, the ovaries influence in a remarkable way the condition of -the blood. In the adult the bone marrow is the chief seat of formation -for the red blood corpuscles; but the bone marrow, and indeed the whole -skeleton, as we have shown in the second chapter of this book, is under -the control of the ovaries and of the thyroid. As these organs are, as a -rule, degenerated in old age, anæmia must result, and indeed Prof. -Naunyn[300] says: “Old people are anæmic.” Geist has already emphasized -the diminution in the quantity of the blood in old age. That blood -formation is deficient in old age is demonstrated by Besançon and Labbé, -who found the activity of the bone marrow diminished in old age, and by -Grawitz,[301] who found that bone marrow underwent important changes in -old age, being transformed into a jelly-like substance. According to -Grawitz, iron—and he always prefers to prescribe an organic rather than -an inorganic iron preparation—is less efficacious in old age. We -attribute this to the degeneration of the blood-forming organs, through -whose intermediary action iron produces its effect. If, however, these -organs are not entirely degenerated, but only partially so, as in the -first few years following the menopause—in women until the end of the -fifties—we can obtain better results; and indeed after giving such women -iron we may observe that they look better, and often fresher (see, also, -Chapter LIII). As organic iron is more easily assimilated, this form is -to be preferred, and the question arises: How should we take it? Of all -kinds of food used at present, spinach and the yolk of eggs contain the -most iron; so we could give these. Fortunately spinach is obtainable at -all seasons in the United States. For those who prefer eggs, yolks in -quantities large enough to satisfy our needs would not be easily -digested, and also as eggs would be difficult to procure fresh every -day, we must think of another expedient. We may take iron preparations -obtained from the blood of animals. But why not take the blood itself, -which contains iron in a form similar to that in our blood, and in -larger quantities than in any other food? This would certainly be more -efficacious, and also less expensive. - -Footnote 300: - - Naunyn: In Schwalbe’s Lehrbuch der greisenkrankheiten, Berlin, 1909. - -Footnote 301: - - Grawitz: Hidem and also in “Klinische Pathologie des Blutes,” third - edition, Leipzig, 1906. - -Bunge mentions that the chlorotic girls of Basel (Bâle) come to the -slaughterhouses in order to drink the blood of animals that have just -been slaughtered. The question arises as to which animal’s blood is the -best. That of the pig is preferable for several reasons. Its blood -contains much iron (according to Bunge 226 milligrammes in every 100 -grammes), its organs are anatomically and histologically very like our -own, and the pig is an omnivorous animal, as we are, being able to eat -even 14 to 20 pounds of meat a day. Several of the organo-therapeutic -preparations, like ovarian extracts, and testicular and kidney extracts, -are, if obtained from the pig, more active than those obtained from -other animals. And, finally, from pigs’ blood very savory sausages and -puddings can be prepared. - -In Denmark and Norway a favorite pudding is prepared from pigs’ blood, -together with flour, sugar, barley, groats, and raisins, and we have -found it very palatable. In these countries many physicians prescribe -this pudding and blood sausages (in England called “black puddings”) to -chlorotic girls. - -We consider pigs’ blood to be of very great value, not only on account -of its iron, but also because it contains, as does blood in general -(according to Claude Bernard), extracts of the ductless glands in their -most assimilable form, and by taking this blood we, at the same time, -introduce these organic extracts. To obtain the greatest possible -benefit from these properties the blood should be drunk fresh; but as -this is not very easy to do for obvious reasons, we can substitute blood -sausages and black puddings. Blood contains chemical substances of great -importance, as iron, manganese, phosphorus and small quantities of -iodine, besides also lecithin, glycogen, glucose, jecorin, etc. It also -contains important ferments, as diastase, and sugar- and fat-splitting -ferments. Likewise it contains important immunizing substances, -opsonins, alexins, etc. - -The blood of pigs is very nourishing, for it is rich in albumin. Indeed, -considering that this blood is wasted in the slaughter houses, it is -necessarily the cheapest kind of food. And it is also an article of food -which is easily digested, absorbed, and assimilated. It is hard to -understand why this article of diet has not been made more use of long -ago. Professor Bunge, the well-known physiologist, likewise strongly -recommends the use of blood as an important article of diet. We show in -the following table, compiled from the researches of Abderhalden,[302] -the composition of pigs’ blood and of ox blood in respect to their -nourishing qualities and different mineral contents. - -Footnote 302: - - Abderhalden: Zeitschrift für Physiolog. Chemie, 1898, 25, 56 (for - pigs’ blood); and Hidem, 1897, 23, 521 (for ox blood). - - - PIGS’ OX - BLOOD BLOOD - per per - cent. cent. - - Water 71.6 80.89 - - Hæmoglobin 14.22 10.31 - - Albumin 4.66 6.98 - - Fat 0.11 0.052 - - Fatty Acids 0.04 - - Sugar 0.069 0.02 - - Cholesterin 0.044 0.199 - - Lecithin 0.231 0.135 - - Phosphoric Acid w. 0.006 0.003 - Nuclein - - Oxide of Iron 0.696 0.054 - - Calcium 0.068 0.007 - - Magnesium 0.089 0.004 - - Potassium 0.2303 0.004 - - Sodium 0.2406 0.0364 - - Entire Phosphoric Acid 0.1002 0.0040 - - Anorg. Phosphoric Acid 0.749 0.017 - - Chlorides 0.2690 - - -According to the researches of T. König,[303] Farwick and C. Kraut blood -sausages have the following composition:— - - - ───────────────────────────────────┬─────────────────────────────────── - IN THE NATURAL SUBSTANCE │ DRY SUBSTANCE - ────────┬────────┬────────┬────────┼────────┬────────┬────────┬──────── - │ │ │Nitrogen│ │ │ │ - │ Nitro- │ │ Free │ │ Nitro- │ │Nitrogen - Water │ genous │ Fat │Extract │ Ashes │ genous │ Fat │and Dry - │Substance│ │Matters │ │Substance│ │Substance - ────────┼────────┬┴───────┬┴───────┬┴───────┬┴───────┬─┴──────┬─┴────── - 49.93% │ 11.81% │ 11.48% │ 25.09% │ 1.64 │ 23.59% │ 22.90% │ 3.77% - ────────┴────────┴────────┴────────┴────────┴────────┴────────┴──────── - - -Footnote 303: - - J. König: “Die menschlichen Nahrungs und Genussmittel,” Berlin, 1903, - I, p. 76. - -Experiments were made in England centuries ago by transfusing the blood -of young animals into the veins of old animals (sheep, cows, and -horses), which latter, by this means, became more lively and active. In -some cases the special senses became more acute—hearing especially, -according to Dr. Hufeland. On man such transfusion has also been tried; -Dever and Riva,[304] in Paris, succeeded in treating certain diseases by -transfusion of animals’ blood, and, as Hufeland states, a lunatic -recovered his health after transfusion with calves’ blood. - -Footnote 304: - - Quoted after Hufeland, Makrobiotik, edited by Steinthal, Berlin, p. - 13, 1887. - -It is strange that this treatment is not more used now. Should we not be -able to treat certain diseases, such as old age, by transfusing the -blood of younger individuals, or of certain animals? This is certainly a -bold question, and we are not yet in a position to answer it definitely. -We must take into consideration the fact that the transfusion of blood, -even though human, into other individuals presents certain dangers. Bier -has tried transfusion in a few cases of lupus, and there appeared at -first symptoms of intoxication followed later by a marked amelioration. -But if transfusion by present surgical methods is not free from dangers -we can give the blood in a more rational manner by the mouth. As Bunge -has shown, the hæmatin is absorbed by the intestines, while the -diapedesis of the blood corpuscles themselves through the intestines has -been demonstrated in the experiments of Grawitz. The serum of Moebius -(anti-thyroidin) also acts if taken by the mouth. - -At the present time nothing hinders us from using the blood of pigs in -the way just mentioned. But care must be taken to obtain fresh and -healthy blood. Pigs often get pneumonia through catching cold during -transportation. Therefore those pigs whose blood we use must have been -previously specially examined. - -For this purpose also pigs should not be too fat. As we learned from -observations in the slaughter houses, a fat pig of 200 pounds may not -have more than a liter of blood, whereas oxen of 900 pounds have nearly -10 to 12 liters of blood. Still, for reasons already mentioned, -preference should be given to pigs’ blood. - -It is most important that, when the diet consists of much milk and -little or no meat, some iron-containing food be taken in addition. - - ------------------------------------------------------------------------- - - - - - CHAPTER XLI. - - SOME REMARKS ON THE HYGIENE OF EATING—HOW TO OBTAIN AN APPETITE—ON - MASTICATION. - - -IF we desire to derive benefit from what we eat in order to keep the -body in good condition, and thus successfully resist the onslaught of -old age, we must possess a good digestion and be able to make use of our -gastric juice. Without this secretion all, or the greater part, of what -we eat will remain undigested in the stomach and intestines, and by its -stagnation produce much disturbance and lessen the vitality of these -important organs. Everything, therefore, depends upon being provided -with an adequate supply of gastric juice. There are two ways of aiding -this: First, by the direct action of the food on the walls of the -stomach. Second, by various means which act on the nervous system that -governs the glands of the stomach and provokes their secretion. As by -the first means only a small amount of gastric juice is secreted, we -will deal with the second. - -The nerves of the gastric glands can be stimulated by various agencies -which influence the central nervous system, and thus provoke appetite; -for instance, sight, for we know of old how the sight of tasty dishes -provokes our appetite. Professor Pawlow, of St. Petersburg, has shown by -experiments on dogs, in whose stomachs he had made a fistula, that -merely showing them a piece of meat was sufficient to cause them to -secrete a large quantity of stomach juice. Umber has also shown on man -that optic influence was able to produce the secretion of gastric juice. - -In addition to sight, smell produces similar results. Professor -Bickel,[305] of Berlin, has experimented on a girl of 23, who, after an -injury from caustic potash, had to have a fistulous opening made into -her stomach, her œsophagus being completely strictured. By holding -steaming hot soup under her nose he caused the secretion of a clear -stomach juice to run through the open fistula. - -Footnote 305: - - Congress für Innere Medicin, 1904. - -The secretion of the stomach juice can also be produced by the sense of -taste. Professor Bickel showed this in the above case by placing on the -girl’s tongue a solution of sugar, and again of salt, and there followed -each time a secretion of stomach juice. - -Pawlow has also proved this by ingenious experiments on dogs. After -making a fistula in their œsophagus he gave them pieces of meat to eat, -which, on being swallowed, fell out again by the open œsophagus, so that -they never reached the stomach; and yet the taste of the meat and -chewing were sufficient to cause the production of a large amount of -gastric juice. - -Thus the secretion of the gastric juice is under nervous influence. But -if pleasant nervous impulses are able to promote its secretion, on the -other hand, as shown by the observations of Beaumont, and also of -Sommerfeld on men, disagreeable impressions are able to check it. Bickel -and Sasaki have also observed this to have occurred in persons who have -been in a state of anger, which coincides with our own observations that -when we are in a depressed mental condition, or when we receive -disagreeable news, we often lose our appetite. If, therefore, we want to -eat with relish we must put aside all mental pre-occupation and worry, -and go to the table in a cheerful mood. Persons of a melancholy -temperament seldom have an appetite, and in melancholia there is often a -refusal to eat, so that nourishment has to be maintained artificially. - -When any one has been working in the open air all day and is of a -cheerful disposition, he will not need anything appetizing to make him -eat. By his work he has digested his food easily, his body craves for -more to keep up his energy, and his empty stomach requires to be filled; -he will be hungry and have a good appetite without any artificial -stimulus. - -But it is a different thing with ladies who sit all day long in their -rooms, or with men who sit all day at their office desks. Such persons -very often need an artificial stimulus for a good appetite and -sufficient gastric juice. We must then resort to small artifices to -induce these. A snow white table cloth, beautiful service, choice fruit -in artistic vases, wearing clean linen and evening dress, and having -agreeable society and possibly music at dinner, will, perhaps, -sufficiently act on the different senses to produce appetite and a free -secretion of the gastric juice. - -In certain restaurants we often see an open buffet with the choicest -dishes displayed, from which we can select our meal; and this certainly -acts as an appetizer. In certain countries, also, it is the custom to -take before dinner little _hors d’œuvres_ or delicacies, like the -Zakuski in Russia, or the smörgasbord in Sweden, which certainly serve -to enhance the appetite. - -Those whose appetite needs stimulation may receive benefit from meat -extracts, such as bouillon, before dinner. These extracts are some of -the few things which can produce a sufficient secretion in the stomach -directly, without the intervention of appetite, as has been shown by the -experiments of many authorities. Such an appetizer would not, however, -be advisable, because bouillon, containing extractive substances, is -more injurious than meat if taken often and in large quantities. - -For such as have no appetite it may be of advantage to wash the tongue -before meals with a solution of salt; this, to a certain extent, will -also cleanse a coated tongue, with which a good appetite is not easily -attained; and at the same time, according to Bickel’s above-mentioned -experiment, it may provoke a secretion of stomach juice. Vinegar and -water will have the same effect as the saline wash. A coated tongue -should always be cleansed before meals, for when the papillæ of taste -are covered, the direct action of the food on them may be prevented. - -Just before dinner, and for an hour after it, no mental work should be -done; and it is often better to open a letter after than before dinner, -so as not to spoil the appetite. A short walk in the fresh air before -dining will also be an appetizer. We have personally noticed a -diminution in appetite on those days when no exercise was taken. - -Much depends on the way the meals are served. Above all things food must -be pleasant to the eye and to the palate, and it is the great art of the -cook to fulfill this. The greatest possible cleanliness is paramount, -for with many people the sight of a dirty cloth or napkin is able to -kill all appetite and check the secretion of gastric juice. - -Reading while eating is contrary to the above indications, unless -perhaps it be something humorous, like Mark Twain’s “Adventures of -Huckleberry Finn,” for instance. If we have the chance of choosing our -neighbors at the dinner table let us rather sit next some one having the -characteristics of Mark Twain than an undertaker or one who talks -business. - -Besides the gastric juice the saliva also plays a very important rôle, -as it contains a valuable ferment which facilitates the digestion of -starch into sugar: the diastatic ferment. In order to have a good supply -of saliva the food must be kept longer on the tongue, as the flow of -saliva is best induced by the stimulation of the nerves of taste; so we -must masticate longer, and move the food between the teeth and on the -tongue for as long a time as possible, so that it will act on the nerves -of taste. - -The secretion of the salivary glands under nervous influence is actuated -in the same way as is that of the gastric juice. It is powerfully -influenced by psychical impressions; for instance, by impulses coming -from sight to the nervous centers and thence to the salivary glands, as -can easily be seen by daily observation. If we offer a hungry dog a -sausage we shall all witness an abundant flow of saliva, and the same -may also be seen in man, and the German saying, “das wasser läuft im -Munde zusammen,” may be literally true. - -The secretion of saliva can be provoked by much the same agencies as -that of the stomach juice, but above all by mastication. This has the -greatest effect on the flow of saliva, especially when accompanied by -good appetite; in fact, we may say good appetite provokes the flow of -saliva and mastication maintains it for a long time. We are thus able, -by abundant salivation, to aid digestion wonderfully, especially with -regard to starchy food, as the diastatic ferment of the saliva assists -in transforming starch into sugar; otherwise such material would be -rather difficult to digest, only depending then on the pancreatic and, -perhaps, intestinal ferments. Another great advantage of thorough -mastication is that the food reaches the stomach in the smallest -possible pieces, perhaps in liquid form, and thus the stomach juice can -reach it freely from all sides, whereby digestion is greatly -facilitated. - -Not only the digestion in the stomach, but also the absorption of food -transformed into a liquid from the intestines is much assisted by -thorough mastication; while, as the result of insufficient mastication, -as with fast eaters, the food may cause much greater work to the walls -of the stomach. Being much less absorbed from the intestine it may -irritate it as a foreign body until expelled by greater efforts of the -intestinal walls. Long-lasting gastric and intestinal catarrhs may -result from insufficient mastication. - -The great advantage of methodical long mastication has been shown by -Harry Campbell,[306] Horace Fletcher,[307] and Van Sommeren, of Venice. -According to their recommendation it would be necessary to masticate -food until it has almost lost its taste. It certainly requires long -practice, especially in the case of fast eaters, to acquire the habit of -prolonged mastication, for nothing is so difficult as to give up habits -indulged in since childhood. Fast eating is not only injurious to -health, but if indulged in in company, it is a breach of good manners. - -Footnote 306: - - “Observation on Mastication,” Lancet, vol. ii, 1903. - -Footnote 307: - - Horace Fletcher: “The A, B-Z of Nutrition,” New York, 1904. - -The authorities on thorough mastication also claim that by so doing they -are able to do with less food, which is the more readily to be believed, -as they are able to digest and absorb everything better, their food -leaves less residue, and they profit more by what they eat than do fast -eaters and bad masticators. - -Good mastication means also good exercise for the teeth, the good -condition of which is of the utmost importance for a healthy digestion -just as it is important for all other organs of the body. When we eat -fast we are inclined to wash down the imperfectly masticated food by -large quantities of water, which may be prejudicial, as we are thus too -freely diluting the contents of the stomach. Many women abstain from -drinking at their meals for fear of getting fat, which is an erroneous -idea, as Prof. Van Noorden has shown that this cannot produce -obesity.[308] On the other hand, not drinking during meals may lead to -bad results. We are accustomed to take most of the water we drink with -our meals; not taking any at meals may largely decrease the amount of -fluid in the body, which has many bad effects. As shown by Pawlow, and -also by Bickel, more stomach juice is secreted when the body contains -more fluid. Then drinking a certain amount of water at meals may assist -in the absorption of the food. There is also the great advantage that by -the aid of fluids the end-products of nitrogenous matters, which have -toxic actions, may be more easily eliminated from the body than with a -dry diet. We believe it is preferable to take even an excess of water, -than none at all, with meals, and there are many people who have no -appetite unless they drink while eating. - -Footnote 308: - - v. Noorden: “Die Fettsucht,” Nothnagel’s Handbuch. - -The question whether after meals we should rest or take exercise must be -answered individually; those suffering from obesity or other disorders -of metabolism, like gout or diabetes, had better take some form of -exercise after a meal, while weak persons should rest. In general, a -short walk after meals, and then remaining quiet for an hour, will prove -to be best; but mental occupation for at least an hour after meals -should be strictly prohibited. - -The time for meals should be when we are hungry, as we should never eat -at other times for fear of not being able to digest well, owing to the -absence of stomach juice. It is essential to take our meals every day at -the same time; our stomach is of such a clock-like mechanism that it -best indicates the hour for meals. If well disciplined it will secrete -its gastric juice every day at the same hour. If possible we should -always eat in company, for then we will eat slower, masticate better, -and, if the company is jovial, probably secrete more gastric juice. - -Just as after meals, so also before them, any strenuous exercise should -be forbidden. A little exercise may promote the gastric digestive -secretions; but if we become tired from much exercise, then certainly -not much and sometimes no gastric juice will be secreted; then meat -extracts, bouillon, or soup will be necessary for obtaining an appetite. -Some people eat too much bread, which may cause overwork for the -stomach, as to digest bread gives it more work than does other food. It -has been found that the albuminous parts of bread require five times -more ferments and pepsin of the stomach than does meat; besides which, -as we have found in many of our patients, there is nothing that causes -an acid stomach so often as does too much bread, especially in nervous -people. - -The most digestible food for most stomachs is meat, if it does not -contain much connective tissue. Meat sauces and bouillon are excellent -appetizers. However, such nourishment at every meal has its -inconveniences, on which we will enlarge in another chapter. It is most -desirable only to take meat once a day—at dinner. - -The albumin in meat is much easier to digest than that in vegetables; to -digest the latter, particularly potatoes, cabbage, etc., we need to have -a thoroughly good stomach. Fat dishes are able to diminish the quantity -of stomach juice, and fatty potatoes or other vegetables with much fat, -demand sound stomachs, in the same way as does rich pastry. Butter is an -easily digested fat if it is fresh, but certainly not when it contains -free fatty acids. - -Besides meat, cereals, such as are taken in America at breakfast, -especially when finely ground and taken in the form of flour, are most -easily digested. It is an excellent American custom to commence -breakfast with grape-fruit, which is somewhat astringent and very -refreshing; but to begin breakfast with an apple or a pear is the -greatest possible offense to a normal stomach, and occurs only because -of the lack of a thorough knowledge of the physiology of the stomach. - - ------------------------------------------------------------------------- - - - - - CHAPTER XLII. - - ON THE USES OF SMALL DOSES, AND THE DELETERIOUS ACTION OF LARGE - QUANTITIES OF ALCOHOL. - - -IN everyday life we are exposed to worry and disappointment; and also, -as many of us easily tire after work, we frequently feel an inclination -to take something to cheer us up and to incite us to further exertions; -thus we take stimulants, such as alcohol, tea, coffee, tobacco, etc. - -We may fairly compare these stimulants to a whip with which we urge on a -horse. A short reflection, however, will teach us that rest would be the -best stimulant for a tired horse; but, unfortunately, physiological -thinking is not yet the commonsense view of all. - -A willing horse requires no whip, and many of us are able to attain a -good old age without requiring any stimulants. The grandfather of the -author of this work has attained the age of 105 without taking any -stimulants. - -As our numerous friends, both in America and England, know, we do not -take any alcohol, not from principle, but because we find no pleasure in -so doing. Still we don’t feel inclined to follow the anti-alcohol -fanatics in their crusade, because we detest fanaticism of any kind, -whether displayed by Chinese, by Mohammedans in Bochara or Morocco, or -by Christians in England or America. We also do not uphold such -narrow-mindedness as prohibiting even the smallest amount of alcohol to -those who only take it in the greatest moderation, solely on the ground -that there are some good-for-nothings who can never take it without -getting drunk. With equal justice might we take away the fortune from a -man who has gained it by his labor, on the ground that there are others -starving because they will not work. We are not prepared, either, to -accept the dictum of the anti-alcoholics that alcohol is a poison even -in small quantities. We do not deny that there are many among them who -cannot stand even small quantities, which is a probable reason why they -are so clamorous against it; but they do not possess normal health, -physically or mentally; and the supposition is not unjustified that -there is in some of them a lessened tolerance for alcohol owing to their -previous immoderate libations. - -The truth is, as shown by many physiologists, such as Atwater and -Benedict, and also by Professor Tigersted,[309] even at the -Anti-Alcoholic Congress at Stockholm, that alcohol may be regarded, but -in small doses only, as a precious gift, for by it we may preserve -important parts of the bodily tissues—carbohydrate and fatty substances, -which may be economized by the use of certain quantities of alcohol. The -nourishing effect can be attained only if not too much be taken, for in -over-abundance a decomposition of albuminous substances can be produced -as a toxic effect. - -Footnote 309: - - Quoted after Dr. Hollitscher, Präger med. Wochenschrift, 1907. - -Alcohol in small doses is unquestionably an excellent stimulant for the -nervous system and the circulatory apparatus. There are many people who -are able to do more work, especially of a physical nature, when they -take a certain amount of alcohol; and at the same time they have a -better appetite for food. Alcohol, however, is of more benefit in this -respect if we take wine; and of all alcoholic drinks, except beer, wine -contains the least percentage of alcohol, especially French wines, which -normally contain only 9 per cent. But this stimulating effect only holds -good when we do not take large amounts, for in the latter case the -quality of work is impaired, especially mental labor. - -In a given quantity, and preferably in the shape of red wine, alcohol is -able to cheer us up, and to a certain extent diminish grief and sorrow; -but after taking large quantities we feel more depressed. - -Beer is more nourishing than wine, but has a more sluggish effect. -English and some kinds of American beer often contain nearly as much -alcohol as some kinds of wine, sometimes more than light Tyrolean or -Italian wines. - -The most beneficial form of alcohol is a light wine, and, as a medical -stimulant, the older vintages of French wines. Beer may, to some extent, -assist digestion, owing to its bitter constituents. It is true that it -contains the least percentage of alcohol of all beverages of this -nature, but it has the disadvantage that it is taken in larger -quantities as one gets accustomed to it, and thus more alcohol and a -larger amount of liquid may be introduced, the result of which may be -injurious to the circulatory system (see “Hygiene of the Food”). - -Observation proves that many old people thrive well on a small amount of -claret or other red wine taken daily at meal times. In such cases it may -be regarded as a harmless tonic, if taken only in small quantities, and -if their health be otherwise normal except for the debility attributable -to old age. Dr. Savile, of London, has also found salutary effects from -moderate and exactly regulated quantities of alcohol in the aged inmates -of the workhouse infirmary. - -In our judgment we shall be best guided by the way in which our regular -patients tolerate alcohol. When, having been accustomed to it all their -life, they ask for wine or whiskey, and they can tolerate it well, we -admit that small amounts act as a kind of tonic for them; but it should -never be given if there is an incompatibility for it, for then it is -distinctly harmful and should be avoided. - -Brandy is the most dangerous form of alcohol,[310] but whiskey in small -doses may be reckoned much less harmful; but the least injurious of all -are light wines and the still lighter kinds of beer, which contain only -some 3 per cent. of alcohol. - -Footnote 310: - - There may be exceptions, however. The father-in-law of a Swedish lady - patient of ours is at present 96½ years old. For a good many years the - old gentleman has been drinking daily a large amount of cognac. - -That wine may be taken without harm, even to considerable old age, can -be illustrated by a series of examples, of which we have mentioned some -already, where persons have reached 100 years of age in spite of -drinking wine every day. They might, perhaps, have lived longer had they -taken no alcohol, for, as a rule, such persons come from long-lived -families, and, as we have said previously, such people may permit for -themselves greater license in this respect; but this must be distinctly -regarded as the exception, for, as the statistics of the United -Temperance Association in England show, total abstainers have a much -greater chance for a long life than have others. According to Neisson’s -investigation of 6111 persons from 16 to 90 years of age who were taking -alcohol, the ratio of mortality among them was three times greater than -for the whole population of England. - -Sir Isambard Owen shows, by a careful analysis of the results of the -Collective Investigation Returns, comprising 4287 persons, that the -average duration of life is greatest among total abstainers and very -moderate drinkers, and that but few addicted to much alcohol were among -the long lived; those in the latter condition can only expect a -shortening of life, which proves conclusively that alcohol is very -deleterious to the organism. - -As post-mortem examinations show, all the organs of the body suffer -degeneration after coming in contact with large quantities of alcohol. -It would be impossible to dilate here upon all these different changes. -We will, therefore, only mention the effects of alcohol on the most -important organs—for example, the heart and blood-vessels. - -As is well known, alcohol, if taken in large quantities, degenerates the -heart muscles and also produces the condition of arteriosclerosis. Its -effects on the brain are particularly deleterious. If taken once only, -but in large measure, it is sufficient to cause intoxication, with -changes in the mental faculty. Taken habitually, as by chronic -alcoholics, these mental changes may develop into a permanent character, -and thus insanity may follow. According to the official statistics of -the Kingdom of Württemburg, about 60 per cent. of the inmates of lunatic -asylums were alcoholics. Out of 579 lunatics of the Provincial Insane -Asylum, in Vienna, in 1899, there were 40 per cent. alcoholics. - -As we have shown in our address at a special meeting of the Philadelphia -Medical Jurisprudence Society, insanity and crime stand in very close -relationship, and, in fact, crime may be regarded as a nervous disease. -We should, therefore, not be surprised to find so many criminals among -alcoholics. According to statistics prepared in Germany, some 63 per -cent. of cases of injury to the person, 69 per cent. of robbery and -murder, and 77 per cent. of sexual crimes were committed by persons -under the influence of alcohol; and according to Dr. Scharffenberg, of -Christiania, if there were no alcoholics crime would be diminished by -one-half. - -A person committing a crime while under the influence of alcohol is no -more responsible than a person who does the same thing while in a state -of delirium caused by some infectious disease, or while under the -influence of such a poison as muscarin or atropin, which produces an -intoxication similar to that of alcohol. - -Of the other organs which are injured by alcohol we must put in the -front rank the various ductless glands, which are of special importance -to us. - -The frequency of impotency in chronic alcoholism proves how injurious to -the sexual glands are large quantities of alcohol. The same applies to -the adrenals, as shown by the frequency of arteriosclerosis in -alcoholics. From one dose of alcohol we can often see an increase in -blood-pressure. It has been shown by Dr. Sajous that alcohol acts in a -very deleterious way upon the pituitary body when taken in anything but -small quantities or well diluted as in beer or light wines; he -illustrates this fact in a very instructive microscopic specimen.[311] - -Footnote 311: - - Sajous: “Internal Secretions,” vol. ii, p. 1332, 1907. - -In the same way the bad effects of alcohol on the kidneys and liver are -amply demonstrated in the handbooks of clinical medicine and -pathological anatomy, with which we are all well acquainted; and the -constant occurrence of cirrhosis of the liver and interstitial nephritis -in alcoholics plainly show this. - -A matter of grave importance to us is also the degeneration of the -thyroid in alcoholics, as found by the researches of de Quervain[312] -and Sarbach[313] and the clinical observations of Hertoghe.[314] - -Footnote 312: - - de Quervain: Semaine Méd., 1895. - -Footnote 313: - - Sarbach: Mitth. Grenzgebiete Med. u. Chir., 1906, p. 213. - -Footnote 314: - - Hertoghe: Loc. cit. - -These degenerating effects of alcohol on the ductless glands will -explain why premature old age is so often found in alcoholics, -especially when brandy and liqueurs are taken; but still worse -consequences than this also arise, viz.: the diminution of the powers of -resistance to infection or intoxication, in consequence of the lack of -those important protective elements which, as we see in Chapter III, are -derived from the ductless glands, a fact which various epidemics amply -prove. My friend, Dr. MacMeans, told me during a stay in Monterey, -Mexico, that in an epidemic of yellow fever, he observed that alcoholics -were among the first to contract it. - -We know the great frequency of tuberculosis in alcoholics, and the great -mortality in such persons from pneumonia. They are unable to withstand -the high fever and cannot combat the infection, and the heart soon -fails; and also, as a general rule, in all cases of infectious diseases -their chances are much worse than are those of other people. - -We note in Chapter VI that heredity depends on the condition of the -ductless glands of the parents. This is also the case with alcoholics, -and it is a fact that the descendants of such are heavily handicapped; -and, as also mentioned in Chapter VI, congenital myxœdema and -scrofulosis is prevalent among them, and their chances for a long youth -discounted. Nervous diseases are also of constant occurrence among -these, such as idiocy, epilepsy, etc., very interesting data as to which -are given by Legrain. A certain alcoholic was eight times in the insane -asylum for delirium tremens. He had nine children; three died at birth -from general debility, one died of convulsions within the first year, -and the other five suffered from trembling in the extremities. The -father of this person was also a drunkard, who hanged himself; the -mother, a brother, and a sister were also dipsomaniacs. - -Martin found in 60 out of 83 female epileptics, alcoholism in the -parents. Demme examined 57 children among such, and found only 10 who -were normal, physically and mentally. - -A terrible genealogy is that traced by Dr. Klausner concerning a woman -named Ada Take, born in 1740, who was a dipsomaniac. She had 709 -descendants, among whom were 100 illegitimate children, 181 prostitutes, -142 beggars, 46 workhouse inmates, 76 criminals, and the remainder were -more or less habitual drunkards. This one family cost the country or -prison authorities for their support over three million florins -($1,200,000). - -In tropical climates the effects of alcohol are most pernicious. -According to Dr. Hueppe, it is the greatest enemy to the European. From -the official report of the British Commissioner General for Central -Africa, in 1894, “the use of beer, wine, and spirits is more destructive -to our tropical colonies than all the bacilli and plasmodia;” and -according to the great African explorer, Emin Pasha, the tropics offer -no dangers to the health of such as can abstain from large amounts of -stimulants. It is very likely that what atrocities have been credited to -Europeans in Africa were due to alcohol. - -From the foregoing facts it is clear that large quantities of alcohol -are most injurious, but there is no scientific evidence to prove, with -exactitude, that small doses are harmful. - -Some experiments in this direction have been made by Laitinen,[315] but -they were performed on rabbits and guinea-pigs, to which he gave very -small doses (only 0.1 centimeter per kilo bodyweight). He found that the -hæmolytic ability of the blood was impaired, and that there was a -greater mortality among their young than among the young of those kept -on water. Laitinen, himself, did not dare to draw conclusions from these -experiments; nor can we, for there is a great difference between a man -and a rabbit. But if an inference may be deduced from such, we can apply -it to children, for, as is well known, the effects of drugs on small -animals offer better comparisons for children than for adults. For this -purpose, however, we need not refer to the experiments of Laitinen, for -Dr. Maurice Kende has lately experimented on 20 children between 6 and -15 years of age, who, after very small quantities of wine, exhibited an -impairment of their mental faculties. - -Footnote 315: - - International Congress of Anti-Alcoholics, Stockholm, 1902. - -Dr. Hercod has also shown that out of 591 Viennese school children, the -best certificates for scholarship were gained by those who took no -alcoholic drinks; instructional results were not quite so satisfactory -in those who occasionally did so; but the worst scholars of all were -those who took alcohol two or three times a day. According to Viennese -life, beer is generally meant by the term “alcohol,” and, in a much less -degree, wine. - -That children are susceptible to alcohol, as to all poisons in general, -has been already mentioned in Chapter X; so it is not surprising if only -small quantities should unfavorably affect their mental faculties. We -have also previously insisted upon the necessity of considering it a -crime, meriting a heavy punishment, to give alcohol to children. But we -again repeat that there is not sufficient strictly scientific evidence, -as yet, to prove that small quantities of alcohol (especially beer or -wine, and possibly whiskey) are deleterious to the majority of adults; -those who cannot stand even small quantities will be best without any; -but we fail to see why a working man, when he comes from his daily -labor, should be forbidden to take his glass of beer. It is certainly -not the temperate users of stimulants, the hard workers, that should be -persecuted by anti-alcoholics, but the intemperate users, who are a real -curse to humanity. If those fanatics will limit their action in this -useful direction only, every physician will be only too anxious to -support them; but instead of this, like Don Quixote against the -windmills, they forbid the use of alcohol entirely to persons who simply -cannot exist without it; in fact, they might just as reasonably forbid -them to eat, drink, or sleep! - -We firmly believe that the best course is to discover the cause which -compels such people to drink so much that they cannot discontinue the -habit, and by finding the cause we shall ascertain the origin of the -disease and can then treat it rationally, as we will endeavor to show in -the succeeding chapter. Physicians, and not clergymen, are best -qualified to fight the alcoholic habit, just as they are best qualified -to fight all other diseases. That alcohol in small quantities cannot be -such a poison as claimed by these faddists, is also shown by the great -number of moderate drinkers who live to be much above 100 years old. At -the present time there are also within our knowledge several persons -over 100 years old who take every day a certain amount of alcohol. Thus -an old general in Berlin, who reached his 103d birthday last December, -is accustomed to go, every day, to a beer house to have his glass of -beer. Mrs. Andie Campbell, of Springburn, near Glasgow, who attained her -103d birthday in January, 1908, attributes, as the newspapers stated, -her old age to the moderate use of whiskey, which she has been -accustomed to drink all her life. According to the report of the -Collective Investigation Committee of the British Medical Association, -most of the 51 centenarians, whose cases were investigated, were total -abstainers, but 5 were very fond of alcohol. One of them, Peggy Walsh, -who is said to have attained 127 years, was in the habit of taking daily -before dinner an ounce of whiskey in water.[316] Thus it seems -conclusive that the use of moderate quantities of alcohol does not -seriously impair our chances for living to a good old age. - -Footnote 316: - - Quoted after Humphrey, “Old Age,” Cambridge, 1889. - - ------------------------------------------------------------------------- - - - - - CHAPTER XLIII. - - SOME REMARKS ON THE CAUSES AND PREVENTION OF THE ALCOHOL HABIT. - - -IT is a strange fact, but one in which all observers agree, that women -who have never been accustomed to take alcohol, can stand considerable, -and sometimes very large, quantities of it during convalescence after -infectious diseases, such as pneumonia, etc. It is equally strange that -in severe cases of diabetes, where previously opium had never been -taken, very large doses of this drug may be used without any -inconvenience. We have also observed that women suffering from severe -diabetes, though unaccustomed to alcohol, could take large quantities of -it—for instance, one or two tablespoonfuls of whiskey three times a -day—without displaying any symptom of mental excitation or other signs -of having taken liquor in a quantity which might provoke a state of -excitation in persons not used to alcohol; in fact, the alcohol has been -well tolerated and taken with pleasure. - -In both these conditions—diabetes (Lorand) and infectious diseases—the -thyroid gland plays an etiological rôle, as we have frequently indicated -in this work. It is, therefore, justifiable now to discuss the point -whether the thyroid has something to do with the apparent paradox that -alcohol can be taken, without the display of any signs of intoxication, -by women who are otherwise never in the habit of taking spirits. - -That this is really so cannot be denied, _a priori_, for the reason that -between the activity of the thyroid and the influence of alcohol a -certain relationship exists. This is evidenced from the observation, -mentioned previously, that alcohol acts upon the thyroid gland, at first -causing hyperactivity, and later on exhaustion of it. As we have already -mentioned, there is a certain analogy between the action of chloroform -and that of alcohol on the thyroid gland. In fact, we think that it is -permissible to assume that drunkenness is a consequence of the -hyperactivity of the thyroid, for in such a condition there are -observable a series of symptoms of thyroid hyperactivity; and it has -been shown by Moebius[317] that in women suffering from Graves’s disease -(hyperactivity of the thyroid) we may find a condition of intoxication -similar to that seen in alcoholic intoxication, although such women had -not taken even a drop of alcohol. This condition is provoked by the -over-abundance of thyroid secretion in the blood. In other words, women -suffering from this disease can be drunk without having taken any -alcohol at all, simply because of the entering into their blood of the -secretion of the thyroid in large, i.e., in toxic, quantity, this having -produced such a condition. - -Footnote 317: - - “Die Basedow’sche Krankheit,” Nothnagel’s Handbuch, second edition. - -According to several authors, whom we have already quoted (de -Quervain,[318] Hertoghe[319]), alcohol has a great influence on the -thyroid, and in chronic alcoholism the thyroid is found to be -degenerated. - -Footnote 318: - - Semaine Médicale, 1905. - -Footnote 319: - - Loc. cit. - -If it can be admitted that drunkenness is caused by the toxic products -of the thyroid, due to the alcohol acting on the thyroid and causing its -hypersecretion, we can also explain the mystery why persons bitten by -poisonous snakes can also, in the same way, take very large quantities -of alcohol without showing its effects, even when they have previously -been quite unaccustomed to it. Snake poison, as do all poisons, creates -a hyperactivity of the thyroid which results in the throwing off of a -large amount of colloid substance. Exhaustion follows this -hyperactivity, and in this condition, as in convalescence from -infectious diseases, and in severe diabetes, where there is also a -similar exhaustion of the thyroid after a previous hyperactivity, a -large quantity of alcohol can be taken, merely because of the fact that -when the thyroid is devoid of its colloid, a condition of hyperactivity, -which is the cause of drunkenness, cannot easily be provoked, unless -enormous doses are given. We must, therefore, in cases of snake -poisoning give greatly increased doses of alcohol in order to again -provoke an increased activity of the thyroid, and thus cause the -eventual destruction of the harmful toxalbumins of the snake poison. - -If women, in a state of convalescence after pneumonia, or with severe -diabetes, and unaccustomed to taking spirits, can stand large quantities -of alcohol without exhibiting any signs of excitation, it is very -probably due to the circumstance that the thyroid has already thrown off -its available amount of colloid, is exhausted, and the doses given are -not yet sufficient to produce a fresh secretion, and thus the symptoms -of drunkenness do not develop. - -The result of these observations is that a degenerated thyroid cannot -easily provoke a condition of drunkenness, which may also explain the -curious coincidence that frequently chronic alcoholics, even after large -quantities of alcohol, do not present typical symptoms of drunkenness; -in fact, sometimes so few of such signs are visible that, if a crime is -committed under such influences, it is difficult to prove they were -really intoxicated at the time, as they present no visible signs of such -a condition. - -From the foregoing we shall, therefore, not be surprised to find that -persons suffering from hypothyroidia or myxœdema can take large -quantities of alcohol, and at the same time evince a great liking for -the same; in fact, at times, they have a regular craving for it. Several -things will explain why myxœdematous people like to take alcohol. They -invariably feel cold, as the thyroid regulates the temperature of the -body; they thus desire to obtain warmth from the spirit (which may -excite the function, in a small degree, of such parts of the thyroid as -are not yet degenerated), and thus produce symptoms of thyroid -hyperactivity, by which warmth may be produced, though they do not -realize that subsequently they will be all the colder. Such people are -also generally of a dull apathetic disposition, never cheerful, but in a -depressed mood, owing to the degenerated condition of the thyroid; and -being thus despondent they are easily dejected by worries or -disappointment. That such people should resort to drink is but natural, -if we consider that they can take alcohol without visible effects. We -must not forget that there are many degrees of hypothyroidia, from light -cases with a simple insufficiency of the thyroid up to graver forms -nearly approaching myxœdema; and all we have said on the above subject -will apply in varying degrees to them. - -From this we shall now also understand why aged people can sometimes -take much alcohol without exhibiting signs of drunkenness, which is -probably the origin of the erroneous idea that “wine is the milk of the -aged.” This can have very baneful results, for if small doses can -undoubtedly produce—especially when light French wines are taken—a tonic -and stimulating effect on the thyroid, after larger doses the -hyperactivity may more readily be followed by exhaustion, in which case, -in old age, the degeneration of the thyroid will be still more -quickened. - -If persons with a degenerated thyroid can take large quantities of -alcohol without getting drunk, on the other hand, those with an -overactive thyroid cannot stand alcohol so well; and that the latter is -the case in Graves’s disease has been already shown by the fact such -people can exhibit the symptoms of intoxication even when they have -taken no alcohol at all. Young girls and women generally, except those -past the climacteric age, are very sensitive to the effects of alcohol, -and easily get intoxicated, owing to the fact that the thyroid is, with -them, more active on account of the intimate connection between it and -the ovaries. Thus, during thyroid treatment we have seen intoxication -appear after a single glass of claret in persons who previously could -drink much more without becoming so affected. - -During treatment with thyroid tablets alcohol is not well borne, -according to our observations. - -It is probable that the sexual glands have also something in common with -this question. We have observed that people with marked sexual -inclinations are seldom habitual drunkards; in fact, we do not recall -having ever come across an instance; also, among total abstainers men of -strong sexual inclination are not infrequently met with, whereas -alcoholics do not usually seem to care much for the fair sex, which -should surprise us the less, in as much as among them impotency is very -frequent, alcohol in large quantities always having a baneful effect on -the sexual glands. In small quantities, to a certain extent, it may -prove stimulating to these glands. - -It is an interesting fact that in those with degenerated sexual glands -there is always a greater liking for alcohol; thus women, after the -menopause, have a greater predilection for spirits, and the greatest -number of cases of drunkenness in women is to be observed among such. -Eunuchs also have a greater inclination for intoxicating agents than -have their more fortunate brethren who are still in possession of their -sexual glands. We do not think that psychic impulses, consequent on such -conditions, can be of sufficient influence to explain the craving for -alcohol, except, perhaps, through the circumstance that persons deprived -of the active sexual glands do not enjoy a high state of mental activity -and are unable to judge of the fatal consequences of the drink habit. If -women, after the menopause, exhibit a greater inclination to drink, we -think it cannot be explained solely by their seeking to drown the -sorrows of lost youth and by substituting for the pleasures of sexual -life those of the bottle. This may certainly influence them to a certain -degree, but in any case it is certain that without the possession of -healthy sexual glands the desire for stimulants is greater; and it would -seem also that in advanced age they can take alcohol more freely than in -their prosperous younger days. Such persons have a partiality for strong -sweet liqueurs. Happily such women are in a great minority. All we wish -to point out is that it is among the older people that this craving -exists, as in the younger ones alcohol cannot be so well borne. - -From such observations on the greater frequency of the alcohol habit -among persons suffering from degenerated conditions of the thyroid and -sexual glands, and on its greater rarity in opposite conditions, we -believe that some therapeutic hints may be gained. The best preventive -against the alcohol habit (which is induced usually by the want of, and -a real craving for, stimulants) will be the satisfying of this tendency -by other means than alcohol. We can even prevent this craving if we can -improve the state of their thyroid or sexual glands. For single persons -marriage is an excellent stimulant, and a first-class psychic treatment -as well. Treatment by means of thyroid gland can also give good results, -as by this the mental condition will be improved and a cheerful -disposition may be gained, which will enable them the better to -withstand worry and depression after disappointment. At the same time -the temperature of the body will be increased, a feeling of warmth -produced, and fatigue much better borne. Thus no whip will be needed, -and the craving for stimulants will be prevented. To women not only -thyroid, but ovarian, extracts should be given. Both exercise a powerful -influence on the mental condition, relieve depression, and remove the -craving for constant stimulation. By these means we possess a basis for -the rational treatment of alcoholism, besides the psychical and ethical -one, on which we will not enter here. But we must emphatically remark -that we must, in the first instance, get rid of the real cause of -alcoholism, viz., the diseased condition of the thyroid and sexual -glands which induces it, and by the removal of the cause we also remove -the consequences. By merely forbidding the use of alcohol and doing -nothing to cure the diseased condition which sets up such an insatiable -craving for it, is like filling a barrel, which has a hole in it, with -water, before we have tried to stop up the orifice. - - ------------------------------------------------------------------------- - - - - - CHAPTER XLIV. - - ON OTHER STIMULANTS—TEA, COFFEE, COCOA, TOBACCO: THEIR MERITS AND - DISADVANTAGES. - - -In many people the use of the above stimulants produces greater energy, -especially for mental work, and the process of thought may be -facilitated by their means, although we are not prepared to approve them -as a general rule. At any rate if such properties are to be found in -these stimulants, they are available only in small amounts and not -exceeding a given limit, for in excess the same rule applies to them as -to alcohol. - -There are, indeed, certain authorities who condemn them, and go so far -even as to call them poisonous. But it is a leading principle of this -work to condemn exaggeration and fanaticism in any form, and always to -observe the means that are best for all rules of life. Sobriety and -impartiality in everything must be the guiding stars for such a work as -this. We must not forget that the millions of human beings that are on -the earth have each a different kind of constitution, and many of them -practically cannot exist without the assistance of certain stimulants, -without which life would be a burden to them; and as it does no good to -make prohibitions which cannot be kept, even though made with the best -of intentions, all we can do is to endeavor to control certain things -and to see that some limit is set for their use. - -There are two varieties of tea, both of which, however, are gathered -from the same plant; their only difference lies in their method of -preparation; their differentiation is in color—black and green. The -former undergoes a process of fermentation and is then dried slowly over -charcoal fires, while green tea derives its color from having been dried -in a fresh condition over a wood fire. - -When we want to make good tea we must take finely washed leaves and make -an infusion, so that the greatest possible surface of the leaves shall -come in contact with the boiling water; and it is best to let this -contact be only for a short time, as otherwise the tea will be too -strong and less beneficial to health. - -The most important elements in tea are thein, a substance that is -identically similar to caffein in coffee, ethereal oils, tannin, and -extractives. Green tea contains more thein and ethereal oils, and also -more tannic acid, than black tea; and the longer it is in contact with -boiling water the greater will be the quantity of tannic acid derived -from it. According to R. Hutchison,[320] the ashes of tea contain a -large percentage of manganates (1.09 per cent. manganese hydroxide) and -much iron (4.47 per cent. oxide of iron). - -Footnote 320: - - Hutchison: “Food and the Principles of Dietetics,” London, 1901. - -After taking a cup of tea there is a feeling of great comfort; we feel -lighter and less fatigued, which is due, as discovered by Koch and -Kraepelin,[321] to the combined action of the ethereal oils and of the -thein. The tannic acid contained in tea may also give good results in -the treatment of certain diarrhœas. The actions of tea are very similar -to those of coffee, which is only natural, since both contain the same -chemical agent, thein or caffein. Still, though chemically the same, -physiologically doubtless there are some slight differences. Although -both promote endurance in physical and mental work, according to some -views, still in many people nervous irritability, such as sleeplessness, -is greater from tea than from coffee. Coffee is a better diuretic than -tea, and it has been found that common salt is eliminated in the larger -quantity after taking coffee. For weak stomachs neither is advisable. - -Footnote 321: - - Koch and Kraepelin: “Psychologies die Arbeiten,” vol. i, p. 378, 1895. - -In many cases tea is less easily assimilated than coffee, on account of -digestive disturbance caused by its tannin contents; while to many -others tea proves more suitable than coffee. When these beverages are -taken in large quantities there are very serious symptoms of nervous -disorders, such as great excitability, sleeplessness, palpitation of the -heart, trembling, etc. Indeed, sometimes the very serious condition of -actual intoxication is brought about. - -It is quite amazing what large quantities of tea are consumed in certain -countries—in England, for example; and in many instances the moderate -use of good wine would certainly create less mischief than the -immoderate use of tea. Tea is not so beneficial to the kidneys as -coffee, and as we have mentioned in the chapter on the hygiene of the -kidneys, irritation of the kidney tissues may be at times observed after -the use of tea. As in the case of alcohol, moderation with tea and -coffee is necessary. According to the researches of Böttger even weak -infusions of tea and coffee are harmful to children, and strong -infusions to grown up people. - -The most important substance in coffee is caffein, a product already -mentioned as being chemically identical with thein. When we take a cup -of coffee about 0.1 gramme of caffein enters the system, and also 0.2 -gramme of tannic acid, as shown by Robert Hutchison. When coffee is -roasted aromatic oils arise, which give coffee its delicious aroma. -Coffee acts as a stimulant to the heart and also to muscular -contractions. Its beneficial action on the kidneys has been referred to. -When coffee is taken it is more hygienic to take it not too strong, and -invariably with cream or milk. - -According to Emil Fisher, caffein is a thrice methylated xanthin, from -which it can be produced artificially. As caffein, or thein, contains -purin bodies, they also augment the amount of uric acid in the body, and -especially so when they are taken in large quantities. Because coffee, -tea, or cocoa give rise to uric acid, Haig would like to banish them -entirely from the diet. We do not feel inclined to follow Haig in such a -fanatical view, for after all it is nearly impossible to so live that we -should not introduce some small amount of uric acid into the system; we -are always producing a certain amount of it in the system, as already -mentioned, and whether a trifle more or less be taken can make no -difference, as minute quantities of uric acid cannot play an important -rôle if our kidneys are in good condition to eliminate them. With a -large amount of meat we eliminate two grams of uric acid in every -twenty-four hours, and even with an entirely vegetarian diet the urine -still contains 0.2 to 0.7 gramme, according to Bunge. Should we be so -unreasonable as to refuse a person a cup of weak tea or coffee, after -their having been accustomed to such for a lifetime, merely to avoid a -few more atoms of uric acid. Especially should we refuse them a weak cup -of coffee, remembering that such is a good diuretic and assists in the -elimination of baneful products through the kidneys? Only to actually -gouty people might such a veto, perhaps, be reasonably applied. - -Cocoa is a very valuable article of food, and at the same time a very -mild stimulant. As its active principle it contains theobromin, which is -a twice methylated xanthin. In its chemical and physiological actions -theobromin is very similar to caffein. It is, however, in some respects -superior to caffein. Thus it can assist muscular activity, according to -some authorities, to a higher degree than caffein or thein. - -Cocoa has the further advantage of being more digestible than coffee or -tea; and as a foodstuff it shows a great superiority over both the -latter, as it contains 12 per cent. of albumin, 13 per cent. of -carbohydrates, and contains fat—indeed, about 50 per cent.—in a fresh -condition. - -Cocoa presents fewer drawbacks than tea or coffee; it is less exciting -to the nervous system, more digestible, and much more nutritious also. -We think, therefore, it is clearly indicated as the best of all -stimulants, and, for reasons already stated, we are not afraid to -recommend it, in spite of the fact that it may nominally increase the -amount of uric acid. Cocoa was also the favorite beverage of the great -botanist Linné. - -Chocolate is composed of cocoa and a large quantity of sugar, and is -quite a pleasant sugar food, which doubtless can be used with profit as -a dessert to a lacto-vegetarian diet. It is also suitable for the use of -tourists and sporting men in order to enable them the better to endure -great fatigue. We often recommend its use in its best quality and in -small quantities to those people from whose diet meat is excluded. - -Tobacco is a plant, the leaves of which, when prepared by a special -process and smoked in the shape of cigars, or in pipes, are able to -produce in many people a feeling of exhilaration; and many such smokers -are able to do more work, especially brain work, with the aid of a good -cigar. Tobacco contains, in addition to noxious salts, a poisonous -alkaloid, nicotine, which produces in small amounts in those not -accustomed to it, and in all people if in larger quantity, a condition -of intoxication. When nicotine is taken for many years, and sometimes -even in a shorter time, either by smoking or chewing, very injurious -consequences from nicotine poisoning may ensue. According to König, -cigarettes are the most dangerous in this respect. It is quite a mistake -to think that no nicotine is introduced into the system through smoking; -and in chewing mixtures the presence of foreign matters must not be -overlooked. Nicotine may exercise a fatal action on various organs—for -instance, on the inner parts of the eye and the optic nerve, and the -nervous system; but without doubt its most injurious action is on the -heart and the stomach. At first it may cause only an irregular pulse and -an occasional feeling of a stopping of the heart; but if continued, in -spite of these symptoms, for a long time, it can undoubtedly produce the -condition of atheromatosis, and will assist in the development of -arteriosclerosis, which is probably caused by the action of this -substance on the adrenals; for it has been noted by many leading -authorities—e.g., Prof. Isaac Adler, of New York—that tobacco produces -effects similar to adrenalin. - -According to Sir Lauder Brunton[322] and others, tobacco raises the -blood-pressure, sometimes enormously. As Brunton says: “I do not know -that there is anything that causes such a tremendous contraction of the -vessels and raises blood-pressure to such an enormous extent as does -nicotine, except, perhaps, the extract of suprarenal capsules, which has -an action almost identical with nicotine.” - -Footnote 322: - - Brunton: Lectures on the Action of Medicine, p. 321, 1897. - -It has also been shown by Esser[323] that chronic nicotine poisoning is -able to produce in animals a great disturbance of the heart and -histological alterations of the vagus fibers, and that if nicotine is -injected into the circulation it excites the vagus and slows the action -of the heart. - -Footnote 323: - - Esser: Arch. für exper. Path. und Pharm., xlix, p. 168. - -Clinically we have observed the great frequency of arteriosclerosis in -great smokers, but we do not think that two or three light cigars a day, -but never before meals, can do any harm, save in exceptional cases. -Indeed, there are a few instances of persons living to be over 100, -notwithstanding the fact that they were smokers—a fact contrary to the -observations of Hufeland, who pretends that he never heard of such a -case. The famous English painter, Mr. Frithe, who died in October, 1909, -used to smoke six cigars a day; and Mr. F——, of Chartres, in France, -passed last year his 100th birthday in spite of his having taken snuff -all his life. - - ------------------------------------------------------------------------- - - - - - CHAPTER XLV. - - ON SLEEP, AND ITS IMPORTANCE IN RIDDING THE BODY OF TOXIC PRODUCTS. - - -SLEEP is one of the most important functions of the body. As the -physiologist, Bunge,[324] remarks, “a man can live for a month without -food, but he must succumb after only a few days if he fails to sleep.” - -Footnote 324: - - Bunge: Loc. cit. - -That sleeplessness leads to death has been proved by experiments on -animals by Maria de Manasseine, who has demonstrated that animals from -three to four months old invariably died if treated in such manner that -they could not sleep at all. At the same time their temperature fell -four to five degrees, and the number of their red blood-corpuscles -decreased from five millions to two millions per cubic millimeter. -Manasseine also discovered important changes in the brain of animals -which had died from sleeplessness. - -Before we get sleepy, as a rule, we feel tired and suffer from fatigue. -Working from morning to night—for even idle persons work through the -action of their organs—our muscles make numerous contractions, and it -has been demonstrated by Weichardt[325] that toxic products are thus -accumulated in them. This savant made animals perform very fatiguing -movements for several consecutive hours; he then injected extracts from -those muscles which had been subjected to such exercise, into other -animals, which animals in turn exhibited symptoms of great fatigue; and -he has gone so far as to show that such animals may even die during the -next twenty to forty hours. - -Footnote 325: - - Weichardt: Munchener Med. Wochenschrift, Nu. 1, 1904; and - Verhandlungen der Physiolog. Gesellschaft, Berlin, Dec. 5, 1906. - -Similar conditions prevail in human beings to a greater or less degree. -According to Prof. Obersteiner, of Vienna, and Binz, sleep is produced -by an accumulation of the products of fatigue in the brain, and these -substances are carried off during sleep. Thus sleep is similar to a -condition of auto-intoxication caused by the accumulation of the -products of work, be it muscular or mental, during the time that we are -awake. - -In the next chapter we shall show that sleeplessness occurs in all cases -where the thyroid gland is degenerated. This gland, as we show in -different parts of this book, destroys the toxic products formed in the -body. When this gland is degenerated these products cannot be destroyed, -and thus a condition of auto-intoxication will follow, as in myxœdema, -which has sleeplessness as one of its most typical symptoms. - -According to our present physiological knowledge the center of sleep is -seated in the brain just as are other functions, such as intelligence, -will-power, imagination, etc. As we have mentioned in the chapter on the -agencies which control the condition of our nervous system and -mentality, all these are changed when the thyroid is altered, for they -suffer alteration after the thyroid is removed or destroyed by disease; -and, on the other hand, they can be improved by thyroid treatment. Thus, -sleep being one of these functions, it is only logical to assume that -the thyroid controls sleep, which proposition we shall support with a -mass of evidence in our next chapter; we will also mention there that -after the injection of adrenalin, in the vicinity of the brain, Dr. -Zeigan[326] has produced sleepiness in animals. Adrenalin produces an -anæmic condition of the parts into which it is injected, caused by the -contraction of the blood-vessels. - -Footnote 326: - - Zeigan: Therapeutische Monatshefte, p. 193, 1904. - -There has been a dispute on this question, whether it is hyperæmia of -the brain, or its anæmic condition, which induces sleep. - -In addition to the experiments of Dr. Zeigan, which we have referred to, -and with which we will deal further in our next chapter, there are also -other circumstances which support the idea that in sleep the brain must -be in an anæmic condition. - -We know that in order to fall asleep the brain must be at complete rest, -for otherwise it is impossible to sleep; if the function of the brain is -roused by any exciting influence, as for instance, if we ponder deeply -over any scientific problem, sleep is out of the question. We think this -can be amply proved by a very interesting experiment carried out by the -physiologist, Mosso, in order to show that the process of thought -produces a hyperæmia of the brain. Mosso made a man lie horizontally on -a sort of scale, so that the balance was perfectly level. The subject -was then told to think deeply, and upon so doing the head end became -heavier, and the balance was depressed in that direction. - -We can also note that any other agency which produces a greater flow of -blood to the brain will be an impediment to sleep. For instance, many -people are unable to sleep when they have taken a certain amount of -alcohol, such as wine, just before going to bed; and this is more -observable in those who are unaccustomed to alcohol, and who become -flushed, feel hot in the head, and become mentally excited after taking -even small quantities. On the other hand persons accustomed to spirit -drinking, in whom no such symptoms are exhibited, may possibly be able -to sleep; this demonstrates toxic action, which may be followed by deep -sleep, by the action of alcohol on the thyroid gland. Taken in small -quantities alcohol excites thyroid action, but taken in large quantities -it causes its exhaustion as already previously mentioned. - -Long ago it was accepted as a well-known fact that a hot head and -flushed face prevent good sleep; but good regular sleep is obtained when -the head is cold. - -Sleepiness after dinner is attributed by Bunge to the accumulation of -blood in the digestive organs, which produces an anæmia of the brain. As -we show in the next chapter, the alteration in the thyroid by its -destruction of toxic products from the intestine, may also in part do -this. - -Very interesting experiments have been carried out by Christern,[327] -under the direction of Prof. Kreis, of Freiburg, who showed that the -pressure of blood in the cavity of the skull of a boy decreased while he -was asleep. - -Footnote 327: - - Quoted after Bunge. - -As we have already stated, sleep is attributed generally to a condition -of auto-intoxication. When we rise in the morning, after having slept -well and soundly during the night, we feel so fresh that these toxic -products must assuredly have left the body during the night. On the -other hand, after a sleepless night we feel so miserable and weak that -the supposition is not unjustified that possibly we have not gotten rid -of these harmful products. Professor Bouchard[328] has endeavored to -show, by an examination of urine passed during the night, that this has -a greater toxic action when injected into animals than has urine passed -during the day. - -Footnote 328: - - Bouchard: Loc. cit. - -As before mentioned, according to Obersteiner and Binz, during sleep the -products of fatigue, which have accumulated in the brain during the day, -are removed by the blood. - -Everything points to the fact that through sleep we are getting rid of -toxic products; and sleep is thus a function, the regularity of which is -of the utmost importance for our prospects for a prolonged youth and -healthy old age. - - ------------------------------------------------------------------------- - - - - - CHAPTER XLVI. - - ON THE CAUSATION OF SLEEP, SLEEPINESS, AND INSOMNIA. - - -WHEN any one is affected by African sleeping sickness, he wants to sleep -at all times. We observed the case of an officer of the Belgian Congo -Army, suffering from this sickness, who actually fell asleep over his -soup while at table. Dr. Willems, of Brussels, also mentions a case of a -patient who fell asleep during his wedding, and of another who went to -sleep on the doorstep while in the act of calling on him for advice. - -Discovery of the cause of such a marked degree of sleepiness caused by -disease should be of the greatest possible assistance in solving the -mystery which enshrouds the lesser degree of sleepiness found in normal -cases. We will, therefore, now discuss the question of the cause of the -uncontrollable desire to sleep in cases of sleeping sickness. - -As we pointed out in a communication to the German Congress of Medicine -in Wiesbaden, in 1905, sleeping sickness is clinically and essentially a -condition quite different to trypanosomiasis. It undoubtedly is the -consequence of the former, which is caused by the bite of the tsetse fly -(Glossina Palpalis); but sleeping sickness presents entirely different -clinical symptoms from the first, and it also takes a much longer time, -sometimes five to seven years, to develop, after the preceding -trypanosomiasis. - -As we could not fail to observe, the above case presented all the -appearances of a myxœdematous condition, among others the same walk, -slowness of movement and of speech, and the same apathetic mental state, -with the same dullness of memory; and it was surprising to witness how -all these symptoms improved only a few days after thyroid treatment had -been instituted. - -The pathological and anatomical changes in patients suffering from -African sleeping sickness, described by the English and Portuguese -Commission charged with the study of this disease, present also a great -similarity to the changes found in myxœdema, and this is especially the -case in connection with the central nervous system. Thus we find in both -conditions similar changes, such as destruction of the nerve cells and -nerve processes, chromatolysis, disappearance of the Nissl bodies, and -also the same typical agglomeration of white blood-corpuscles in and -around the blood-vessels, etc. The most striking point in reference to -this similarity is the fact that the condition in the central nervous -system is in both conditions named alike, viz., pylo-encephalo-myelitis. -Walter Edmunds has found similar changes in dogs and monkeys after -removal of the thyroid. - -This singular similarity also coincides with the etiology of the two -conditions. Myxœdema is most often the consequence of a previous -infectious disease; in the case of sleeping sickness, this previous -infectious disease is trypanosomiasis. In trypanosomiasis we find all -the symptoms of Graves’s disease. In the chapter on the agencies which -grant us immunity against infections and intoxications, we explain the -presence of the symptoms of Graves’s disease. The symptoms of -trypanosomiasis can be explained in the same way, as can those which -occur in other infectious diseases, as they are expressions of the -defense of the thyroid against infection. The consequence of such -overwork of the thyroid is its degeneration, which results in the -symptoms of a myxœdematous condition, as found in sleeping sickness. - -According to Koch, arsenic, in the form of atoxyl, can give good results -in such a condition; but with arsenic we introduce one of the main -elements contained in the thyroid gland, and arsenic can also afford -favorable results in the treatment of myxœdema. - -The most typical symptom of African sleeping sickness is the great -somnolence which cannot be controlled or resisted, as stated in the few -examples given above. This somnolence is also one of the typical -symptoms of myxœdema, being according to Pilcz, one of the four cardinal -symptoms of this disease. We also find this in animals or persons in -which the thyroid has been removed. We have observed dogs in which this -has been done, and they were always so fast asleep that the loudest -noise could not rouse them. From the foregoing there can be no doubt -that the thyroid gland has something to do with sleep, and this is best -exemplified by the circumstance that there is sleepiness in all those -conditions where the thyroid gland is degenerated, as in the instances, -just quoted, of myxœdema and of animals in which the thyroid has been -removed. In addition to these examples, sleepiness can also be observed -in cases of tumors of the pituitary body—for instance, in acromegaly. -However, as has been shown by Gley, Rogowitsch,[329] Stieda,[330] -Sajous,[331] and others, the pituitary gland and the thyroid are in a -very close relationship, and, as I have also pointed out in a previous -paper, we find pretty constantly alterations of the thyroid gland in -acromegaly. Salmon also mentions that in tumors of the pituitary body, -with sleepiness, there was generally found an atrophic condition of the -thyroid. - -Footnote 329: - - Loc. cit. - -Footnote 330: - - Loc. cit. - -Footnote 331: - - Sajous: Loc. cit. - -Sleepiness is frequently observed in certain cases of obesity. Such a -condition was described several years ago, under the name narcolepsy, by -Sainton. I have also observed similar cases. Thus, an English patient of -mine, a gentleman weighing 260 pounds, would fall asleep on any -occasion—in church, at the theatre, and at concerts; and I have heard of -a similar case from a confrère (related to me by Dr. Echlin, of Ottawa), -who was a very fat man and who snored much louder during an operation -than did the narcotized young lady, whom Dr. Echlin was operating on for -appendicitis. - -The sleepiness in these cases must also be attributed to the thyroid -gland, which governs metabolism, as shown by the researches of Prof. -Magnus-Levy,[332] of Berlin, Thiele, Nehring, etc., and also by my own -works. The fat-reducing action of thyroid extracts confirms this -clearly. - -Footnote 332: - - Path. des Stoffwechsels of v. Noorden, second edition, vol. ii. - -Sleepiness is a frequent symptom of chlorosis; and it is a fact that in -chlorosis the thyroid is very often altered, which might thus explain -it. - -Sleep produced by narcotics and alcohol can also be brought in relation -with altered thyroid functions. We have already mentioned that we have -observed during narcosis with chloroform and ether a marked swelling of -the thyroid gland, indicating a condition of hyperactivity, which is -followed by exhaustion; and after previous mental excitation, depression -and sleep follow. The action of alcohol on the thyroid has also been -explained in a previous chapter on alcohol. - -The sleepiness we notice after a heavy dinner, and more particularly -after partaking of a large amount of meat, can also be traced to thyroid -changes; for we know that the thyroid gland destroys toxic products -formed in the intestines, especially those toxines caused by the -destruction of albuminoids, as shown by Blum. - -The best proof, however, of the truth of the assertion that a -degenerated state of the thyroid produces sleepiness, is to be found in -the fact, which we have established by a number of observations on -patients, and also on ourselves, that the serum of animals, in which the -thyroid has been removed, causes sleep. We will deal more fully with -this in our next chapter on the treatment of sleeplessness. - -If sleepiness is so frequent in all degenerative changes of the thyroid, -on the other hand insomnia is the rule in cases of hyperactivity of the -thyroid gland, as in Graves’s disease, in which we know there exists a -condition of hyperactivity of the thyroid. We also find insomnia in -diabetes, but only in the preliminary stages, where there is no acetone -and diacetic acid in the urine. In severe cases we often find, on the -contrary, sleepiness; and this may be attributed to the fact that severe -cases of diabetes present features of a myxœdematous condition, as we -have found by the disappearance of the acetone and diacetic acid through -treatment with thyroid extracts. Sleeplessness can also be produced -artificially by giving thyroid preparations in large quantities. - -If sleepiness may be produced by thyroid degeneration, and sleeplessness -through thyroid hyperactivity, the conclusion is not unjustified that -the thyroid exerts a controlling influence upon sleep; it is, however, -quite possible that the other ductless glands may also influence sleep. - -Subsequently to my communication to the German Congress of Internal -Medicine in 1905, wherein I showed that the thyroid governs sleep, Dr. -Salmon, of Florence, in a monograph on sleep, tried to show, _without -any knowledge of my communication_, that sleep is governed by the -pituitary body. As, however, the pituitary body and the thyroid are in -close relationship, and as Salmon also mentions that in cases of tumors -of the pituitary body the thyroid has been found atrophic, I am inclined -to attribute the primary rôle to the thyroid. We can produce sleepiness -by the serum of thyroidectomized animals, and sleeplessness by thyroid -extracts; but we do not yet know any similar facts about the pituitary -body. - -From the communications of various authorities, it appears possible also -that the adrenals influence sleep as first pointed out by Professor -Sajous in 1903 in the first volume of his work (p. 520) on the Internal -Secretions. Dr. Zeigan[333] injected a milligramme of adrenalin, mixed -with 5 grammes of physiological salt solution, into the vicinity of the -brain of cats, producing, within one minute, a deep sleep lasting from -thirty to fifty minutes; and when the cats awoke they remained very -drowsy for some time afterward. - -Footnote 333: - - Therapeutische monatshefte, p. 193, 1904. - -From the above observations therapeutic conclusions may also be deduced, -as we will show in the chapter on the treatment of sleepiness and -sleeplessness. - - ------------------------------------------------------------------------- - - - - - CHAPTER XLVII. - - HYGIENE OF SLEEP—PREVENTION OF INSOMNIA. - - -WE are all acquainted with the tale of the man who was blind in one eye -and deaf in one ear, who at once went to sleep when his sound eye and -ear were closed. In this case there was nothing to stimulate the centers -of perception in the brain. - -This example is very instructive for the question we shall now have to -discuss. The best hygiene of sleep is to avoid all agencies that may -cause excitation of the brain. We have seen, in the preceding chapter, -that an anæmic condition of the brain must be sought; and this is best -attained when the brain is at complete rest and nothing is acting on it -which may cause an afflux of blood, and thus hinder an anæmic condition. -A sleeping brain must not work, as any kind of mental labor, even the -smallest noise, when it is able to attract attention by having been -conveyed to the centers of perception, may impede sleep. Sometimes the -loudest noise, such as an electric car passing with bell ringing, will -not awaken us, or prevent our falling asleep, if we are accustomed to -it; for it will then excite no attention and consequently will cause no -work for the brain; but should some one speak loudly in an adjoining -room, or should any unusual noise occur in our vicinity, although -infinitely less than the above mentioned, it may be sufficient to -prevent our sleeping, for we pay more attention to it, and thus the -repose of the brain is prevented. - -The miller will sleep soundly in spite of the rumbling of his mill -wheels, to which he has been accustomed for years; but should the mill -stop he may awake, for this would arrest his attention. - -From the foregoing it follows logically that in order to sleep soundly -it is best to exclude everything that can arouse the organs of -perception, and which, if conveyed to the brain, may invite attention -and thereby brain work. We must, therefore, exclude noise and light from -our sleeping chamber, as we all know from personal observation that we -sleep soundest in a room that is thoroughly darkened and where no noise -can penetrate. - -Some people are accustomed to a slight light in the room during the -night, for complete darkness would create attention, and thus they would -not be able to sleep so well. For such the light through the transom -will be advantageous; but for many people such light would prevent them -falling asleep. - -When a sleeping chamber is too warm we may be prevented from sleeping; -people mostly sleep best in a room that is not warmed, as this favors an -anæmic condition of the brain and excludes the sensation of heat that is -adverse to sleep. We also sleep better in autumn and winter than in -summer, unless the room be heated and an artificial summer created -thereby. - -The air in the room must not be oppressive, so as not to invite the -attention of our senses of perception; it would, therefore, be wisest to -take the largest room in the house to sleep in, and not the smallest, as -many do. People with a large bedroom and small sitting-room will have -more chances for a long life than those reversing this order of things. -A hygienic bedroom must be large, not heated during the night, and the -upper part at least of the window should always be open, and preferably -one at a part of the house facing a large garden or open space. - -In order that the brain may be at rest it is essential that the other -organs should also be resting. Any organ that is working, particularly -if the work be laborious, or if the organ be diseased, will send -impulses to the brain. It is very difficult to sleep if any part of the -body is aching; the sensory nerves bring this to the center of -perception in the brain, and this awakens us. When the stomach is loaded -we may the sooner drop to sleep, for reasons mentioned in the preceding -chapter; but digestion during sleep is more labored, and thus again -impulses will be sent to the brain. The same occurs when the intestines -are filled with gases. - -This necessitates the practical advice not to eat too much for supper, -and particularly not to go to bed for some two and a half to three hours -at least after that meal; and most people will sleep better if they do -not take much meat, and for such as suffer from sleeplessness not any -meat at all, at night. The most hygienic hour for our evening meal would -be about 7 o’clock, not later; and for the prevention of sleeplessness 6 -o’clock is better. - -But if it is difficult to sleep with the stomach full, an empty stomach -may also cause difficulties, particularly when there is much -hydrochloric acid in the stomach. A glass of milk and a biscuit is a -good remedy if awakened from such causes. - -Flatulency also may often be the cause of disturbed sleep, and to -prevent this certain kinds of food, liable to cause it, should not be -taken in the evening; such are beans, peas, or lentils, and potatoes -especially, if beer be taken at the same time. By such combinations a -regular chemical laboratory in the intestines will be formed during the -night, and for five to six hours after such a meal, or longer, according -to the time we go to bed, sleep will be disturbed. So long as there is -flatulency it is impossible to sleep, and the quickest way to put an end -to it is to insert a suppository of glycerine into the rectum, which -will soon cause a copious evacuation, provided that the intestines have -not been previously weakened by too many drugs. After this remedy the -flatulency will cease, and sound sleep for the rest of the night will -follow. - -Many people are apt to awake during the night after five or six hours’ -sleep if they have partaken of much meat at the evening meal and then -gone at once to bed. Only to catch an early morning train would it be -permissible to commit such a breach of the true hygiene of sleep. To -observe this hygiene fully we must also avoid taking mineral waters with -diuretic action for some time before going to bed, for the dilatation of -the bladder from the accumulated urine may convey sensations to the -brain and thus disturb sleep. - -Total sexual abstinence may cause insomnia, especially in persons who do -not observe complete chastity; for this marriage is the best preventive, -as it is for other troubles of a like nature. - -In women, when menstruation comes on, there is also disturbed sleep very -frequently; and many unmarried women suffer from insomnia. - -Sleep can the more easily be disturbed when it is the lightest, which is -generally the case during the early morning, for which reason at this -period all noise should be most carefully avoided. Sleep about midnight -is generally the deepest, and a noise that would not disturb us at that -hour will frequently do so in the early morning hours; thus, the -midnight hours being the best for sleep, it seems advisable to go to bed -about ten or half-past ten, and it is certainly not hygienic to retire -after twelve, as then it is more difficult for most people to get asleep -than it is at ten or eleven. - -It follows from the preceding considerations that mental work in the -hours before going to bed will be contrary to the hygiene of sleep. When -the brain is engaged in intense thought there is an afflux of blood -thereto, as mentioned before. It takes some time before the brain -becomes sufficiently anæmic for sleep; for which reason also it is not -wise to read books, especially interesting ones, in bed. It is a very -bad habit to read in bed until late in the night, as is done by many -ladies who complain of insomnia and take somnifacient drugs instead of -extinguishing the light as soon as they go to bed, and excluding all -agencies that may excite their attention, in order to allow the brain to -come to a state of rest. - -We must now answer the question: How many hours’ sleep shall we indulge -in? - -On an average, for the adult male, six to seven hours’ sleep is -necessary to feel rested thereafter and to fully appreciate the saying -that “Sleep is Nature’s sweet restorer.” Young girls and women require -much more sleep than do men; but children, and especially infants, -require the most. - -Infants are usually almost always asleep, possibly owing to the fact -that the thyroid and other ductless glands are not yet fully active; and -for this reason children also require longer sleep. The older we get the -less sleep we require. Sometimes in old age there is obstinate insomnia, -which is due to changes in the blood-vessels of the brain, by which high -blood-pressure is caused and the anæmic condition of sleep prevented. - -It is unwise to say you must sleep six, seven, or eight hours to have -enough. Each individual requires a different time according to his -bodily requirements, which he must study by careful observation. The -deeper the sleep, the shorter will be the time that will be required for -it. The essential thing is to feel rested in the morning, and it does -not matter if we have slept only five and one-half hours if we only feel -that we have slept enough. There are many people, usually over 50 years -of age, who feel rested and perfectly well after but five hours’ sleep. -But if after even seven hours’ sleep we still have a feeling of -weariness and depression, so to speak, we have not freed the body of -toxic products during sleep, so the time was insufficient and must be -made up the following night. - -It is a very strange thing, when we have not been able to sleep long -enough for one or two nights, and we do not feel in good condition in -consequence, that a longer sleep on the third night will be able to -restore us entirely. I believe this is a clinical argument in favor of -the theory that sleep serves to free the body from the products of -intoxication, which may be stored up for two or three days and disappear -after one night’s sufficient sleep. - -Too much sleep may be nearly as bad as too little. After sleep too long -continued we feel very heavy and oppressed; we must, therefore, observe -the right medium in this as in everything else. The greatest maxim for -longevity is moderation in all things. - -Granted the great importance of sleep as a function of ridding the body -of toxic products and of replacing spent energy, it will be only too -natural for us to do our best to assure its regular performance if we -are desirous of living long and retaining the vigor of youth as much as -possible. Indeed, sleeplessness, if continued for a few nights, is most -dangerous in tending to produce premature old age. We have only to look -at the face of a person who has passed a sleepless night or nights and -we shall see sunken eyes, hollow cheeks, and pendant features which bear -a strong resemblance to the face of an elderly person. It is then -interesting to note how one night of sound sleep will restore the normal -youthful appearance, which is an indication of the beneficial influence -of sleep in the problem of senility. - -Sleepless nights must be avoided by every means. If possible never -travel at night, unless we feel assured that our sleep on the train will -not be disturbed; always, if we can, give the preference to day travel. -The less often we go to bed after midnight the better will be our -chances for the retention of youth and a long life. - -Going to bed early enables us to rise early; and this is a powerful -factor in long life, proven by the fact that the majority of people -living to be 100 or over were early risers. The great importance of this -has been perpetuated by Franklin, the founder of many notable societies -and institutions, in the familiar verse:— - - “Early to bed, and early to rise, - Makes a man healthy, wealthy, and wise.” - -Franklin lived to be 85 years old. - -We have often noticed very old people go to bed after sunset and rise -with the earliest dawn. As a rule, people who go to bed early, some -hours before midnight, enjoy the soundest sleep because of the fact that -sleep is always deepest at about midnight. Usually only those living in -villages can indulge in this healthy habit, and doubtless this is one of -the reasons for their long life and robust health. - - ------------------------------------------------------------------------- - - - - - CHAPTER XLVIII. - - THE TREATMENT OF SLEEPINESS AND INSOMNIA. - - -WE have mentioned in a previous chapter that insomnia is a source of -great danger to our prospects for a continued youthfulness and a long -life. - -Before dealing fully with this subject it may be useful to refer to the -treatment of sleepiness also, as our remarks concerning this will tend -to explain better the novel and most rational treatment of insomnia -which we here advocate. - -We have already seen that the degeneration or removal of the thyroid -gland produces sleepiness, and its hyperactivity sleeplessness, as in -Graves’s disease. It therefore appears rational that if we wish to treat -sleepiness we must first create a condition of hyperactivity in the -thyroid gland, or at least we must improve its action. - -The best way to attain this is to administer thyroid extracts, which, -as we have stated before, are able, according to our researches, not -only to improve sleepiness, but even to create the opposite -condition—sleeplessness. - -We have already referred in another part of this book to our observation -of a case of sleeping sickness in an officer of the Belgian Congo Army, -who was almost always asleep. To him we administered thyroid tablets, -and after a few days there was a marked change in his mental attitude -and in his whole condition, and the sleepiness improved. But we obtained -still better results in the case of a very stout man weighing 124 kilos, -who was always falling asleep, so much so that he was arrested in the -picture gallery at Versailles, where he had fallen asleep while looking -at the pictures. This patient would fall asleep when out walking, and -this occurring in the streets of Carlsbad, he was picked up under the -impression that he was drunk, while in reality he was perfectly sober. -Having treated him for a few weeks with thyroid tablets, his sleepiness -was much improved, so much so that he did not fall asleep in our waiting -room, where formerly the other patients would prevent him from falling -off his chair when sleeping. This gentleman was the patient of Professor -Launois, of Paris, and on his return home after a six weeks’ treatment -we found that he was cured of his sleepiness and had lost 16 kilos (35½ -English pounds). - -We were also able to observe, in our own person, the action of thyroid -extracts; for, having for a few weeks taken two tablets daily (about 10 -grains), we began to suffer from sleeplessness, and our rest did not -again become natural until after we had discontinued the thyroid -treatment. This was an experiment that we made for our own personal -instruction, and judging from the results, we considered that they -indicated the trial of thyroid extracts in cases of habitual sleepiness. - -To treat insomnia we naturally must first endeavor to prevent it, to do -which we must bear in mind the advice tendered in the chapter on the -hygiene of sleep. The best means to insure good sleep is to partake of a -light early supper, and to have a very dark and quiet room. It is -decidedly unreasonable to resort to injurious drugs for sleeplessness, -instead of darkening the window and transom to exclude the light, and -sleeping in a room where no noise can penetrate. - -Persons suffering from sleeplessness must, above all, lead a hygienic -life; they must take exercise every day, walking or running in the open -air, even in cold weather, so as to produce some fatigue before going to -bed. Sitting the whole afternoon and living in an overheated room is -absolutely inimical to sound sleep; but overexercise and excessive -fatigue may also be as bad. - -It is an excellent thing for persons, whose sleep is not as it should -be, to drive in an automobile or carriage for an hour, at least, before -going to bed, the former being preferable owing to the greater current -of fresh air. We often notice children getting drowsy after being out in -the pure open air; and in places which are situated at a certain height -up a mountain, we often obtain excellent results in insomnia. - -Many people sleep better after a warm (not hot) bath, lasting twenty -minutes at least, just before going to bed; on the other hand, a cold -bath might prove too stimulating and hinder sleep. - -Some people experience difficulty in falling asleep; others easily do -this, but awake soon, after four to five hours of sound sleep, and then -cannot fall asleep again. A very dark and quiet room may overcome this -perhaps, but a room into which light enters from the street or through -the transom will never do so. When there has been no sleep for a whole -night, and no sleep on the second night till after midnight, we may give -a remedy to produce sleep, but not otherwise. In principle we are -decidedly against the use of remedies to induce sleep, and we only -permit such after two partially sleepless nights—when on the third night -there is no sleep until midnight, or after a thoroughly sleepless night -when there is also no sleep the following night till midnight. - -We have already mentioned that the effects of one sleepless, or several -partially sleepless, nights, may be compensated for by one thoroughly -good night’s sleep. As through sleeplessness toxic products are, in all -probability, retained in the body, certain hygienic rules must be -observed after a sleepless night, thus, for instance, a cold room ought -to be heated before we get up, for the effects of such a night are, -according to our observations, felt more when we get up in a cold room -than when we get up in a well-warmed one. - -It will also be most beneficial to take a very hot, or even a Turkish or -Russian, bath after a sleepless night, in order to eliminate toxic -products by abundant perspiration. An electric light bath may give -better results, using principally the blue rays, as such have a soothing -effect upon the nervous system, besides creating a free sudorific -action. - -If all the hygienic rules above indicated are applied and fail, then the -conditions are such that we may resort to sleeping remedies, adopting, -however, the principle to try first the most innocuous, and especially -such as the patient will not become addicted to the use of. - -The principal object is to diminish the excitability of the brain, and -bromide is one of the least dangerous remedies to obtain this result. We -will therefore first try sodium bromide, say, 20 grains, in a glass of -water. Valerian also can give good results, and is not a dangerous -remedy. There is a German preparation, bromural, composed of bromide and -valerian, which is a very mild sleeping mixture. Chloral is also an -excellent drug for reducing the excitability of the brain, but it is not -so harmless as the others. There has, of recent years, been introduced -from Germany a preparation, isopral, made from chloral, and for which it -is claimed that it is a mild sleeping mixture to the use of which people -do not become addicted. - -Such remedies may be prescribed when there is only a temporary -sleeplessness and not one of habitual long standing. When sleeplessness -is more inveterate and obstinate the above remedies will give no result, -and then stronger drugs must be resorted to, such as veronal; but this -must never be given in large doses, as it may produce in certain persons -symptoms of intoxication if more than 1 gramme (15 grains) be taken. The -principle of this remedy, which contains urea, is to produce a condition -analogous to intoxication, by producing fatigue. None of these agents -should be used otherwise than under the supervision of a physician. - -Some of our patients complained of heaviness in the head after the use -of veronal, while others approved of it and found that they could also -sleep on the following night, even after only the one dose. - -It would be most injurious to health to use these sleeping mixtures -habitually, especially opium and morphine. We have mentioned here only a -few with which we have experimented on ourselves or tried on patients in -cases of necessity, as all such remedies may be injurious to the brain -if taken often. - -We feel inclined to attribute greater importance to a sleeping remedy -which is based on physiological observations of sleep. As we have -already stated, thyroid degeneration or removal produces sleepiness; we -have, therefore, tried the serum of animals whose thyroid has been -extirpated, and, as will be proved, we have had good results in each -case. - -Being struck by the similarity of the symptoms of diabetes to those of -Graves’s disease, and as a logical consequence of our researches on the -frequency of a hyperactivity of the thyroid in diabetes, we tried a -remedy for this condition which has produced as good results as many -authorities have obtained in their treatment of Graves’s disease. This -is the serum of goats from which the thyroid has been removed, prepared -according to the formula of the celebrated neurologist, Dr. Moebius, of -Leipzig, who died recently. This remedy, named after its discoverer -“anti-thyroidin Moebius,” has not only afforded us good results in the -diminution of glycosuria, as we showed by a number of cases in the book -that we published upon the origin of diabetes, but also, what is still -more interesting to our present subject, every patient suffering from -insomnia exhibited an improvement; in fact, there was not a single case -which did not benefit by this treatment.[334] - -Footnote 334: - - Loc. cit. - -Following an automobile accident we suffered much from insomnia. We -tried this remedy personally, and after doses of 5 grammes (75 grains) -we were each time able to sleep for about eight hours, and felt -refreshed afterward. We have found this remedy superior even to veronal, -for the latter, when tried personally and afterward in patients, did not -give the same effect as anti-thyroidin. - -This remedy has, however, one great drawback, and that is the exorbitant -cost; and it requires to be taken in considerable amounts, at least 45 -to 70 grains at a dose, although in some patients a soothing result has -been obtained from 20 grains three times a day. - -This drug diminishes the excitability of the nervous system, and is, -therefore, an excellent remedy for insomnia, for it depends on a -physiological appreciation of our knowledge of the influence of the -thyroid gland on sleep. We have lately published an article on the -hypnotic effect of anti-thyroidin Moebius in the “Therapie der -Gegenwart” of Berlin, November, 1907. - -Instead of the anti-thyroidin Moebius—the extravagant price of which -forbids its general use—we would recommend extirpating the thyroid gland -of a goat, which is a very simple operation, and making use of the milk, -following the example of Professor Lanz, of Amsterdam, and of Walter -Edmunds in London. - -Our observations on the great influence of anti-thyroidin on sleep were -confirmed by Professor Lanz in a discussion following an address we -delivered before the Society for the Advancement of the Medical and -Natural Sciences, in Amsterdam, on the 15th of March, 1905.[335] He also -mentioned the case of a dog whose master, a peasant, was tending the -professor’s goats, whose thyroids had been removed and whose milk was -being administered by the professor to his patients suffering from -Graves’s disease. The peasant was told to give the goats’ milk to his -dog, but after a time, the peasant refused to do this, as since the -goats’ milk had been given to the dog, he always wanted to go to sleep, -even when accompanying his master in his walks. - -Footnote 335: - - Nederlandsch Tijdschrift voor Geneeskunde, 1905. - - ------------------------------------------------------------------------- - - - - - CHAPTER XLIX. - - HYGIENE OF THE SEXUAL GLANDS—THE DANGERS OF SEXUAL OVERACTIVITY AND OF - TOTAL SEXUAL ABSTINENCE. - - -WE have referred, in previous chapters of this work, to the great -influence of the sexual glands on several of the most important organs, -and shown in what a marvelous way these glands affect our vitality and -prospects of longevity (see Chapter V); consequently it is only natural -that we should use our best endeavors to maintain these glands in good -working condition, which we can do in a rational manner by protecting -them from all harmful agencies, which may be numerous. It would exceed -the limits of this book to enumerate all the different causes of -diseases of the sexual glands, so we will confine ourselves to the most -frequent, which, although not immediately producing actual disorders of -the glands, may yet lower their vitality in the long run and finally -lead to their degeneration. - -The infectious diseases of the sexual glands, acquired by contagion -through sexual intercourse, occupy a prominent place among the agencies -deleterious to them. They are well dealt with in the handbooks on this -subject, so will not be further referred to here. The best way to avoid -them is by marriage. This may, in the majority of cases, be a safeguard -for the man but not for the woman; for, unhappily, in very many -instances women are infected by their husbands as soon as they enter the -bonds of matrimony. - -In Chapter VII we mentioned the injurious consequences of these -infections, not only for men, but also for women, and told how in the -former sexual potency, and in the latter fertility, may be ruined by -such. The best way to deal with the matter would be to pass a law -enforcing the examination of the prospective husband by a physician; and -if such a law were applied also to the woman, the propagation of certain -hereditary diseases might be arrested. Long ago Plato thought of such an -emergency. He recommended that before a marriage judges should examine -both man and woman, the man to be stark naked, and the woman partially -so; after the inspection the judges were to deliver their opinion -whether the couple should be married or not. - -Nearly as injurious as infectious diseases may be the abuse of the -sexual glands by too frequent intercourse, by masturbation, or by other -irritations of these glands, such as excitation, without subsequent -satisfaction, especially in cases of interrupted copulation with a view -to avoid offspring. - -Too frequent sexual intercourse may soon sap the vitality of these -glands and, indeed, hasten the symptoms of old age, even in young -persons. As already mentioned, even young girls may acquire some of the -attributes of old age by such means. They soon become fat and bloated, -the features lose their juvenile aspect, and the cheeks become pendant; -the muscles lose their tonicity, and there is a marked difference -between the muscles of a young maiden and those of a woman of the same -age who has been leading a life of debauchery for some time. The latter -will invariably, if not always, look older—which ought to be an object -lesson on this subject. Premature old age can similarly be brought about -by constant conditions of exhaustion of the ovaries consequent to -frequent pregnancies. When a woman has a child year after year, as a -rule, especially if living in straitened circumstances, she usually -looks older; but this is not so in all cases, as we have before -remarked. - -Moderation, therefore, must be strictly observed. - -The ancient Hindoos recommended to men sexual abstinence of long -duration, thinking that by this means the internal secretion of the -sexual glands would be absorbed into the system and that they would -thereby reap all the benefits inherent in such a secretion. By this it -seems that thousands of years before Claude Bernard and Brown-Séquard -the Hindoos already appreciated the great importance of the internal -secretions. - -According to the Prophet Mohamed, sexual intercourse should not be more -frequent than once in eight days. Zoroaster recommends once in nine, -Solon and Socrates once in ten, and Moses eight days before and eight -days after menstruation, and Luther twice a week (der Woche Zwie). The -Holy Book of the Jews, The Talmud,[336] an encyclopædia of Jewish -knowledge embracing a period of from 500 years before to 500 years after -Christ, recommends the following in respect to marital intercourse: -Young strong men, every day; workmen, once a week; mental workers, once -a month. Acton advises copulation once only in from seven to ten -days.[337] - -Footnote 336: - - Quoted after Prof. Kisch “Das Geschlechtsleben des Weibes,” Vienna, - second edition, 1908. - -Footnote 337: - - Quoted after Prof. Kisch, as are most of the quotations in this - chapter. - -Pomeroy says matrimony is Nature’s nectar, but if we indulge too freely, -instead of nectar Nature will offer us water or bile, and finally deadly -poison. To avoid sexual overactivity in married people Kisch recommends -a separate bed for man and wife. - -Far more dangerous than too frequent intercourse are frequent -excitations of the sexual organs without final sexual satisfaction. In -this way a continual hyperæmia of the caput gallinaginis in the prostate -can be set up; and as this is where the ducts of the seminal vesicles -end, premature emissions and impotency may result. Thus we see that -masturbation and interrupted copulation may produce the same effect; -indeed, these practices are far more injurious to virility than sexual -overactivity if indulged in in the normal way. - -Frequent sexual excitations are also very deleterious to the female -sexual organs, which are thereby brought into a hyperæmic condition; and -if this dangerous practice be often repeated serious disorders may -follow, and especially is this the case if intercourse be interrupted -before the seminal emission. - -According to Professor Kish such preventive coition (_congressus -interruptus_) may be followed by a relaxation of the uterus and chronic -metritis. The hyperæmia and stagnation of the blood may lead to -inflammation of the ovaries and parametritis, and perhaps to new -growths. Neugebauer and Pigeolet have often observed cancer of the -uterus in women who made a habit of indulging in sexual intercourse with -the use of preventives against conception. Metritis and parametritis -after such a proceeding have been observed by Bircher, Valente, etc. - -Certain abuses of the female sexual organs, such as copulation during -menstruation, may also be ruinous to those organs; metritis, -parametritis, ovarian inflammation, etc., may be the result of such -grave violations of this most elementary rule of the hygiene of the -sexual glands. - -The ancient Mosaic Laws prescribed the punishment of death for -intercourse during menstruation. During this period all kind of work -should be prohibited, and for many women it would be wisest to rest -completely, especially during the first day. - -Women should not marry under a certain age, preferably not under 20. -With the Spartans no man was allowed to marry before 30, and no woman -before 20, and we know what a robust and strong nation they were. This -is most essential to avoid premature senility, which can easily develop -in women who commence sexual intercourse at an early age. No woman -should be permitted to marry until she is fully developed physically and -mentally. There are cases where women are not fully developed at 18, or -even at 20, and in such cases marriage should be deferred to a later -period. - -Close observation of the rules for a rational hygiene of the sexual -organs also demands that chlorotic girls should not marry until their -condition is improved by iron treatment, the sexual organs in cases of -severe chlorosis or anæmia not being fit for use. - -We have referred to the dangers of sexual overactivity, and we will now -endeavor to show that the opposite extreme, viz., complete inactivity of -these glands, may also lead to disastrous consequences. When nature -created our different organs they were intended to be used, and there is -no part and no organ in the body that should not fulfil its function -(even the appendix, as lymphatic tissue, has one). No exception can be -made in favor of the sexual organs, although the hypocrisy of certain -faddists would have us believe that these organs alone out of the whole -body should serve no purpose whatever. Indeed, the whole anatomical -construction and the physiological working of these organs—differing in -each sex—shows that Nature intended them to be used in conjunction with -each other. - -These organs are glandular formations having, like all other glands of -the body, a secretion, which, like the secretions of the other ductless -glands—as, for example, the thyroid—if produced in too large quantities, -may have toxic effects. That this really is the case is shown by the -experiments of Loisel, who found that the extracts from the testicles, -and still more so from the ovaries, if injected into other animals, have -toxic effects. - -The sexual glands, being glands with an epithelial formation, must -certainly produce a secretion; they could not be an exception to one of -the fundamental laws of anatomy and histology. The accumulation of this -secretion may produce certain toxic effects, judging from the -experiments of Loisel.[338] We may, therefore, conclude that the -complete inactivity of these glands or, in other words, total sexual -abstinence, may have injurious effects on the general health, as also on -the condition of the glands themselves; and we are able, by experiments -and clinical and anatomo-pathological observations, to confirm this -view. - -Footnote 338: - - Loisel: Journal de l’Anat., xi, p. 536; C. R. S. B., L. ix, p. 403. - -Regaud[339] has observed that when guinea-pigs are kept for a long time -in complete sexual abstinence, away from their females, the testicles -present degenerative changes, and at the same time the volume of the -gland is considerably diminished. The seminal epithelium shows many -cells with signs of degeneration. He also observed similar signs in the -epithelium of the seminiferous tubules during winter hibernation, and -also in the spring when the animals were not sleeping but if they were -kept in total sexual abstinence. Although they were well nourished these -animals showed no spermatogenesis. - -Footnote 339: - - Regaud: Comptes rendus de l’Association des Anatomistes p. 198, 1903. - -Regaud comes to the conclusion that “la continence forcée peut done -avoir pour conséquence des modifications importantes de l’épithélium -séminal”—enforced abstinence (sexual) may thus lead consequently to -important modifications of the seminal epithelium. - -According to Mingazzini,[340] the ovaries of female animals that are -kept in captivity and sexual abstinence present degenerated follicles, -this being very different to the ovaries of other females living in -freedom, the comparisons having been made in the same season of the -year. - -Footnote 340: - - Mingazzini: Corpi lutes veri e falsi; R. F. Laboratorio di Anatomia - normale della Reale Universita di Roma, vol. iii, 1893. - -There is some evidence to show that similar results may happen in man. -When men live a long time—not for weeks or a few months, but for a very -lengthened period—in total sexual abstinence, the size of the testicles -may sometimes be found diminished. Unfortunately there have not as yet -been made, at least to our knowledge, histological examinations of the -sexual glands of those who really have led a life of total sexual -abstinence. But a remote proof in support of our proposition that such a -condition may lead to histological changes in these important glands, is -the fact that Baldwin has discovered histological changes in the ovaries -of hysterical women, of whom a large proportion were either spinsters or -women who became widows early in life. Of course this is but a very -indirect proof, devoid of the scientific value of the observations of -Regaud and Mingazzini. - -There are, however, important clinical facts which support the -supposition that total sexual abstinence may lead to alteration of these -glands. Thus we have observed impotence in the cases of several men -after sexual abstinence of long duration, which entirely disappeared in -nearly every case after copulation at regular intervals; and we arrive -at the conclusion that a regular use of these organs, which are intended -by Nature to be used, is a necessity, and that impotence can frequently -be best cured by marriage. In marriage only can hygienic and regular -sexual intercourse best take place; and thus marriage is the best -hygiene for the sexual glands. For this and other important reasons we -will devote a special chapter on marriage, which will succeed this. In -some maidens near the thirties we can note the appearance of symptoms of -fading; through the loss of fatty tissue those parts of the body that -were formerly round become angular, and there thus develops the -condition of leanness so typical of old spinsters; hairs may also appear -on the chin and upper lip. That all this is caused by the inactivity of -the sexual glands, which, as already explained, influence the outward -appearance of the body, is best demonstrated by the fact that after -marriage a great change takes place in such women, and the fading -rose-tree blooms again. Thus marriage re-creates youth. - -The deleterious effects of total sexual abstinence on the sexual glands -have also been observed. Professor Kisch noted that with women who had -lived an active sexual life and who had had several children, whom they -had fed from the breast, menstruation continued till a later period in -life than it did in old maids, or in women who early in life had become -widows, or in barren women. - -That total sexual abstinence may have very injurious effects on the -nervous system, as mentioned in Chapter IV, and assist in the -development of hysteria and neurasthenia, is shown by the fact that when -there is an accumulation of semen in the male, or a swelling of the -Graafian follicles in the female, then an excitation of the nervous -system follows, with sexual desire. That the nervous system can be -excited and even seriously damaged by too frequent and too excessive -impulses conveyed from the sexual glands, has been mentioned by us at -various times in this book. - -The continual resistance to satisfy sexual desire, and especially -satisfaction by artificial means, may lead to ruinous consequences for -the nervous system and the sexual glands. - -Happily there can be no doubt that many men and women lead healthy -lives, in spite of their struggles against satisfying the desire of the -sexual organs to follow their natural bent; but such cases are not the -rule, and most of such people have some kind of disorder, especially of -the nervous system or the digestive organs, as, for instance, -cardialgia, or acidity of the stomach. We have already referred to the -alteration in these organs following changes in the sexual organs. - -There are people with a frigid disposition,—which is certainly not -normal—and such may not be troubled by their sexual glands. On the other -hand, there are people with too great a sexual inclination. The -suppression of these desires in them may often lead to ruin of the -nervous system. Prof. Krafft-Ebing found that individuals with -neuropathic constitutions often have their desires exaggerated in a -pathological way, and he came to the conclusion that in such persons, -through enforced sexual abstinences, the nervous system may be ruined. -Professor Erb, the famous Heidelberg specialist for nervous diseases, -declared at the Congress of the German Society for the Suppression of -Vice, held a few years ago at Frankfort, that there are adult -individuals in whom sexual abstinence for a long time produces serious -mischief in the nervous system. - -Buddha says: “Sexual instinct is stronger than the iron hook with which -wild elephants are tamed; it is hotter than fire; it is an arrow that -pierces the soul of man.” - -Briefly, neurologists, especially since Freud’s labors, now realize the -importance of the injurious influences of an abnormal sexual life, many -disorders of the nervous system and mind having been traced to the -conflict between the demands of nature and a too rigorous sexual -repression, through fear, disgust, shame, etc. - -One of the pioneers of the movement in Germany for the emancipation of -women—Johanna Elberskirchen—demands free scope for the sexual feelings -of women and their satisfaction within physiological limits and -according to physiological necessity. - -We are of the opinion that, as a rule, there is a certain difference -between sexual desire in man and the same in woman. Man mostly wants -satisfaction simply; in women there is generally a higher motive: she -demands love, and refuses satisfaction alone. - -Nature, who has created the sexual organs of male and female as a -masterpiece of very clever and skilful construction, with admirable -forethought in even the smallest details of this very complicated -mechanism, has appointed to them a very important purpose, viz., the -propagation of the race; and she pursues her ends in a most artful way, -giving to each sex certain attributes by which the opposite may be -attracted. The peacock, for instance, is furnished with a wonderful -collection of beautiful feathers to excite the sexual feelings of the -hen, which has a much plainer exterior. In man the relations are -reversed; here beauty is more conspicuous in the female, and it is by -their charms, the attributes of their sex, that men are attracted,—who, -unfortunately, look rather to the beauty of the outside, which is -transient, than to that of the soul, which is eternal. - -This book is a plea for a simple and natural life, and for obedience to -the laws of Nature rather than for neglect or abuse of them. Sexual -desires are the outcome of the existence of the sexual glands, and they -are enforced upon us in a way that is sometimes nearly irresistible -after long-continued sexual abstinence. Disobedience to the imperious -commands of Nature will draw down upon us her revenge and punishment, -and ailments and disease, and bodily and mental misery, may be the -consequences of the complete suppression of the functions of these -glands in adults. There may be exceptions, and certain women or men may -pass a lifetime in such an unnatural way without any apparent ill -consequences to their health; but such are rare. It has been observed -not infrequently that spinsters were fast fading when they were married, -but that after a time they looked much younger, especially after their -first child. As already quoted above from Kisch, sexual life and, -therefore, youth are longer preserved in women who use their sexual -glands and have children than in those who do not. Thus there is no -alternative, and marriage is the safest course. Marriage, if the -partners are well suited, is indeed the most useful and beneficial -institution there is; and, as we will show in the next chapter, it is -one of the most important agencies in the treatment of old age, and for -the longest possible conservation of youth. - -But the question now arises, what should those do who cannot get -married, not through any fault of their own, if they should escape all -the mischief due to an unnatural suppression of the sexual functions or -their satisfaction in an unnatural way? We will now endeavor to give a -few useful hints on the subject. - -First of all, a hyperæmic condition of the sexual organs should be -avoided by all means, and care should especially be taken to have the -bowels opened every day, as otherwise hyperæmia of the pelvic organs -will follow. This may also be a consequence of rich food and a sedentary -life, which, therefore, should be avoided. Cold hydrotherapeutic -washings of the surface of the body, particularly of the sexual parts, -may also be beneficial. As during long sexual abstinence the probability -is that toxic products are being evolved and are accumulating in the -system, a good purge every five or six days would seem to be a -necessity, as also would a hot bath. Reading light literature should be -avoided. We especially recommend much exercise in the open air and -sunshine, long walks, mountain climbing, sports, long journeys -(especially by automobile), etc. - -The best safeguard against sexual desires is an active busy life, which -affords no opportunity for idle thoughts. - -For persons doomed, from one cause or another, to lead a life of -complete sexual abstinence, the best and safest course to prevent sexual -desire is to lead a strenuous business life, drowning the desires in a -flood of useful and busy occupations. - -Thus unmarried girls and widows may well pass their time in charity, -nursing the sick, and other occupations tending to make them useful, -rather than spend their time in fruitless dreams; and by such -occupations they obtain a happiness which they might not have found, -perhaps, even in married life. - -The surest kind of occupation for the prevention of the above-mentioned -desires is strenuous mental work. When the mind is busy with serious -problems these desires cannot obtrude themselves; and, indeed, we have -often observed in persons whose lives have been devoted to serious -scientific work, which has entirely absorbed them, a total absence of -sexual desire for a long time, and even impotency. This, however, we -will consider later as a consequence of defective hygiene during mental -labor (see Chapter L, on the hygiene of the brain worker). - -We do not recommend mental work so exaggerated beyond the ordinary -limits that it might cause harm to the brain and nervous system; but it -is certain that when mental work is done within reasonable limits, and -when it occupies the greater part of our time, but not all, it is a -great protection against sexual desires, restricting them without any -injury to the functions of the sexual glands. - -Thus, as we see, there are certain remedies against sexual desires for -those that cannot satisfy them; but the most natural solution of this -question can be brought about in the safest way by marriage. - - ------------------------------------------------------------------------- - - - - - CHAPTER L. - - ON MARRIED LIFE AS AN IMPORTANT MEANS FOR PROLONGING LIFE. - - -OPINIONS differ as to whether married life can be generally considered -as a source of happiness; some there are who say it is the acme of -happiness, while others do not agree that it is exactly a heaven on -earth. - -Personally we possess positive evidence in favor of the view that -marriage can make people very happy; for we know of a number of cases of -suicide following the loss of husband or wife, and we have a clear -recollection of seeing many widows or widowers break down at the mere -mention of their departed, years after the bond of matrimony had been -thus severed. - -Certainly agencies that can make people happy, such as marriage, ought -to be able to lengthen existence and remove petty cares, worry, and -sorrow that are so prevalent in this life, and which, in the long run, -tend to induce premature old age. As the Germans say, “Getheiltes Leid -ist halbes Leid” (“a sorrow shared is but half a sorrow”), and the man -who can share his misfortunes with a beloved wife does not carry his -burden alone. - -This is of the greatest importance, for, as we shall show in the next -chapter, the body is governed by the mind, and thus mental emotions of a -depressing nature assist in the development of disease and the symptoms -of premature old age, in combating which a single man is always at a -great disadvantage. - -We shall also show that, as a rule, our mishaps and disappointments are -due to our own fault of omission or commission, to want of foresight, -etc. It is a positive fact that many a man, famous in history, owed his -position and success to the advice and assistance of a clever and -sympathetic better half; this term is, indeed, not devoid of foundation, -for a man does not so seldom become perfect through his better half, the -woman. The female character is so essentially different to the male, -because of her different anatomical and physiological constitution, that -by the uniting of the female to the male some deficiency in the -character in the latter may be supplied, and _vice versâ_, with equal -benefit to both. Thus the uniting of the woman to the man is most -desirable, if only for this reason. - -It would lead us too far to insist on the enormous advantage of married -life for public morality, for the prevention and repression of crime, -and even for the welfare of the State, the soundest foundation of which -is family life. Each family is a little community in itself, with the -father at the head as king, and the mother as queen. And as the State -wants subjects, so the family wants children; for the great pleasures -connected with the various stages of a child’s growth from the cradle to -the altar, serve as the key to a lengthened and the longest possible -existence. Cornaro gives us a very instructive example in his saying “in -the society of the young we become young again;” and so children restore -youth. - -Not only because of the favorable mental influence exercised by marriage -must this be recommended as one of the most efficient means for -attaining a long life, but also because of various other advantages -induced by the improved hygienic conditions of various organs. Thus, -marriage is able to satisfy the sexual desires,—the complete suppression -of which is so injurious to most healthy men and women,—without there -being any risk of contracting diseases of the sexual organs with their -terrible consequences. For this reason alone married persons have the -best chances for preserving their youth, provided they exercise -moderation and do not indulge in the pleasures of matrimonial life -beyond the physiological limits. - -It is much easier to observe the rules of hygiene for the various -organs, as outlined previously, in married than in single life; for in -the latter condition one is concerned for himself alone, whereas in the -former, four eyes instead of two are on the watch. Thus the first -symptoms of disease are often visible to the eyes of a loving wife, and, -as prevention is better than cure, such a disease may then be checked by -promptly applied treatment. Most diseases could be cured if treatment -could be administered at the very beginning, whereas curable diseases -often terminate fatally from neglect of a sufficienctly early treatment. -There can be no doubt about it, but that as a rule, a married man is far -better nursed, in case of sickness, than is a single man; and we all -know that a good nurse can often do just as much good, sometimes even -more, than the most skilful physician. It is certain that the -therapeutic results in the English and American hospitals would be -inferior to those obtained at present if there were not such excellent -nurses, of whom these countries may indeed well be proud. Marriage, -through the regular habits it causes, can also favorably influence -certain chronic diseases; thus, according to Rénon, even heart -affections can be favorably influenced by married life. - -As a rule married life also implies the possession of a home, whereas a -single man or woman most often have no real home. They are obliged to -frequent restaurants for their meals, where there is great likelihood of -their damaging their stomach or intestines by irregularities in food or -drink—at least in the case of men, who also have no reason to stay -indoors in the evening, and are thus more exposed to the life-shortening -influences of an irregular life. - -As we have already seen, the best means for attaining a very long life -is moderation in everything; and there is no doubt that this can be much -better observed in married than in single life. - -For all the foregoing reasons we must emphatically advise all who desire -long life and the preservation of youthfulness as long as possible, to -marry, and if they become bereaved, to marry again. Celibacy is a -condition unknown to uncivilized nations; the ancient Hindoos considered -it a crime that should be punished; and, according to Du Perron, the -Parsees of the present time, who still follow the religion of Zoroaster, -regard celibacy as a deadly sin. According to Tsen-ki-tong,[341] an old -maid is a phenomenal rarity in China. - -Footnote 341: - - Tsen-ki-tong: “China und die Chinesen,” German translation from the - Chinese, Leipzig, 1875. - -The best proof of the supposition that marriage is conducive to long -life is the example given us by the long-lived patriarchs mentioned in -another chapter, nearly all of whom were married; for if they became -widowers, even though over 100 years in age, they soon married again. - -It is one of the saddest sights on earth to see an old bachelor alone in -the world; and we consider that the happiest beings are those who, in -their green old age, are surrounded by numerous children and -grandchildren. According to Schopenhauer, such persons never die, for -their flesh and blood survive in their descendants. - -Being still a bachelor we may incur the reproach that we speak of -marriage as the blind man speaks of color, and particularly by seeming -blind to the evils that may be present in the married state. We cannot -deny the fact that some people are most unhappy; but it is our firm -belief that all the ills that befall us on this earth are due to -ourselves. If we select our nuptial mate with care and sound judgment, -paying more attention to the internal rather than the external -qualities, treating her with the utmost consideration of character, -first studying and then adapting ourselves to them, we shall not find -sharp edges but smooth sides, and we shall never come into collision -with them. Everywhere and anywhere, everyone is the author of his own -luck. - - ------------------------------------------------------------------------- - - - - - CHAPTER LI. - - HYGIENE OF THE MIND—EMOTIONS AND WORRY AS CAUSES OF OLD AGE. - - -WHEN the famous surgeon Vesalius was dissecting a woman, he discovered -that her heart was still feebly beating. He was so overcome by mental -distress at his discovery that he suddenly dropped dead. Other -instances, also showing that strong emotions of the mind are able to -kill people, are known, and history also tells us of the case of Louis -of Bourbon who dropped dead from fright at witnessing the exhumation of -his father’s bones. Not only can severe emotions caused by fear or -grief, but pleasing ones, when they exceed a certain limit, are also -able to produce instantaneous death. Thus it is said that when -Leibnitz’s niece found a large amount of gold under the bed of the -famous philosopher, after his death, she had such a powerful emotion of -joy that she fell dead. The same sudden end was the fate of Sophocles -when he heard that one of his tragedies had been awarded the highest -prize. - -Death is happily rather rare under such circumstances; but diseases of a -serious kind, especially diabetes, can be caused frequently from strong -mental emotions of a depressing nature. We have published two cases of -young women who suddenly contracted severe diabetes after a fright, -while previously there had been no symptoms of such; and in a third case -glycosuria was increased very considerably. This last case was one of -mild diabetes; the sugar increased to a very great extent the day -following the intelligence that he had lost half his fortune through a -coal mine accident. Professor Naunyn, in his book on diabetes, after -quoting our own observations, also states the interesting fact that -after the bombardment of Strassburg in the war of 1870, many cases of -diabetes developed in consequence of the fear and anxiety brought about -by it. - -Strong emotions of the mind thus tend to shorten existence by their -fatal action on several of the most important organs, such as the heart, -and in particular the ductless glands: the adrenals, thyroid, pituitary, -pancreas, liver, kidneys, and the sexual glands. These are governed by -the sympathetic and vagus, and mental emotions, by acting on these -nerves, produce alterations in these important glands. - -By acting on the adrenals mental emotions produce higher blood-pressure, -in consequence of the toxic action of the increased adrenal secretion, -and thus favor the development of diseases of the heart and circulatory -system, especially arteriosclerosis, which so very frequently shortens -life (see also Chapter XVI). - -That mental emotions act upon the thyroid is shown by the alteration of -this gland in consequence, which can sometimes go so far that often -Graves’s disease (hyperthyroidia) has been observed, at times shortly, -and at other times suddenly, after the mental shock. The hyperactivity -of the thyroid may eventually be followed by its exhaustion; and so it -happens that as one of the causes of myxœdema mental depression is often -mentioned. - -That alterations of the pituitary body after mental emotions can take -place, is shown conclusively by the fact that competent authorities, -like Professor Pel and many others, have published cases of acromegaly -after such a cause. We personally observed a case in which grief from -incarceration caused the disease to which also diabetes was added. -Sajous has long urged that the pituitary is the _sensorium commune_, -i.e., the central organ upon which all severe emotions react. - -It is indeed tragical that diabetes mellitus so frequently attacks those -who suffer reverses in their life. Unlike death in the cases above -mentioned, it is only brought about in those who have had mental emotion -in consequence of disappointment, loss of fortune, and, in some cases, a -wife’s infidelity, etc. Thus, not satisfied with bringing misfortunes, -Fate adds disease, so that their lives are threatened with being -shortened. We shall insist, later on, that this disease, as most -diseases generally, only develops in consequence of our own fault or the -fault of our forefathers. - -The alterations of the pancreas in consequence of mental emotions can be -best demonstrated by the frequency of diabetes after such a cause, as -just referred to above. Pawlow observed a checking of the pancreatic -juice after such an agency. - -The action of mental emotions on the sexual glands is shown by the -sudden appearance of menstruation. We have recently heard of a young -lady who attempted suicide because of disappointment in love; she threw -herself into a river, which fortunately was not deep at the moment, and -this act caused the sudden return of her menstrual period. - -Cases of sudden menstruation after various kinds of mental emotion have -often been observed; and in men under similar circumstances impotency is -not infrequently noted, though, in most cases, it is only temporary. - -The alterations of the liver are shown by jaundice, and of the kidneys -by an increased flow of urine in consequence of mental emotions. -According to Clifford Allbutt,[342] strong, mental emotions play an -important part in the origin in many cases of interstitial nephritis. - -Footnote 342: - - Quoted after James Tyson. Loc. cit. - -It is a well-known fact that persons, after strong mental emotion of a -distressing kind, have suddenly turned gray, as is related of Marie -Antoinette, Queen of France; and we ourselves have seen a similar case -in a young lady, one of our relatives, who in one night had her -jet-black hair turned white. - -That care, worry, grief, and sorrow are able to bleach the hair, -although not so suddenly as above, is generally known; and not only gray -hair, but a haggard, worn appearance, and all the other attributes of -old age, with changes in the arteries, as is so often the case in old -age, have over and over again been attributed to the above causes. It is -a well-known fact that premature old age is probably brought about more -frequently by the above agencies than by any of the other contributory -causes. - -Not only premature old age, but also premature death, can be caused by -such agencies; for there is no longer any doubt that, in persons with -mental depression, resistance against infections and intoxications is -reduced, and that such persons are thus at the mercy of the microbes, -which are to be found in billions everywhere. On the other hand, we can -often observe that a merry disposition may cause long-lasting youth and -a very long life. The celebrated English painter, Mr. Frithe, who died -quite recently at the age of 92, when asked the reasons for his vigor -and robustness used to answer: “No worries, and six cigars a day.” -Having seen on the island of Capri an old boatswain of 80 years -vigorously handling his oars, we inquired of him the reasons for his -robustness and received as his answer: “Sempre allegre” (always merry). -This “sempre allegre” should also be our own motto for life, because of -its efficacy in warding off old age. - -There are some admirable teachings in the Upanishads and Vedanta of the -Hindoos: never to seek for riches and fame, and to give up ambition. -Indeed this, more than anything else, would assure a perfect -tranquillity of the mind, as exemplified by the image of Buddha; but for -the future of mankind and the progress of scientific research, a certain -amount of ambition is necessary. We think the noblest aim is to do good -for its own sake, and not for the sake of honors; but if honors are -obtained, to accept them calmly, going on in the usual way; for -otherwise it happens, as we so often witness, that too much ambition, -with its wear and tear, exposes us to premature disease by -arteriosclerosis, the most prevalent disease among men who have reached -fame, especially among statesmen, whose honors are, indeed, dearly paid -for. - -It would lead us too far to enter into particulars as to how the various -organs, even the stomach, can possibly, even in a powerful way, -influence the conditions of the mind; but we must make an exception in -the case of the ductless glands. If the mind influences these, on the -other hand they exercise a marvelous action on the mind, as already -stated. - -Degenerated conditions of the thyroid are always followed by weakening -of the mental powers, and they are also able to alter the normal -conditions of the mind. As a rule, as we so often see, persons having -such are low spirited and possess no will-power or energy. The loss of -will-power through extirpation of the thyroid or by its degeneration has -been already mentioned in Chapter IV. - -People with a weak thyroid, and especially if to this be added a -degenerated state of the testicles, or of the ovaries are usually -melancholy and despondent. They have exceedingly often what the French -call “idées noires”—they are always full of “dark ideas.” In everything -they undertake they always foresee a bad issue; and it is not singular -that this bad issue very often really comes about, for it is caused with -mathematical certainty by their own incapability, absentmindedness, and -entire want of foresight. This is another illustration of our theory -that most of our want of success and our mishaps, if not all of them, we -bring upon ourselves by our own faults. We often notice that such people -lack the most elementary rules of foresight, precaution and -circumspection. They are horribly absentminded, a fact we have noted -especially in old spinsters, who may pass their best friends a dozen -times on the street without recognizing them. Such persons may also -easily fall victims to accidents, as being run over by a carriage, etc. - -The fact that these “dark ideas” are frequent in people with a -degenerated thyroid has also been observed by Dr. Leopold Levi, of -Paris, and Dr. Baron Henry de Rothschild, who, in their Annals on -Children’s Diseases, published by Dr. de Rothschild’s Hospital for Sick -Children, give a detailed description of the alterations in the mind in -cases of thyroid degeneration. That these dark ideas must be ascribed to -degeneration of the thyroid and of the sexual glands, besides the proof -from the observations mentioned in Chapter IV, is best shown by the fact -that, as we have seen in many cases, they may be much improved and, not -infrequently, may disappear through the use of thyroid, testicular, and -ovarian extracts. Courage, as was shown in the same chapter, is a -quality of the mind which is entirely dependent upon the intact -condition of the sexual glands; it is lacking in castrates, and seldom -seen in persons with degenerated sexual glands. - -These persons are like a reed in the wind, waving backward and forward -without any energy; the least untoward event may beat them down. They -are pained by circumstances and are always governed by them, whereas a -person with a healthy thyroid and healthy testicles, like the heroes -sculptured by the Greek artists, who have fire and courage in their -eyes, faces all circumstances. Such as these control all circumstances, -sometimes even fate, and it is not fate that governs them. Sometimes we -feel inclined to think that there is no such thing as fate, at least for -such men. They mould their own destiny themselves, and always succeed in -pushing on with their iron will. - -Will-power is, as repeatedly mentioned, essentially a product of -thyroid, and also probably of intact testicular or ovarian, activity. It -is always wanting in persons who have been castrated, and is very often -absent in those leading a life of sexual debauchery. - -According to the above, persons with weak thyroids or weak and -degenerated sexual glands are bound to fail in their undertakings, and -are thus more exposed to disappointments of all kinds, reverses of -fortune, etc.; therefore, such people are the most frequent subjects of -mental depression. - -Taking into consideration what has been said above, we conclude that the -source of disappointment lies, in many cases, if not in most, in our own -fault, because of loss of foresight or some slight omission, which, -indeed, is so often apt to overthrow all our most beautiful plans. Often -it is due to errors of judgment, and frequently also to want of -perseverance, the consequence of defective will-power. - -We have already shown in Chapter IV, and above, that degeneration of the -thyroid and of the sexual glands is always followed by similar -alterations of the mind. - -If we want rationally to prevent mental depression we must first remove -its cause. In many cases it is caused by alterations of mental activity -subsequent to changes in different ductless glands, and also in other -organs that influence the condition of the mind. Logically, we must -improve the functions of these glands if we want to proceed rationally, -and then our mental activity will improve, and failures like -disappointments may, in all probability, be avoided. We can effect this -by means of extracts of certain animal organs. - -It has been shown by the celebrated physiologist, Brown-Séquard,[343] by -experiments on himself, that testicular extracts were able to improve -his mental vigor and enabled him to do a much greater amount of work. We -have made similar observations in several cases, especially when at the -same time thyroid extracts were used, but also without them. Thus we -think that we do not go too far, on the basis of the observations of -Brown-Séquard and other authorities, including our own, when we say -that, through the improvement of our mental power by therapeutic -measures, like organic extracts, we may be able to influence success to -a favorable degree, and that everybody is, indeed, as already quoted, -“the smith of his own luck,” as the German proverb says; and thus we can -protect ourselves against failure, disappointment, and mental -depression. We are thus justified in saying that a man with healthy -ductless glands in perfect working condition, and thus of perfect mental -power, is the man who can face any emergency and, to a certain extent, -direct fate at his own pleasure. Such a man can get practically -everything he wants, and Napoleon probably was made of such stuff. For -such men there are no obstacles in the world. - -Footnote 343: - - Brown-Séquard: Loc. cit. - -It is of great importance that not only the glands with internal -secretion, but also all the other organs of the body, should be kept in -hygienic condition, carrying out the rules laid down in other parts of -this book. - -It has been shown by noted historians that great men, such as Napoleon, -had to blame their downfall indirectly to faulty hygiene—for instance, -of the digestive organs. That the condition of the stomach—this too -often ill-used organ—influences the mind in a powerful way, is borne out -by many interesting examples. - -There can be no doubt, however, that there are causes of ill-luck which -we cannot avoid, as, for instance, loss of near relatives by death, such -as parents or children, or disappointment in nuptial affection or -love—although here, to a great extent, omissions, lack of sound -judgment, and last, but not least, lack of perseverance can be imputed. - -If then, in spite of all our precaution, an accident or death of a dear -relative occurs, we must use every endeavor to control our grief and -sorrow. Fortunately the human frame is so wonderfully built that there -is self-defense not only against disease, but also against affections of -the mind. Thus we have the gift of forgetfulness, and if this sometimes -be a drawback, in most cases it is a divine blessing. We must endeavor -to obliterate the remembrance of our disappointments. We must remember -that mourning for a great number of years will not restore life for one -minute to the dear departed, but that a day of it is sufficient to run -down our own health and create deep furrows in our face. Happily, -average man is so constituted that, as time goes on, he must naturally -lose his sorrow; time heals all grief, and here also will-power has its -effects; and those who lack it, examples of whom we have referred to -above, are easily subject to suicide. - -It would also be necessary to change such of our habits as are allied to -superstition and prejudice. As in many things, the Chinese are more -rational in their customs; at their times of mourning every one is -dressed in shining and beautiful white; they use a white coffin, which -is much more pleasing to the sight, and certainly much more cheerful, -than our depressing dark ones; and when the whole house and church are -draped in black our depression, with its terrible consequences to our -health and vitality, is so much the more increased. Thus the dead often -shorten the lives of the living. - -Then, living in total seclusion, garbed in deep black, with long black -veil, remaining away from all places where the mind can be cheered, not -even allowed to attend a concert, how can a poor widow forget, -especially if her will-power from causes mentioned, is diminished? Shall -we then be greatly surprised if, as occurs occasionally, such a widow or -widower commits suicide, to which such irrational prejudices are simply -impelling them? - -And yet it will certainly not be impossible to ameliorate such a state. -With a strong will-power systematically trained from childhood, we can -accustom ourselves to drive out disagreeable thoughts of bereavement, -fear, anxiety, etc. Realizing that what is irreparably lost can never be -recovered, notwithstanding oceans of tears and the deepest sorrow, we -must succeed in understanding the uselessness of it and make up our mind -to eradicate entirely from our recollections things that can never be -altered. Not to worry about anything is the surest and most successful -way to attain long life and a green old age, and by the exercise of some -will-power and consistent training such a mental condition can be -obtained. - -There are certain external agencies which can powerfully assist to bring -about forgetfulness. Such are music, the arts, literature, and above all -scientific occupations. Where is there a grief that cannot be soothed by -one of the beautiful symphonies of Beethoven, or by the works of Mozart, -or by other classics: Haydn, Haendel, Bach, Schubert, Chopin, Wagner, -Grieg; or by the paintings of Velasquez, Rembrandt or Van Dyck; or by -the pictures of the beautiful women painted by the great English masters -Gainsborough, Reynolds, Romney, and Lawrence; and which of the saddest -faces will not turn to a smile when reading Mark Twain? The pursuit of -scientific research is also a mighty weapon, and we know a famous savant -who passed the remainder of the day in his laboratory after he had -accompanied the hearse of his wife to the cemetery. - -When we are deeply depressed over a severe loss if we pay a visit to a -museum, where we can see the manifestations of life that existed -hundreds or thousands of years ago, it may give us some comfort. -Considering the bodies in the British Museum of Egyptian kings and -queens, etc., that lived thousands of years ago, together with the -jewels that they were wearing, and all the other signs of splendor that -existed so many ages before, we ask: in the face of these thousands of -years what are those few years of worry on earth? As Schopenhauer said: -“The world existed 50,000 years ago, and will last 50,000 years more, -and what are the few years of our life in face of these thousands?”—and -we would like to say “in face of these millions” of years, as the -scientific history of mankind attests. - -A trip to the country, mountains, forests, or seaside, being out in the -flower-covered fields and sunshine, and especially foreign travel, -thereby changing all our surroundings and habits, should soon be able to -soothe our sorrows. In early childhood a love for the fine arts, music, -painting and literature should be developed, as these form a valuable -support for the mind in later years. A knowledge of Latin and Greek, -which are soon forgotten, should not be the aim of the school education, -but rather the refinement of character in the child. - -The most valuable aid in the treatment of mental depression is religion, -for this gives what nothing else can give in equal degree—Hope! Hope, -without which we should always exist in continual gloom! We will point -out, in a few words in the next chapter, the advantages of religious -belief. - - ------------------------------------------------------------------------- - - - - - CHAPTER LII. - - HYGIENE OF THE MIND—RELIGIOUS BELIEF AS A MEANS OF PROLONGING LIFE. - - -A RELIGIOUS lady of the Dutch aristocracy, whom we have known for years, -lost within a short time both her grown-up son and her husband, to whom -she was most devotedly attached. Imagining that she must have been -completely crushed, we inquired of a member of the family how she had -sustained these terrible losses. The answer was that she was perfectly -calm and that she was the most composed member of the whole family. - -We know from personal observation that this lady was truly religious; -and we are, therefore, inclined to believe that only her great sense of -religion enabled her to withstand so well these terrible shocks. Her -case is a typical one, showing that persons of a truly religious belief -are better able to withstand depressing impressions. They will not give -way to despair so readily as most irreligious people, and it is -exceedingly rare to find a case of suicide among such. - -Not only will truly religious people avoid suicide and mental -depression, with all their fatal consequences, as we have shown in the -preceding chapters, but they will also, as a rule, withstand diseases -better than others. As we have noted, truly religious people, when -seriously ill, have such a strong faith and hope in their recovery—they -invariably are convinced that God will help them—that this has proved to -us a most invaluable aid in their medical treatment. The importance of -this fact is also confirmed by our friend, Dr. Eberson, one of the -busiest practitioners in Amsterdam, who remarked to us that the outlook -for recovery was always more favorable in such cases. As Prof. Charles -Beck, of New York, told us, he often remarked that his religious -patients could stand narcosis better: they showed less anxiety, and thus -the heart action became less excited. Thus religion can undoubtedly tend -to prolong life; and in this we are not saying anything novel, for it is -well known that the mind has a wonderful influence over the body. -Religion acts on the mind, and the mind powerfully governs the body. - -This is made use of by certain religious sects in what are known as -“faith cures;” and that in certain cases, and especially in nervous -diseases, such as hysteria or neurasthenia, these cures may be of -service, cannot be denied on the ground of the above observations. - -The influence of the mind over the body was recognized hundreds of years -ago by all great physicians. The great philosopher, Kant,[344] insisted -upon it in a special article, and Charcot has effected some wonderful -cures by such means in hysteria, as have hundreds of other physicians. -We all agree, for we see it every day, that the mind governs the body; -but there are also certain agencies that govern the mind, and religion -is one of the most important of these. - -Footnote 344: - - Journal der pract. Arzneikunde, vol. v, 1788. - -Therefore, happy are they who are truly religious, for their days may be -longer, and they are better prepared to meet the vicissitudes of life! - -There are many scientific people who do not believe in a Superior Being -because His presence cannot be scientifically proved. But there are many -things that are quite inexplicable, but which none the less do exist, -and in which we do believe. Are there not many such things, even in -medicine, which are most mysterious, but nevertheless true? If we -consider the human body we find that to the smallest details, to the -minutest of the millions and millions of cells of which it is composed, -it is built up in a most marvelous way. It is admirable with what -ingenuity and forethought the smallest particles are put together to -suit one another. There may be an artistic genius who can erect one -wonderful construction, as a masterpiece of art; but in the human body -the microscope will reveal thousands and thousands of such masterpieces, -perfect in the smallest details, which no artist could be capable of -putting together and of making them work admirably in unison. - -And the physician must be an artist, too, to discover which of the -wheels in this most wonderful machinery are not doing their duty; and if -it took but a second to conceive a human body, it takes a whole lifetime -to study all the recesses and angles of this masterpiece of mechanism. - -The admirable forethought with which the different parts are formed in -man or animal, must give us the idea that it must be the sequence of a -cause, as indeed there is in this world no effect without a cause; and -this cause must be the action of a Superior Power. - -To give one of the numberless examples for the truth of this, we should -like to quote the ingenious mechanism affecting the eyes of certain -young animals, such as dogs. As is well known, puppies cannot see for a -few days after birth, but are prevented from so doing by a delicate -mucous membrane that covers their eyes. And yet there is a cause for -this, which cause is the result of a most tender circumspection; for -these little animals are provided with this membrane so that strong -light, like sunshine, shall not irritate the eye until certain -modifications have taken place in the inner eye, which allow these parts -to stand such a light; and as this requires a few days, the membrane in -question closes the eye during that time. It seems as if Almighty Nature -stands with her hands over the eyes of these puppies to protect them -from being harmed by the light. - -Maternal love is a necessity in all animals to save the race from -extinction. There are a few exceptions in which animals occasionally -kill their young for certain reasons; but this is confined to a few of -them such as cats and dogs, and only happens the first or second days -after labor, being due probably to mental alterations induced by the -processes of birth; it may happen also in man. It is truly marvelous how -insects provide for their descendants, which they will never see, for -they themselves die prior to their development. An interesting example -has been lately quoted by a naturalist. The wasp, before dying, thinks -of a most ingenious way for providing food for her larvæ. This is in the -form of a worm; but as this worm would putrefy before the development of -the larvæ, the wasp does not kill the worm but merely stings it in the -spinal cord. This does not kill the worm, but simply paralyzes it, and -thus the worm will live on till the larvæ are developed, when there they -will find their food ready prepared for them by their far-seeing mother. -Who is the cause of such foresightedness being given to these insects? - -There are certain people who cannot believe in a Supreme Being, because -injustice, mishaps, and accidents happen daily. But there are natural -laws which must pursue their course. When a child falls out of a top -floor window and is killed on the pavement below, the law of gravity is -acting; but the accident may be due also to a want of foresight on the -parents’ part. If disease overtakes us it is also frequently, if not -always, due to our own fault, or that of our forefathers. On the other -hand, we see the wonderful work of Nature; for, as already shown in -Chapter III, our body is wonderfully provided with every means of -defense against disease; and like a careful mother, Nature warns us -first, for hardly ever do we get ill without there being some -premonitory symptoms. Thus, before chronic kidney affections come on, we -eliminate for some months, and sometimes longer, casts; and before -diabetes comes on traces of sugar, as a rule, appear in the urine for a -certain time; and then is the time for us to follow a diet in order to -avoid these diseases. Infectious diseases also give warning symptoms -before they develop, and these, as well as others, may sometimes be -prevented by a timely defense and certain hygienic measures on our part. -Even against poisonous animals we are protected in a wonderful way. -Thus, before the rattlesnake bites he utters a warning by his rattles, -and before the mosquito gives us malaria through its sting a premonitory -hum falls on our ear. Unfortunately we have not sufficient space to give -further examples of the admirable way in which a Superior Power is doing -His best to protect us, and if mishaps do very often occur, very -frequently, if not always, as already mentioned, it may be traced to -certain of our own actions. - - ------------------------------------------------------------------------- - - - - - CHAPTER LIII. - - DISEASE CONSIDERED AS A SELF-DEFENCE OF NATURE. - - -MANY a man bemoans his fate when bed-ridden and tortured by pain, and -yet we cannot fail to recognize, upon further consideration, that such -suffering often serves but to pave the way for recovery. Very frequently -the advent of slight pain is the earliest indication that something in -our organism is amiss, and promptly leads us to think of measures for -the prevention of further trouble. A sickness can often be controlled at -the outset upon using proper measures, and thus entirely averted. Severe -pains not infrequently mean the saving of life, since they compel -indolent or careless persons to seek the physician’s help while there is -still time. How few persons, indeed, would consult the doctors and -discontinue excessive eating, were they not forced to do so by their -aches and pains. - -Not a few diseases are to be classed as serious and dangerous to life -owing to the fact that, of themselves, they do not give rise to -discomfort, and lull their victims into a false sense of security. Many -a diabetic would live longer, were he reminded by tormenting pains of -the necessity of careful treatment and restriction in his diet. Thus -even pain is of service to mankind. - -Other annoying symptoms of disease must also be regarded as expressions -of nature’s efforts towards self-cure. When a person makes use of an -article of food that has undergone deterioration, nature often endeavors -to remove it by an evacuation of the intestinal canal. Again, no harm is -done when a glutton at length upsets his stomach, loses his appetite, -and allows the ill-used organ to rest. And he is being let off cheaply, -if his over-burdened stomach procures its own relief by vomiting. When a -person has an attack of gout and sweats profusely, noxious substances -are likewise eliminated thereby. When the illness is over, however, one -feels not infrequently all the more fresh and rested after -convalescence, whence the ancient Greeks not incorrectly said: “Το παθὸς -ἱάτρος έστι.” - -Indeed that sickness is oftentimes directly beneficial in its effects is -a matter of frequent observation. If, for example, a markedly obese -person becomes diabetic—in such cases the disease appears in a mild -form, as a rule,—his chances of long life are thereby not infrequently -improved. I observed this in the case of an American lady who weighed -162 kilogrammes (357 pounds). The mild form of diabetes which this lady -developed was certainly not to her detriment, for whilst she could lose -weight as a result and live for a long period, her situation would have -been far different had the obesity progressed still further. - -We have already endeavored to show that fever is in reality an -expression of efforts of the body at self-healing, as we likewise -maintained with reference to skin affections. So, too, the syphilitic -patient who exhibits diffuse skin-eruptions, as well as other localized -manifestations in the peripheral tissues, has a better outlook with -respect to the dreadful nervous consequences of this disease than one -who never exhibits the outer signs of the infection. - -We perceive, therefore, that that which we call disease is nought else -but nature’s attempt to attain health—a kind of defensive reaction -against harmful substances. The disease proper has often already been -present for some time; it already exists at the very instant in which -the invading foe makes its entrance into the body. Between this time and -the moment when the reaction of the body,—that is, what we are in the -habit of calling the disease,—appears, a considerable period may -frequently elapse; oftentimes it may even extend through several years, -as in leprosy or in the sleeping sickness. It would thus be entirely -rational to interfere at a time when the enemy has not yet penetrated -into the body. Unfortunately the signs which might acquaint us with its -presence have not at that time found distinctive expression. Vague -symptoms such as mild headache, want of appetite, lassitude, low -spirits, etc., may alone exist, and yet it is necessary that even these -should be watched for. Already in this period it would be advisable to -seek the physician’s aid, and if many be deterred therefrom because of -the expense involved, it should be recalled that oftentimes fifty visits -cannot procure the result which might have been obtained by a few -preventive measures. Thus the very mildest symptoms of illness are not -to be disregarded,—a fact with which children in particular must be -impressed. Older persons and teachers should likewise be made familiar -with this precept. What a multitude of human lives could be saved in -this way! - -But in order to recognize the slightest indications of an approaching -illness, deviations from the normal state of health would have to be -closely studied. The science which apprises us of the functions of -normal organs would have to be given more extensive recognition, and -physiology would have to become the basis of the physician’s every -thought and method of treatment. The system prevailing among the -Chinese, who in many ways surpass us in logic, and who pay the doctor -only so long as they are in health, is thus not so unreasonable. The -best plan of all would be for each family to have its own -house-physician, whom it could consult regularly, especially if there be -children; for such a person alone is capable of recognizing the earliest -deviations from the normal. The prevention of disease would have to -constitute the basis of all our therapeutic endeavors. - -In order to become of real assistance to Nature, however, the physician -must be continually following in the wake of her efforts to secure -health. If the defensive reaction brought about by Nature against toxic -materials is too feeble, he must assist her by proper remedies. Thus -when the use of spoiled food is followed by diarrhœa, he must not arrest -the latter; otherwise he would, indeed, be locking the wolf in with the -sheep. On the contrary, he must imitate Nature and accordingly -administer a purgative. Again, if on taking cold or during a gouty -attack a person falls into a profuse sweat, it would certainly be -illogical to administer a remedy to counteract this beneficent -influence; another means of producing perspiration should rather be -availed of, as, for example, the salicylates. If, on the other hand, the -reaction is too strongly marked, as, for instance, in a young girl with -very active thyroid gland, who in consequence of typhoid exhibits a -dangerous rise of temperature or hyperpyrexia, then the physician must -put on the brakes and save her life by appropriate antipyretic measures. - -In view of the above deductions, it is not unjustifiable to believe that -the symptoms of disease, i.e., what we designate as disease, together -with many other supposed ills, in reality contribute toward the -preservation of mankind. - - ------------------------------------------------------------------------- - - - - - CHAPTER LIV. - - HYGIENE OF THE MIND—ADVICE TO BRAIN WORKERS. - - -SCHOLARS, who live entirely from the product of their mental labors, -often do not present a healthy appearance, and are not infrequently -subject to nervous, gastric or intestinal disorders, chronic -constipation, etc. In laborious mental activity an excessive amount of -blood flows to the brain, that of other organs being withdrawn, and thus -diminished formation of gastric juice is favored and the appetite -reduced. Intellectual activity should, if possible, be suspended a full -hour before and after meals. Congestion of the brain likewise interferes -with proper sleep, which, as a rule, can only become truly deep when the -brain is bloodless. Intellectual efforts should therefore be avoided for -a period of one to two hours before going to bed, and especially one -should not read in bed. - -After a good night’s sleep the brain is adequately rested and hence -capable of doing the most work. For this reason the morning hours are -the best of all for mental labor; the very early hours have the -additional advantage of absolute quiet and freedom from disturbance. -Personally I work preferably from 5 to 8 o’clock in the morning, -especially in the winter time when one cannot well go out walking so -early. - -In a previous chapter I mentioned the fact that organs upon which great -demands are made more readily become the seat of arteriosclerosis -because of the abundant flow of blood to them. In persons of great -intellectual activity we accordingly find marked sclerosis of the -cerebral arteries, especially if they have the bad habit of smoking and -drinking excessively. Besides, drinking interferes with the quality of -work done. The influence of smoking in the production of -arteriosclerosis we have already discussed. Under normal conditions -intellectual workers can live to an advanced age—this we know from -numerous celebrated instances: Hippocrates, Democritus, Plato, Plutarch, -Leibnitz, Newton, Galileo, Michael Angelo, Carlyle, etc. Socrates wrote -his Panathenæ in his 94th year, the celebrated Dr. Hufeland the fifth -edition of his “Makrobiotik” at a ripe old age, while Goethe’s powers of -execution remained to the last undiminished. Recently I received from an -English colleague 80 years of age, who had attained eminence by his -studies on metabolism, an excellent work on diabetes, which he had just -brought out. - -With but very few exceptions, we find that the great master-intellects -who attained to an advanced age led lives of moderation in every -respect—not only as to their bodies, but also their minds. Whoever lives -as hygienically as did Newton, can, like him, become very old in spite -of bodily weakness. Newton was a very frugal eater, had no passions and -never worked until over-fatigued. Not to work to excess, to permit one’s -self to rest at the proper time—this is the chief precept in the hygiene -of the mind. The brain requires rest even more than any other organ from -which great activity is demanded. One should not work more than a few -hours at a stretch. - -I strongly recommend going to bed at ten or eleven o’clock, rising at -five to half-past six o’clock, and then after refreshing one’s self, at -once settling down to work. Breakfast may be eaten at about eight -o’clock. A walk should then be taken before going back to work, which -should be interrupted an hour before dinner-time and only resumed an -hour after the meal. In the warmer seasons it is best to work in the -garden or in the woods whenever the nature of the work permits. It is -advisable to leave off one hour before supper, and then, as a general -rule, do nothing further, but take a walk, if possible also before -supper. In general, mental workers need plenty of exercise in the open -air; especially in the woods or elsewhere in the midst of foliage is the -flow of ideas more easily aroused. When it is not too hot, one may sit -out in the sun while working, though the eyes and the book or paper -should be shaded. The combination of pure air, sunshine, and mental -occupation is of great value. Laboratories and libraries should be so -disposed as to correspond strictly to all rules of hygiene regarding air -and light. - -In winter time one gains distraction by visiting friends, attending -society meetings, concerts, theatres, etc. In every season of the year -it would be well to spend Sundays in the country. It is necessary, -likewise, to follow the general rules of hygiene. Insofar as the diet is -concerned it is strongly to be recommended during heavy mental labor, -especially where much thinking is required, that meat-eating be given up -and a vegetarian diet, with the addition of milk products and eggs, -adopted. At any rate, a diet rich in meats must be avoided; it not only -makes one heavy and dull, but also creates a want for alcohol, coffee, -tobacco and other unwholesome stimulants, for which a diet containing -little or no meat need evoke no desire. - -Regularity and moderation heighten the expectations of long life in -mental workers and guard against the premature failure of the -intellectual powers which must sooner or later follow upon overwork. -This not infrequently happens quite early in life. Boerhaave could -already cite two such cases; “I have known a young man who knew -everything and was a prodigy of learning, but who hardly lived to the -age of 25, and another who worked day and night with the industry of a -bee, and without any definite illness died in his nineteenth year in a -state of emaciation.” In common with scholars and men of letters -physicians must take particular care of themselves, their brains being -continually on a stretch. The efforts they make to prolong the lives of -others shorten their own—the irony of fate! Few callings demand as much -mental work as that of the medical man. We physicians often have to deal -with infectious diseases; since the continued mental strain is capable -of injuring our bodily health and hence diminishing our resisting power -against infections, it is advisable for us as far as possible to avoid -all harmful influences,—and especially excess of any kind. - - ------------------------------------------------------------------------- - - - - - CHAPTER LV. - - ON THE PREVENTION OF PREMATURE OLD AGE, AND THE TREATMENT OF OLD AGE, - THROUGH CERTAIN DRUGS: ARSENIC, IRON, AND IODIDES. - - -IT can often be observed that people who habitually take arsenic, either -for medicinal or other purposes, look better and younger; and we have, -ourselves, noted in some of them a disappearance of wrinkles. Wrinkles -are caused by the loss of the fatty tissue from under the skin, and as -arsenic causes an increase of fat in the tissues it may improve such a -condition. - -As is well known in some parts of Europe, notably in Styria, the habit -of eating arsenic is very prevalent among the peasants; and it is -strange to note that most of these people live to a great age, and at -the same time are extremely immune to all kinds of bodily fatigue—for -instance, they can climb the highest peaks in their native mountainous -country without great exertion. They take arsenic because it enables -them to undertake harder work, such as climbing, with greater ease, and -also improves their appearance. - -We have known several ladies, famous actresses among them, who have -indulged in this habit from vanity. A very interesting case was tried, -about ten years ago, before an Austrian court of justice, in which a -servant girl tried to poison her mistress by arsenic in small -quantities. To the dismay of the servant, however, the lady continued to -become more beautiful; so the murderess determined to give a larger -dose, which induced grave symptoms of intoxication, and caused the -discovery of the plot. - -It is equally well known that animals obtain a glossy and sleek coat -through the administration of arsenic in small quantities. - -There can be no doubt that when arsenic is taken in small quantities it -may prove of therapeutic value against old age; but as very aged people -are often antagonistic to its use, it would seem to offer better results -if used as a preventive against premature old age rather than as a cure -after old age had much advanced. - -As arsenic can give good results, especially in combination with iron, -in anæmia, and also in neurasthenia and hysteria, we think that its use -would be particularly beneficial in women near the forties, and -especially during the years before and after the climacteric until about -the sixtieth year. According to Grawitz, arsenic acts better than iron -in the anæmia of the aged. - -Arsenical treatment has given us excellent results also in nervous -troubles of women at a much earlier age. It has often produced an -increase in the weight and an improvement in the personal appearance of -our patients. - -As, according to Gauthier[345] and Bertrand, the thyroid gland contains -arsenic, we are thus administering an important element of this gland. -The observation of Dr. Sajous[346] is of great importance, that arsenic -dilates the arterioles. Indeed, we have also made similar observations; -thus we found after the use of arsenic in several cases a higher -vascular pressure and irregularities of the pulse similar to those -occurring after tobacco smoking, which, as shown before, has also a -stimulating action upon the adrenals. In a few cases there was also -pigmentation of the skin. By using arsenic while taking thyroid extracts -we stimulate the antagonists of the thyroid, the adrenals; and thus the -symptoms of hyperthyroidia can be avoided by simultaneously giving -arsenic in small doses. As we shall, in the next chapter, recommend the -use of thyroid extracts in the prevention of premature old age, and in -the treatment of old age, this simultaneous use of arsenic can increase -the benefit of such treatment; but for the purpose in question arsenic -should be given in the smallest possible doses, as Fowler’s solution, -beginning with 3 drops and increasing to not more than 5 or 6 drops per -day, by slow and gradual degrees, and then decreasing slowly again, but -not for longer than for three or four weeks altogether. In women -something more could be given. Far better than Fowler’s solution would -be the various mineral waters that contain the most useful form of -arsenic, as such waters usually contain also iron, which still further -increases their value. Such mineral waters can be found in various -countries, viz.: in Austria, in the Tyrol: Levico, very rich in arsenic -and iron, and Roncegno, rich in arsenic; in Bosnia: Guberquelle, very -rich in iron; in Switzerland: Val Sinistra; in France: Royat, Bourboule, -etc. They are absolutely innocuous if taken under medical care. We must -begin by taking one tablespoonful of these arsenical waters, and -gradually increase to five or six tablespoonfuls a day, when we must -then again gradually diminish the amount. - -Footnote 345: - - Revue de Médecine Bulletin Académie de Médecine, vol. xliii, p. 116, - 1900. - -Footnote 346: - - Sajous: “Internal Secretions,” vol. ii, p. 1312, 1907. - -By taking such waters, increasing slowly and gradually and then -decreasing in a similar way, the most efficacious arsenic and iron -treatment can be obtained, and a simultaneous thyroid treatment better -endured. It is better to take such remedies after meals, and the patient -must be kept under constant medical supervision, just as they are during -iodine or thyroid treatment. - -We have often observed that women, especially in the forties or fifties, -looked much younger after a treatment by iron preparations, particularly -when in combination with iron and arsenic; mineral mud baths, containing -much iron, have been used; and we are quite emphatic in asserting that -such treatment, possibly more in women than in men, though in these we -have not infrequently noted the same results, is able to improve the -symptoms of old age; for we have had opportunities of observing this in -many cases, sometimes even in women at the beginning of the sixties. - -The best results can be observed in women between 30 and 60, even though -they sometimes have no previous anæmia, who look much healthier after -such a combined iron, arsenic, mineral water, and mud-bath treatment. In -men similar results have been noted; but in the case of women it must be -regarded as a specific. - -In the same way as iodides act on the thyroid, we are inclined to think -that arsenic and iron are specifics to promote a better action of the -sexual glands, especially the ovaries, and probably also of the -adrenals. - -According to Professor von Noorden[347] and other authors, chlorosis is -due to a degenerated condition of the ovaries. But the adrenals also may -be altered, causing the great muscular weakness of chlorotic girls. Thus -Dr. Sajous[348] has attributed chlorosis to adrenal degeneration. If, as -observed for centuries, arsenic and iron are specifics in augmenting -hæmoglobin in the blood, it is a question whether this effect is -obtained by the action of these preparations upon the ovaries, or upon -the adrenals, as advocated by Dr. Sajous.[349] The probability is that -they act upon both glands. Mud baths which are rich in iron are -especially potent and successful against chlorosis and anæmic -conditions, and at the same time against ailments of the ovaries and -uterus, as is well known to gynæcologists. Iron seems also to exercise -beneficent action on the male sexual glands. Impotency, as we have also -seen, can often be improved by iron preparations, or by mineral waters -containing iron and arsenic. Hysteria, as ancient physicians supposed it -to be, and as we have tried to show,[350] is due, in great probability, -very frequently to alterations in the female sexual organs, and iron -treatment, especially arsenic and iron mineral waters, improves many -cases. - -Footnote 347: - - v. Noorden: “Die Bleichsucht” Nothnagel’s “Handbuch der pract. - Medicin.” - -Footnote 348: - - Sajous: “Internal Secretions,” vol. i, p. 87, Philadelphia, 1903. - -Footnote 349: - - Loc. cit., p. 95. - -Footnote 350: - - Congress of Belgian Neurologists, 1906. - -As well known to urologists, the general condition in cases of chronic -posterior gonorrhœa, and in prostate troubles from such a cause, is -often improved through iron treatment; as also is neurasthenia, even -though some cases are not in etiological relation with such a cause. - -We must thus consider iron, especially when in combination with arsenic, -as one means of improving the condition of the sexual organs judging -from the foregoing reported clinical observations. The fact that iron of -itself is no longer regarded as being useful in senility—i.e., when the -sexual glands are more or less degenerated—points to the value of its -combination with arsenic. We consider iron, especially in the form of -the easily absorbed iron mineral waters, and in the form of the iron -contained in mud baths, as a valuable means for the prevention of -premature old age, and for the treatment of old age. Iron, and -especially inorganic iron, is indicated as a preventive of old age for -the reason that it stimulates to greater activity the blood forming -organs, as has been shown by Harnack and von Noorden. It is a fact, upon -which we have already insisted, that the organs which control the -condition of the bone marrow, the seat of the blood forming -mechanism—i.e., the thyroid and the ovaries,—are degenerated in old age. -Iron acts upon the bone marrow through the intermediate agency of these -glandular structures. - -It can be administered in the form of the perchloride or of other -inorganic preparations. According to Bunge, organic iron preparations -and iron contained in food have the advantage of being more readily -absorbed and assimilated. (See chapter on the blood as an article of -iron-containing food.) But Grawitz still prefers to prescribe inorganic -iron, such as reduced iron or perchloride of iron. An old iron -preparation of great efficacy is the Blaud pills. - -A very successful method of iron treatment is by mineral waters which -are rich in iron—in Austria, Franzersbad; in Germany, Langenswalbach. We -prefer such waters as contain arsenic besides iron, as already -mentioned. - -When mud baths are used simultaneously, it will be advisable not to take -thyroid extracts also; but to await doing so till after the course of -baths is finished. - -Increase of fat and of connective tissue are the most typical and -anatomo-pathological changes in the tissues produced by old age. It is -evident that drugs which can combat these changes are also able to treat -and improve the condition of old age. There is no inorganic drug which -can give such good results in these conditions, according to our present -knowledge, as the iodides. It is generally believed that through the use -of potassium iodide we are able to diminish fat in many cases. The -increase of connective tissue in different organs, that takes place in -the cirrhosis of these organs, has also been treated by iodides with -success, according to some authorities, and, according to others, -without any. At any rate, in arteriosclerosis there can be no doubt that -iodides do give good results as they facilitate the circulation of the -blood by diminishing its viscosity. According to Heinz,[351] iodides can -combat connective tissue hypertrophy by rendering the vessel walls more -permeable. They also increase the activity of the leucocytes. - -Footnote 351: - - Heinz: Virchow’s Archiv, clv, p. 44. - -When we administer iodides we give in them the main element of the -thyroid gland—iodine, so that iodide treatment acts on these glands and -increases their iodine contents. Iodine is a rational remedy for -preventing old age, for the reason that, as Baumann and Jollin have -found, the thyroid gland of aged persons contains but little iodine. We -know, through the researches of Blum, Baumann, Kocher, Aeschbacher, -etc., that by administering iodide we increase not only the iodine -content of the thyroid, but also, as the experiments of Garnier show, -its colloid substance. Iodides are best taken in the form of a saturated -solution of sodium iodide, or other preparations containing this salt. -They act best when taken in small quantities (not over 15 grains of the -iodide a day), such amounts stimulating thyroid activity; larger doses, -by overstimulating, may cause a subsequent exhaustion of the thyroid. - -That iodide treatment is able to increase thyroid activity is best shown -by the fact that it may be followed by iodism, which presents most of -the symptoms that follow large doses of thyroid extracts. It is very -probable that many benefits obtained by iodide treatment can be -explained through its action in increasing thyroid activity. - -Instead of using inorganic iodine, it would seem more logical to use -organic iodine, as contained in the thyroid gland. We could thereby, to -a certain extent, replace iodides successfully by thyroid extracts; the -drawback, however, is that some thyroid preparations contain only a -minimum quantity of iodine, while others contain more. It would, -therefore, be advisable, when thyroid extracts are used, which contain -only a very little iodine, to use in combination therewith, very small -quantities of iodide of potassium; say, one day one or two thyroid -tablets, and the next day the iodide. It is best, when we are trying to -treat the symptoms of senility by combined iodide and thyroid -preparations, to feel our way very cautiously, every third day examining -the heart and pulse (see following chapter). - -Such treatment should be undertaken only when a thorough knowledge is -possessed of the physiology and pathology of the thyroid gland. - -The fact that iodides improve the circulation of the blood makes them, -in old age, especially useful, as arteriosclerosis is then very frequent -and the iodides become of special value. Similar remedies are also -indicated in all conditions arising from tertiary syphilis, which is -very often a cause of premature senility. For all the reasons given -above we think that iodide treatment, in small doses, especially in -combination with thyroid treatment, can give good results in our -struggles against old age, and in its treatment when it has advanced on -us. - -We have often observed that old people taking iodides for -arteriosclerosis, present a much more youthful appearance after such -treatment; and Dr. G. W. Gibson, physician of the Royal Infirmary in -Edinburgh, tells us that he has observed the same thing. We might -especially mention the case of an English gentleman 58 years of age, who -had six years ago a hemorrhage in the right eye; since that time he has -been taking iodides, and in spite of his age is looking quite fresh and -youthful—indeed, he recently married a young lady of 18 years. - - ------------------------------------------------------------------------- - - - - - CHAPTER LVI. - -ON THE PREVENTION OF PREMATURE OLD AGE AND ON THETREATMENT OF OLD AGE BY - ANIMAL EXTRACTS. - - -WHEN, some twenty-two years or more ago, the first accounts came to hand -of the marvelous effects of extracts from the thyroid gland of sheep, -they were at first received, as in general are all reports about -wonderful cures, with incredulity or scepticism; and it is quite -possible that the same might be the case regarding the success of our -method of treating the symptoms of old age, and the prevention of their -premature development, by thyroid and other organic extracts, were it -not that we are supported by a mass of evidence, to which we will at -once refer. - -It has been noticed by all the leading investigators on the effects of -thyroid extracts, such as G. Murray,[352] Hector Mackenzie,[353] -Hertoghe,[354] and others, that the majority of old people treated for -myxœdema by thyroid extracts, after a certain period of treatment, -presented a much younger appearance, sometimes even to the extent of -from ten to twenty years. This fact is perfectly true, as we can see -from the photographs of these cases, taken before and after treatment, -by Murray, Laache,[355] Oppenheim,[356] Ewald,[357] Hertoghe, and many -others; the greater number of these photographs show persons looking -very much younger after but a few months’, and in some instances less, -treatment. Several of the above-mentioned authorities, and also -Vermehren[358] and others, report that dark hair has grown on places -which, before the treatment, were bare, and where previously gray hair -had fallen off. This would appear incredible were it not a fact, -familiar to all who are in the habit of prescribing, in many cases, -treatment by thyroid extracts. - -Footnote 352: - - Murray: “Diseases of the Thyroid Gland,” vol. i, London, 1901. - -Footnote 353: - - Mackenzie: British Med. Journal, Oct. 29, 1892. - -Footnote 354: - - Hertoghe: Loc. cit. - -Footnote 355: - - Laache: Deutsche Med. Wochenschrift, 1893. - -Footnote 356: - - Oppenheim: Lehrbuch der Nervenkrankheiten, Nu. ii, p. 1390. - -Footnote 357: - - Ewald: “Die Erkrankungen der Schilddrüse,” second edition, 1909. - -Footnote 358: - - Vermehren: Loc. cit. - -Similar facts have been observed by us personally in a number of cases, -among them two, of a very interesting character, in the wards of Dr. -Hector Mackenzie, at St. Thomas’s Hospital, in London. One was a woman -of 65, who looked more like 42 after several years’ treatment with -thyroid extracts; the other was a woman of 42 who, as it seemed to me, -looked quite ten years younger after taking daily one thyroid tablet for -twelve months. About 2 years ago we saw in the wards of Dr. G. A. -Gibson, at the Glasgow Royal Infirmary, a woman of 72 who, after a -similar treatment during the past twenty years, looked, as we agreed -with Dr. Gibson, only between 50 and 60. Most of the above cases were -those of persons suffering from myxœdema; so the question arises whether -all other people, not affected with this complaint to the same extent, -may not also derive equal benefit from a similar treatment. - -We have shown in several chapters of this book that in old age the -iodine content of the thyroid gland is much diminished and the tissue of -the gland itself is degenerated in varying degrees, at times -approximating to myxœdema; and, as found also by Sir Victor Horsley, -Hale White, Vermehren, Ewald, and ourselves, old age presents clinical -symptoms similar to those of myxœdema. - -Naturally not every old man has the whole thyroid gland degenerated, and -clinically, therefore, there will be varying degrees in the myxœdematous -conditions, some presenting more and some less of the symptoms; so that -some men of 80 years of age may look younger than others at 65 or 70. - -If a man of 60, suffering from absolute myxœdema, that is, a complete -degeneration of the thyroid gland, will present an appearance of 50 or -less, after thyroid treatment, as shown in the photographs of the -above-mentioned authorities, and as seen by ourselves, why should -another man of 60, having only partial symptoms of this complaint, as -usual at this age, not benefit to the same extent and look younger after -similar treatment? It would be quite adverse to all notions of pathology -for a man, in a better condition of general health and suffering only -from a mitigated and partial form of a disease, not to derive equal or -greater benefit from a similar treatment as the other person of the same -age affected by a complete development and thus increased degree of the -same disease. This, indeed, would be contrary to all sound reasoning. - -But we have had personal opportunities of treating numerous persons, not -actually myxœdematous, but exhibiting only slight symptoms of such a -condition, such as are found in people with premature senility, and also -in many cases of obesity and arteriosclerosis, and in every case we have -been able to observe a more youthful appearance afterward. - -The features have become notably more refined and more sharply defined, -and there were many other benefits that may often follow thyroid -treatment, such as loss of excessive weight, increased quantity of urine -and of perspiration, and better action of the intestines. The gait -especially became much easier; some were able to climb hills, whereas -prior to the treatment they became fatigued from less than a ten minutes -walk. The improvement in the mental condition was sometimes striking; -memory especially became much better, as did also the general -intelligence. It was also very interesting to note that abrasions, or -any kind of sores, healed rapidly with fine granulations; for which -reason such a treatment may give good results also in leg ulcers. We -have obtained the best results from our thyroid treatment in those -persons who were prematurely ageing; but even in the aged we have -produced an improvement in the symptoms. - -By the amelioration of the functions of the skin, kidneys, and -intestines, which functions are, as a rule, impaired in old age, such -treatment may already be indicated; and especially since the production -of heat is thereby augmented, which is a great advantage to old people, -who usually complain of cold. At the same time we are able to increase -the processes of oxidation, which are, as already mentioned, diminished -in old age. Thus, from the improvement in all these functions from the -administration of thyroid extracts in old age, the treatment is, _prima -facie_, justified. Great care must, however, be exercised in prescribing -such extracts, and they should never be given unless the effects on the -patient can be properly observed every three or four days, as all the -drugs which are as effective as the thyroid, such as arsenic or other -active drugs, can do much mischief if taken in large quantities. For -such, so to say, physiological purposes as we are required to give them, -thyroid extracts should be administered in a quantity just sufficient to -make up the amount of thyroid secretion which the body demands; the -greater the age, the larger the dose; but we must not forget that, as in -advanced cases of myxœdema, so also in advanced senility, we must not -expect too great results from the treatment. The thyroid extracts that -we give can only act if the thyroid gland still has some of its -secreting structure intact and is not yet completely degenerated, which -latter is the case in complete myxœdema and advanced senility. It is -best to commence at about 40, and in persons with symptoms of premature -senility, even before this. Simultaneous obesity will offer the best -opportunity for this treatment, and by the mere reduction of superfluous -fat a more youthful appearance may be obtained. In younger people, about -or prior to middle age, one tablet daily, or sometimes two for a week or -so, then going back to one a day, will be the best method. It also is -necessary to have free intervals of five or six days between treatments, -and then to commence _de novo_. We must bear in mind that the effects of -the thyroid gland may be cumulative. - -From observations on ourselves and on patients we recommend for such as -are not advanced in age, say, below 40 or 45, one tablet for a week or -two, then stop for a few days, resuming with one tablet for a week; then -an interval of three days before commencing again; while for those with -symptoms of premature senility two or more tablets could be given, -proceeding as above. In more advanced age two or three tablets may be -given for two, three or four weeks before a free interval of several -days takes place. - -We must emphasize the fact, however, that a physician who prescribes -such extracts, should have a thorough knowledge of the physiology and -pathology of the thyroid gland for his safe guidance. On the other hand, -we again urge that patients should never use them otherwise than under -the guidance of a physician. - -When thyroid is taken in an irrational way in large doses, or when -continued for too long a time, we may sometimes have the very opposite -symptoms for a time—even more fat, and in some cases older looks; but if -we abandon the treatment for two or three weeks we may witness, as we -ourselves have done, a general improvement in the condition and personal -appearance; after iodide treatment we may observe the same, sometimes -with increase of fat. Thyroid extracts cause a greater activity of the -thyroid, and at times even an overactivity—thyroidism—which may be -followed by its exhaustion. This has been proved by experiments by -Christiani, who transplanted a fresh thyroid gland on an animal with -healthy thyroid, and thereby produced a degeneration of the latter. -Walter Edmunds, by feeding monkeys and dogs on too large a quantity of -thyroid extract, produced in their central nervous systems changes -similar to those following extirpation of the thyroid gland. Much iodide -of potassium is apt to produce, not only a diminution in size of the -thyroid, but sometimes its degeneration (see Garnier,[359] Chapter III). -As we have observed, the symptoms of exhaustion of the thyroid after -thyroid treatment are, as a rule, merely temporary, and may pass off -after a rest of a week or so; but yet we must sound a warning against -hasty and imprudent treatment. - -Footnote 359: - - Loc. cit. - -These extracts contain more or less iodine according to their -manufacture; and it has been shown by Claude Bernard that iodine is not -easily eliminated from the body, but is retained for a given time; so -that the effects of the treatment may be felt also in the free interval, -and according to our observations, often better then than during actual -treatment. Taking the extracts for too long a time without intervals -may, at times, produce disagreeable symptoms, such as palpitation of the -heart, nervous excitability, sleeplessness, etc.; so that during the -course of the treatment the patient should be examined every three or -four days as to the condition of the heart and urine; and if the pulse -rises above 90, if it were lower before, the treatment should be -suspended for a few days; much meat, alcohol, strong tea or coffee, -should be avoided. When thyroid extract in large doses and much meat are -taken together, according to our observation in a few cases, traces of -sugar may appear in the urine up to, say, from 0.1 per cent. to 0.4 per -cent., which quickly disappear if the meat is reduced, in spite of -continuing the thyroid cure, as we have noted in two cases. It is, of -course, well understood that thyroid treatment should not be tried in -patients who show symptoms of a hyperactive condition of the thyroid -gland—e.g., a rapid heart action, etc.; but we must rather try to -improve only a _deficient_ activity of the thyroid gland. By giving -small quantities of iodides before beginning thyroid treatment we could -best ascertain the condition of the thyroid gland; for if symptoms of -iodism appeared we would then be in the presence of a very active -thyroid, and thyroid treatment would be contraindicated. In many cases -of inactivity of the thyroid gland we have obtained excellent results by -administering simultaneously thyroid preparations and small quantities -of iodides. The use of stimulants such as alcohol, strong tobacco, and -strong tea or coffee, should be forbidden during thyroid treatment. - -Taken in the above manner with the necessary precautions and only under -medical supervision, thyroid as a preventive for premature senility, and -as a treatment for the symptoms of senility, is entirely harmless. We -have never observed the least inconvenience in any of the numerous cases -we have treated when our instructions as to doses and diet were carried -out, nor in ourselves. We have personally, for experimental purposes, -taken these extracts for the past five years—once for ten months with -short intervals—and stood it very well. Sometimes a few occasional -pimples were seen, and sometimes sore throat developed, and in some -patients headache. It is essential that only fresh preparations from a -reliable source should be used. - -The effects of these extracts on the nervous system and mentality are -very remarkable. As already mentioned, we noted greater immunity from -fatigue, bodily and mental, in many patients, and also in ourselves. -Memory seems to have been much improved. - -The same has also been noted by Hertoghe, who told us that he used to -take three tablets immediately before beginning his lectures. We do not -think it advisable to exceed two or three tablets a day; and even then -it is best not to take this quantity, as a general rule, for longer than -one week, when we must then reduce this quantity to one tablet. - -In combination with thyroid extracts or alone, ovarian extracts have -given us favorable results in the treatment of aged women, and also in -younger ones before the menopause, especially after oöphorectomy. -Obesity that follows the menopause, or the degeneration or extirpation -of the ovaries, and which may also be regarded as one of the primary -symptoms of old age, has been in nearly every case very favorably -influenced by ovarian extracts, particularly in such cases as thyroid -extracts were used at the same time. - -A very interesting case is mentioned by Burghart[360] of obesity in a -young woman of 20, consequent to an undeveloped condition of the ovaries -and uterus. By giving ovarian extracts he was able to reduce the weight -by 8 kilos, and when the treatment was discontinued, obesity returned. - -Footnote 360: - - Burghart: Deutsche Med. Wochenschrift, p. 610 and 627, 1899. - -As we have already shown, the ovaries also influence the processes of -oxidation. Loewy and Richter were able to considerably increase -oxidation in animals by ovarian extracts. Very important also is the -fact that Spillman and Etienne[361] observed an increase in the number -of red blood-corpuscles after ovarian treatment. For the above reasons -alone, ovarian extracts should be tried in old age, where we find, as -already stated, a diminution of oxidation, and very frequently also, in -old women, an anæmic condition. Chroback and Landau were the first to -employ with good results ovarian preparations for the relief of the -symptoms following castration in women. According to our observations on -many women under our care, the greatest benefit can be afforded by -ovarian treatment to cases having the disagreeable nervous disorders -which follow the menopause, such as hot flushes, nervous depression, -headaches, nervous insomnia, etc., these symptoms having disappeared in -nearly every case after several weeks’ treatment. - -Footnote 361: - - Spillman and Etienne: C. R. du Congrès de Medecine de Nancy, p. 953, - 1896. - -We consider ovarian extracts to be a specific against the painful -feelings of heat in women in the years succeeding the menopause, or -after oöphorectomy in younger years. In order that these extracts should -be active, it is necessary that they should be prepared from the corpus -luteum part of the ovaries, which contains their internal secretions. -The pig would be the best animal for the purpose, for its ovaries have -been found superior to those of other animals; and they also contain -more iodine, much more than the ovaries of cattle. - -When prescribing ovarian extracts we may give larger doses than of -thyroid extracts, as they are less dangerous when taken in large -quantities than the latter. We usually begin with two tablets, -increasing to four, a day. - -Less active than the ovarian preparations are the extracts of the -testicles, at least in the form in which they are at present used. It is -very probable that this may be due to the testicles of bulls being -mainly used up to now, for just as their ovaries are, so also may the -testicles of cattle be less efficacious. In addition it is also probable -that these extracts do not contain certain effective parts of the -testicles. It has been demonstrated by several authorities, as Shattock -and Seeligmann,[362] Ansele, and Bouin, that the internal secretion of -the testicles is derived, to a certain extent, from the interstitial -cells, a group of cells imbedded in the spaces between the individual -tubules. In some animals, as in the pig, as found by Shattock, these -cells are contained in such amount that they form a special part of the -testicles called by Shattock “paratubular glands;”[363] and for this -reason alone pigs’ testicles should be preferred. It seems that the -interstitial cells can only play a rôle in combination with certain -other parts of the male sexual organs, for certainly when alone they -cannot represent the part of the testicles which gives the real internal -secretion. This is shown by the fact that they are found in the largest -number in degenerated conditions of the testicles—for example: in -cretins (Lanz), in undescended testicles (Bellingham Smith), and in -atrophied testicles of old men (Haviero Spangaro[364]). - -Footnote 362: - - Shattock and Seeligmann: Transactions of the London Path. Society, p. - 57, vol. lvi. - -Footnote 363: - - Shattock: Loc. cit. - -Footnote 364: - - Spangaro: Anatomische Hefte, Wiesbaden, vol. lx, 1902. - -That testicular extracts are able to improve the symptoms of senility -has been shown by the celebrated physiologist, Brown-Séquard,[365] from -experiments on himself. He used an extract prepared from the crushed -testicles of guinea-pigs or dogs. After injecting these extracts into -his arms and legs, this old savant of 72 noted a considerable increase -in his muscular and mental powers. As he mentioned in his communication -to the Paris Biological Society, he observed in himself an augmentation -of the energies of the nervous centers; he found that he could do more -work than formerly, and that without getting tired he could more easily -ascend the staircase, nearly running, just as he used to do until he was -60; and by the dynamometer he noticed a decided increase in the muscular -power of his extremities. All his excretory functions were improved; he -had laxative action of the bowels without resorting to purges to the -same degree as formerly; his stream of urine became much longer, thus -indicating a better muscular power in the urethra; he could work -standing for a few hours, whereas before he was always obliged to be -seated; and he found that his intellectual powers increased -considerably. - -Footnote 365: - - C. R. de la Société de biologie, 1 and 15, Juin, 1889. - -It is almost unnecessary to add that this startling communication was -received, in spite of his great fame, with scepticism, and by many even -with derision. And yet it is these discoveries by Brown-Séquard that -have laid the foundation of our present knowledge of the internal -secretions. That the effects were not due to auto-suggestion has been -shown by the experiments of Zoth and Pregl,[366] who found, by means of -Mosso’s ergograph, an increase of muscular power through the injection -of testicular extracts. It is also very interesting to note that in a -few diseases which usually occur only in advanced age, testicular -extracts have given good results, such as in Parkinson’s disease and in -tabes dorsalis, as shown in the communications of Brown-Séquard and -D’Arsonval to the Paris Biological Society in 1892. - -Footnote 366: - - Pflüger’s Archiv. vol. vi, pp. 335 and 379, 1896. - -We have also, for experimental purposes, tried on ourselves testicular -extracts from the pig, and indeed we found a decided increase in -muscular and mental powers. Thus we were able to climb the highest hills -much more quickly and with much less fatigue than before; and we made -the same observation in regard to increased mental activity; and we must -strictly defend ourselves from any suspicion of having been influenced -by auto-suggestion, which is not to be inferred after similar -observations of other authorities. Similar results we have personally -observed after injection of spermin (Poehl). This substance, obtained -from the testicles of animals, was introduced by Prof. v. Poehl,[367] of -St. Petersburg, and has been commented upon by many authorities, among -them Professor Senator and P. F. Richter. According to Poehl it advances -all the processes of oxidation in the tissues, as is shown also by the -experiments of other authorities—for instance, Prof. Tarchanoff, Prof. -Loewy, Richter,[368] etc.—who found that it is able also to powerfully -alkalinize the blood. It has been proved by a mass of experimental -evidence that spermin is a catalytic ferment, and that it regulates -tissue oxidation. Poehl insists that the diminution of alkalinity of the -blood may also reduce the resistance of the body to infection, a fact -fully sustained by the theory of Dr. Sajous,[369] that immunity is -influenced by alkalinity; and it is probably due to this that many -authorities have obtained good results from spermin treatment in various -infectious diseases and in conditions of auto-intoxication. Loewy and P. -F. Richter found that spermin increases hyperleucocytosis and the -alkalinity of the blood. The same effects have been claimed by -Brown-Séquard and D’Arsonval for testicular extracts. They reported -cases of successful cures in tuberculosis, and Ouspenski[370] has -successfully treated Asiatic cholera with them. - -Footnote 367: - - Poehl and Tarchanoff: Organotherapie, vol. i, St. Petersburg. - -Footnote 368: - - P. F. Richter: Organotherapie, Berlin. - -Footnote 369: - - Sajous: “Internal Secretions.” - -Footnote 370: - - C. R. Soc. de biologie, Nov. 5, 1892. - -In the experiments made by Loewy and Richter, at the suggestion of -Professor Senator, on animals, it was found that experimental diseases, -such as pneumonia, terminated much better after an injection of spermin -(see, also, Chapter III). - -As found by Bukojemsky,[371] Hirsch, etc., spermin treatment has given -good results in senile marasmus; and senile pruritus can be improved by -it, as stated in two cases by Bosse.[372] Very interesting, also, are -this latter savant’s observations in a case of optic atrophy due to -syphilis, when spermin was used. The patient was nearly blind, and after -sixteen injections of spermin he could again see the hands of a watch. - -Footnote 371: - - Petersburgh Med. Wochenschrift, Nu. 7, p. 67, 1904. - -Footnote 372: - - Journal für med. Chemie u. Pharm., Dec., 1892. - -Spermin is contained in different organs, especially in the ductless -glands; and among these the testicles are naturally the richest in such -a secretion. In order to obtain the best testicular preparation, the -whole substance of the testicles must be taken, together with the -interstitial cells, and not the latter only. Brown-Séquard prepared his -extracts from guinea-pigs and dogs, which do not have a large number of -these cells. We should like to take into consideration the discovery of -Professor Lanz, who found in the testicles of impotent cretins a large -quantity of interstitial cells; yet neither the physical nor mental -condition of cretins permit the inference of very active sexual glands. - -In our opinion, the most active testicular extracts would be those -derived from the testes of the pig; but not from the testicles only, for -the preparation should also contain extracts from the prostate as well, -for in the human body the action of the testicles is inseparable from -that of the prostate. This has been shown by the experiments of Camus -and Gley, who found that seminal fluid exhibits more lively movement of -the spermatozoa when a little prostatic liquid is added to it. It is -thus very probable that by adding prostatic extracts to those of the -testicles, the vitality of such extracts may be enhanced. - -It is important to note that in his article on old age in Dr. Stedman’s -well-known work, Boy-Teissier[373] relates that he obtained very good -results from Brown-Séquard’s testicular extracts in the treatment of old -age. - -Footnote 373: - - “Twentieth Century Practice” by Thomas Stedman, M.D., London, p. 491, - 1897. - -We have seen in Chapter V what a marvelous influence the sexual glands -exercise on vitality and long life; if, therefore, by testicular -extracts we can enhance the activity of the sexual glands, it would -really be worth while to do so. - -In addition to thyroid, ovarian, and testicular preparations, the -extracts also of the kidneys should give good results in the treatment -of old age and in the prevention of a prematurely aged condition, by -improving the eliminative functions of the kidneys. - -It has been found by many authorities, of whom we especially mention -Gilbert and Carnot,[374] Obolenski,[375] Dubois,[376] Renaut,[377] and -Teissier,[378] that by giving extracts of the kidneys they were able to -improve the condition of patients suffering from various forms of renal -diseases, especially when suffering from uræmic conditions and -parenchymatous inflammations. We have also tried such extracts and -found, indeed, beneficial results in many cases, as reported in an -address we gave to the Medical Association of Greater New York on -October 15, 1906. Since then we have had opportunities of noting similar -results in a still greater number of patients, especially in aged -people, among them being several with arteriosclerosis. In each case we -have observed a decrease in the number of casts. In some cases of -chronic parenchymatous nephritis we were surprised to find that there -were no casts at all, after several weeks’ treatment by renal -extracts—four tablets a day—whereas, before treatment, there were found -in one case twenty hyaline and granular casts in one specimen of urine -only. We have also noticed, in many cases, a notable diminution of -albumin, although it seems to us that the decrease in the number of -casts has been more prominent; and in many cases there has been an -increased flow of urine. - -Footnote 374: - - L’opothérapie, Paris, 1898. - -Footnote 375: - - Wratch, No. 27, 1899. - -Footnote 376: - - Soc. de biologie, p. 287, 1903. - -Footnote 377: - - Bull. gén. de thérapeutique, p. 30, 1907. - -Footnote 378: - - Teissier: Bull. Méd., No. 57, p. 617, 1907. - -From the above results of treatment by renal extracts, such a treatment -with extracts prepared by maceration of the kidneys of pigs, appears -indicated, as a means to prevent premature old age, and also in old -people generally, especially since we never observed any deleterious -symptoms after administering two to four tablets a day. It would, -possibly, be useful to recommend in such cases pigs’ kidneys daily; and -as they are not palatable raw, unless tolerated in that condition, they -can be grilled. - -Good effects, and probably to a greater degree, may be observed also -after the use of pancreatic extracts. Their use in old age is indicated -by the fact that there is in the pancreas, just as there is in the -kidneys or thyroid, an increase of connective tissue in old age, and -thus the pancreas is not able to produce the necessary amount of -ferments for the digestion and assimilation of the proteid, -carbohydrate, and fat food. We also often see, therefore, aged people -lose weight, especially in advanced senility. - -According to the observations of many authorities, among them -Abelmann,[379] H. Salomon,[380] and E. Meyer,[381] it would seem that, -by the use of certain pancreatic extracts, there is a very decidedly -better assimilation of proteid, of amylaceous, and especially of fatty -matters. As in old age there is often a decrease of stomach and -pancreatic juice, pancreatic extracts seem to be especially indicated. - -Footnote 379: - - Abelmann: Quoted after Oser, Nothnagel’s “Practice” p. 109; “Diseases - of the Pancreas,” p. 101. - -Footnote 380: - - Salomon: Berl. klin. Wochenschrift, Nu. 3, 1902. - -Footnote 381: - - Meyer: Zeitschrift für exper. Path. u. Ther., vol. ii, 3 H. - -We have obtained good results in each case that we have treated by -pancreatic extracts, and also in experiments on ourselves, having used a -preparation introduced by H. Salomon. Even in aged persons we have noted -easier digestion and the disappearance of digestive trouble after two or -three tablets of the extract of pancreas taken immediately after dinner -and supper. In cases of liver and gall-stone troubles, where previously -there was a considerable loss of bodily weight, in nearly every case -after pancreatic treatment there was no more falling off in the weight, -and in some instances we have even found a considerable increase in -weight. It is our custom to apply these extracts to every case where we -want to increase bodily weight by a better assimilation of the food. -Especially in cases where we have given much milk do we find that it is -much better tolerated by the addition of these extracts to the food. We -have also found, by experiments on ourselves, that the feeling of -oppression and heaviness in the stomach after hearty meals, especially -of indigestible food, has been much improved by the use of two to three -of these pancreatic tablets. Especially have they proved useful after -late dinners in preventing a disturbance of the sleep. - -We have given above an account of the different organic preparations by -which we can treat the symptoms of old age with good results. According -to our experience it is not advisable to use all these extracts at one -and the same time, but only a few. At any rate, thyroid tablets can be -used for a long time, but in every case with intervals between the -treatment. With these ovarian or testicular extracts can be used, as can -also pancreatic extracts. The last mentioned ones should be used only as -long as necessary—until digestion is improved and bodily weight is -increased, if so desired. They may then be discarded until again needed. -Thyroid extract should also be discarded, after two weeks’ or one -month’s use, for a week or so, and then slowly begun again. It is -difficult to give general instructions that will suit every case; it is -therefore best to treat cases in an individual manner, the prime maxim -being that by such extracts the function of certain glands should be -improved until what was defective or deficient has been made up. The -thyroid extracts require that the effects should be carefully watched; -but all the other extracts are free from harmful consequences, -especially if not taken in abusive doses, and provided also, of course, -that they are fresh and not decomposed by long keeping. - - ------------------------------------------------------------------------- - - - - - CHAPTER LVII. - - A FEW HINTS ON YOUTHFUL APPEARANCE. - - -THE youthful appearance of a person is dependent chiefly upon the -condition of the complexion, of the teeth and of the hair. If a person -has a fresh complexion, and if the muscles of the face are firm and not -relaxed his face will show a youthful appearance. A few wrinkles around -the eyes and the crow-feet, which we find especially with persons of a -vivid, lively disposition, whose faces show a sensitive expressiveness -do not prejudice the youthful appearance of such persons. - -In order to keep the complexion fresh and to protect the skin from -fading there are a few hygienic measures to follow. It is not -advantageous to wash the face daily with a soap. It is much better to -dip the towel, when we get up, in cold, soft water, the best in rain -water and then to wet the face all over, or to bend over a basin with -cold rain water and to throw with the hand the water against all parts -of the face. Thus by the refreshing cold of the water the muscles of the -face will be “toned up” and their relaxation prevented. The same way it -will be advisable to wet the face with a little eau de cologne or -alcohol of 30 per cent. whenever fatigued during the day in order to -prevent the relaxation of the muscles of the face. The skin of the face -should be made only lightly wet, for the frequent thorough washing of -the skin will tend to make it very dry. In order to remove the dirt from -the face the best method is to employ a very mild soap which contains -much fat. It is advisable to put on the face in the evening before going -to bed an ointment that is made out of animal fat, e.g., lanolin to -which may be added glycerine or some other kind of fat of animal origin. -But it is not necessary to do this every day. Massage of the face, by -which the blood-supply of the muscles can be augmented may be of great -benefit, if it is done in a scientific way and carefully. To improve the -complexion of the face and to prevent the unæsthetic reddish skin with -dilated blood-vessels, the tincture of benzoin or cosmetics that contain -it can be used with profit. Those, however, who are so happy as to have -a naturally fresh, rosy complexion should never use benzoin, for -according to our observations the strong tinctures made with it may be -detrimental to their skin. - -Of great importance to the freshness of the complexion is also a regular -daily thorough cleaning of the intestines, we have often made the -observation, that the yellowish dark complexion of constipated persons -gets much improved after a copious evacuation; thus in this sense the -use of purgative mineral waters, and also the use of laxative fruits -like grapes taken daily in large quantities often much improve the -complexion. Then also the condition of the liver is of great importance -for a fine complexion, and everything that improves the functions of the -liver can contribute to conserve the same. In this connection we refer -the reader to our chapter on the hygiene of the liver. - -Of great use also are bodily exercises, for instance long walks in the -open air, as thus the circulation of the blood is much improved in the -periphery of the body and thus also is the face and the nutrition of the -tissues of the skin improved. It is also of importance to carefully -observe our teachings on the rational hygienic use of food as given -previously. It is a fact that the complexion of great meat eaters is not -so fresh and finely delicate as that of persons living on -lacto-vegetable foods. We have also often made the observation, that -persons eating meat in abundance gain a better complexion after having -been put on a diet of milk, eggs, butter, cereals and other vegetable -foods, especially abundance of fruit. - -It is also a fact that a bright, cheerful disposition favorably -influences the expression of the face and the complexion. Passions, -grief and sorrow may prove very detrimental, as they often leave lines -and wrinkles in the face. - -We have already mentioned previously that certain drugs such as arsenic, -iron and iodides can prove of great benefit for the production of -youthful looks, as they powerfully influence the formation of the blood -and affect its circulation through the tissues, and also the general -nutrition. Furthermore the thyroid preparations can bring about the same -results and they also contribute to obtain and retain a youthful -appearance as we have shown previously. We will only mention here the -important fact that wrinkles in the face are of frequent occurrence in -degenerated conditions of the thyroid gland; in young individuals and -even in infants this may be seen. On the other hand may be observed the -disappearance of wrinkles after thyroid treatment as shown in our -chapter on the treatment of old age through animal extracts. Hot baths -are also useful to aid in retaining a youthful appearance as they -promote a better circulation of the blood through the tissues of the -skin and an improvement of the functions of the skin. - -Above all it is the condition of the teeth that is of utmost importance -for youthful looks. For if they fall out atrophy of the alveolar process -takes place, and when the lips and the cheeks lack their osseous support -they will fall in. The chin in consequence gets pointed, the height of -the face is diminished and the whole face looks much older. To avoid -this everything should be done to keep the teeth in good condition and -to prevent their decay and their falling out. - -The ruin of the teeth may be brought about by external and internal -causes. The first are less dangerous, for they are chiefly of bacterial -origin and they can be avoided by a scrupulous cleaning of the teeth. -Much more serious and sometimes even unavoidable are the internal causes -thus especially the bad nutrition of the gums. If the gums are not -sufficiently supplied with blood or if the blood is lacking certain -important elements, or if it contains elements of a toxic nature as for -instance in diabetes, they become atrophic. They retract and the support -the teeth receives is insufficient. - -When the saliva is of an acid nature tartar gets deposited on the teeth -and this may cause the formation of pus in the alveoli of the teeth -i.e., produce alveolar pyorrhœa. In such a condition the base of the -teeth is surrounded by pus, which destroys the substance of the teeth -which are then lost. Most frequently we find an acid saliva in meat -eaters and in certain diseases, especially in diabetes, gout, etc. -According to Paterson the above condition is very frequent in persons -with chronic nasal and pharyngeal catarrhs, especially when breathing -through the mouth. - -The best means to obtain a regular supply of blood to the gums is the -massage of the gums by the finger, on which may be put a little olive -oil, and then gently rub the lower jaw from below upwards, and the upper -jaw from above downwards. Equally a rubbing of the teeth with a brush -that is put in an alcoholic solution of 30 per cent. will do good. The -acid saliva can be remedied by an alkaline mouth water, or a paste -containing bicarbonate of sodium in large quantities. It is also very -beneficial to the gum to clean it with alcohol of 30 per cent. gargling -or drawing it between the teeth, as is also the use of certain -antiseptic and stringent mouth waters like borax with tincture of myrrh, -or ratanhia with myrrh, etc. Hydrogen peroxide is an ideal antiseptic -for the teeth and gums, and in strong solution it may prove useful in -cases of a hyperæmic and inflamed condition of the gum. - -The condition of the sexual glands and of the thyroid gland also -powerfully influence the condition of the teeth, which can be seen -plainly by the fact that all the alterations of these glands, as in -pregnancy, in chlorotic conditions, etc., may produce important changes -in the condition of the teeth and the alveolary processes. In some cases -we were able to improve a swelled and hyperæmic condition of the gum by -the administration of thyroid extracts. - -Youthful looks also very much depend upon the condition of the hair. -When the hair is scarce and what there is left is gray a person appears -much older than he really is. When we get to a certain age—and many -persons even before—the connective tissue in the capillaries which -provide the hair root with blood becomes augmented and the elasticity of -their walls become lost. Thus there will be a difficulty in the regular -blood-supply to the hair roots or bulbs. We have already in these pages -insisted on the fact that iodides are able to improve the circulation of -the blood in the capillaries and thus they may give good results in such -cases, especially in aged persons. We may also improve the blood -circulation by massage of the scalp done in a gentle way and carefully. -According to Ehrmann the faradization of the hair gives also good -results. Above all we should not make difficult the blood-supply to the -hair roots by the wearing of hard stiff hats which compress the -blood-vessels. Less often the falling out of the hair is caused by -bacterial diseases and such can be best combated by antiseptic ointments -by sublimate, alcohol, by washing with tar soap, etc. - -There exists here also a sympathetic connection between the condition of -the hair and that of the thyroid and the sexual glands. In the -degenerated conditions of these glands we frequently find the hair very -spare, it remains short, dry and brittle and falls out very easily. -After having treated such cases for a certain time with thyroid -extracts, we can obtain often a great improvement in the condition of -the hair. It may in the beginning fall out the more, but this happens -only with hair that is already morbidly decayed, but afterwards we will -observe a still better growth of new hair. Arsenic may also give similar -results according to our own observations and that of other authorities. - -Youthful looks can also be obtained by a slender figure. Slender persons -look often younger than they are, whereas corpulency conveys more the -impression of a higher age than would correspond to the real number of -years. Therefore those who wish to look young must avoid becoming -corpulent. Above all the quantity of meat should be limited, for -corpulency can be best brought about by much meat in the diet, if at the -same time also amylaceous or starchy foods and sweets are taken in -quantity. Besides a frugal diet, much exercise contributes in most -persons to the prevention of obesity. Turkish baths, and according to -the prevalent opinion, also the use of certain purgative mineral waters -like those of Carlsbad, Marienbad or Kissingen will also give good -results. Very often we can see good results with a great loss in the -weight of corpulent persons after the use of thyroid preparations as we -have mentioned previously. - - ------------------------------------------------------------------------- - - - - - CHAPTER LVIII. - - THE “TWELVE COMMANDMENTS” FOR THE PRESERVATION OF YOUTH, AND THE - ATTAINMENT OF A GREEN OLD AGE. - - -IN his report on the autopsy of Thomas Parr, who lived to the age of 152 -years and 9 months, Dr. Harvey, physician to the king, attributed his -death to the change from a frugal diet of subrancid cheese, milk in -every form, and coarse, hard bread, to the rich feeding he received in -London, and to the change from the healthy air of the country to the -foggy climate of the metropolis. We also dwelt on the important fact -that by his leading such a peasant’s life, free from care owing to its -simplicity it contributed to his very advanced age; for, as the great -Harvey pithily put it, “sorry fare, but free from care.” - -We thus see that this celebrated discoverer of the circulation of the -blood ascribed special importance, for the attainment of an advanced old -age, to these same agencies, viz.: living temperately and in the open -air, and absence from worry, the importance of which we have -demonstrated by scientific evidence in the various chapters of this -book. - -We have found, among the cases of those who lived to a great age, -sometimes much over one hundred years, very numerous instances of -persons who were in poor circumstances, existing on a very simple diet, -but who were free from cares. To attain such a measure of simple diet -does not require any very great effort of mind; peasants obtain it -without care or worry. If we were asked for the best means of living to -be 100 years old we would say: become a peasant or a pauper and be -received into an English workhouse. - -It is astonishing how many of the inmates of the English workhouses and -other similar institutions for the poor become very aged. They have no -anxieties about getting their daily bread, and oftentimes they are fed -better than they would have been in their homes, although only the -minimum amount of hygienic food is given. (This certainly would not have -applied to the English workhouses before the days of Charles Dickens.) -Workhouse inmates lead a very regular and frugal life, rising in the -small hours of the morning and retiring to bed early in the evening. -Thus, in winter time, they can never contract pneumonia by coming home -late from the overheated theatre, concert, or club-house. They also need -not worry about their fortunes, for they have none. - -We may thus conclude that a workhouse may be a more favorable place for -reaching a good old age than a palace, which coincides with the pithy -words of Dr. Harvey already quoted. - -To the three agencies of frugality, fresh air, and no worries we would -like to add the great advantage of sunshine, plenty of milk in the diet, -and little meat, a daily proper action of the bowels, a daily bath, -rational clothing, and above all—considering the great importance of the -functions of the glands with internal secretion as a means of freeing -our body from poisonous products, and thus preventing premature old -age—we must insist on the rational hygiene of these organs, and on the -reinforcement of their functions, if changed by age or disease, by means -of extracts obtained from similar organs of healthy animals. - -From long study of the lives of the patriarchs of great age—who, -according to evidence, sometimes legal, and acknowledged also by such -authorities as Professor Pflüger[382] and Pel,[383] have attained an age -much over 100, and in some cases even of 160—we have come to the -conclusion that, by following the hygienic rules we have laid down in -the various chapters in this book, we certainly can preserve our -youthfulness till 50 or 60, and our life to 100 or over. - -Footnote 382: - - Loc. cit. - -Footnote 383: - - Pel: Loc. cit. - -We fully acknowledge the value of descent from long-lived families, but -we may refer to the instances we have quoted of persons descended from -short-lived families and yet living to be nearly 100. - -It would, indeed, be most foolish to feel like an old man or woman when -but 40 or 50, and to die perhaps at 60, when, by the exercise of a -little judgment, we can considerably prolong our youth, which may -otherwise be fast flitting away, preparing us for an early grave, and -enjoy our life twice as much by being free from pains and ailments. - -Most of the evils that befall us in this world, including premature old -age and early death, are, in our opinion, as we have often repeated, -solely due to our own negligence; and to avoid such a fate we recommend -the following precepts:— - -1. To be as much as possible in the open air, and especially in the -sunshine; and to take plenty of exercise, taking special care to breathe -deeply and regularly. - -2. To live on a diet consisting of: meat once a day, eggs, cereals, -green vegetables, fruit, and raw milk of healthy cows (as much as the -stomach will permit); and to masticate properly. - -3. To take a bath daily; and in addition, once a week or once every two -weeks, to take a sweat bath (if the heart can stand it). - -4. To have a daily action of the bowels; and in addition to take a -purgative once a week if there is any tendency to constipation. - -5. To wear very porous underwear, preferably cotton; porous clothing, -loose collars, light hat (if any), and low shoes. - -6. To go to bed early, and to rise early. - -7. To sleep in a very dark and very quiet room, and with a window open; -and not to sleep less than six to six and one-half hours, or more than -seven and one-half, and for women eight and one-half, hours. - -8. To have one complete day’s rest in each week, without even reading or -writing. - -9. To avoid mental emotions, and also worries about things that have -happened and cannot be altered, as well as about things that may happen. -Never to say unpleasant things, and to avoid listening to such, if -possible. - -10. To get married; and if a widow or widower, to marry again; and to -avoid sexual activity beyond the physiological limit, as also to avoid a -total suppression of the functions of these organs. - -11. To be temperate in the use of alcohol and tobacco, and also in the -use of coffee or tea. - -12. To avoid places that are overheated, especially by steam, and badly -ventilated. To replace or reinforce the functions of the organs which -may have become changed by age or disease, by means of the extracts from -the corresponding organs of healthy animals; but only to do this _under -the strict supervision of medical men_ who are thoroughly familiar with -the functions of the ductless glands. - - ------------------------------------------------------------------------- - - - - - GLOSSARY. - - -=Acetone, Acetonum.= An inflammable, colorless liquid of an acrid taste - and a penetrating odor. Occurring in small quantities in the blood - and urine and in considerable quantities at times in diabetic urine. - -=Acetonitrile.= Methyl cyanide. A colorless volatile liquid. - -=Acetonuria.= The presence of an abnormal amount of acetone in the - urine. - -=Acromegalia, Acromegaly.= A chronic nervous disease, usually of adults - and marked by abnormal processes of growth, especially in the head, - face, and extremities: Marie’s disease. It has in many cases been - found to be associated with disease of the pituitary body and the - thyroid gland. - -=Adenoid.= Resembling a gland. Name given to masses of hypertrophied - glands normally present in the nasopharynx. - -=Adolescence.= Youth: the period between puberty and full development. - -=Adrenal.= Situated near the kidney. The suprarenal capsule. - -=Agglutinin.= A substance, occurring according to some investigators in - blood-plasma, according to others only in the serum after - coagulation, comparatively resistant to heat, drying, putrefaction, - etc., showing many of the characteristics of proteids, and producing - agglutination or sticking together by its action on the surface of - foreign cells. - -=Alexin.= Any principle that accompanies a pathogenic cell growth and is - antagonistic to its evil effects, a defensive proteid. Any - albuminous preparation used for protective inoculation. - -=Alkalimetry.= The process of determining the amount of free alkali in - various substances. - -=Alveolar.= Belonging to the alveoli. - -=Alveoli.= (_a_) Bony socket of a tooth; (_b_) an air-cell of the lung; - (_c_) a cavity, pit, or recess. - -=Amenorrhea.= Absence or stoppage of the menstrual discharge, normal - during pregnancy. - -=Amphibia.= A class of vertebrates forming a transitional group between - the fishes and air-breathing animals, usually having gills in the - larval form and lungs in the adult. - -=Amyl Nitrite.= A drug which produces vasodilation—opening of the - blood-paths. Formerly used in trigeminal neuralgia and malaria. - -=Amylaceous.= Composed of starch: starch-like. - -=Amylolytic.= Tending to dissolve starch, and thus to favor its - conversion into sugar: sometimes applied to the saliva. - -=Analogous Tissue.= A diseased tissue resembling a normal elementary - tissue of the body. - -=Anemia.= Deficiency of the blood in quantity or quality, either general - or local. - -=Anomaly.= Irregularity: deviation from rule. - -=Antipyretic.= A remedy to lower temperature. - -=Antipyrin.= A colorless, almost odorless, crystalline powder or tabular - crystals, with a slightly bitter taste, prepared by the condensation - of phenylhydrazine with aceto-acetic ether with the subsequent - menthylation of the product. - -=Antitoxic.= The quality of counteracting poisons: overcoming toxic - influences. - -=Antivenin, Antivenomous Serum.= A polyvalent blood-serum prepared from - animals rendered immune to snake-venom. - -=Aorta.= The larger arterial trunk arising from the left ventricle of - the heart, and indirectly giving origin to every artery except the - pulmonary and its ramifications. - -=Arborization.= A branching distribution of veinlets or of - nerve-filaments, especially the branched terminal ramifications of a - nerve-axon. - -=Arteriosclerosis.= Sclerosis or hardening of the walls of an artery, - especially of the inner coats. - -=Atheroma.= A form of fatty degeneration of the coats of the arteries in - arteriosclerosis, producing patches of induration or of softening. - -=Athyroidia.= A condition caused by an insufficiency of thyroid - secretion. - -=Atrophy.= A regressive metamorphosis, “wasting away” (not always due to - imperfect nutrition), in which the parts become smaller by - diminution of their elements, either in size or in number. - -=Attenuated.= Drawn out thin. The lessening of weight, as by dietetic - and medicinal treatment. - -=Auto-intoxication.= Poisoning with toxic products elaborated within the - body. Self-infection from self-formed poisons. - -=Axilla.= The armpit. - -=Bacteria.= Any of the microscopic, unicellular masses of protoplasm - referred to a genus. Each is surrounded by an envelope, the total - vital capacity of each species being represented by every cell. - -=Butyric.= Relating to or derived from butter. - -=Cachexia.= A depraved condition or habit of body or nutrition. - -=Calcium Carbonate.= A soft, white, inodorous substance. =Chalk.= It - occurs in shells, bones, and marble. - -=Callus.= The osseous substance deposited between and around the divided - portions of a fractured bone. Unnatural hardness or induration of - any soft part or a thickening of the cuticle, caused by pressure or - friction. - -=Calorie.= The unit of heat, or the quantity of heat required to raise 1 - gram of water 1 degree centigrade. - -=Carbohydrate.= Any one of a group of chemical compounds in which carbon - is combined with hydrogen and oxygen, which exist in the same - proportions as in water, the carbon atoms usually being a multiple - of six. - -=Catabolism.= The production of a simpler substance from a more complex. - Passage of tissue material from a higher to a lower plane of - specialization or complexity. - -=Catalysis.= In chemistry a reaction that appears to take place owing to - the mere presence of another body that apparently undergoes no - change. - -=Catalytic.= Belonging to or causing catalysis. - -=Cellulose.= A carbohydrate forming the framework or skeleton of plants, - and the most abundant substance in the vegetable kingdom except - water. - -=Chlorotic.= Relating to chlorosis. A person affected with chlorosis, or - “green sickness,” a form of anemia. - -=Choledochus.= The common bile-duct. - -=Choline.= A ptomaine found in brain tissues, in the bile, in yolks of - egg, and in many decomposing animal and vegetable tissues. - -=Chromatolysis.= The breaking down and dissolution of the chromatin of - cell-nuclei. - -=Chromophile.= Stainable or easily stained, or absorbing of color. - -=Cirrhosis.= A disease of the liver or other organs marked by - proliferation and increase of the interstitial connective tissue, - which subsequently contracts or shrinks, producing atrophy and - degeneration of the parenchymatous substance. - -=Climacteric.= A particular epoch of the ordinary term of life marked by - periods of seven years, at which the body is supposed to be - peculiarly affected, and to suffer considerable change. Used to - indicate the “change of life,” or cessation of menstruation in - women. - -=Clinical.= Pertaining to the sick-bed treatment of a patient. - -=Colloid.= Resembling glue. - -=Connective tissue.= The framework tissue which supports and connects - other tissues and organs. - -=Convoluted Tubule.= The contorted portion of a uriniferous tubule. - -=Corpus Luteum.= “Yellow body,” the yellow mass in the ovary occupying - the place of a Graafian follicle which has discharged its ovum. - -=Cretinism.= A congenital disease, characterized by goiter, stunted - growth, swelled abdomen, wrinkled skin, wan complexion, vacant and - stupid countenance, misshapen cranium, idiocy, and comparative - insensibility. Disturbance of the function of the thyroid gland is - accredited as the cause. - -=Cystitis.= Inflammation of the urinary bladder. - -=Dementia Præcox.= Any form of dementia beginning at puberty and marked - by negativism, stereotypy, mannerisms, and verbigeration. - -=Desquamation.= A scaling off. The separation of laminæ or scales from - the skin, or from mucous or serous surfaces, or from bones. - -=Dextrin.= A soluble carbohydrate into which starch is converted by - action of diastase or dilute acids. - -=Diabetes Mellitus.= A disorder of metabolism characterized by chronic - hyperglycemia and glycosuria on a diet not containing excessive - amounts of sugar, and associated with polyuria, polydipsia, - polyphagia, emaciation; often dryness of the mouth and skin; - sometimes boils, carbuncles, spontaneous gangrene, loss of sexual - power, or nervous affections. - -=Diuresis.= Increased discharge of urine, from whatever cause. - -=Ductless Glands=. Glands without an excretory duct. - -=Dynamometer.= An instrument with which to measure the force of muscular - contraction, especially of the hand grasp. - -=Ectropion.= Eversion of the edge of a part, especially of the eyelid or - eyelids. - -=Edema.= A swelling from effusion of serous fluid into the cellular - substance. - -=Emunctory.= Excretory. Any excretory duct of the body. - -=Endometritis.= Inflammation of the inner lining membrane of the body of - the uterus. - -=Enemata.= Liquids or injections thrown into the rectum; clysters. - -=Enteroptosis.= Prolapse of the intestines. - -=Enzyme.= A ferment. A substance showing proteid-like reactions, easily - destroyed by moderate heat, originating from living cells, either - directly or through the intermediate stage of a pro-enzyme, and - showing a metabolic activity in converting a specific substance or - substances into certain other products in a manner and to an extent - independent of the amount of enzyme present and without being itself - used up in the process. - -=Epiphysial.= Pertaining to or of the nature of an epiphysis. - -=Epiphysis.= A piece of bone growing upon another, as the bulky - extremities of long bone which are in early life separated by - cartilage from the shaft. - -=Epithelium, -lia.= Epithelial cells: cells which form the surface of - the skin, mucous membranes, and line all canals having - communications with the external air. - -=Erythematous.= Of the nature of erythema; redness of the skin. - -=Ethnographical.= Concerning the science of the characteristics of the - human family. - -=Etiology.= The science of the causation of disease. - -=Exophthalmic Goiter.= Synonyms: Graves’s disease, Basedow’s disease. A - disease marked by protrusion of the eyes, enlarged thyroid gland, - anemia, and overaction of the heart. - -=Extirpation.= The complete removal or eradication of a part by the - knife or by caustic. - -=Faradization.= A method of treating disease by a localized application - of induction currents. - -=Follicle.= A little bag: applied in anatomy to a very small cavity or - tubular gland, as the hair glands and the sebaceous glands of the - skin. - -=Follicular.= Resembling or belonging to a follicle. - -=Gastroptosis.= A downward displacement of the stomach. - -=Glomerulus.= (1) A small, rounded mass. (2) A part of the kidney; a - coil of blood-vessels projecting into the extended ends of each - uriniferous tubule. - -=Glycosuria.= The presence of sugar in the urine. - -=Graves’s Disease.= (See Exophthalmic Goiter.) - -=Hemianopsia.= Blindness in one-half of the field of vision of one or - both eyes. - -=Hemoglobin.= A red, crystalline substance, of uncertain and very - complex composition, found in red blood-corpuscles of the venous - blood, and believed to consist of hemochromogen and a proteid. - -=Histology.= The science of the minute structure and composition of the - different tissues of organized bodies. - -=Hyaline Cast.= A nearly transparent and clear urinary cast. - -=Hydrothyonuria.= The presence of hydrogen sulphide in the urine. - -=Hyperactivity.= Abnormal activity. - -=Hyperemia.= Excess of blood in any part due to increased influx or - obstruction of the outflow. - -=Hyperesthesia.= Morbid increase of the general sensibility, or of one - of the special senses. - -=Hyperleucocytosis.= Increase in the number of leucocytes in the blood. - -=Hyperplasia.= The increase of the number of the individual structural - elements of a tissue. - -=Hyperpyrexia.= Abnormally high fever, especially when over 42° C. or - 106° F. - -=Hypersecretion.= Excessive secretion. - -=Hypertrophy.= Enlargement of a part or an organ, especially when due to - over-nutrition. - -=Hypothyroidia.= Diminished function of the thyroid gland. - -=Impermeable.= Not permeable: not permitting a passage through. - -=Interstitial Hepatitis.= Inflammation of the interstitial connective - tissue of the liver. - -=Interstitial Nephritis.= Acute or chronic inflammation of the kidneys. - -=Lab-ferment.= The ferment (or enzyme) of rennet which coagulates milk, - forming curds. - -=Lactation.= The time or period of secreting milk. - -=Lactic.= Pertaining to or derived from milk. - -=Lanolin.= A body consisting of cholesterin and fatty acids obtained - from sheep’s wool: used as a basis for ointments, especially with - equal parts of petrolatum, on account of its ready absorption and - its peculiar resistance to the growth of bacteria. - -=Lecithin.= A complex nitrogenous fatty substance occurring widely - spread throughout the animal body; chemically, a glycerophosphate of - neurin. - -=Leguminous.= Pertaining to the fruit or seed that is used as a food, - such as peas, beans, etc., rarely any esculent vegetable. - -=Leucocyte.= A white blood-corpuscle or one of the cells resembling it. - -=Leucocytolysis.= The destruction of leucocytes, as by bacterial - extracts. - -=Leucomaine.= Any of a number of basic bodies, such as ornithin, the - hexone and purin bases, etc., which are the normal products of - tissue metabolism. - -=Maceration.= The act of steeping a substance in hot or cold water, - usually to extract its virtues. - -=Maltose.= Malt-sugar, identical in composition with milk-sugar, but in - its properties much more like grape sugar. It is derivable from - starch or glycogen, by the action of saliva, pancreatic juice, or - malt diastase. - -=Menstrual.= Having to do with menstruation. The blood discharged in - menstruation. - -=Metabolism.= The process by which living cells or organisms are capable - of incorporating substances obtained from food into an integral part - of their own bodies. - -=Metrorrhagia.= Excessive discharge (usually hemorrhagic) from the womb, - especially when occurring at other times than during menstruation. - Uterine hemorrhage. - -=Molecular.= Pertaining to molecule. A very small particle of matter. - -=Muscarine.= A poisonous alkaloid obtained from Agaricus muscarius. - -=Mydriasis.= A preternatural or morbid dilatation of the pupil of the - eye. - -=Myxedema.= The name given to a condition characterized by a - hyperplastic and modified deposit of connective tissue in all parts - of the body. - -=Narcosis.= The progress of narcoma or the production of narcotism by - drugs, as opium, or by poisonous products originating in the body. - Narcoma, stupor, or the state of being under the influence of - narcotic medicine. - -=Necrotized.= Lifeless. - -=Nephritis.= Inflammation of the kidneys, which, when acute, involves - chiefly the renal parenchyma, and, when chronic, either the - parenchyma or the connective tissue or both. - -=Neural.= Belonging to nerves. - -=Neurasthenia.= Nervous debility. Nervous prostration. An exhausted - condition with irritability; a functional derangement of the nervous - system, either spinal or cerebral, due usually to overwork or other - excessive expenditure of energy. - -=Neuroglia.= The tissue, probably of ectodermic origin, forming the - basis of the supporting framework of the nervous tissue of the - cerebrospinal axis. - -=Neuron.= The cerebrospinal axis. - -=Neuropathic Constitution.= The nervous diathesis: that constitution of - body and mind which predisposes to nervous disease. - -=Nuclein.= The phosphorized proteid or nitrogenous substance found in - cell-nuclei. It is believed to furnish the functional activity of - the cell. - -=Omnivorous.= Feeding or subsisting on food of all kinds. - -=Oöphorectomy.= Excision of one ovary. - -=Opsonin.= From opsono, “I prepare the ground for.” An undetermined, - unstable substance in the serum of the blood that renders bacteria - more susceptible to ingestion by phagocytes. - -=Osteomalacia.= A chronic disease marked by progressive softening of all - bones, due to the loss of their earthy constituents, so that they - become flexible and fragile and unable to support the body. - -=Oxidation.= The combining of a certain quantity of oxygen with metals - or other substances. The formation of an oxide. - -=Palpation.= Examination by the hand or by touch: manipulation of a part - with the fingers for the purpose of determining the condition of the - underlying organs. - -=Pancreas.= A long, flat, racemose gland of a reddish color situated in - the epigastric region beneath the stomach on a level with the first - to the third lumbar vertebræ. Its function is an important part of - the digestion of proteids, fats, and carbohydrates. - -=Parametritis.= Inflammation of the connective tissues in the immediate - vicinity of the uterus. - -=Parathyroid.= Situated beside the thyroid gland. One of the small - glands, usually four to five in number, distinct from the accessory - thyroids, lying along the lateral lobes, and possessing an important - internal secretion independent of the thyroid gland. - -=Parenchymatous Tissue, Pulp Tissue.= The tissue forming the pulp or - parenchyma of an organ. - -=Pathology.= The doctrine or consideration of diseases, and, in a broad - sense, of every deviation from normal structure, composition, or - function. That branch of medicine which treats of disease, their - origin, nature, and termination, special attention being paid to the - disorders of function and alterations of structure preceding and - resulting therefrom. - -=Perchloride.= A chloride containing more chlorine than a protochloride. - -=Percussion.= The act of striking any part of the body with the fingers, - or with an instrument, to ascertain its condition by the sound - obtained. - -=Pericardium.= The membranous bag which contains the heart. It consists - of an external layer of fibrous tissue and an internal serous layer, - the latter of which surrounds the heart. - -=Peristalsis.= A peculiar worm-like movement of the intestines and other - tubular organs by which they gradually propel their contents onward. - -=Pernicious.= Highly dangerous. - -=Phagocytosis.= The ingestion of foreign bodies, microbes, etc., by the - action of phagocytes (certain of the colorless blood-cells). - -=Pigmentation.= The coloring matter in the skin. - -=Pituitary Body.= The small ellipsoidal body which rests on the sella - turcica and is attached to the base of the brain by a pedicle. - -=Plethoric.= Fullness; a state marked by excess of blood in the vessels. - -=Plexus Myentericus.= Auerbach’s plexus. A plexus of sympathetic fibers - between the longitudinal and circular intestinal muscle-fibers. - -=Pneumococcus (of Friedländer).= The bacterium of pneumonia. - -=Polydipsia.= Excessive thirst. - -=Polyuria.= A disease characterized by thirst and by a persistently - excessive flow of watery urine. - -=Porosity.= The state of having pores. - -=Portal Veins.= The large veins entering the liver at the transverse - fissure and bringing to it the blood from the digestive tract and - the spleen. - -=Prognosis.= The foreknowledge of the course of a disease drawn from a - consideration of its signs and symptoms. - -=Proliferation.= Reproduction of similar forms, both normal and morbid, - but especially applied to cell-genesis. - -=Propagation.= Reproduction. - -=Prophylaxis.= The art of guarding against disease. The observation of - the rules necessary to the preservation of health, or the prevention - of disease. - -=Proteid.= Any one of a class of complex, nitrogenous, levorotatory - organic compounds forming the essential part of animal and vegetable - tissues. - -=Protozoa.= The name for the primary type of lowest division of the - animal kingdom. - -=Psoriasis.= A cutaneous disease, characterized by a rough, scaly - cuticle, continuous, or in separate, irregular patches, generally - with fissures of the skin, and occurring especially on the extensor - surfaces of the body. - -=Psychoses.= Disturbances of the mind. - -=Ptosis.= A falling, or prolapsus, especially applied to a drooping of - the upper eyelid due to paralysis of the levator palpebræ superioris - muscle. - -=Puerperium.= The state or period of confinement of a pregnant female. - -=Pyrexia.= The state of fever. - -=Radicle.= An ultimate division of a vessel or nerve. - -=Retrograde-metamorphosis.= The process by which somewhat complex bodies - are broken up into simpler ones, and in the end into waste products. - -=Salicylate.= A salt of salicylic acid. - -=Sebaceous.= Fatty. Suety. Applied to glands which secrete an oily - matter resembling suet. - -=Segmentation.= The process of division by which the fertilized ovum - divides before differentiation into layers occurs. - -=Sella Turcica.= The depression within the three clinoid processes of - the sphenoid bone, lodging the pituitary body. - -=Senility.= Old age. - -=Septicemia.= Blood poisoning. Fever and prostration due to the entrance - of pyogenic or other micro-organisms or ptomaines into the - circulation. - -=Serum.= The clear liquid which separates in the clotting of blood from - the clot and the corpuscles, or any clear liquid resembling it. - -=Skeletal.= Of or relating to a skeleton. - -=Spermatorrhea.= An involuntary emission of semen without copulation. - -=Spermin.= A preparation of the prostate gland and testicle of animals. - -=Subcutaneous.= Situated, introduced, or living just under the skin. - -=Sudorific.= Inducing or causing sweat. - -=Suppurative.= Producing or discharging pus. - -=Tabes Dorsalis.= Locomotor ataxia. A chronic disease due to - degeneration and sclerosis of the posterior columns of the spinal - cord, and marked by lightning-like flashes of pain and a peculiar - gait. - -=Tachycardia.= A disturbed condition of the heart’s action in which - great acceleration of the pulse occurs. - -=Tertiary.= Third degree. - -=Theobromine.= A bitter, colorless, crystalline powder, capable of - forming salts with acids, and sparingly soluble in hot water. - -=Thymus.= A bilobed, elongated body which develops from the entoderm of - the last two visceral clefts, and is situated in the neck and thorax - of the newborn child. - -=Thyroid Gland.= A reddish organ, one of the so-called ductless glands, - giving rise to one or more internal secretions and situated in front - of and on either side of the trachea. - -=Thyroidectomy.= Excision of the thyroid gland or of its cartilage. - -=Tonicity.= The state of normal tone or tension. - -=Tortuosity.= Bent or twisted irregularly. - -=Transudation.= The morbid passing or oozing of blood, or other fluid, - practically unaltered, through the pores of the skin or membranes. - -=Trypanosome.= One of any species of trypanosoma. The organism is a - spindle-shaped, more or less elongated, protoplasmic body, - containing two chromatic masses, a centrosome generally placed at - the posterior end and a larger nucleus mesially situated, with a - flagellum and an undulatory membrane, starting from the centrosome, - and running along the protoplasmic body. - -=Trypanosomiasis.= A diseased condition produced by trypanosomes. - -=Trypsin.= A ferment of pancreatic juice which has the power of - converting proteids into peptones, best in alkaline solution, but - also active in neutral solution. - -=Unesthetic.= Not having lost sensation. - -=Unossified.= Not having formed bone. - -=Urea.= A white, transparent, crystallizable solid, the principal solid - constituent of urine. - -=Uric Acid.= A crystalline substance obtained from urine. - -=Urotoxic.= Relating to the poisonous elements of the urine. - -=Urticaria.= “Hives.” An exanthematous fever characterized by an - eruption like the elevations produced on the skin by the sting of a - nettle, and attended with burning and itching. - -=Vascularization.= The act or process of becoming vascular, as in - neoplasms, thrombi, etc., or furnished with new blood-vessels. - -=Vasodilatation.= Widening of the walls of the blood-vessels; admitting - more blood to the periphery. - -=Vermicular.= Worm-like. - -=Viscosity.= Adhesiveness. - - ------------------------------------------------------------------------- - - - - - INDEX. - - - Abderhalden, 333, 336. - - Abelard, 43. - - Abelmann, 447. - - Abelous, 161. - - Achard, 204, 286. - - Acne, microbes in, 213. - - Acton, 391. - - Adami, 9, 150, 156. - - Adcock, Sir Hugh, 43. - - Adler and Hensel, 162. - - Adler, Isaac, 107, 169, 366. - - Adler, Max, 322. - - Adrenals and circulatory system, hygiene of, 164. - adrenal hypersecretion, 165. - adrenals and cardiac nerves, 164. - agencies, harmful, to avoid, 166. - arteriosclerosis, 164, 165. - causes of, 165. - high blood-pressure and, 164. - and kidney disease, 165. - blood-test for, 165. - preventives of, 168. - atheroma, 164. - mental emotions, 165. - sexual glands, 165. - thyroid gland, 166. - tobacco a stimulant of, 427. - - Aeschbacher, 431. - - Age, old, blood-drinking for, 332. - commandments for, 455. - milk diet for. See _Diet, milk_. - premature, from alcohol, 352. - prevention and treatment of, - arsenic, 426. - for women, 427. - for sexual glands, 429. - in mineral waters, 428. - gland, thyroid, 434. - iodides for, 431. - for arteriosclerosis, 431. - iron, 429. - for sexual glands, 429. - kidney extracts, 445. - ovarian extracts, 440. - pancreatic extracts, 445. - prostatic extracts, 445. - spermin, 444. - testicular extracts, 441. - value of vegetarian diet to prevent, 311. - - Air, close, 272. - fresh, automobiling for, 266. - forests, 267. - - Air, mountain, 266. - indoor, results of, 277. - outdoor, benefits of, 277. - vitiated, 264. - - Albertoni, 35, 86, 141, 142. - - Albuminuria from constipation, 202. - - Alcohol habit, cause and prevention of, 356. - gland, thyroid, exhaustion of, as cause of drunkenness, 357. - glands, sexual, and, 360. - preventive, 361. - treatment of, 361. - ovarian extracts, 361. - thyroid, 361. - immunity to large doses of, 356. - persons easily affected by, 359. - quantities, large, effects of, 350. - age, old, premature, 352. - arteriosclerosis, 350. - brain, 350. - delirium tremens, 353. - progeny of, 353. - epileptics, 353. - genealogy, a terrible, 353. - glands, ductless, 351. - liver, 351. - kidneys, 351. - pituitary, 351. - sexual, 351. - thyroid, 352. - heart muscles, 350. - insanity, 350. - and crime, 351. - in tropical climates, 353. - on children, 354. - on thyroid gland, 357, 358. - quantities, large, immunity to, 357, 358. - resistance, diminution, 351. - diseases, nervous, 352. - fever, yellow, 352. - myxœdema, 352. - of powers of, 352. - pneumonia, 352. - scrofulosis, 352. - tuberculosis, 352. - uses of, 347. - as a preservative of tissues, 348. - as a stimulant, 348. - circulatory apparatus, 348, 349. - nervous system, 348. - wine, 348. - beer, 348. - brandy, 349 - disadvantage, 349. - for snake poison, 358. - least injurious, 349. - longevity, 350, 355. - most injurious, 349. - overabundance, effect of, 348. - tonic, 349. - whiskey, 349. - wine, 348, 349. - - Allbutt, Clifford, 406. - - Amato, 80. - - Amberg, 164. - - Anderson, Mrs., 105. - - Ansele, 442. - - Appearance, youthful, hints on, 449. - baths, 454. - diet, 453. - disposition, cheerful, 450. - drugs, 451. - exercise, 450, 454. - glands, sexual, 452. - hair, 452. - and thyroid gland, 453. - skin, care of, 449. - slenderness, 453. - teeth, care of, 451. - - Appendicitis. See _Intestines_. - - Arloing, 212, 256. - - Arteriosclerosis, etiology, 165, 167. - diet, 165. - coffee, 165. - meat, 165. - tea, 165. - diseases, infectious, 165. - syphilis, 165. - in brain workers, 423. - poisons, 165. - alcohol, 165. - lead, 165. - mercury, 165. - tobacco, 165. - preventives of, 168. - adrenals, reduction of activity of, 168. - blood, viscosity of, 168. - diet, 168. - exercise, 168. - thyroid, increase of activity of, 168. - - Atwater, 287, 348. - - Aubert, 209. - - Aubertin, 161. - - - Baelz, 283. - - Baldwin, 39, 394. - - Ballet and Enriquez, 27. - - Bamossi, 151. - - Bang, 325. - - Basch, 169. - - Baumann, 91, 118, 152, 323, 431. - - Bayon, 5, 23, 98. - - Beck, Charles, 414. - - Bedclothing, 229. - - Behring, 326, 327. - - Benda, 4. - - Benedict, 287, 348. - - Berger, 18. - - Bernard and Bigart, 161. - - Bernard, Claude, 125, 169, 335, 391, 439. - - Bertrand, 427. - - Besançon, 334. - - Bianchini, 298. - - Bickel, 339, 340, 341, 344. - - Bier, 337. - - Binz, 369, 371. - - Bircher, 392. - - Blood as food, 333, 337. - chemicals in, 335. - experiments with, 337. - ferments in, 335. - immunizing substances in, 336. - iron in, 333. - in drugs, 333. - in food, 333. - lack of, in chlorosis, 333. - in anæmia, 333. - organic and inorganic, 333. - blood, 334. - best, 335. - eggs, 334. - nuclein of eggs, 333. - spinach, 334. - ox, 336. - pigs’, 335, 336. - extracts in, 335. - puddings, 335. - sausages, 335, 336. - transfusion, dangers of, 337. - - Blum, 5, 9, 22, 35, 86, 96, 139, 142, 145, 318, 329, 375, 431. - - Blumenkranz, 232, 241. - - Blumenthal and Jacobi, 83. - - Boas, 202. - - Bocci, 153. - - Boerhaave, 425. - - Boix, 153. - - Bokenham, 9, 150. - - Bonardi, 56. - - Bonnamour, 161. - - Bordet, 134. - - Borylac, 162. - - Bosse, 444. - - Böttger, 364. - - Boubnoff, 258. - - Bouchard, 142, 153, 154, 371. - - Bouchard and Hanot, 156. - - Bouchut, 298. - - Bouin, 442. - - Boverie and Loeper, 162. - - Breathing, deep, 267. - benefits of, 269. - contra-indications, 269. - nasal, 270. - - Breisacher, Leo, 5, 9, 22, 138, 145, 318, 329. - - Brieger, 34, 172. - - Brissaud, 311. - - Brown, 105. - - Brown-Séquard, 8, 32, 125, 159, 198, 391, 410, 442, 443, 444, 445. - - Brunton, Sir Lauder, 9, 150, 169, 245, 268, 366. - - Buchner, 134. - - Buddha, 396. - - Bukojemsky, 444. - - Bunge, 204, 205, 210, 285, 286, 297, 305, 306, 307, 333, 335, 336, 337, - 365, 368, 370, 430. - - Burghart, 440. - - - Camerer, 238. - - Campbell, 111. - - Campbell, Harry, 268, 343. - - Camus, 445. - - Carrion, 31. - - Casselli, 31. - - Cecca, 103. - - Celibacy, 402. - - Celsus, 256. - - Charcot, 84, 96, 257, 415. - - Charrin, 21, 140, 160, 161, 323. - - Chittenden, 282, 283. - - Christern, 371. - - Christiani, 438. - - Chroback, 441. - - Circulatory system and adrenals, hygiene of, 164. - - Cirrhosis, hepatic, production of, 153. - - Clothing, rational, 219. - (See _Skin, Hygiene of_.) - - Cohendy, Michel, 185, 186. - - Cold, to prevent, 233, 278. - feet. See _Feet_. - - Combe, 7, 102, 184, 186. - - Constipation, habitual, prevention and treatment of, 175. - conditions, associated, in women, 176. - diet for, 178. - drugging for, 190. - emotions, effect of, 175. - fermentation, 188. - glands, ductless, 176. - sexual, 176. - hygiene of, 176. - nerves, intestinal, 176. - splanchnics, 176. - prevention of, 176. - diet, 176, 178. - cereals, 176, 177. - fruits, 177. - meat, 176. - milk, 178. - special, 178. - vegetables, 177. - thyroid, effect of, 175. - treatment, 179. - cascara sagrada, 180. - electricity, 179. - enemata, 179. - hydrotherapeutics, 179. - laxatives, 180. - massage, 179. - mineral waters, 180. - rectum, irrigation of, 179. - rhubarb, 180. - vagus, action of, 175. - - Cornaro, 292, 401. - - Cornil, 32, 47. - - Crispino, 5, 23, 98. - - Cunningham, 51. - - Cyon, 31. - - - Danilewsky, 281. - - Darier, 165. - - Darnecy, 41. - - D’Arsonval, 32, 443, 444. - - Delcour, 135, 136, 196. - - De l’Enclos, Ninon, 54. - - Dellamare, 93, 167. - - Demange, 110. - - Demange and Oettinger, 96. - - De Manasseine, Marie, 368. - - Demme, 353. - - Denison, Charles, 260. - - De Quervain, 5, 23, 25, 98, 104, 352, 357. - - Dercum, 44, 110. - - Determann, 168, 320. - - Dettweiler, 310. - - Dever, 337. - - Diabetes, opium in, 356. - sleepiness and, 376. - - Diamare and Kuliabko, 78. - - Diet, blood. See _Blood_. - for habitual constipation, 178. - meat, avoidance of, in aged, 323. - in infancy, 323. - boiled, 322. - canned, 322. - preservatives in, 322. - catharsis for, 324. - dangers of, 317. - heaviness following, 317. - in disease, 317. - dangers of, nervous disorders, 317. - results of, 317, 324. - absence of, from, 321. - in diabetes, 320. - in gout, 320. - on ductless glands, 317. - on kidneys, 319. - on pancreas, 319. - on uric acid formation, 320. - fresh, 322. - moderate, 322. - on circulatory apparatus, 320. - putrefaction, 324. - acids for, 324. - roasted, 322. - water and, 323. - white, 322. - milk, additions to, 329. - advantages of, 330. - for old age, 330, 332, 335. - antiseptic action of, 331. - asses’, 332. - boiled, 327. - digestibility of, 329. - ease of, on kidneys, 330. - on liver, 330. - on stomach, 330. - for athyroidia, 329. - goats’, 332. - human, 331. - ideal, 328, 331. - in childhood, 330. - kefir, 329. - longevity by, 329. - of thyroidectomized goats, 326. - raw, 327. - secretions of ductless glands in, 325. - substances in, 325, 326. - in acid fermented, 328. - suppression of myxœdema by, 325. - yogurth, 329. - vegetarian, advantages of, 309, 310, 311. - age, old, value to prevent, 311, 312. - conditions improved by, 321. - disadvantages of, 309, 312, 313, 314. - anatomical, 309. - diseases avoided by, 310, 311. - diseases from, 313, 314. - condition for, 314. - predisposition to, 314. - lack of obesity from, 311. - results of, 315. - to reduce uric acid, 311. - with proteids and fats, 309, 310. - Diet, vegetarian, with proteids and fats, in disease, 310. - - Disease a self-defense, 419. - benefits of, 420. - early recognition of, 421. - treatment, 421. - - Dubois, 446. - - Duclaux, 256. - - Du Perron, 402. - - Dupuytren, 42. - - Dürig, 37. - - Dwellings, situations for city, 264. - - - Easterbrook, 27. - - Eating, appetite, æsthetics for, 342. - checking, 340. - conditions producing, 340. - lost, in the sedentary, 340. - normal, 340. - stimulation for, 341. - bouillon, 341. - exercise, 342, 344, 345. - _hors d’œuvres_, 341. - smörgasbord, 341. - tongue washing, 341. - vinegar and water, 341. - dinner, rest before and after, 341. - food, most digestible, 345. - butter, 345. - cereals, 345. - fat, 345. - meat, 345. - vegetables, 345. - gastric juice, adequate supply of, 339. - augmenting, 339. - mentally, 339, 340. - sight, 339. - smell, 339. - taste, 340. - hygiene of, 339. - insalivation, 342. - advantages of, 343. - meals, companions at, 342. - drinking with, 344. - time for, 344. - reading while eating, 342. - exceptions, 342. - saliva, secretion of, 342. - stimulation of, 342. - mastication, 342. - teeth and, 344. - - Eberson, 414. - - Echlin, 374. - - Eckermann, 53. - - Edgreen, 165, 169. - - Edmunds, Walter, 22, 35, 96, 140, 373, 388, 438. - - Edwards, 256. - - Ehrmann, 453. - - Eiselsberg, 5, 96, 167. - - Eisenheart, 47. - - Elberskirchen, Johanna, 397. - - Emden, 152. - - English, 202. - - Erb, 396. - - Erdheim, 19, 91, 92, 144. - - Espagno, 105. - - Esser, 367. - - Ewald, 3, 90, 93, 172, 290, 434, 435. - - Exercise, advantages of, 251. - benefits of, 244. - breathing, 262. - effects of, 244. - massage, antiquity of, 245. - by self, 247. - effects of, 245, 246. - on heart, 246. - Harvey, 245. - sports, 247. - best, 248. - climbing, 250. - for heart trouble, 251. - Oertel’s treatment, 251. - contra-indications, 247. - cycling, 249. - dilatation of heart, 248. - effects of, 247. - horseback riding, 248. - riding, 249. - running, 250. - Swedish gymnastics, 245. - Ling, Peter, 245. - Mitchell, S. Weir, 245. - to induce perspiration, 239. - treatment, Nauheim, 246. - walking, 249. - - - Farwick, 336. - - Fassin, 28, 136. - - Feet, cleanliness of, 234. - cold, 252. - cause, 252. - circulation, 252, 254. - senile gangrene, 254. - clothing, 252. - shoes, 252. - socks, 253. - treatment, 253, 254. - exercise, 253. - massage, 253. - rubbing, 253. - - Fehling, 14. - - Ferranini, 164. - - Finsen, 256, 257, 258, 261. - - Fishel, 202. - - Fisher, Emil, 364. - - Flamini, Mario, 325. - - Fleischer, 46. - - Fletcher, Horace, 282, 292, 343. - - Flexner, 311. - - Flourens, 50. - - Food, blood. See _Blood_. - carbohydrates, 301. - cellulose, 308. - advantage of, 308. - vegetables, 301. - diet, rational, 304. - disadvantages of, 302. - fats in, 301. - leguminous, 301. - albumin in, 301. - butter with, 304. - composition of, 301. - containing iron, 306, 307. - minerals, 305. - lime, 305. - iron, 305. - potatoes, 304. - rice, value of, 302. - digestibility, 289, 290, 291. - cold, 291. - hot, 291. - in aged, 290. - in robust, 289. - hygiene, 280. - albumin, 283, 284. - bouillon, 287. - carbohydrates, 281, 284. - condiments, 286. - harmfulness of, 286. - sauces, 286. - vinegar, 286. - diet, model, 292, 293. - eating, excessive, 280. - experiments, 282, 283. - fats, 281, 284. - feeding, over-, dangers of, 280. - principle of, 280. - under-, dangers of, 280. - groups of, 281. - in pregnancy, 285. - iron, 286. - keynote, 291. - minerals, 285. - nutritive value of, 281. - potatoes, 286. - proteid, 281, 284. - rice, 283, 286. - salt, 285. - alkali, 286. - soup, 287. - stimulants, 287. - alcohol, 287. - beer, 287. - whiskey, 288. - wine, 288. - cocoa, 289. - coffee, 289. - tea, 289. - tobacco, 289. - three kinds, uses of, 284. - time for meals, 292. - Food, hygiene, water, 285. - hard, 287. - in foodstuffs, 287. - with meals, 287. - most digestible, 345. - preparation of, 289. - proteid, 294. - albumin, 294. - animals, examination of slaughtered, 295. - butter, 298, 303. - cheese, 298. - digestion of, 299. - putrefaction of, 299. - eggs, 299. - fish, 296. - meat, 294. - composition of, 294. - cold storage, 295. - extractives, 295. - milk, 296. - composition of, 296, 297, 298. - most perfect, 300. - oysters, 295. - quantity of, 289. - sausages, 296. - too rich, 289. - diseases caused by, 289. - weather requirements of, 289. - - Fordyce, 330. - - Förster, 305. - - Forsyth, 318, 330. - - Forsyth, D., 22. - - Franklin, Benjamin, 260, 281. - - Fraser, 151. - - Frerich, 83. - - Fries, 167. - - Frithe, 367. - - Fröhlich, 18. - - - Galeotti and Lindemann, 22, 140. - - Gall, 41. - - Garnier, 13, 23, 27, 31, 57, 58, 141, 314, 431, 438. - - Gasne and Laude, 13. - - Gassenghi, 30. - - Gauthier, 14, 427. - - Geist, 334. - - Generali, 144. - - Georgiewski, 24, 27. - - Gibson, 432. - - Gibson, G. A., 4, 435. - - Gilbert, 8, 84. - - Gilbert and Carnot, 446. - - Gillet, 298. - - Glaesner, 152. - - Gland. See individual glands, by name. - thyroid, administration of, skin eruptions following, 213. - a function of, 139. - Gland, thyroid, alcohol and chloroform on, 357. - and alcohol, 356, 357. - and temperature, 237. - death following extirpation of, 138. - degeneration of, in alcoholics, 352. - exhaustion of, 357, 358. - extirpation of, effects of, 167. - hyperactivity as cause of drunkenness, 357. - in infants, 323. - maintaining life after extirpation of, 139. - milk as stimulant of, 330. - results of disease of, on other organs, 141. - intestines, 143. - kidneys, 142, 143. - liver, 141, 142. - sleeplessness and, 369. - - Glands, ductless, effects of meat on, 317. - secretions of, in blood, 335. - in milk, 325. - parathyroids, influence on convulsions, 144. - sexual, abuse of, 390, 391, 392. - arsenic for, 429. - diseases of, 389. - frequency of, 391. - hygiene of, 389. - hyperactivity of, 213. - inactivity of, 393. - treatment of, in unmarried, 398. - intercourse, too frequent, 390. - interrupted, 392. - iron for, 429. - marriage, age for, 392. - sudorific, 215, 226. - thyroid, destruction of poisonous products through, 138. - - Gley, 3, 142, 144, 374, 445. - - Goethe, 43, 53. - - Goldscheider, 212. - - Gombault, 84. - - Gouget, 199. - - Gout, skin diseases in, 213. - - Graffenberger, 257. - - Grawitz, 257, 313, 334, 337, 427, 430. - - Greenfield, W. S., 21. - - Groedel, 164. - - Gruber and Durham, 134. - - Grundzach, 185. - - Guerrini, 31. - - Guieysse, 99. - - Guilbert, Yvette, 101. - - Gumprecht, 154. - - Gunzburg, 200. - - Gymnastics. See _Exercise_. - - - Haig, 131, 242, 288, 299, 320, 321, 364. - - Halck, 83. - - Hall, Walker, 131, 288, 302, 310, 320. - - Hallion, 31. - - Hamel, 268. - - Hanot and Boit, 156. - - Hanseman, 77. - - Harnack, 430. - - Harvey, 49, 50, 245, 455, 456. - - Haüsermann, 333. - - Heating, artificial, air, indoor, effects of, 277. - air, outdoor, effects of, 277. - cold, catching, avoidance of, 278. - from warm rooms, 277. - diseases, respiratory, 278. - for old people, 275. - for young people, 275. - hot water, 279. - hygiene of, 275. - method of, most rational, 276. - fireplace, open, 276. - railways, overheated, 278. - steam, injuriousness of, 278, 279. - effects after, 279. - mitigation of, 279. - radiators, dusty, 279. - tonsillitis from, 278. - temperature, high, 275. - without ventilation, 275. - indoor, best, 276. - - Hegar, 46. - - Heger and Buys, 150. - - Heger, Paul, 149. - - Heinz, 431. - - Hemmeter, 149, 202. - - Hemp, 326. - - Hensel, 107, 169. - - Hercod, 354. - - Heredity and the ductless glands, 352. - - Hertoghe, 5, 12, 13, 14, 15, 25, 29, 37, 58, 68, 83, 95, 102, 104, 126, - 352, 357, 434, 440. - - Herter, 185. - - Hesse, Walter, 326. - - Heyn, F., 120. - - Hippocrates, 256. - - Hirsch, 444. - - Hirschfeld, 152. - - Hochenegg, 44. - - Hofmeister, 4, 104. - - Holm, 259. - - Horsley, Sir Victor, 3, 90, 91, 93, 435. - - Houssaye, 318. - - Huchard, 107, 168, 169, 199. - - Hueppe, 353. - - Hufeland, 50, 260, 288, 337, 367, 424. - - Hugo, Victor, 54. - - Huler, 202. - - Humphrey, 324, 355. - - Hun, 142. - - Hunt, 23, 141. - - Hutchison, 131, 325. - - Hutchison, R., 363, 364. - - - Ibsen, 54. - - Inada, 168. - - Indian, longevity of, 265. - - Insomnia. See also _Sleep_. - treatment of, 384. - medical, 386. - milk of thyroidectomized goats, 388. - serum of thyroidectomized goats, 387. - preventive, 384. - bath, 385. - hygiene, 384. - room, 385. - - Intestines, hygiene of, 182. - acid, lactic, 184, 185, 186. - bacillus maya, 184. - yoghurt, 184. - albumins, prepared, 183. - for the aged, 183. - appendicitis, 192. - adenoids, 196. - cause and prevention of, 192. - causes of, 194, 195. - constipation, 194. - exercise, 194. - psoas, influence of, 192. - test for, 194, 195. - tonsils, 195. - assimilation in the aged, 183. - bowel movement, residue after, 191. - constipation, 188. See _Constipation_. - and fermentation, 188. - appendicitis from, 191. - drugging for, 190. - corsets, effects of, 190. - defense, natural, 184. - liver, 184. - thyroid, 184. - diet, 186. - fats, 186. - cheese, 186. - diseases of, coincident with stomach disorders, 182. - drinks, ice-cold, 187. - enemata, 191. - fæcal impaction, 191. - Intestines, hygiene of, food, quality of, 187. - foods, 184. - injurious, 187. - canned, 187. - fish, 187. - fruits, 187. - meats, 187. - oysters, 187. - preservatives, 187. - sausages, 187. - unmasticated, 182. - fermentation of, 182. - poisonous effects, 184. - glands, sexual, 189. - habits, 189. - purgation, 188. - putrefaction, 183, 184, 186. - meat, 186. - water, lack of, 191. - - Iron. See _Blood, iron in_. - in drugs, 333. - in food, 333. - lack of, in anæmia, 333. - in chlorosis, 333. - organic and inorganic, 333. - - - Jaffé, 202. - - Javal, 286. - - Jayle, 104. - - Jeandelize, 13, 92, 141, 142, 144. - - Jersoni, 44. - - Jollin, 323, 431. - - Josué, 5, 162, 163. - - - Kant, 415. - - Keill, James, 51. - - Keller, 205. - - Kende, Maurice, 354. - - Kidney disease, test for, 165. - - Kidneys, benefits of sweating upon, 242. - hygiene of, 203. - alcohol, 205. - casts, hyaline, 203. - clothing, 208, 231. - diet, lacto-vegetarian, 204. - diseases, infectious, 206. - drugs, 206. - importance of, 215. - intestines, 207. - liver, 204. - meat, 204. - milk, 204. - rhinitis and, 207. - rice, 205. - salt, 204, 215. - sauces, 205. - skin, 207, 215. - spices, 205. - tea, 205. - tonsillitis and, 207. - Kidneys, hygiene of, water, 206. - mineral, 206. - internal secretion of, 198. - milk an ideal food for, 331. - diet and, 330, 331. - - Kisch, 46, 391, 392, 395, 398. - - Kishi, 96, 140, 142. - - Kitasato, 34. - - Klausner, 353. - - Kliffel, 80. - - Kobler, 202. - - Koch, 151, 373. - - Koch and Kraepelin, 363. - - Kocher, Albert, 24, 431. - - König, 299. - - König, T., 336. - - Koranyi, Alexander, 205. - - Kossel, 333. - - Kovesi, 205, 241, 242. - - Krafft-Ebing, 396. - - Kraut, C., 336. - - Kreis, 371. - - Kretschy, 46. - - Krüger, 34. - - - Laache, 126, 434. - - Labbé, 334. - - Labbé, Marcel, 311. - - Laitinen, 353, 354. - - Landau, 46, 441. - - Langhans, 92. - - Langlois, 159, 160, 161. - - Lanz, 21, 22, 24, 27, 57, 72, 140, 196, 326, 388, 442, 445. - - Latzko, 104. - - Laulanié, 142. - - Launois, 95, 99, 384. - - Lautenbach, 150. - - Lefas, 80. - - Legrain, 352. - - Legry and Renault, 13. - - Lehman and Strassmann, 46. - - Lehmann, 306. - - Leichtenstein, 202. - - Lemaire, 165. - - Lenkey, 258. - - Leube, 241. - - Leuret and Hoffmann, 41. - - Levi, Leopold, 408. - - Levy, Magnus, 238, 323, 374. - - Leyden, 47. - - Liebermeister, 233. - - Life, indoor, 262. - effects of, 263. - examples of, 262. - married, as a means of morality, 401. - children in, 401. - disease, venereal and, 401. - happiness in, 400. - longevity, 403. - Life, married, meals and, 402. - means for prolonging life, 400. - sickness and, 401. - open air, 262. - effects of, 262, 263. - examples of, 262, 267. - - Ling, Peter, 245. - - Lingard, 32. - - Liver, hygiene of, 155. - bathing, 158. - climates, hot, 157. - hypertrophied liver, 157. - diet, alcohol, 155. - best, 157, 158. - condiments, 155. - meat, 155. - milk, 155, 157. - spices, 155. - stimulants, 155, 157. - vegetable, 155, 157, 158. - water, 157. - milk diet and, 330, 331. - other organs and, 155. - intestines, 155. - pancreas, 156. - stomach, 156. - - Livon, 31. - - Loeper, 286. - - Loewy, 18, 33, 233, 441, 444. - - Loewy, A. and Y., 266. - - Loewy and Richter, 97. - - Lohrisch, 188. - - Loisel, 42, 393. - - Longevity, alcohol and, 350. - greatest, 266. - - Longfellow, 125. - - Lucas Championnière, 46. - - Ludwig, 244. - - Luksch, 161. - - Lunin, 305. - - Luntz, 266. - - Lussana, 150, 151. - - Luther, 391, 396. - - Luttje, 200. - - Luzatti, 298. - - - Macallum, 144. - - Mackenzie, 142. - - Mackenzie, Hector, 434, 435. - - Mac Means, 352. - - Madelung, 19. - - Magnus-Levy, 17, 95. - - Mahomet, 96. - - Manfur, 298. - - Marbé, 28. - - Mariagalli and Negri, 46. - - Marriage, age for, 392. - - Marti, 257. - - Martin, 353. - - Masey, 248. - - Massage. See _Exercise_. - - Meat. See _Diet_. - - Mendel, Lafayette, 323. - - Mering and Minkowski, 77. - - Merklen, 298. - - Merschejewski, 46. - - Metschnikoff, 47, 51, 53, 98, 112, 124, 184, 185, 329. - - Metschnikoff and Matschinski, 32. - - Meyer, E., 8, 198, 447. - - Milk. See _Diet_. - of thyroidectomized goats, 326. - raw, for stomach, liver, and kidneys, 330. - - Mind, hygiene of, 404. - arteriosclerosis in, 423. - brain workers, advice to, 423. - bedtime, 424. - exercise, 424. - mealtime, 424. - moderation, 423, 424. - outdoor life, 424, 425. - rest, 423. - diseases from, 404. - diabetes, 404, 405. - emotions, strong, death from, 404, 407. - organs affected by, 405. - adrenals, 405. - hair, 406. - liver, 406. - pancreas, 406. - pituitary, 405. - sexual glands, 406, 409. - stomach, 411. - thyroid, 405, 408, 409. - ideational channels, 411. - causes of depressed, 411, 412. - enlivening, 413. - life, religious belief for prolonging, 414. - Cause, the great, 416. - effect on anæsthesia, 415. - faith, 414. - - Minervini, 93. - - Mingazzini, 39, 394. - - Minkowski, 80. - - Minnich, 167. - - Mintz, 259. - - Mitchell, S. Weir, 245. - - Moebius, 25, 41, 42, 43, 53, 357, 387. - - Mohammed, 391. - - Mohn, 258. - - Moleschott, 256. - - Molière, 199. - - Morat and Doyon, 83. - - Moritz, 248. - - Moro, 298. - - Morvan, 7, 102. - - Moschini, 161. - - Moses, 391. - - Mossé, 304, 325, 370, 391, 443. - - Müller, 168. - - Müller, Friedlich, 206. - - Muller, P., 47, 168. - - Murray, 71. - - Murray, G., 21, 126, 142, 434. - - - Napoleon, 43. - - Narbuth, 18. - - Naunyn, 84, 248, 334, 404. - - Nehring, 95, 374. - - Neisson, 350. - - Nencky, 152. - - Neugebauer, 392. - - Neusser, 85, 142. - - Nicholas, 161. - - Nobecourt, 298. - - Nuclein for yolk of eggs, 333. - - Nuttall and Thierfelder, 170. - - - Obersteiner, 368, 371. - - Obolenski, 446. - - Oertel, 251. - - Oeruni, 257. - - Oesterreicher, 56. - - Offer, 322. - - Offerhaus, 192, 193. - - Old age, milk diet for. See _Diet, milk_. - - Oliver and Schäfer, 5, 31, 69. - - Opie, 77, 80. - - Opium in diabetes, 356. - - Oppenheim, 160, 434. - - Oppenheim and Loeper, 160. - - Ord, 7, 96, 102. - - Ortner, 212. - - Oser, 169. - - Oswald, 91, 325. - - Ottfried, 168. - - Ouspenski, 444. - - Ovaries, influence of, on the blood, 334. - - Owen, Sir Isambard, 350. - - - Paris, Matthew, 45. - - Parr, 329. - - Parr, Thomas, autopsy on, 455. - - Pasha, Emin, 353. - - Paterson, 452. - - Paton, James, 221. - - Pavy, 19. - - Pawlow, 69, 77, 339, 340, 344, 406. - - Pel, 21, 58, 105, 106, 405, 456. - - Pelikan, 45. - - Penzoldt, 200. - - Perrando, 13, 57, 58. - - Perrin, 141. - - Pettenkoffer, 209, 221, 263, 273. - - Pflüger, 50, 456. - - Pigeolet, 392. - - Pilcz, 36, 374. - - Pineles, 4, 92, 111, 144, 167. - - Plato, 390. - - Plutarch, 107. - - Poehl, 33, 127, 443, 444. - - Poison, snake, alcohol for, 358. - - Politiman, 105. - - Pomeroy, 391. - - Poncet, 12. - - Posner, 306. - - Pottenger, 265. - - Pregl, 443. - - Products, poisonous, destroyed through thyroid and parathyroid glands, - 138. - thyroidectomy, effects of, 138. - on animals, meat-fed, 138. - on animals on meatless diet, 138. - on animals on milk diet, 138. - toxic, destruction of, by adrenals, 159. - after adrenalectomy, 159. - from muscular exercise, 368. - immunizing constituent, 159. - infectious diseases, 160. - microbes, 160. - poisons, microbic, 161. - destruction of, by the liver, 149. - albuminoids, 152. - carbohydrates, 152. - enlargement of liver, 153. - excretion of, 150. - bile, 150. - urine, 153. - hepatic cirrhosis, 153. - reduction in liver disease, 154. - elimination of, through intestines, 170. - constipation, 172, 202. - internal, 173. - fæcal intoxications, 172. - intestines, microbes in, 170. - effect on liver, 170. - purgation, regular, 173. - secretions, anti-bacterial, 174. - elimination of, through kidneys, 197. - albuminuria, 199. - from constipation, 202. - casts, urinary, 199. - chloroform, 201. - drugs, poisonous, alcohol and, 200. - kidneys, internal secretion of, 198. - liver and, 199. - mercury, 201. - mustard and, 200. - pepper, 200. - potassium chloride, 200. - radishes, 200. - Products, toxic, elimination of, salicylates, 201. - tea, black, 200. - thyroid and, 198. - elimination of, through the skin, 209. - carbonic acid, 209. - perspiration, 210, 212. - retention of, 211. - skin, causes of diseases of, 212. - burns, 212. - eruptions of, 213. - glands of, 209. - respiration through, 210. - - Prudden, 142. - - Prun-Hudden, 85. - - Puddings, blood, 335. - - - Quarters, ill-ventilated, dangers of, 271, 272. - air of, 272. - microbes in, 272. - infectious diseases from, 272. - persons, sickly, 271. - unused to, 271. - schoolrooms, 273. - sleeping room, 273. - flowers in, 273. - furnishings of, 273. - ventilation of, 274. - windows, open, 273. - - Queirolo, 212. - - Quincke, 156. - - - Rechenberg, 283. - - Remlinger, 168. - - Renaut, 446. - - Rénon, 402. - - Rénon and Delille, 31. - - Rénon, Delille, and Azam, 32. - - Richter, P. I., 18, 33, 205, 441, 444. - - Rieger, 41. - - Rigaud, 39, 393, 394. - - Riva, 337. - - Roese, 287, 305. - - Roger, 150, 153, 160, 314. - - Roger and Garnier, 5, 23, 98, 154. - - Rogowitsch, 4, 141, 374. - - Romberg, 165, 166, 168. - - Rooms, sleeping, 264. - - Rosenblath, 142. - - Rosenblatt and Jeandelize, 96. - - Rosenquist, 322. - - Rothschild, Baron Henry, 408. - - Roth-Schulz, 205, 241, 242. - - Rousseau, 41. - - Roux, 160. - - Rovighi, 149. - - Rubner, 233, 281, 284, 287, 288, 294, 297, 301, 302, 303. - - - Sainton, 374. - - Sajous, 2, 4, 9, 19, 21, 25, 28, 31, 32, 33, 34, 35, 65, 68, 79, 85, - 92, 112, 117, 130, 136, 159, 161, 162, 167, 313, 351, 374, 376, 405, - 427, 429, 444. - - Salaskin and Zaleski, 153. - - Salmon, 374, 376. - - Sandstrom, 144. - - Sanquirico and Canales, 141. - - Sarbach, 352. - - Sasaki, 340. - - Sauerbeck, 77. - - Sausages, 335, 336. - - Savile, 349. - - Sawada, 164. - - Sawandowski, 26. - - Scharffenberg, 351. - - Schiff, 138, 150. - - Schmidt, 188, 306. - - Schmitz, 185. - - Schopenhauer, 124, 403, 413. - - Schottelius, 170. - - Schur and Wiesel, 165. - - Schwoner, 56. - - Sciolla, 141. - - Séglas and Vauquelin, 153. - - Senator, Hermann, 1, 8, 86, 168, 172, 198, 199, 202, 203, 319, 322, - 444. - - Sexual glands, 165, 176, 351, 452. - and emotions, 406, 409. - spermin, 444. - - Shattock, 442. - - Shattock and Seeligmann, 442. - - Sherril, Edwin, S., 38. - - Siccard, 311. - - Singer, 185. - - Skin and kidneys, hygiene of, bathing, 231. - baths, carbonic acid, 243. - foot-, 234. - cold, 234, 235. - baths, sea, 235. - heart in, 236. - hot, 235. - warm, 235. - by means of perspiration, 237. - composition of perspiration, 238, 241. - fur clothing, 237. - circulation in, 231. - massage, 233. - rubbing, 233. - diseases, etiology of, 212. - eruptions, 213. - acne, 213. - from cheese, 213. - from drugs, 213. - from oysters, 213. - Skin eruptions, in diabetes, 213. - in gout, 213. - in Graves’s disease, 213. - in masturbation, 213. - in menstruation, 213. - in sexual abstinence, 213. - pimples of chastity, 214. - psoriasis, 214. - dust, 231. - elimination of toxic products through, 209. - excretion by, 214, 232, 244. - exfoliation, 231. - pores, 231. - perspiration, abundant, 238. - baths, 240. - for old people, 240. - baths to induce, 239. - electric, 239. - exercise, 239. - light, 239. - effect on kidneys, 241. - excessive, 238. - salicylates for, 239, 243. - soap, 231. - water, 231. - - Skin, hygiene of, 215. - advantages of, 218. - armpits, 224. - bathing, 216, 225, 240. (See also _Skin and Kidneys, hygiene of, - through bathing_.) - air, 217, 225. - cold, 218, 225. - foot-bath, 228, 234. - for old people, 240. - water, 216, 225. - clothing, blue, 225, 258. - bedclothing, 229. - changing, 224. - collar, starched, 224, 228. - harmfulness of, 224. - cotton, 221. - advantages of, 221. - dry, 223. - fur, 237. - gray, 225, 258. - hats, 226. - health, impediments to, 228. - leather, 224, 227. - light, 225. - advantages of, 225. - linen, 220, 221. - starched, 224. - loose, 220, 229. - night-shirt, 229. - overcoat, 225. - porous, 219. - pumps, 227. - Skin, clothing, ramie, 221. - rational, 219. - rubbers, 225, 227, 228. - sandals, 227. - shoes, 227. - canvas, 227. - half-shoes, 227. - slippers, 227. - silk, 221. - trousers, 229. - wool, 219. - drawbacks to, 219, 220. - cold, catching, 225. - glands, sudorific, 215, 226. - importance of, 215. - neck, 224. - scalp, 226. - soles, 224. - - Sleep and its value, 368. - adrenalin and, 369, 376. - after dinner, 370. - alcohol, 370. - brain, anæmia and, 369. - hyperæmia and, 369. - cause of, 369. - auto-intoxication, 371. - control of, by thyroid gland, 369. - death from loss of, 368. - experiment of Mosso, 370. - function of, 381. - hygiene of, 377. - brain, excitation of, 377. - chamber, sleeping, 378. - food, 378. - hours of, 380. - noise, 380. - sleepiness, 373. - gland, thyroid, 374. - sleepiness, and insomnia, cause of, 372. - sleeping sickness, 372. - cause of, trypanosomiasis, 373. - changes, pathological, 373. - treatment, 373. - - Sleepiness and insomnia, treatment of, 383. - treatment of, thyroid extract, 383. - - Sleeplessness, effects of, 382. - - Slowzoff, 150, 151. - - Smith, Bellingham, 442. - - Sneve, 212. - - Sobolew, 77. - - Socrates, 391, 424. - - Solomon, H., 447. - - Solon, 391. - - Sommerfeld, 340. - - Spallanzani, 211. - - Spangaro, Saverio, 51, 92, 442. - - Spillman and Etienne, 441. - - Spolverini, 298. - - Sports. See _Exercise_. - - Springer and Serbanesco, 13. - - Stedman, 445. - - Steinhaus, 80, 156. - - Stengel, 77. - - Stepanoff, 28. - - Stieda, 4, 374. - - Stimulants, 347, 362. See also _Food_. - chocolate, 365. - cocoa, 365. - advantages of, 365. - theobromin, 365. - coffee, 364. - black, 362. - caffein, 364. - effects of, 364. - for digestion, 341, 342. - tea, 362. - and coffee, comparison of, 363. - effects of, 362. - good, 363. - green, 362. - thein, 363. - tobacco, 366. - nicotine, 366. - effects of, 366. - arteriosclerosis, 367. - poisonous, 366. - - Stohmann, 281. - - Stomach, milk diet and, 330. - - Strassberger, 188. - - Strasser, 232, 241. - - Strauss, 204, 286. - - Strauss, H., 8, 198, 204, 241, 242, 289. - - Strümpell, 120. - - Sunlight, action of, chemical, 256, 257. - therapeutic, 256. - altitude, 258. - bactericidal effect of, 256. - benefits of, 255, 259, 260. - cheeks, pale, 257. - red, 257. - clothing for, 258. - corpuscles, red, 257. - experiments with, 256. - hæmoglobin, 257, 259. - in old age, 260. - in the open air, 258. - mental effects of, 255. - rays, chemical, and altitude, 258. - ultra-violet, 256, 257. - - Svaerdrup, Captain, 264. - - System, circulatory, and adrenals, hygiene of, 164. - - - Take, Ada, 353. - - Tanberg, 27. - - Tanecki, 46. - - Tarchanoff, 444. - - Tarchanow, 33. - - Tarnowska, Pauline, 7. - - Tavel, 196. - - Teissier, 199, 446. - - Tigersted, 348. - - Tizzoni, 35, 86, 141, 142. - - Thaon, 31. - - Thiele, 95, 374. - - Thompson, Sir William, 222. - - Thyroid gland. (See _Gland_.) - - Torri, 5, 23, 31. - - Traube, 169. - - Troin and Rivet, 165. - - Trüper, 120. - - Tsen-ki-tong, 403. - - Tuberculous persons, 262, 265. - - Tunnicliffe, 245. - - Twain, Mark, 342. - - Tyson, James, 204, 319, 406. - - - Unna, 213. - - Uspenski, 32. - - - Valente, 392. - - Van der Bergh, Heymans, 154. - - Van der Ecke, 142. - - Van Sommeren, 343. - - Vassale, 144. - - Vaughan, 299. - - Vegetables. See _Food_. - - Vegetarian diet. See _Diet_. - - Vermehren, 3, 85, 90, 93, 95, 126, 142, 434, 435. - - Vesalius, 404. - - Viault, 259. - - Vidal, 286. - - Vidal and Javal, 204. - - Vimont, 41. - - Voith, 282. - - Von Noorden, 74, 241, 282, 306, 320, 344, 374, 429, 430. - - - Wagner, 30. - - Waldvogel, 152. - - Wallerstein, 201. - - Wassermann, 34. - - Water. See _Food_. - - Waters, mineral, arsenic in, 428. - iron, in, 430. - - Watson, 318. - - Watson, Chalmers, 9, 22, 140, 145, 330. - - Weber, Parkes, 165. - - Weber, Sir Herman, 111, 146, 268. - - Weichardt, 368. - - Weichselbaum, 77. - - Weinberg, 51. - - Weiske, 308. - - Weiss, J., 307. - - Weljaminoff, 34. - - Westergaard, 116. - - White, Hale, 91, 435. - - Whitwell, 36. - - Widal and Boivin, 162. - - Widmark, 257. - - Wiley, 295. - - Wille, 78. - - Willems, 372. - - Winternitz, 233. - - Woroschiloff, 302. - - Wright, Sir Almroth, 28, 136. - - - Xanthin bodies, 364. - - Xanthin bodies, caffein, 364. - theobromin, 365. - - - Yersin, 160. - - - Zagari, 150. - - Zander, 247. - - Zeigan, 369, 376. - - Zoroaster, 391, 403. - - Zoth, 443. - - Zunz, 18, 249. - - ------------------------------------------------------------------------- - - - _Other Publications of F. A. Davis Company, Philadelphia_ - - --------------------------------------------------------- - - Health and Longevity Through Rational Diet - - PRACTICAL HINTS IN REGARD TO FOOD AND THE USEFULNESS - OR THE HARMFUL EFFECTS OF THE VARIOUS ARTICLES OF DIET. - - BY - - DR. ARNOLD LORAND - - _Physician to the Baths, Carlsbad, Austria, etc., etc._ - -Translated from the Original German Edition, with an Introduction by -VICTOR C. VAUGHAN, M.D., Ann Arbor, Mich. Being a complete code of -instructions as to the different foods and how they can be best -employed. Royal Octavo. 425 pages. Handsomely Bound in Cloth (uniform -with “OLD AGE DEFERRED”). $3.00, net. - - SYNOPSIS OF CONTENTS: - -Introduction, with remarks upon the importance of the Appetite and the -Object of the Processes of Nourishment. - - I. The Influence of Food Upon Man. - - II. The Fundamental Laws of Rational Feeding. - - III. The Injurious Modes of Feeding. - - IV. The Good and Evil Effects of Various Food Substances. - Meat Diet. Fish Diet. Milk Diet. Cereals. Green Vegetables. - Fruit Diet. Beverages. - - V. Vegetarianism and its Advantages and Disadvantages. Hints for - the Prevention of the Latter. - - VI. The Practical Advantages of Rational Feeding. Useful Hints. - - VII. Hints for Those Obliged to Take their Meals in Restaurants. - The Injurious Effects of the “Table d’Hôte” Diet. - - VIII. The Increased Activity of Certain Functions Brought About - by Food. - - IX. The Increased Muscular Power Resulting from a Suitable Diet. - - X. Conclusion. The Relationship of Food to Old Age and Longevity. - Glossary. List of Diseases. Index. - - - --------------------------------------------------------- - -Many people naturally sidestep books on diet because they expect to be -warned against their pet dietary follies. This is not the Lorand way. In -a most entertaining manner Dr. Lorand explains to the reader the -advantages, disadvantages and nutritive values of different foods so -clearly that a person of ordinary intelligence can exercise good -judgment. Obviously, no person of reasonable common sense deliberately -follows the path of error in diet; if he has the facts he can go ahead -and choose for himself; Dr. Lorand’s book provides the facts. - - --------------------------------------------------------- - -JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (Chicago, Ill.). - -Methods of cooking are described and interesting remarks are made as to -the size and distribution of the ill effects arising from various -special and one-sided diets. It is full of valuable hints from which all -can profit. It may be recommended to the layman as well as to the -practitioner. - - ------------------------------------------------------------------------- - - - Consumption: How to Prevent It and How to Live With It - ITS NATURE, CAUSES, PREVENTION, MODE OF LIFE, CLIMATE, - EXERCISE, FOOD, AND CLOTHING NECESSARY FOR - ITS CURE. - - By N. S. DAVIS, A.M., M.D. - - Second Revised Edition. 12mo. 172 pages. Extra Cloth. $1.00, net. - -Most families unfortunately give little attention to the prevention of -Consumption until the subject has been brought to their notice in a -menacing way. The author with great clearness has set forth the cardinal -principles not only of the prevention of the disease, but of its -hygienic treatment when established. - -This work provides much valuable information as to climates, diet, -exercise, environment and family safeguards identified with the -treatment of a case in the family when once established. - -NEW ORLEANS MEDICAL AND SURGICAL JOURNAL. - -Dr. Davis has written a thoroughly practical book. He handles the -subject in such a way that the intelligent victim of consumption can -read it with profit. It is the kind of book which the physician can -recommend to his patients and their relatives. - - - --------------------------------------------------------- - - - Safeguarding the Special Senses - - GENERAL ADVICE REGARDING THE USE AND PRESERVATION - OF THE EYES, EARS, NOSE AND THROAT. - - BY - - HENRY O. REIK, M.D. - - Illustrated with 4 Full-page Plates, 2 in Colors. 12mo. 123 pages. - - Attractively Bound in Cloth, 75 cents, net. - -Any defect in the sight, hearing, or organs of speech tremendously -reduces a person’s efficiency. A neglected child therefore may -reasonably be expected to later on blame the parents who failed in their -duty. Adults who are careless about colds affecting the ears, or who -defer the use of glasses when necessary, may rightly expect the onset of -defective hearing or cataract in their later years. - -It is said that probably 50 per cent. of the practice of specialists is -made up of attempts to remedy the results of these forms of neglect. - - -THE BOSTON MEDICAL AND SURGICAL JOURNAL. - -Such a book as this should find an especially useful place among the -laity as well as in the profession. In fact, the simplicity of style is -such that persons of small medical training would find it entirely -understandable. - - ------------------------------------------------------------------------- - - - Health and Beauty - - BY - - JOHN V. SHOEMAKER, M.D., LL.D. - - Royal Octavo. 475 pages. Extra Cloth. Bevelled Boards. Price, $1.50, - net. - -This work is based upon an enormous experience not only as a specialist -in skin diseases, but as a physician engaged in general practice. The -contents of the book are therefore authentic and founded upon actual -knowledge rather than theory. - -There may be good health without good looks, but seldom good looks -without good health. This treatise tells you how these two highly -desirable conditions may be co-existent. There is a place in every -family library for a book of this kind. - - - SYNOPSIS OF CONTENTS: - - I. The Skin and Complexion. - II. The Appendages of the Skin. - III. The Usefulness of the Skin and of the Hair. - IV. The Complexion. - V. The Elements of Beauty and Grace. - VI. World Influence of Woman’s Charms. - VII. Expression, Sexual Attraction, Wedlock. - VIII. How to Cultivate and Preserve a Good Complexion. - IX. The Bath. - X. Digestion and Indigestion. - XI. Education of the Body. - XII. Cultivation of the Mind. - XIII. Clothing and Dress. - XIV. The Influence of Climate Upon Health. - XV. Ventilation. - XVI. Disfigurement from Disease, with Some Treatment of it. - XVII. Eruptive Fevers. - XVIII. The Hair, its Fashions and its Diseases. - XIX. The Nails and Their Diseases. - XX. Cosmetic Preparations. Index. - - ------------------------------------------------------------------------- - - - Confessions of a Neurasthenic - - BY - - WILLIAM TAYLOR MARRS, M.D. - - Eight Illustrations. 116 pages. Bound in Handsome Cloth. Price, $1.00. - -CONFESSIONS OF A NEURASTHENIC is designed to show the mental absurdities -of that extremely cautious and anxious individual who wishes under any -and all circumstances to take extraordinary good care of himself. - -The hero of this sketch has always found real, continuous effort too -severe a tax upon his health. Therefore, he shifts from one occupation -to another. His various adventures in search of a calling at once -congenial and devoid of mental and physical strain are not only very -amusing to read, but point a most useful moral. - - - --------------------------------------------------------- - - - The Practical Care of the Baby And Young Child - - BY - - THERON WENDELL KILMER, M.D. - - _Lecturer on Pediatrics in New York Polyclinic Medical School and - Hospital; - Attending Pediatrist, St. Bartholomew’s Clinic; Consulting Pediatrist, - Home of St. Giles, Garden City, New York, etc._ - - With 68 Illustrations. Second Revised Edition. 158 pages. - 12mo. Cloth, 75 cents, net. - -The remarkable reduction in the death rate among infants in New York -City is the answer to what physicians there have been doing in recent -years. They have given extraordinary attention to the care of children. -Dr. Theron W. Kilmer has been closely identified in this good work and -in compiling his book for the public, he was guided not only by an -extensive personal experience, but by a thorough knowledge of what -numerous other specialists in the Care of the Infant and Young Child -have been doing. - -Kilmer’s “Care of the Baby” is a thoroughly safe counsellor in the -family, the clear text and numerous fine illustrations fulfilling every -requirement. - - ------------------------------------------------------------------------- - - - - - ● Transcriber’s Notes: - ○ Missing or obscured punctuation was silently corrected. - ○ Typographical errors were silently corrected. - ○ Inconsistent spelling and hyphenation were made consistent only - when a predominant form was found in this book. - ○ Text that was in italics is enclosed by underscores (_italics_); - text that was bold by “equal” signs (=bold=). - ○ The use of a caret (^) before a letter (or letters) shows that the - following letter or letters was intended to be a superscript, as - in S^t Bartholomew or 10^{th} Century. - - - -*** END OF THE PROJECT GUTENBERG EBOOK OLD AGE DEFERRED *** - -***** This file should be named 64237-0.txt or 64237-0.zip ***** -This and all associated files of various formats will be found in: - https://www.gutenberg.org/6/4/2/3/64237/ - -Updated editions will replace the previous one--the old editions will -be renamed. - -Creating the works from print editions not protected by U.S. copyright -law means that no one owns a United States copyright in these works, -so the Foundation (and you!) can copy and distribute it in the -United States without permission and without paying copyright -royalties. 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